critical thinking
Donald Trump has nominated Dr. Mehmet Oz, a celebrity physician known for his US television show, to lead the Centers for Medicare and Medicaid Services (CMS). Some 20 years ago, I had the pleasure to briefly meet Oz at a conference. I can honestly say that I rarely met anyone who was – in my view – oozing that much quackery as he was. Oz’s nomination has sparked (not just my but) widespread disbelief, mainly due to Oz’s long history of irresponsibly promoting even the worst forms of so-called alternative medicine (SCAM) for his own fame and fortune.
After being nominated, Oz posted a comment on X: “I am honored to be nominated by @realDonaldTrump to lead CMS. I look forward to serving my country to Make America Healthy Again under the leadership of HHS Secretary @RobertKennedyJr“
Personally, I am beginning to find Trump’s recent appointments too tiresome and ridiculous for further detailed comments. They seem to me like a deliberate provocation and an indication of the systematic destruction that Trump has in mind for his second term in office.
Instead of a comment, let me therefore show you some of the comments on the appointment that have appeared on X.
- Robert F. Kennedy Jr @RobertKennedyJr Very excited that my friend @DrOz has agreed to run CMS. Thank you @realDonaldTrump for this outstanding nomination. Welcome Dr. Oz to The Avengers. Let’s Make America Healthy Again!
- Elizabeth Warren @SenWarren Running Medicare and Medicaid for over 100 million Americans isn’t like hosting a daytime talk show. Dr. Oz is another rich guy who doesn’t care if your health care costs go up or an insurance company denies you coverage. These decisions have life and death consequences.
- Billboard Chris @BillboardChris Dr. Oz has been appointed to head Medicare and Medicaid. He needs to come out and publicly disavow this abhorrent garbage he pushed on his show about ‘transgender children.
- Michael Steele @MichaelSteele Robert F. Kennedy at HHS; now Dr. Mehmet Oz to run Medicare and Medicaid. And Republicans want to cut the social safety net to pay for renewing Trump’s tax cuts. Reality TV personalities for a Reality TV administration. Unfortunately, we live in a world where diseases are real, people are poor and reality hits many of us hard every day
- The Resistor Sister @the_resistor More like The Apprentice Administration NONE of them are qualified.
- seanmack @seanmack1025 When does Dr Doolittle get a job. I bet doctor Phil feels left out.
- Peter Morley @morethanmySLE Donald Trump’s CMS pick Dr. Mehmet Oz suggested in 2020 Lupus patients were IMMUNE to COVID if we took Hydroxychloroquine. FACT: I have Lupus & have been on this since medication since 2014 & I had Covid 3x. This man should NOT be overseeing Medicare & Medicaid!
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The bon mot that describes the situation best: If you put a clown in a palace, the clown does not become a king, but the palace turns into a circus.
Guest post by Catherine de Jong
Academic circles have reacted with surprise to the announcement on 12 November of the appointment of chiropractor Sidney Rubinstein as endowed professor at the Vrije Universiteit Amsterdam. The website of the Dutch Chiropractors Association (NCA) states:
“On 1 August 2024, Mr. Sidney Rubinstein was appointed professor by special appointment at the chair “Optimizing Management of Musculoskeletal Health” at the Vrije Universiteit in Amsterdam. In addition to his work as a chiropractor in his own practice, Rubinstein has been working at the Vrije Universiteit for a long time. In addition to treating patients, he has always focused on research and development within chiropractic and musculoskeletal (MSK) disorders.”
Chiropractic is an alternative method of treatment. There is no scientific evidence for clinically relevant positive treatment outcomes. For that reason, chiropractic is not mentioned as a treatment option in the guidelines of general practitioners and medical specialists in the Netherlands. Both the profession and the education are not recognized in the Netherlands. On the website of the NVAO (Dutch-Flemish Academic Organization, www.nvao.net), chiropractic does not appear as an accredited program. There is now plenty of research, especially case reports, on the damage that treatment by a chiropractor can cause, such as cerebral infarctions due to arterial dissection of carotid arteries due to cracking of the neck by chiropractors.
On June 20, 2008, the website of Medisch Contact (magazine of KNMG, Dutch Society of Medical Doctors) stated: “First Dutch chiropractor gets his PhD: Sidney Rubinstein will be the first chiropractor in the Netherlands to obtain a PhD today. Rubinstein states that most of the side effects of chiropractic are harmless and temporary.”
This dissertation, for which Sidney Rubinstein obtained his doctorate at VU Amsterdam, was substandard and was criticized in a letter sent to the same journal. The subsequent correspondence with, among others, the supervisor can be read here. In short, a dissertation that VU Amsterdam cannot be proud of.
The Cochrane database contains two reviews published by Rubinstein on chiropractic, or Spinal Manipulative Therapy (SMT) for acute and chronic back pain, respectively. The conclusion was the same in both cases: In summary, SMT appears to be no better or worse than other existing therapies for patients with acute/chronic low‐back pain. In a 2013 update (Spinal manipulative therapy for acute low back pain: an update of the Cochrane review. Spine 2013; 38(3): E158-77), Rubinstein comes to the same conclusion: SMT is no more effective for acute low back pain than inert interventions, sham SMT or as adjunct therapy. SMT also seems to be no better than other recommended therapies. Rubinstein himself has concluded years ago that chiropractic or SMT has no greater effect than other treatments (like standard physiotherapy), but still it needs to be researched again and again?
At the end of the news item on the NCA’s website, the truth is revealed: the NCA subsidizes half of the chair! The members of this organization (there are now more than 500 chiropractors in the Netherlands) have diligently raised the money for this chair. Since its foundation in 1896 by the grocer/magnetizer D.D. Palmer, chiropractic has had every chance to prove its usefulness, but it has not succeeded. That Rubinstein can change that situation is, of course, extremely unlikely.
This appointment is therefore in fact a political publicity stunt for a still pointless alternative treatment. It will do both the practice of Sidney Rubinstein and that of other chiropractors a lot of good that there is now a professor of chiropractic in the Netherlands.
The other half of the chair is paid for by the university. This means that public money that could have been better spent is now going to be wasted on research into an alternative treatment that we already know is useless, by a researcher who has already shown that there is no added value of treatment by a chiropractor.
A substandard dissertation and a purchased chair, but Sidney Rubinstein can call himself a professor. With the appointment of chiropractor Sidney Rubinstein as endowed professor at VU Amsterdam, the university is jeopardizing its good name and contributing to the unjustified elevation of Sidney Rubenstein’s status and his pointless method of treatment, chiropractic.
Can this appointment really be reconciled with the scientific norms and values that VU Amsterdam wants to uphold?
While medical experts across the world have expressed dismay at Trump’s appointment of Robert Kennedy, the ‘International chiropractors Association’ has just published this remarkable note:
Donald J. Trump made it official that he was nominating Robert F. Kennedy, Jr. to serve as the Secretary of Health and Human Services. Secretary-designee Kennedy has spent his entire career championing the health of the nation through education, advocacy, research and when needed litigation.
Among his many accomplishments are protecting the environment with Riverkeeper and the Natural Resources Defense Council His work at Riverkeeper succeeded in setting long-term environmental legal standards. Kennedy won legal battles against large corporate polluters. He became an adjunct professor of environmental law at Pace University School of Law in 1986 and founded the Pace’s Environmental Litigation Clinic which he co-directed for a decade.
It would be in the Pace Law Review that the landmark paper, “Unanswered Questions from the Vaccine Injury Compensation Program: A Review of Compensated Cases of Vaccine-Induced Brain Injury” (https://digitalcommons.pace.edu/cgi/viewcontent.cgi?article=1681&context=pelr) would be published in 2011.
Kennedy became laser focused on the autism epidemic while giving lectures on the dangers of mercury in fish, he was repeatedly approached by the mothers of children born healthy who regressed into autism after suffering adverse reactions from childhood vaccines, including their concern about the mercury-based preservative, thimerosal, being used in vaccines including the Hepatitis B vaccine given at birth. Kennedy’s approach to the issue was the same as it always, looking at the science. He assembled a team who gathered all the science and reviewed the issues with him. This resulted in the publication of the book, Thimerosal: Let the Science Speak
The Evidence Supporting the Immediate Removal of Mercury—a Known Neurotoxin—from Vaccines.
After establishing and leading the nonprofit Children’s Health Defense, last year Kennedy stepped back from the organization to throw his hat in the ring to be President. Becoming the embodiment of his uncle John F. Kennedy’s famous quote, “Ask not what your country can do for you, but what you can do for your country!”, Kennedy reached out to President Trump to form an alliance to focus on the crisis of chronic disease in the United States, and suspended his campaign to focus on the Make American Healthy Again (MAHA) Initiative.
ICA President, Dr. Selina Sigafoose Jackson, who is currently in Brazil promoting the protection of chiropractic as a separate and distinct profession stated, “Many ICA members have been supporters of Robert F. Kennedy, Jr.’s philanthropic activities and are all in on the MAHA Initiative. The Mission, Vision, and Values of the ICA align with the stated goals of the MAHA Initiative. We stand ready to provide policy proposals and experts to serve as advisors to the incoming Administration and to Secretary Kennedy upon his swearing in.”
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Perhaps I am permitted to contrast this with some health-related truths about Robert F. Kennedy, Jr. (my apologies, if the list is incomplete – please add to it by posting further important issues):
- Robert F. Kennedy, Jr. has, since about 20 years, been a leading figure of the anti-vaccine movement.
- During the epidemic, he pushed the conspiracy theory that “the quarantine” was used as cover to install 5G cell phone networks.
- He claimed that “one out of every six American women has so much mercury in her womb that her children are at risk for a grim inventory of diseases, including autism, blindness, mental retardation and heart, liver and kidney disease.”
- He wrote that, “while people were dying at the rate of 10,000 patients a week, Dr. Fauci declared that hydroxychloroquine should only be used as part of a clinical trial. For the first time in American history, a government official was overruling the medical judgment of thousands of treating physicians, and ordering doctors to stop practicing medicine as they saw fit.”
- He pushed the conspiracy theory that COVID-19 had been “ethnically targeted” to spare Ashkenazi Jews and Chinese people.”
- He claimed in a 2023 podcast interview that “There’s no vaccine that is safe and effective”.
- In a 2021 podcast, he urged people to “resist” CDC guidelines on when kids should get vaccines.
- He founded Children’s Health Defense’ that spreads fear and mistrust in science. One chiropractic group in California had donated $500,000 to this organisation.
- In 2019, he visited Samoa where he became partly responsible for an outbreak of measles, which made 5,700 people sick and killed 83 of them.
- He called mercury-containing vaccines aimed at children a holocaust. In 2015, he compared the horrors committed against Jews to the effects of vaccines on children. “They get the shot, that night they have a fever of a hundred and three, they go to sleep, and three months later their brain is gone. This is a holocaust, what this is doing to our country.”
- He repeatedly alleged that exposure to chemicals — “endocrine disruptors” — is causing gender dysphoria in children and contributing to a rise in LGBTQ-youth. According to him, endocrine disruptors are “chemicals that interfere with the body’s hormones and are commonly found in pesticides and plastic.”
- He stated “Telling people to “trust the experts” is either naive or manipulative—or both.”
- He plans to stop water fluoridation.
- He slammed the FDA’s “suppression” of raw milk.
- He said that a worm ate part of his brain which led to long-lasting “brain fog.”
- He has a 14-year-long history of abusing heroin from the age of 15. The police once arrested him for possession; he then faced up to two years in jail for the felony but was sentenced to two years probation after pleading guilty.
- He stated: “WiFi radiation … does all kinds of bad things, including causing cancer…cell phone tumors behind the ear.”
- He claimed that rates of autism have increased even though “there has been no change in diagnosis and no change in screening either.” Yet, both have changed significantly.
- He wrote: (Fauci’s) “obsequious subservience to the Big Ag, Big Food, and pharmaceutical companies has left our children drowning in a toxic soup of pesticide residues, corn syrup, and processed foods, while also serving as pincushions for 69 mandated vaccine doses by age 18—none of them properly safety tested.”
- He stated that cancer rates are skyrocketing in the young and the old – a statement that is evidently untrue.
- He authored a viral post on X: “FDA’s war on public health is about to end. This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma. If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Preserve your records, and 2. Pack your bags.”
- He has also aligned himself with special interests groups such as anti-vaccine chiropractors.
- He stated categorically: “You cannot trust medical advice from medical professionals.”
- He said he’s going to put a pause on infectious diseases research for 8 years.
- He promoted the unfounded theory that the CIA killed his uncle, former President John F. Kennedy.
- He linked school shootings to the increased prescription of antidepressants.
- An evaluation of verified Twitter accounts from 2021, found Kennedy’s personal Twitter account to be the top “superspreader” of vaccine misinformation on Twitter, responsible for 13% of all reshares of misinformation, more than three times the second most-retweeted account.
PS
Let me finish with a true statement: The World Health Organization has estimated that global immunization efforts have saved at least 154 million lives in the past 50 years.
It has been announced that Tulsi Gabbard (born 1981) was selected by Donald Trump to become the future Director of National Intelligence (DNI) who serves as executive head of the United States Intelligence Community (IC) and directs and oversees the National Intelligence Program (NIP). All IC agencies report directly to the DNI. “For over two decades, Tulsi has fought for our Country and the Freedoms of all Americans. As a former Candidate for the Democrat Presidential Nomination, she has broad support in both Parties – She is now a proud Republican!” Trump wrote. “Tulsi will make us all proud!”
Tulsi Gabbard is an Army Reserve officer who served as a Democratic representative for Hawaii’s 2nd congressional district from 2013 to 2021. During her time in Congress, Gabbard became known for her strong stand against Islamic terrorism in the Middle east and her controversial positions on Syria. After ending her presidential candidacy, she endorsed Joe Biden in March 2020. After her departure from the House of Representatives in January 2021, Gabbard took more conservative positions on issues such as abortion, foreign policy, LGBTQ rights, and border security. She appeared frequently on Fox News, often serving as a fill-in host for Tucker Carlson Tonight. In October 2022, Gabbard left the Democratic Party citing differences on foreign policy and social issues. In August 2024, Gabbard endorsed Donald Trump for the 2024 United States presidential election and became an honorary co-chair of Trump’s 2024 presidential transition team. To understand Gabbard’s ambitions, her aunt, Dr Caroline Sinavaiana Gabbard, once claimed that it is necessary to look to Tulsi’s upbringing in a secretive cult whose members show absolute loyalty to a reclusive guru.
Tulsi Gabbard has long been known for belonging to the above-mentioned weird cult, the ‘Science of Identity Foundation’ (SFI). The cult has been described as an alt-right branch of Hare Krishna and reportedly developed thousands of followers across Hawaii, Australia, New Zealand and Southeast Asia and worships its founder as an extention of god. Former members of the SFI and others close to Gabbard have said the group’s influence could be affecting her political motives. People have said the SFI forbids people to speak publicly about the group, requires people to lie face down when their guru, Chris Butler, enters a room and even sometimes eat his nail clippings or “spoonfuls” of the sand he walked on.
The Science of Identity Foundation (SIF) was founded in 1977 by Jagad Guru Siddhaswarupananda (Chris Butler). It teaches the practice of meditation and kirtan—along with the timeless yoga wisdom—to help individuals achieve greater spiritual, mental, and physical well-being. Jagad Guru Siddhaswarupananda (Chris Butler) describes himself as a highly respected yoga guru (teacher) coming in a long line of authentic spiritual masters in the ancient Vedic tradition known as Vaishnavism. He has taught students all over the world in the science of yoga. Many individuals inspired by Jagad Guru have now taken on the role of teachers to assist him in spreading yoga wisdom. Kirtan is a call-and-response or antiphonal style song or chant, set to music, wherein multiple singers recite the names of a deity, describe a legend, express loving devotion to a deity, or discuss spiritual ideas. It may include dancing or direct expression of bhavas (emotive states) by the singer. Many kirtan performances are structured to engage the audience where they either repeat the chant, or reply to the call of the singer.
Tulsi Gabbard has been with the SIF since her childhood, and Chris Butler is her spiritual guide. Tulsi’s father, Mike Gabbard, a Hawaii State Senator was also associated with SIF. He opposed to same-sex marriage and viewed spirituality as a weapon against sexually deviant practices. Tulsi’s mother, Carol Gabbard, even served as the treasurer of the SIF.
Philip Ingram, former British Army senior intelligence and security officer, said: ‘I think appointing anyone with zero intelligence experience to be director of national intelligence should be an alarm call.’ And John Bolton cautioned that “with his announcement of Tulsi Gabbard to be the Director of National Intelligence, he (Trump) is sending a signal that we have lost our mind when it comes to collecting intelligence. Up until a few hours ago, I would have said that was the worst cabinet appointment in recent American history. Of course, since Matt Gaetz’s nomination, he clearly has taken the lead on that score.”
That, of course, was before Trump announced that the anti-vaxer, Robert Kennedy (who might be the subject of my next post), will be responsible for health!
This study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors.
The authors selected from a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics) 18–63 years old malignant breast cancer survivors who were experiencing pain and were ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients.
Among 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven percent were receiving antidepressants and 3% completed ≥ 2 long-term prescription fills of opioids. Prevalence of opioid usage reduced from 29 to 19% (P < 0.001) and NSAID usage reduced from 21 to 14% (P = 0.001) post-acupuncture. The relative prevalence of opioid and NSAID use decreased by 20% (P < 0.05) and 19% (P = 0.07), respectively, in the acupuncture-treated group compared to non-treated patients (n = 16,129). However, the reductions were not statistically significant after adjustment for confounding. Patients receiving acupuncture for pain (n = 264, 53%) were found with a relative decrease by 47% and 49% (both P < 0.05) in short-term opioid and NSAID fills compared to those treated for other conditions. High-utilization patients (≥ 10 acupuncture sessions, n = 178, 36%) were observed with a significant reduction in total healthcare costs (P < 0.001) unlike low-utilization patients.
The authors concluded that, although adjusted results did not show that patients receiving acupuncture had better outcomes than non-treated patients, exploratory analyses revealed that patients treated specifically for pain used fewer analgesics and those with high acupuncture utilization incurred lower healthcare costs. Further studies are required to examine acupuncture effectiveness in real-world settings.
Oh, dear!
Which institutions support such nonsense?
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA.
- School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA.
- College of Korean Medicine, Kyung Hee University, Seoul, South Korea.
- Integrative Medicine Program, Departments of Supportive Care Medicine and Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
- School of Pharmacy, Chapman University, RK 94-206, 9401 Jeronimo Road, Irvine, CA, 92618, USA. [email protected].
- School of Pharmacy & Pharmaceutical Sciences, University of California Irvine, 802 W Peltason Dr, Irvine, CA, 92697-4625, USA. [email protected].
And which journal is not ashamed to publish it?
It’s the BMC Med!
The conclusion is, of course, quite wrong.
Please let me try to formulate one that comes closer to what the study actually shows:
This study failed to show that a ‘real world impact’ of acupuncture exists. Since the authors were dissatisfied with a negative result, subsequent data dredging was undertaken until some findings emerged that were in line with their expectations. Sadly, no responsible scienctist will take this paper seriously.
The BMJ just published an article entitled “Disinformation enabled Donald Trump’s second term and is a crisis for democracies everywhere“. Please allow me to show you a few excerpts from this paper:
Donald Trump did not win the 2020 election, but asserting that he did became a prerequisite for Republicans standing for nomination to Congress or the Senate to win their primaries. An entire party became a vehicle for disinformation. Trump did win the 2024 presidential election, and key to that victory was building on the success of that lie. If you control enough of the information ecosystem, truth no longer matters…
… Readers of The BMJ will recall the huge amounts of misinformation (wrong or misleading content that is unknowingly shared) and disinformation (false content that is deliberately spread) during the covid-19 pandemic, some generated or amplified by politicians. This reduced vaccine uptake, promoted ineffective treatments, and encouraged attacks on health workers. In the past, factually incorrect statements might have had only local consequences, but a lie can now circle the world in seconds. Yet the speed in which disinformation can spread is only part of the problem…
… Part of Musk’s reason for buying Twitter was to influence the social discourse. And influence he did—by using his enormous platform (203 million followers) to endorse Trump, spread disinformation about voter fraud and deep fakes of Kamala Harris, and amplify conspiracy theories about everything from vaccines to race replacement theory to misogyny. Musk’s platform is effective: his endorsement of Trump coincided with Republican leaning posts being algorithmically favoured over Democrat leaning posts. A more mundane example: after Musk published three non-evidence based posts on X that favoured one medication over another, sales of the former rose by 18% while the other fell by 11%. …
The warning signs are clear for democracies around the world. Firstly, governments must regulate social media companies more rigorously. Brazil’s victorious dispute with X shows what is possible, and a major battle between the European Commission and Musk is under way. Beyond that, we must grapple with how to hold the world’s richest people to account when they directly interfere with national and international politics.
Secondly, public health agencies must create robust surveillance systems for infodemics just as they have for epidemics. They must monitor the emergence of disinformation and counter it or, ideally, anticipate and counter (pre-bunk) it among vulnerable audiences (and build population resilience). Independent organisations that are countering disinformation are already being deliberately targeted (https://counterhate.com/). And we must accelerate research on “inoculating” people against the algorithms and content that attempt to radicalise them.
Finally, politicians and the public health community must not be afraid of calling out disinformation, and we must all support and applaud them in doing so. And moving beyond responding to false rhetoric, we must also get on the front foot and create compelling counter narratives of a better politics that can support a kinder, more inclusive, and socially just world.
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I’d like to thank the authors (Martin McKee, professor of European public health, Christina Pagel, professor of operational research, and Kent Buse, co-founder of ‘Global Health) for their courage to speak out and stand up for the truth. I am in full agreement with them and encourage all my readers to study their excellent paper in full.
Two years ago, I reported about an acupuncture review that was, in my view, a fairly clear case of scientific misconduct. To remind you, here is my from 22/11/22 about it:
Acupuncture is emerging as a potential therapy for relieving pain, but the effectiveness of acupuncture for relieving low back and/or pelvic pain (LBPP) during pregnancy remains controversial. This meta-analysis aimed to investigate the effects of acupuncture on pain, functional status, and quality of life for women with LBPP pain during pregnancy.
The authors included all RCTs evaluating the effects of acupuncture on LBPP during pregnancy. Data extraction and study quality assessments were independently performed by three reviewers. The mean differences (MDs) with 95% CIs for pooled data were calculated. The primary outcomes were pain, functional status, and quality of life. The secondary outcomes were overall effects (a questionnaire at a post-treatment visit within a week after the last treatment to determine the number of people who received good or excellent help), analgesic consumption, Apgar scores >7 at 5 min, adverse events, gestational age at birth, induction of labor and mode of birth.
Ten studies, reporting on a total of 1040 women, were included. Overall, acupuncture
- relieved pain during pregnancy (MD=1.70, 95% CI: (0.95 to 2.45), p<0.00001, I2=90%),
- improved functional status (MD=12.44, 95% CI: (3.32 to 21.55), p=0.007, I2=94%),
- improved quality of life (MD=−8.89, 95% CI: (−11.90 to –5.88), p<0.00001, I2 = 57%).
There was a significant difference in overall effects (OR=0.13, 95% CI: (0.07 to 0.23), p<0.00001, I2 = 7%). However, there was no significant difference in analgesic consumption during the study period (OR=2.49, 95% CI: (0.08 to 80.25), p=0.61, I2=61%) and Apgar scores of newborns (OR=1.02, 95% CI: (0.37 to 2.83), p=0.97, I2 = 0%). Preterm birth from acupuncture during the study period was reported in two studies. Although preterm contractions were reported in two studies, all infants were in good health at birth. In terms of gestational age at birth, induction of labor, and mode of birth, only one study reported the gestational age at birth (mean gestation 40 weeks).
The authors concluded that acupuncture significantly improved pain, functional status and quality of life in women with LBPP during the pregnancy. Additionally, acupuncture had no observable severe adverse influences on the newborns. More large-scale and well-designed RCTs are still needed to further confirm these results.
What should we make of this paper?
In case you are in a hurry: NOT A LOT!
In case you need more, here are a few points:
- many trials were of poor quality;
- there was evidence of publication bias;
- there was considerable heterogeneity within the studies.
The most important issue is one studiously avoided in the paper: the treatment of the control groups. One has to dig deep into this paper to find that the control groups could be treated with “other treatments, no intervention, and placebo acupuncture”. Trials comparing acupuncture combined plus other treatments with other treatments were also considered to be eligible. In other words, the analyses included studies that compared acupuncture to no treatment at all as well as studies that followed the infamous ‘A+Bversus B’ design. Seven studies used no intervention or standard of care in the control group thus not controlling for placebo effects.
Nobody can thus be in the slightest surprised that the overall result of the meta-analysis was positive – false positive, that is! And the worst is that this glaring limitation was not discussed as a feature that prevents firm conclusions.
Dishonest researchers?
Biased reviewers?
Incompetent editors?
Truly unbelievable!!!
In consideration of these points, let me rephrase the conclusions:
The well-documented placebo (and other non-specific) effects of acupuncture improved pain, functional status and quality of life in women with LBPP during the pregnancy. Unsurprisingly, acupuncture had no observable severe adverse influences on the newborns. More large-scale and well-designed RCTs are not needed to further confirm these results.
PS
I find it exasperating to see that more and more (formerly) reputable journals are misleading us with such rubbish!!!
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Now – 2 years later! – the journal (BMJ-Open) has retracted the article and posted the following notice about the decision:
BMJ Open has retracted this article.1 After publication, multiple issues were raised with the journal concerning the design and reporting of the study. The editors and integrity team investigated the issues with the authors. There were fundamental flaws with the research, including the control group selection and data extraction, not amenable to correction.
I am delighted that this misleading paper is now officially discredited. Yet, I do have some concerns:
WHY DOES IT TAKE 2 YEARS TO IDENTIFY SOMETHING AS FRAUDULENT RUBBISH, WHEN IT TOOK ME ALL OF ~30 MINUTES?
Instead of just insisting on a triumphant ‘I TOLD YOU SO’, let me provide some constructive advice to reviewers and journal editors.
- Many journal editors are to lazy to find reviewers themselves and ask the submitting author to name a few. Having myself published in the BMJ Open (the journal that published the paper in question) I fear that this might have been the case in the present instance. This habit invites poor reviews, e.g. reviews from colleagues who owe a favour to the submitting authors. It does not promote objective reviews and should be abandonned.
- Papers on acupuncture originating from China (as the one in question) are very likely to be biased (or worse), as we have so often discussed on this blog. Editors should be extra careful with such submissions.
- Reviewers who have in the past overlooked obvious flaws in a paper should be banned from further reviewing in future.
- Editors should understand the reviewers’ comments only as guidelines and still have an obligation to check the actual submissions themselves. the responsibility for publishing an article lies with them alone.
- Editors who repeatedly make such mistakes should be dismissed.
I think that adhering to these suggestions might improve the quality of published research … and, by Jove, this would be badly needed in the realm of so-called alternative medicine!!!
We all tend to believe that natural means harmless. Sadly this notion is far from true. The Korea Adverse Event Reporting System (KAERS) compiles spontaneously reported adverse event data for medicinal products including herbal medicines. This study analyzed adverse event data specifically related to herbal medicine products from the KAERS database.
Individual case safety reports (ICSRs) encompassing 84 types of herbal medicine products, identified by item codes from 2012 to 2021, were extracted from the KAERS database. Descriptive statistics were employed to analyze the characteristics of the extracted reports, and adverse event information was systematically categorized and analyzed based on the MedDRA System Organ Class and preferred term classification.
In total, 1,054 ICSRs were extracted, with some documenting multiple adverse events in a single ICSR, resulting in 1,629 extracted adverse events. When categorized by the MedDRA System Organ Class, gastrointestinal disorders were the most prevalent (28.7%), followed by skin and subcutaneous tissue disorders (20.1%). Based on the preferred terms, the most frequently reported adverse events were:
- diarrhea (5.8%),
- urticaria (5.3%),
- pruritus (4.7%),
- rash (4.4%),
- abdominal discomfort (4.2%).
The most frequently reported herbal medicines were:
- Bangpungtongseong-san (297 cases),
- Kyeongok-go (144 cases),
- Eunkyo-san (108 cases).
The authors conclused that spontaneously reported adverse events associated with herbal medicine products were systematically documented using the KAERS database. This study, which focused on voluntarily reported adverse reactions, underscores the need for additional research to estimate the incidence rate of adverse events and assess causality.
The authors also noted that serious adverse events, including death, life-threatening conditions, initial or prolonged hospitalization, and other importantmedical events, were individually evaluated for each reported adverse event. Out of the 1,054 ICSRs, 48 (4.6%) included one or more serious adverse events (four ICSRs were identified with duplicate labels spanning two serious adverse event categories). Further, among the 1,629 adverse events, 99 (6.1%) were identified as serious adverse events. Two cases of death were reported, with causality categorized as unknown or unlikely. Regarding life-threatening conditions, three cases of dyspnea, nausea, and dizziness have been reported, all of which resulted in recovery. Thirty-one cases of initial or prolonged hospitalization have been reported. Among the adverse events associated with hospitalization (51 events in total, considering the multiple events reported in one ICSR with hospitalization), the most frequent were:
- increased aspartate amino transferase and alanineaminotransferase levels (7 case seach),
- dyspnea (3 cases),
- liver function test abnormality (2 cases),
- nausea (2 cases),
- rash (2 cases).
Sixteen cases of other important medical events were reported, and among 43 related events, dyspnea (5 cases), angioedema (4 cases), urticaria (4 cases), anaphylactic reaction (3 cases), chest discomfort (2 cases), and dizziness (2 cases) were reported.
Yes, the ‘natural equals harmless’ fallacy is very widespread. It certainly is an excellent advertising gimmick. However, as this study demonstrates very clearly, it is as fallacious as it is dangerous.
It has been reported that a chiropractor from Boulder City, US, has lost his license to practice for five years. The sentence could be extended if he does not adhere to requirements imposed by the Chiropractic Physicians’ Board of Nevada.
During a hearing, Tenney and his attorney, Hal Reiser, appeared before the board via Zoom to discuss the 25 charges against him. These charges stemmed from him reportedly hosting seminars to provide various services, treatments, nutritive supplementation devices related to diabetes, weight loss and neuropathy.
In a unanimous vote, the board approved Tenney’s voluntary surrender of his license effective immediately. Within 30 days, he must pay $44,514 in fees, costs and fines to the Chiropractic Physicians’ Board of Nevada. He must also provide refunds to three of the complainants in the case, in the amount of nearly $25,000. His attorney said that has been done and that in all, Tenney has refunded more than $150,000 to those who paid following one of his seminars and will continue to do so.
“Dr. Tenney’s failure to comply with any term or condition of this Settlement Agreement will result (in the) Board staff changing the public information related to Dr. Tenney from voluntary surrender to revoked,” a board report states. “Thereafter, Dr. Tenney’s license will be treated as having been revoked, and Dr. Tenney may not apply for reinstatement for at least 10 years after the change of such status.” Once the five-year period is up, Tenney would have to appear before the board for reinstatement.
“Some of the reviewed contracts contain references to an entity called Boulder Wellness,” the report states. “In the course of the investigation, it was determined that Boulder Wellness is a fictitious business name for Boulder Chiropractic, Inc. registered with the Clark County Clerk’s office on July 27, 2020.”
Though the contracts indicated a set price for the goods and services to be provided, they showed that Tenney would negotiate the price of contracts with the patients, ranging from a low of $1,500 to a high of $9,000, the document states. Most of the patients in the reviewed contracts paid in cash on the day of the signing of the contracts.
The board had received a consumer complaint from Patient FH about his and his wife’s attendance at a seminar and subsequent enrollment in a wellness program sold by Tenney in September 2021 in Pahrump.
From April 16, 2022 to Aug. 22, 2022, he hosted more than 50 seminars, sometimes two a day, with a total of 895 participants over that span. These seminars were held in Nevada, Utah and Arizona.
After learning all this, you might ask who is Tad Tenney?
Tad Tenney grew up and graduated in Prescott, Arizona in 1987. After spending two years on a missionary tour of Argentina on behalf of the LDS church, he returned home fluent in Spanish. He attended Snow College where he played basketball for a year. After a successful year, he transferred to Salt Lake Community College where he obtained an Associates of Arts. It was here that he fell in love with the idea of becoming a doctor of Chiropractic care.
Tad went onto attend college in Dallas Texas and obtained his Bachelor of Science and Chiropractic care. He moved to Boulder City in 1998 where he opened his practice. Over the last twenty years as his practice has evolved to include a whole health approach for every individual he encounters through his practice. Since his practice opened, he has had more than thirty thousand patient visits and over ten thousand individual patients. The Boulder City Chiropractic Health now specializes in the treatment of diabetes, neuropathy, back and joint pain, depression, and anxiety. It is truly a passion for him as his patients continue to recover without medications or surgery.
In 2018, Tenner was asked: “What are some things that help you continue through difficult moments?” He replied as follows: “Daily I keep a few sayings in mind. The first is: “Every day is a new life to a wise man.” The second is: “no matter what your past is you have a spotless future.” My mom often shared the second with me. These remind me that no matter the shortcomings or failures, I can change it all tomorrow or in the days ahead.”
It looks to me like Tenner needs to change quite a lot to achieve a spotless future.
Spanish colleagues and I just published an article entitled “Is Osteopathic Manipulative Treatment Clinically Superior to Sham or Placebo for Patients with Neck or Low-Back Pain? A Systematic Review with Meta-Analysis”. Here is its abstract:
The aim of this systematic review and meta-analysis was to compare whether osteopathic manipulative treatment (OMT) for somatic dysfunctions was more effective than sham or placebo interventions in improving pain intensity, disability, and quality of life for patients with neck pain (NP) or low-back pain (LBP). Methods: A systematic review and meta-analysis was carried out. Searches were conducted in PubMed, Physiotherapy Evidence Database, Cochrane Library, and Web of Science from inception to September 2024. Studies applying a pragmatic intervention based on the diagnosis of somatic dysfunctions in patients with NP or LBP were included. The methodological quality was assessed with the PEDro scale. The quantitative synthesis was performed using random-effect meta-analysis calculating the standardized mean difference (SMD) with RevMan 5.4. The certainty of evidence was evaluated using GRADEPro. Results: Nine studies were included in the qualitative synthesis, and most of them showed no superior effect of OMTs compared to sham or placebo in any clinical outcome. The quantitative synthesis reported no statistically significant differences for pain intensity (SMD = −0.15; −0.38, 0.08; seven studies; 1173 patients) or disability (SMD = −0.09; −0.25, 0.08; six studies; 1153 patients). The certainty of evidence was downgraded to moderate, low, or very low. Conclusions: The findings of this study reveal that OMT is not superior to sham or placebo for improving pain, disability, and quality of life in patients with NP or LBP.
As always, it seems important to stress that our review has several limitations. Firstly, the searches were conducted in the most relevant databases; however, some studies not indexed in these sources may have been missed. Secondly, the diverse NP and LBP diagnosis, as well as the lack of data reported by some studies, complicates the interpretation of the results and may weaken our conclusion. Thirdly, the primary studies pragmatically applied interventions based on diagnoses of various somatic dysfunctions, resulting in a high degree of heterogeneity among the treatments applied.
Despite these limitations, it is fair to say, I think, that OMT is not nearlly as solidly supported by reliable evidence as most osteopaths try to make us believe. In essence, this means that, if you suffer from NP or LBP, you best concult a proper doctor or physiotherapist.
