cost-effectiveness
- United States: $12,474 per capita
- Germany: $6,191 per capita
- Canada: $6,207 per capita
- Australia: $6,597 per capita
- France: $6,517 per capita
- Italy: $3,066 per capita
- United Kingdom: $5,139 per capita.
Extraordinary! The US spends 4 times more than Italy? Does that correlate with life expectancy? The short answer is NO! Here are the life expectancy averages for men and women (data from 2023/4):
- United States
- Men: 75.8 years
- Women: 81.1 years
- United Kingdom
- Men: 79.54 years
- Women: 83.33 years
- Canada
- Men: 80.74 years
- Women: 85.03 years
- Australia
- Men: 82.43 years
- Women: 85.97 years
- Germany
- Men: 79.21 years
- Women: 83.88 years
- France
- Men: 80.6 years
- Women: 86.2 years
- Italy
- Men: 81.75 years (or 81.94 years according to some sources)
- Women: 85.87 years (or 86.01 years according to some sources)
So, the United States have the highest per capita healthcare costs but ranks lowest in life expectancy. The UK has lower healthcare costs per capita while achieving higher life expectancies. Germany has higher healthcare costs per capita and relatively high life expectancies. France has moderate healthcare costs per capita ($6,400 and $6,600) and higher life expectancies.
How can this be? In the hope of getting a glimps of an answer, I searched the costs for a few specific interventions (where data were available for the listed countries). Here we go.
The estimated costs of a flu jab in various countries:
- United Kingdom:
Free for people aged 65 and over, pregnant women, those with certain long-term health conditions, and healthcare workers on the NHS.
Otherwise, costs range from £9.95 to £21.95 at pharmacies.
- United States:
Costs vary depending on the provider, insurance coverage, and type of flu vaccine.
Private sector costs per dose range from $19.48 to $32.45 for standard flu vaccines and $73.36 to $79.17 for high-dose vaccines for seniors.
CDC contract prices per dose range from $13.92 to $22.21 for standard flu vaccines and $56.40 to $56.45 for high-dose vaccines for seniors.
- Germany:
Statutory health insurance typically covers the cost of flu vaccinations for people 60 and older, certain chronic conditions, and some other risk groups.
Without insurance or for non-covered groups, prices can range from €15 to €35 per shot, but exact costs are not readily available.
- Canada:
Flu shots are often covered by provincial health plans for seniors and those with certain health conditions.
Without coverage, prices can range from $20 to $40 CAD per shot, but exact costs vary by province and provider.
- Australia:
Free flu vaccinations are available for people aged 65 and over, Aboriginal and Torres Strait Islander people aged 6 months and over, pregnant women, and people with certain medical conditions under the National Immunisation Program.
Otherwise, costs can range from $15 to $30 AUD per shot at some pharmacies and clinics.
- France:
Flu vaccinations are covered by the national health insurance for people 65 and older and those with certain health conditions.
For others not covered, prices can range from €10 to €25 per shot, but exact costs are not readily available.
- Italy:
Free flu vaccinations are offered to people 65 and older, pregnant women, and those with certain health conditions.
For others, costs can range from €15 to €30 per shot, but exact costs are not readily available.
The costs of a simple eye test in various countries:
- United Kingdom:
Basic Eye Test: £25-£30, depending on the optician.
Free Eye Test: Eligible for those under 16, over 60, with diabetes or glaucoma, or receiving certain benefits.
- United States:
Average Cost: around $100, but can range from $50 to $250.
- Canada:
Specsavers Canada: $99, including an OCT scan, at participating locations.
Free Eye Test: Eligible seniors have their eye exam costs covered by provincial healthcare.
The estimated costs for simple and surgical molar extractions:
- Germany
Simple extraction: around $113
Surgical extraction: costs may vary, but Germany has an average dental procedure cost of $210
- United Kingdom
Simple extraction: $495
Surgical extraction: $2,930
- USA
Simple extraction: $200
Surgical extraction: $4,000
- Canada
Simple extraction: $150-$198
Surgical extraction: $2,000
- Australia
Simple extraction: $160-$350
Surgical extraction: $2,500
- France
Simple extraction: around $126 (tooth extraction average cost)
Surgical extraction: costs may vary
- Italy
Simple extraction: $97
Surgical extraction: costs may vary, but Italy has an average dental procedure cost of $173.
The estimated costs of an acupuncture session in different countries:
- United States: $60-$150, with initial visits ranging from $100-$150 and cosmetic acupuncture sessions costing $120-$200. Community acupuncture clinics offer more affordable options at $25-$50 per session.
- Canada: $95-$135, with prices higher in cities like Toronto and Vancouver.
- United Kingdom: £40-£70 per session, with first sessions potentially costing $88-$100 due to consultations.
- Australia: AUD 75-AUD 120 per session, depending on location and practitioner experience.
________________________
Do these data make sense?
I am not sure.
If anything, they seem to suggest that the US is very poor value for money when it comes to healthcare. Of course, this is all going to change now that Trump and Kennedy are in charge …
… SADLY, NOT FOR THE BETTER, I’M AFRAID!
Common Harms of CSM
- Musculoskeletal discomfort: Temporary soreness, stiffness, or pain in the muscles or joints after treatment.
- Headaches: Some individuals may experience headaches following spinal manipulation.
- Fatigue: Feeling tired or experiencing fatigue after treatment.
These harms occur after CSM in about 50% of all patients. They impact on their quality of life and usually last 1-3 days.
Serious Harms of CSM
- Vertebral artery dissection (VAD) and stroke: A tear in the vertebral artery can lead to stroke; the harm can be permanent.
- Death: A stroke can be fatal.
- Atlantoaxial dislocation
- Spinal cord injury: Damage to the spinal cord, potentially resulting in numbness, weakness, or paralysis.
- Herniated discs: Manipulation can exacerbate existing disc issues or cause a new disc herniation.
- Fractures: Osteoporotic patients or those with bone conditions are at risk of vertebral fractures.
- Cauda equina syndrome: Compression of nerves in the lower spine, potentially causing bowel or bladder dysfunction.
- Nerve damage: Injury to spinal nerves, leading to numbness, tingling, or weakness.
- Eye Injuries: these include central retinal artery occlusion, nystagmus, Wallenberg syndrome, ptosis, loss of vision, ophthalmoplegia, dipiopia and Horner’s syndrome.
The frequency of these harms is not known.
Other Risks
- Neglect: This happens whenever a chiropractor treats a condition that can more effectively be treated with another therapy.
- Misleading advice: This occurs whenever a chiropractor gives advice outside his area of competence, for instance, a recommendation against immunisations.
- False diagnoses: Chiropractors often diagnose a ‘vertebral subluxation’, a condition that exists only in their fantasy.
- Worsening of existing conditions: Manipulation may exacerbate underlying spinal problems or conditions like spinal instability.
- Waste of money: This occurs each time a patient pays for ineffective CSM.
The frequency of these risks is not well-documented but can be estimated to be very high.
_____________________________
I have often pointed out that the value of a therapy is not solely determined by its potential for harm. It depends crucially on the risk/benefit profile. The benefits of CSM are few and mostly uncertain. Thus the question arises:
DO THE BENEFITS OF CSM OUTWEIGH ITS RISKS?
I let you, the reader, answer this question.
PS
References for the above statements can be found in my book.
Jessica Knurick, PhD, RDN published a comprehensive list of things the Trump admin did to harm public health. It is as impressive as it is frightening; allow me to show it to you:
Food Assistance & Nutrition Access
- Eliminated USDA’s local food program connecting farmers to schools.
- Eliminated USDA’s Farm-to-Food Bank program that helped food banks source fresh, local food.
- Cut funding for the Patrick Leahy Farm to School Program, which supported hands-on nutrition education and local food sourcing in schools.
- Proposed $1.3B cuts to WIC, slashing fruit and vegetable benefits for at-risk women, infants, and children.
- Proposed over $300 billion in SNAP cuts, which could result in 3.2 million individuals losing access to nutrition assistance.
- Halted USDA food deliveries to food banks, worsening supply during high demand.
- Defunded SNAP-Ed, reducing nutrition education for low-income families.
Food Safety & Regulation Rollbacks
- FDA budget cuts paired with plans to shift food inspections to state agencies, weakening oversight and consistency.
- Massive staff cuts at the FDA, including food safety scientists and inspectors — an estimated one-third of the food safety workforce has been let go.
- Cut food toxicologist staff at FDA responsible for evaluating chemical risks in the food supply.
- Jim Jones, former EPA official and head of FDA’s Human Foods Program, resigned in protest, stating he could no longer protect the food supply under the current conditions.
- Suspended the Food Emergency Response Network’s proficiency testing program, limiting early detection of foodborne threats.
- Paused milk quality testing during the bird flu outbreak, raising public safety concerns.
- Eliminated USDA food safety advisory committees, silencing key scientific voices on foodborne risks.
- Proposed permanent increases in meat processing line speeds, ignoring warnings from labor and food safety experts.
- Continued deregulatory mandates requiring agencies to eliminate ten existing regulations for every new one introduced, undermining long-term food safety infrastructure.
Scientific Research & Public Health Infrastructure
- Proposed $18B in NIH cuts; plan to consolidate 27 research centers.
- Froze new NIH grants and terminated 694 existing awards totaling $1.81 billion, disrupting research on cancer, HIV, ALS, and other critical health issues.
- Halted all federal grant funding via OMB memo (later withdrawn under court pressure).
- Barred NIH subawards to foreign institutions, cutting off international research partnerships.
- Removed 8,000+ public-facing federal health and science webpages, including datasets on youth risk behavior, reproductive health, and environmental hazards.
- Announced a major restructuring of HHS with a plan to eliminate 20,000 positions, weakening the workforce behind public health programs and research infrastructure.
- Eliminated CDC’s Division of Environmental Health Services and Practices, which included programs addressing childhood lead poisoning, asthma, safe water, radiation exposure, and climate-related health risks.
- Eliminated all NIOSH (National Institute for Occupational Safety and Health) programs except for the World Trade Center and Black Lung Disease programs, gutting workplace safety and occupational health research.
- Proposed elimination of the Head Start program, disrupting early education, health screenings, and nutrition services for low-income families.
- Proposed elimination of the Healthy Start, a proven program that reduces maternal and infant mortality by employing women in low-income communities to provide health education and support for pregnant and postpartum families.
- Eliminated the CDC Division of Oral Health, ending federal support for preventing tooth decay and promoting dental health in underserved communities.
- Pushed back against community water fluoridation efforts, and initiated steps to end federal support for community water fluoridation.
- Eliminated the federal Newborn Screening Advisory Committee, disrupting evidence-based updates to newborn screening and risking delayed diagnoses.
- Targeted CDC’s Chronic Disease Division (NCCDPHP) for elimination, undermining programs focused on tobacco prevention, cancer screening, and school health.
- Terminated $11.4 billion from the CDC’s COVID Epidemiology and Laboratory Capacity (ELC) grant program, undermining state efforts to modernize public health data infrastructure, lab capacity, and disease surveillance systems.
- Terminated multiple HIV surveillance and prevention research programs, including the Adolescent HIV Prevention Network and NIH-funded provider training initiatives, weakening national data systems and care delivery pipelines.
- Closed CDC’s Division of STD Prevention and Viral Hepatitis laboratories, which previously served as global reference centers for tracking antibiotic resistance and emerging infectious threats.
- Eliminated the HHS Office of Climate Change and Health Equity (OCCHE), which addresses the health impacts of climate change on vulnerable communities.
- Withdrew the U.S. from the World Health Organization, severing access to global disease surveillance systems and pandemic coordination.
Communication Suppression & Scientific Censorship
- Imposed a communications freeze at CDC and other health agencies, delaying public health guidance and halting the MMWR.
- Required all federal health agency guidance to be reviewed by political appointees.
- Censored terms like “equity,” “diversity,” “nonbinary,” and “systemic racism” in federal research and agency communications.
- Censored federal scientists critical of administration narratives — including Kevin Hall, whose research on ultra-processed food was reportedly suppressed, and who subsequently resigned.
- Promoted misinformation about seed oils, infant formula, and CGMs as diet tools over evidence-based obesity treatment, fueling distrust in public health recommendations.
Vaccines & Immunization Policy
- Canceled key CDC and FDA vaccine advisory meetings, including sessions on flu strain selection and childhood immunization schedules, disrupting routine vaccine planning and oversight.
- Removed COVID-19 vaccines from the CDC’s routine immunization schedule for healthy children and pregnant women, despite established benefits in preventing severe outcomes.
- Limited approval of updated COVID-19 vaccines to seniors and high-risk groups, requiring new clinical trials for broader use, potentially restricting access for millions of Americans.
- Terminated $258 million in HIV vaccine research funding, setting back global efforts to develop a viable HIV vaccine by an estimated decade.
- Canceled a $600 million contract with Moderna for avian flu vaccine development, raising concerns about pandemic preparedness and national health security.
Environmental Health & Deregulation
- EPA launched the “biggest deregulation day in U.S. history,” targeting environmental protections across multiple sectors.
- Rolled back environmental protections related to agriculture and industry, including expanded coal operations that increase mercury, arsenic, and lead in soil, water, and food.
- Rolled back PFAS drinking water protections, despite mounting evidence of harm.
- Slashed EPA staff and budget by $300 million, including deep cuts to enforcement and environmental justice teams.
- Cut clean energy programs on farms and in rural communities, reducing support for climate-smart agriculture.
- Defunded programs designed to protect disadvantaged communities facing disproportionate environmental harm.
- Proposed eliminating the EPA’s Office of Research and Development, potentially terminating up to 75% of its 1,540 staff members, including chemists, biologists, and toxicologists. This move has been criticized as undermining the agency’s scientific integrity and legislative mandates.
- Established an email system allowing industrial polluters to request presidential exemptions from Clean Air Act regulations, enabling companies to bypass rules on toxic emissions like mercury and arsenic
- CDC unable to assist with lead contamination crisis in Wisconsin due to understaffing and budget cuts.
Healthcare Access, Drug Costs, and Tobacco Policy
- Proposed deep cuts to Medicaid, including block grants and work requirements, which the Congressional Budget Office (CBO) estimates would result in 8.6 million people losing health insurance.
- Shortened Affordable Care Act (ACA) open enrollment periods, making it harder for people to sign up for insurance.
- Reversed Medicare drug negotiation policy, allowing pharmaceutical companies to raise prescription drug prices without limits.
- Rescinded Biden-era EMTALA guidance requiring emergency rooms to provide abortion care when a pregnant patient’s life is at risk
- Suspended J-1 visa processing, threatening to strand residency programs and worsen healthcare workforce shortages as the July 1 start date approaches.
- Proposed major cuts to the Substance Abuse and Mental Health Services Administration (SAMHSA), including suicide prevention and community mental health grants, despite rising mental health needs.
- Reversed the planned menthol cigarette ban, despite overwhelming evidence it would save lives and reduce tobacco-related health disparities, particularly in Black communities.
Global Health and Foreign Aid
- Froze $43 billion in USAID funding without notice, halting vaccine distribution, disaster relief, and food aid programs.
- Announced plans to merge or eliminate USAID under a “government efficiency” strategy.
- Paused PEPFAR funding for global HIV/AIDS relief (later granted waiver but created confusion and service disruption).
- Estimated to have caused approximately 300,000 deaths globally, including over 200,000 children, due to abrupt cuts in aid programs combating HIV/AIDS, malaria, malnutrition, and providing clean water and food aid.
__________________
I find it very hard to believe that:
- this is not based on a concerted strategy,
- it is merely caused by incompetence due to inept individuals in key positions,
- the list will not get longer as Trump procedes,
- by and large Americans accept this without much effective counter-action.
If you, my American friends, don’t do something very soon, it will be too late. This is no longer purely an American issue; health has long become international, and soon we will all suffer from Trump’s systematic demolition of healthcare and research.
PS
Thank you Jessica for this brave effort
The French newspaper ‘L’Express’ just published an open letter that might be of considerable relevance to the readers of this blog. Here is my translation:
Since 2016, all private sector employers have been required by law to offer supplementary health insurance to their employees. As a result, 96% of the population is now covered. The costs for this are also borne by each household, social security contributions and common taxes used to fund the general health insurance scheme.The same obligation applies since 2020 for the State in respect of its civil servants, and the French Ministry of Education, the country’s largest public employer, has just signed contracts with MGEN and CNP assurance. This contract, which complies with the ministerial order implementing the law and setting out the cover provided, is a cause for concern, as it provides for coverage of non-conventional healthcare practices (e.g. homeopathy, osteopathy, acupuncture, naturopathy, chiropractic, relaxation therapy, etc.). According to the Ministry of Health itself, most of these practices have ‘not been the subject of scientific or clinical studies demonstrating their modes of action, their effects, their effectiveness or their harmlessness’.This coverage would reinforce the general public’s belief that these treatments are effective. This is happening while proven therapies such as psychology, prescription sport and dietetics are rarely covered by mutual insurance companies.In a report published in September 2024, the French Senate proposed to counter the sharp rise in complementary health insurance charges by reviewing the coverage of unconventional healthcare practices (so-called alternative medicine, SCAM). According to this report, the cost of these practices has increased fivefold over the last eight years, reaching almost €1 billion in 2023, excluding the cost of spa treatments.
Therapeutic excesses
We support this proposal. It is clear to us that, in addition to being useless, these unproven practices mislead patients as to what constitutes genuinely effective treatments, when in fact they are nothing more than an expenditure that does nothing to improve the health of anyone, at the expense of genuinely beneficial care. What’s more, they expose us to the risk of therapeutic aberrations, or even the abandonment of care in cases where it is necessary.The government says it wants to make savings on health spending. Wouldn’t it be more effective, and also better understood by the general public, to do so by promoting treatments whose effectiveness is supported by a scientific consensus? And would it not be better to stop the reimbursement of unproven practices likely to lead to delays in treatment and health abuses? We need to set a limit on ‘private solidarity’ expenditure, the cost of which continues to rise well above the rate of inflation, particularly for the most vulnerable households and the elderly.
The Ministry’s announcement of initiatives to combat misinformation in the health sector cannot be reconciled with the funding of unconventional therapies, about which Miviludes has repeatedly warned. The work of the Descartes Foundation shows that sensitivity to these practices and sensitivity to esotericism are linked, creating a breeding ground for health misinformation and conspiracy theories.
An individual choice
Mutual insurance companies cannot legitimise wellness practices at the expense of optimum reimbursement for proven treatments. Health issues are everybody’s business, and the most vulnerable should be able to count on national solidarity in the interests of all French people.
The Collectif No FakeMed is calling on the authorities to be rigorous in ensuring that only practices based on scientific knowledge, in both health economics and evidence-based medicine, are covered by the public purse and mutual insurance companies. It is possible to offer a cover for some wellness treatments, but this must be a matter of personal CHOICE, and therefore an option, not an obligation.
Signatories
Institutions and associations:
- Collectif No Fakemed;
- Conseil national de l’ordre des masseurs-kinésithérapeutes;
- Conseil national de l’Ordre des Sages Femmes;
- Conseil national de l’Ordre des pédicures-podologues;
- Collectif ‘Vaccins France informations & discussions’;
- Collectif Chanology France; syndicat ReAGJIR.
Individual signatories:
- Pr Agnès Buzyn, ancienne ministre, présidente du think tank Evidences ;
- Dr Pierre de Bremond d’Ars, médecin généraliste et président du Collectif No Fakemed ;
- Isabelle Derringer, présidente du Conseil de l’Ordre des Sages Femmes ;
- Pascale Mathieu, présidente du Conseil national de l’ordre des masseurs kinésithérapeutes ;
- Dr Eric May, médecin généraliste, directeur santé Malakoff, président de la Fédération Nationale de Formation des Centres de Santé ;
- Éric Prou, président de l’Ordre national des pédicures podologues ;
- Dr Sophie Augros, médecin généraliste ;
- Dr Mehdi Bahaji, anesthésiste-réanimateur ;
- Marie-Ange Barbier, diététicienne, membre du bureau du collectif No Fakemed ;
- Dr Damien Barraud, médecin hospitalier ;
- Karine Brezellec, trésorière adjointe du Conseil national de l’ordre des masseurs kinésithérapeutes ;
- Dr Laurent Brindel, membre du bureau du collectif No Fakemed ;
- Gérald Bronner, professeur à la Sorbonne, membre de l’Académie nationale de médecine, membre de l’Académie des technologies ;
- Dr Matthieu Calafiore, Maître de conférences des universités, directeur du département de médecine générale de l’Université de Lille ;
- Dr Julie Chastang, médecin généraliste, maîtresse de conférence des universités (Sorbonne Université) ;
- Pr Laurence Compagnon, médecin généraliste ;
- Dominique Costagliola, membre de l’Académie des sciences, directrice de recherche émérite Inserm ;
- Laurent Cordonier, docteur en sciences sociales, Chercheur associé au GEMASS, Sorbonne Université – CNRS (UMR 8598) ;
- Dr Raphaël Dachicourt, président de Réagir ;
- Dr Jeremy Descoux, Cardiologue, Président fondateur du Collectif No Fakemed ;
- Arthur Dian, ancien ostéopathe, M2 en histoire et philosophie des sciences ;
- Jean-François Dumas, secrétaire général du Conseil national de l’ordre des masseurs kinésithérapeutes ;
- Pr Edzard Ernst, MD, PhD, FMEdSci, FRSB, FRCP, FRCP(Edin.) professeur émérite à l’Université d’Exeter;
- Élisabeth Feytit, créatrice du podcast d’éducation à l’esprit critique Méta de Choc ;
- Dr Jean-Jacques Fraslin, médecin généraliste ;
- Roger-Philipe Gachet, Secrétaire Conseil national de l’ordre des masseurs kinésithérapeutes ;
- Dr Julien Gere, neurologue ; Pr André Grimaldi, diabétologue ;
- Florian Gouthière, journaliste scientifique ;
- Dr Nicolas Groëll, médecin généraliste ;
- Dr Jérome Grosjean, biologiste ;
- Kalou, créateur de contenu dédié à l’information et la prévention du phénomène sectaire ;
- Jean-Paul Krivine, rédacteur en chef de Science et pseudo-sciences, Association française pour l’information scientifique ;
- Dr Corentin Lacroix, Whydoc, médecin généraliste et vulgarisateur ;
- Marion Lagneau, trésorière du collectif No Fakemed ;
- Guillaume Limousin, ingénieur, docteur en sciences, professeur de mathématiques en collège ;
- Dr Christian Lehmann, médecin généraliste et écrivain ;
- Dr Stéphanie Marsan, médecin généraliste, membre du bureau du collectif No Fakemed ; Dr Elodie Lemarthe, secrétaire générale du collectif No Fakemed ;
- Dr François Maignen, docteur en pharmacie et statisticien ;
- Dr Hervé Maisonneuve, médecine de santé publique ;
- Gilles Marchiano, secrétaire adjoint du Conseil national de l’ordre des masseurs kinésithérapeutes ;
- Pr Matthieu Molimard, professeur de pharmacologie CHU de Bordeaux ;
- Dr François Morel, chirurgien, membre du bureau du collectif No Fakemed ;
- Dr Nathan Peiffer Smadja, infectiologue ;
- Grégoire Perra, enseignant et lanceur d’alerte sur les écoles Steiner-Waldorf et l’anthroposophie ;
- Sylvain Peterlongo, masseur-kinésithérapeute, membre du bureau du collectif No FakeMed ;
- Pr Nicolas Pinsault, vice-président du Conseil national de l’ordre des masseurs kinésithérapeutes ;
- Dr Franck Ramus, CNRS ;
- Mathieu Repiquet, étudiant en médecine et en santé publique ;
- Pierre Rigal, secrétaire adjoint du Conseil national de l’ordre des masseurs kinésithérapeutes ;
- Laurent Salsac, infirmier, membre du bureau du collectif No Fakemed ;
- Natalia Trouiller, lanceuse d’alerte sur les violences sexuelles dans l’Eglise catholique ;
- Stéphanie de Vanssay, enseignante, militante contre les dérives scolaires ;
- Brigitte Vincent, vice-présidente du Conseil national de l’ordre des masseurs kinésithérapeutes ;
- Dr Frederic Villebrun, médecin généraliste ;
- Dr Nicolas Winter, praticien hospitalier aux urgences pédiatriques Valenciennes et vulgarisateur sur les réseaux To be or not Toubib ;
- Dr Florian Zores, cardiologue.
I suppose we all heard that DONALD TRUMP has recently turned his genius towards the film industry. Specifically, he wrote:
“The Movie Industry in America is DYING a very fast death. Other Countries are offering all sorts of incentives to draw our filmmakers and studios away from the United States. Hollywood, and many other areas within the U.S.A., are being devastated. This is a concerted effort by other Nations and, therefore, a National Security threat. It is, in addition to everything else, messaging and propaganda! Therefore, I am authorizing the Department of Commerce, and the United States Trade Representative, to immediately begin the process of instituting a 100% Tariff on any and all Movies coming into our Country that are produced in Foreign Lands. WE WANT MOVIES MADE IN AMERICA, AGAIN!”
Well done Donnie!
After this decisive move, the hero of the mentally challenged announced another, even more far-reaching and long-awaited measure:
“TARIFFS ON RATIONAL THOUGHT”
On his patform ‘UNTRUTH ASOCIAL’, Trump proclaimed:
Rational thinking in America is DYING a very fast death. Other Countries are offering all sorts of incentives to draw scientists and other experts away from the United States. Universities and many other areas within the U.S.A., are being devastated and pseudo-science is thriving as a result. This is a concerted effort by other Nations and, therefore, a National Security threat. It is, in addition to everything else, messaging and propaganda! Therefore, I am authorizing all my government Departments and other relevant bodies of the US administration, to immediately begin the process of instituting a 100% Tariff on any and all RATIONAL THOUGHTS coming into our Country that are produced in Foreign Lands. WE WANT SCIENCE MADE IN AMERICA, AGAIN!
Trump’s latest move earned criticism as soon as it became public. Democrats pointed out that it was Trump himself who had driven US scientists to seek employment outside their home country. A spokesperson of the Whit House responded with merely a two-word-statement:
FAKE NEWS!
Being a dedicated crook and a liar himself, Donald Trump has long had an inclination to surround himself with crooks and liars. As discussed repeatedly, this preferance naturally extends into the realm of healthcare, Some time ago, he sought the advice of Andrew Wakefield, the man who published the fraudulent research that started the myth about a causal link between MMR-vaccinations and autism.
Early November this year, Trump stated that, if he wins the election, he’ll “make a decision” about whether to outlaw some vaccines based on the recommendation of Robert F. Kennedy Jr., a notorious vaccine critic without any medical training. The president doesn’t have authority to ban vaccines but he can influence public health with appointments to federal agencies that can change recommendations or potentially revoke approvals.
Now that he did win the election, Trump suggested that Robert F. Kennedy Jr., his pick to run Health and Human Services, will investigate supposed links between autism and childhood vaccines, a discredited connection that has eroded trust in the lifesaving inoculations.
“I think somebody has to find out,” Trump said in an exclusive interview with “Meet the Press” moderator Kristen Welker. Welker noted in a back-and-forth that studies have shown childhood vaccines prevent about 4 million deaths worldwide every year, have found no connection between vaccines and autism, and that rises in autism diagnoses are attributable to increased screening and awareness.
Trump, too stupid to know the difference between correlation and causation, replied: “If you go back 25 years ago, you had very little autism. Now you have it.” “Something is going on,” Trump added. “I don’t know if it’s vaccines. Maybe it’s chlorine in the water, right? You know, people are looking at a lot of different things.” It was unclear whether Trump was referring to opposition by Kennedy and others to fluoride being added to drinking water.
Kennedy, the onetime independent presidential candidate who backed Trump after leaving the race, generated a large following through his widespread skepticism of the American health care and food system. A major component of that has been his false claims linking autism to childhood vaccinations. Kennedy is the founder of a prominent anti-vaccine activist group, Children’s Health Defense. The agency Trump has tasked him with running supports and funds research into autism, as well as possible new vaccines.
The debunked link between autism and childhood vaccines, particularly the inoculation against mumps, measles and rubella, was first claimed in 1998 by Andrew Wakefield who was later banned from practicing medicine in the UK. His research was found to be fraudulent and was subsequently retracted. Hundreds of studies have found childhood vaccines to be safe.
Autism diagnoses have risen from about 1 in 150 children in 2000 to 1 in 36 today. This rise has been shown to be due to increased screening and changing definitions of the condition. Strong genetic links exist to autism, and many risk factors occurring before birth or during delivery have been identified.
If Trump does, in fact, ‘outlaw’ certain vaccinations, he would endanger the health of the US as well as the rest of the world. Will he really be that stupid?
“Is Chiropractic Worth the Taxpayer’s Expense?” is the interesting question asked in this article by Ikenna Idika Ogbu from the Department of Neurosurgery, University Hospitals of North Midlands, UK and Chandrasekaran Kaliaperumal from the Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, UK. Here is the abstract:
Chiropractic remains a service provided outside the NHS in the United Kingdom and the argument for inclusion has been ongoing since the 90’s. There are significant patient-reported benefits from chiropractic backed by evidence in specific use-cases as cervicogenic headaches and there are significant potential cost-savings from the inclusion of chiropractic as an NHS service. The evidence, however, does not particularly favour the use case of chiropractic, especially in the context of Low Back Pain (LBP) and the benefits of chiropractic are unclear. Considering the potential cost-savings for the NHS and the society, there should be consideration for its inclusion. However, the evidence will need to be clearer to argue for inclusion of chiropractic in the NHS spectrum of services, especially for spinal services.
So, the authors confirm that, even for back pain, “the benefits of chiropractic are unclear”, and in the next sentence they advocate “consideration for its inclusion.”
Does that make sense?
No!
Let’s be clear: the least expensive way to proceed in the short term is usually to do nothing. No treatment is invariably less expensive than treatment! Yet, this logic obviously does not account for the two most important factors in this equation: risk and benefit.
- Not treating a condition can cause prolonged, needless suffering.
- Not treating a condition can cause significant follow-up costs.
- Treating it can cause adverse effects and additional suffering.
- Adverse effects can cause significant follow-up costs.
- Treating the condition effectively will result in less suffering.
- Treating the condition effectively will result in less follow-up costs.
It follows that we should treat health problems:
- effectively,
- with few risks of side-effects,
- as cheaply as possible.
It also follows that costs are by no means the only factor in this complex equation. Cost-effectiveness without effectiveness is not possible. Moreover, cost-effectiveness withoout an acceptable degree of safety is unlikely.
In the case of chiropractic, we have hardly reliable proof of effectiveness or safety. And this means that, before we can consider chiropractic to be paid for from public money, we first need solid evidence for its safey and efficacy – each for the relevant health problem to be treated. Once we have reliable data about all this – AND ONLY THEN – might we consider including chiropractic into the public healthcare budget.
In other words, the above cited paper is naive and ill-informed to the extreme.
The JOURNAL OF BUSINESS ETHICS (I did not even know such a journal existed) recently carried a most interesting article. Here is its abstract:
Consumers spend billions of dollars per year on homeopathic products. But there is powerful evidence that these products don’t work, i.e., they are not medically effective. Should homeopathic products be for sale? I give reason for thinking that the answer is ‘no.’ It has been suggested that the sale of homeopathic products involves deception. This might be so in some cases, but the problem is simpler: it is that these products don’t do what people buy them to do. More precisely, homeopathic products don’t meet the “desire-satisfaction condition,” according to which products for sale in markets should satisfy the desires that people buy them to satisfy. I defend my view against objections, and conclude by acknowledging some of the practical difficulties of banning products people want to buy.
Allow me to introduce you to the logic of the author, Jeffrey Moriarty, in a little more detail. Essentially, he argues as follows:
- There is powerful evidence that homeopathic products don’t work, i.e., they are not medically effective. As we have discussed ad nauseam on my blog, this is certainly true.
- Thus they don’t meet the “desire-satisfaction condition,” according to which the sale of a product should satisfy the desire(s) that people buy it to satisfy. Regulators prohibit retailers from advertising in ways that cause reasonable people to have materially false beliefs. It doesn’t matter to regulators whether advertisers cause false beliefs intentionally, and therefore deceive consumers, or unintentionally, and therefore merely mislead them. The point is to prevent consumers from acting on false information; however, they acquire it.
- If a product doesn’t meet the “desire-satisfaction condition” condition, then there is a presumption against selling it. When people act on false information in markets, they are likely to make themselves worse off. We can understand how this works in terms of the satisfaction of desires. People engage in market exchanges in order to satisfy their desires. When their desires are satisfied as a result of market exchange, they are better off. You want a car that runs and seek to buy one. When you purchase the car, and it does run, you are better off. But when people act on false information, they are likely to frustrate rather than satisfy their desires. As a result, they are likely to be worse off. If the car you purchase doesn’t run, you are worse off. You spent your money on something you didn’t want.
- The products people buy should satisfy the desires they buy them to satisfy. This is the “desire-satisfaction condition” for market exchange. Transactions that reliably don’t result in desire-satisfaction are problematic. Because desires aren’t satisfied, this is evidence that value isn’t being created; the party whose desires are not satisfied is worse off. Since markets should make people better off, there is a presumption against allowing these transactions.
- The author states that his arguments also apply to other medicines and medical treatments that we have powerful reason to believe don’t work.
Jeffrey Moriatry concludes: When people purchase homeopathic products, they act on false information, and in doing so, fail to satisfy their desires. This is a sign that the purchase does not create value for them. Since market transactions should create value, there is a presumption in favor of prohibiting this transaction … we give states broad authority to decide what sorts of products can and can’t be sold, including medicines. This suggests that people generally think that banning the sale of certain products, despite the costs of doing so, is worth it. It also suggests that people think that the state uses its power competently and fairly—or at least that it doesn’t use it so incompetently and unfairly that it is better for the state not to have this power. The state would be doing nothing out of the ordinary in prohibiting the sale of homeopathic products.
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These arguments are interesting and relevant (sorry, if I have not represented them fully; I recommend reading the full article). Personally, I have never argued that the sales of homeopathics should be banned; I felt that good and responsible information is essential and would eventually reduce sales to an insignificant level. Yet, after reading this paper, I have to admit that its arguments make sense.
I’d love to hear what you think about them.
This study aimed to investigate the clinical effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention to prevent the recurrence of low back pain.
WalkBack was a two-armed, randomised clinical trial, which recruited adults (aged 18 years or older) from across Australia who had recently recovered from an episode of non-specific low back pain that was not attributed to a specific diagnosis, and which lasted for at least 24 h. Participants were randomly assigned to an individualised, progressive walking and education intervention facilitated by six sessions with a physiotherapist across 6 months or to a no treatment control group (1:1). The randomisation schedule comprised randomly permuted blocks of 4, 6, and 8 and was stratified by history of more than two previous episodes of low back pain and referral method. Physiotherapists and participants were not masked to allocation. Participants were followed for a minimum of 12 months and a maximum of 36 months, depending on the date of enrolment. The primary outcome was days to the first recurrence of an activity-limiting episode of low back pain, collected in the intention-to-treat population via monthly self-report. Cost-effectiveness was evaluated from the societal perspective and expressed as incremental cost per quality-adjusted life-year (QALY) gained. The trial was prospectively registered (ACTRN12619001134112)
Between Sept 23, 2019, and June 10, 2022, 3206 potential participants were screened for eligibility, 2505 (78%) were excluded, and 701 were randomly assigned (351 to the intervention group and 350 to the no treatment control group). Most participants were female (565 [81%] of 701) and the mean age of participants was 54 years (SD 12). The intervention was effective in preventing an episode of activity-limiting low back pain (hazard ratio 0·72 [95% CI 0·60–0·85], p=0·0002). The median days to a recurrence was 208 days (95% CI 149–295) in the intervention group and 112 days (89–140) in the control group. The incremental cost per QALY gained was AU$7802, giving a 94% probability that the intervention was cost-effective at a willingness-to-pay threshold of $28 000. Although the total number of participants experiencing at least one adverse event over 12 months was similar between the intervention and control groups (183 [52%] of 351 and 190 [54%] of 350, respectively, p=0·60), there was a greater number of adverse events related to the lower extremities in the intervention group than in the control group (100 in the intervention group and 54 in the control group).
The authors concluded that an individualised, progressive walking and education intervention significantly reduced low back pain recurrence. This accessible, scalable, and safe intervention could affect how low back pain is managed.
Rigorous clinical trials of excercise therapy are difficult to conceive and conduct because of a range of methodological issues. For instance, there is no obvious placebo and thus it is hardly possible to control for placebo effects. Nonetheless, the benefits of exercise therapy for back pain is undoubted. As previously discussed on this blog, a recent systematic review concluded that “the relative benefit of individualized exercise therapy on chronic low back pain compared to other active treatments is approximately 38% which is of clinical importance.”
I have always been convinced of the health benefits of excercise. In fact, 40 years ago, when I did my inaugural lecture at the University of Munich (LMU), excercise was its topic and I concluded that, if exercise were a pharmaceutical product, it would out-sell any drug. The new study only confirms my view. It adds to our knowledge by suggesting that exercise also reduces the risk of recurrences.
Forget about spinal manipulation, acupuncture, etc., despite the undeniable weaknesses in the evidence, exercise is by far the most promissing treatment for back pain
‘Chiropractic economics’ might be when chiropractors manipulate their bank accounts or tax returns, I thought. But, no, it is a publication! And a weird one at that – it even promotes the crazy idea of maintenance care:
The concept of chiropractic maintenance care has evolved significantly. Initially seen as a method for managing chronic pain, it now includes a broader range of patients and focuses on overall wellness. Modern maintenance care aims to keep patients healthy regardless of their symptoms or history, alleviating and preventing pain through regular, prolonged care. This approach is largely preventive, serving as both secondary and tertiary care. Studies show chiropractic maintenance care often includes diverse treatments such as manual therapy, stress management, nutrition advice and more, with flexible intervals typically around three months. This evolution underscores the importance of evidence-based, individualized patient care. This article shares the evolution of chiropractic maintenance care, looks at what a modern maintenance care appointment can include and explores best practices for DC maintenance care in 2024.
An interview study of Danish chiropractic care showed maintenance care sessions included a range of treatment modalities, including manual treatment and ordinary examinations alongside multiple packages of holistic additions, like stress management, diet, weight loss, advice on ergonomics, exercise and more. In other anecdotal accounts, chiropractic maintenance care seemed to follow a more traditional guideline of lower back pain management and adjustment. The study hypothesized that maintenance care could also help patients from a knowledge perspective, stating, “DCs could obviously play an important role here as ‘back pain coaches,’ as the long-term relationship would ensure knowledge of the patient and trust towards the DC.”
Researchers found that three-month intervals were the most common spacing of maintenance care treatments for patients. Most commonly, patients sought or scheduled chiropractic maintenance care over the course of one to three months.
Chiropractic maintenance care has evolved past simply being a method of ongoing chronic pain management. Today’s patients want to achieve overall wellness, and regular trips to their DC can become a part of that if you work to transition patients into a wellness plan after their acute phase of care is over.
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The author of this article seems to have forgotten two little details:
- Chiropractic maintenance care is not supported by sound evidence, particularly in relation to economics (even the above cited paper stated: “We found no studies of cost-effectiveness of Maintenance Care”).
- Chiropractic maintenance only serves one economic purpose: it boosts the chiropractors’ income.
Yes, easy to forget, particularly if your name is ‘Chiropractic Economics’.
And also easy to forget that maintenance care would, of course, require informed consent. How would that look like?
Chiro (C) to patient (P):
If you agree, we will start a program that we call maintenance care.
P: Can you explain?
C: It consists of regular sessions of spinal manipulations.
P: That’s all?
C: No, I will also give you advice on keeping fit and living healthily.
P: Why do I need that?
C: It’s a bit like servicing your car so that it works reliably when you need it.
P: Is it proven to work?
C: Yes, of course, there are tons of evidence to show that a healthy life style is good for you.
P: I know, but I don’t need a chiro for that – what I meant do the manipulations keep my body healthy even if I have no symptoms?
C: The evidence is not really great.
P: And the risks?
C: Well, yes, if I’m honest, spinal manipulations can cause harm.
P: So, to be clear: you ask me to agree to a program that has no proven benefit and might cause harm?
C: I would not put it like that.
P: And how much would it cost?
C: Not much; just a couple of hundred per year.
P: Thanks – but no thanks.
