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

critical thinking

Apparently, Hahnemann gave a lecture on the subject of veterinary homeopathy in the mid-1810s. Ever since, homeopathy has been used for treating animals. Von Boennighausen was one of the first influential proponents of veterinary homeopathy. However, veterinary medical schools tended to reject homoeopathy, and the number of veterinary homeopaths remained small. In the 1920ies, veterinary homoeopathy was revived in Germany. Members of the “Studiengemeinschaft für tierärztliche Homöopathie” (Study Group for Veterinary Homoeopathy) which was founded in 1936 started to investigate this approach systematically.

Today, veterinary homeopathy is still popular in some countries. Prince Charles has become a prominent advocate who claims to treat his own life stock with homeopathy. In many countries, veterinary homeopaths have their own professional organisations. Elsewhere, however, veterinarians are banned from practicing homeopathy. In the UK, only veterinarians are allowed to use homeopathy on animals (but anyone regardless of background can use it on human patients) and there is a British Academy of Veterinary Homeopathy. In the US, homeopathic vets are organised in the Academy of Veterinary Homeopathy.

If this sounds promising, we should not forget that, as discussed so often on this blog, homeopathy lacks plausibility the evidence for veterinary homeopathy fails to be positive (see for instance here). But, hold on, there is a new study, perhaps it will change everything?

This ‘study‘ was aimed at providing an initial insight into the existing prerequisites on dairy farms for the use of homeopathy (i.e. the consideration of homeopathic principles) and on homeopathic treatment procedures (including anamnesis, clinical examination, diagnosis, selection of a remedy, follow-up checks, and documentation) on 64 dairy farms in France, Germany and Spain.

The use of homeopathy was assessed via a standardised questionnaire during face-to-face interviews. The results revealed that homeopathic treatment procedures were applied very heterogeneously and differed considerably between farms and countries. Farmers also use human products without veterinary prescription as well as other prohibited substances.

The authors of this ‘study’ concluded that the subjective treatment approach using the farmers’ own criteria, together with their neglecting to check the outcome of the treatment and the lack of appropriate documentation is presumed to substantially reduce the potential for a successful recovery of the animals from diseases. There is, thus, a need to verify the effectiveness of homeopathic treatments in farm practices based on a lege artis treatment procedure and homeopathic principles which can be achieved by the regular monitoring of treatment outcomes and the prevailing rate of the disease at herd level. Furthermore, there is a potential risk to food safety due to the use of non-veterinary drugs without veterinary prescription and the use of other prohibited substances.

So did this ‘study’ change the evidence on veterinary homeopathy?

Sadly not!

This ‘study’ is hardly worth the paper it is printed on.

Who conceives such nonsense?

And who finances such an investigation?

The answer to the latter question is one of the few provided by the authors: This project has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under Grant Agreement No 311824 (IMPRO).

Time for a constructive suggestion! Could the European Union’s Seventh Framework Programme with their next research project in veterinary homeopathy please evaluate the question why farmers in the EU are allowed to use disproven therapies on defenceless animals?

I have written about this more often than I care to remember, and today I do it again.

Why?

Because it is important!

Chiropractic is not effective for kids, and chiropractic is not harmless for kids – what more do we need to conclude that chiropractors should not be allowed anywhere near them?

And most experts now agree with this conclusion; except, of course, the chiropractors themselves. This recent article in THE CHRONICLE OF CHIROPRACTIC is most illuminating in this context:

It was only a matter of time before the attack on the chiropractic care of children spread to the United States from Australia and Canada and its also no surprise that insurance companies would jump on the bandwagon first.  According to Blue Cross and Blue Shield Children under the age of 5 years should not receive chiropractic care (spinal manipulation) ” . . . because the skeletal system is not mature at this time.”

The Blues further contend that:

“Serious adverse events may be associated with pediatric spinal manipulation in children under the age of 5 years due to the risks of these procedures in children this age.”

The Blues claims that their determination is based on standards of care – though they do not state which ones.

“This determination was based on standards of care in pediatric medicine as well as current medical evidence.”

This is not the first time Blue Cross attacked the chiropractic care of children. In 2005 CareFirst Blue Cross claimed that:

“Spinal manipulation services to treat children 12 years of age and younger, for any condition, is considered experimental and investigational.”

The ridiculous and false claims by Blue Cross come on the heels of a ban placed on spinal manipulation of infants by the Chiropractic Board of Australia (see related story) and attacks on chiropractors who care for children in Canada by chiropractic regulatory boards there.

There is in fact plenty of evidence to support the chiropractic care of infants and children and there are practice guidelines (the highest level on the research hierarchy pyramid) that support such care.

The real issue is not whether or not evidence exists to support the chiropractic care of children – the real issue is power and the lack of any necessity for evidence for those with the power.

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END OF QUOTE

What can we learn from this outburst?

  1. Chiropractors often take much-needed critique as an ‘attack’. My explanation for this phenomenon is that they sense how wrong they truly are, get defensive, and fear for their cash-flow.
  2. When criticised, they do not bother to address the arguments. This, I believe, is again because they know they are in the wrong.
  3. Chiropractors are in denial as to what they can and cannot achieve with their manipulations. My explanation for this is that they might need to be in denial – because otherwise they would have to stop practising.
  4. They often insult criticism as ridiculous and false without providing any evidence. The likely explanation is that they have no reasonable evidence to offer.
  5. All they do instead is stating things like ‘there is plenty of evidence’. They don’t like to present the ‘evidence’ because they seem to know that it is worthless.
  6. Lastly, in true style, they resort to conspiracy theories.

To any critical thinker their behaviour thus makes one conclusion virtually inescapable: DON’T LET A CHIROPRACTOR NEAR YOUR KIDS!

An abstract from the recent ‘2nd OFFICIAL SIPS CONFERENCE ON PLACEBO STUDIES’ caught my attention. It is not available on-line; therefore let me reproduce it here in full:

The role of placebo effects in mindfulness-based analgesia 1. Jonathan Davies. University of Sydney, Sydney, NSW, Australia. 2. Louise Sharpe. University of Sydney, Sydney, NSW, Australia. 3. Melissa Day. University of Queensland, Brisbane, QLD, Australia. 4. Ben Colagiuri. University of Sydney, Sydney, NSW, Australia.

Background: Mindfulness meditation can reduce pain both in experimental and clinical settings, though it is not known to what extent mindfulness-specific vs placebo-like expectancy effects account for these changes. This study aimed to: 1. establish whether placebo effects contribute to mindfulness-mediated analgesia; and 2. identify putative cognitive mechanisms responsible for placebo- vs mindfulness-mediated analgesia. Methods: We compared the effects of focussed-attention mindfulness training (6 x 20 min), sham mindfulness, and a no-treatment in a double-blind RCT for experimental heat pain. Sham mindfulness instructions lacked the ‘active ingredients’ of the real training but were matched on all other contextual factors. Results: Both real and sham mindfulness training led to greater pain tolerance relative to no treatment, but there was no difference between the real and sham training. This was accompanied by increased expectancy, beliefs, and pain-related cognitive processes in the two mindfulness groups relative to no treatment, but again there were no differences between real and sham training on these outcomes. There were no effects on pain intensity, pleasantness or threshold. Conclusion: These findings suggest that mindfulness training – at least those involving focused-attention – may lead to improved pain tolerance via the placebo effect rather than any specific mindfulness-related mechanisms. Potential mediators of these effects will be discussed.

I find this study remarkable in two ways:

  1. It shows that, with a bit of fantasy, ingenuity and will, one can design and use sham procedures even in clinical trials of mind/body therapies.
  2. Its results suggest that, if one does control for placebo effects, these treatments may not prove to be more than a placebo therapy.

What implications might this have for clinical practice?

Mindfulness is currently hugely popular. It would not be surprising, if the news that it might rely purely on placebo effects would calm down the enthusiasm about this treatment. Many might ask, does it matter? As long as patients benefit, the mechanism of action seems irrelevant. This, of course, is an interesting debate which we have had on this blog many times before.

What do you think?

Yesterday, I had the honour and pleasure to present to the UK press my new book entitled ‘ALTERNATIVE MEDICINE, A CRITICAL ASSESSMENT OF 150 MODALITIES’ (see also my previous post). The SCIENCE MEDIA CENTRE had invited me to do a ‘media briefing’ on the occasion of its publication. I did this by outlining the background around so-called alternative medicine (SCAM) and explaining the concept of the new book which essentially is – as its title indicates – to provide concise and critical assessments of 150 modalities.

In the course of my short presentation, I mentioned the following exotic modalities in order to show that my book goes beyond the ‘usual suspects’ of acupuncture, chiropractic, etc.:

  • BERLIN WALL
  • COLLOIDAL SILVER
  • PALEO DIET
  • PLACENTOPHAGY
  • URINE THERAPY
  • CUPPING
  • GUA SHA
  • LYMPH DRAINAGE
  • SLAPPING THERAPY
  • VISCERAL OSTEOPATHY
  • JOHREI HEALING
  • LEECH THERAPY
  • NEURAL THERAPY
  • ZERO BALANCE
  • APPLIED KINESIOLOGY
  • IRIDOLOGY
  • LIVE BLOOD ANALYSIS
  • PULSE DIAGNOSIS
  • RADIONICS

As it turned out, the journalists present found the BERLIN WALL remedy the most fascinating aspect of my talk. And this is clearly reflected in today’s articles covering the event:

Image

The DAILY TELEGRAPH published an article much in the same vein, and so did THE SUN and the EXPRESS (not available on line). The only UK newspaper I have seen so far going beyond the Berlin Wall topic is THE DAILY MAIL. The paper mentions several other so-called alternative medicines (SCAMs) that consumers need to be protected from, in my view.

Interestingly, none of the articles mentioned that my new book is not an exercise in debunking. During my presentation, I made the point that several of my assessments of 150 modalities do arrive at positive conclusions for therapies that demonstrably generate more good than harm.

I also tried to point out to the journalists that SCAM includes a range of diagnostic techniques. None of them are valid which means that they present a real danger to consumers through false-positive and false-negative diagnoses. In particular the latter scenario can cost lives.

All in all, I did enjoy yesterday’s press briefing very much. I am aware of the fact that, in the realm of SCAM, the press have a most important role to play. Consumers rarely consult their doctor when deciding to use SCAM; frequently they go by what they read in the papers.

In this context, I find it noteworthy that, during the last years, the UK press have become considerably more sceptical. Not so long ago, most UK journalists used to praise SCAM like the best thing since sliced bread; today this attitude has laudably shifted towards a more rational stance. I am sure that the excellent work of the SCIENCE MEDIA CENTRE has played a crucial part in this positive development.

The journal NATURE has just published an excellent article by Andrew D. Oxman and an alliance of 24 leading scientists outlining the importance and key concepts of critical thinking in healthcare and beyond. The authors state that the Key Concepts for Informed Choices is not a checklist. It is a starting point. Although we have organized the ideas into three groups (claims, comparisons and choices), they can be used to develop learning resources that include any combination of these, presented in any order. We hope that the concepts will prove useful to people who help others to think critically about what evidence to trust and what to do, including those who teach critical thinking and those responsible for communicating research findings.

Here I take the liberty of citing a short excerpt from this paper:

CLAIMS:

Claims about effects should be supported by evidence from fair comparisons. Other claims are not necessarily wrong, but there is an insufficient basis for believing them.

Claims should not assume that interventions are safe, effective or certain.

  • Interventions can cause harm as well as benefits.
  • Large, dramatic effects are rare.
  • We can rarely, if ever, be certain about the effects of interventions.

Seemingly logical assumptions are not a sufficient basis for claims.

  • Beliefs alone about how interventions work are not reliable predictors of the presence or size of effects.
  • An outcome may be associated with an intervention but not caused by it.
  • More data are not necessarily better data.
  • The results of one study considered in isolation can be misleading.
  • Widely used interventions or those that have been used for decades are not necessarily beneficial or safe.
  • Interventions that are new or technologically impressive might not be better than available alternatives.
  • Increasing the amount of an intervention does not necessarily increase its benefits and might cause harm.

Trust in a source alone is not a sufficient basis for believing a claim.

  • Competing interests can result in misleading claims.
  • Personal experiences or anecdotes alone are an unreliable basis for most claims.
  • Opinions of experts, authorities, celebrities or other respected individuals are not solely a reliable basis for claims.
  • Peer review and publication by a journal do not guarantee that comparisons have been fair.

COMPARISONS:

Studies should make fair comparisons, designed to minimize the risk of systematic errors (biases) and random errors (the play of chance).

Comparisons of interventions should be fair.

  • Comparison groups and conditions should be as similar as possible.
  • Indirect comparisons of interventions across different studies can be misleading.
  • The people, groups or conditions being compared should be treated similarly, apart from the interventions being studied.
  • Outcomes should be assessed in the same way in the groups or conditions being compared.
  • Outcomes should be assessed using methods that have been shown to be reliable.
  • It is important to assess outcomes in all (or nearly all) the people or subjects in a study.
  • When random allocation is used, people’s or subjects’ outcomes should be counted in the group to which they were allocated.

Syntheses of studies should be reliable.

  • Reviews of studies comparing interventions should use systematic methods.
  • Failure to consider unpublished results of fair comparisons can bias estimates of effects.
  • Comparisons of interventions might be sensitive to underlying assumptions.

Descriptions should reflect the size of effects and the risk of being misled by chance.

  • Verbal descriptions of the size of effects alone can be misleading.
  • Small studies might be misleading.
  • Confidence intervals should be reported for estimates of effects.
  • Deeming results to be ‘statistically significant’ or ‘non-significant’ can be misleading.
  • Lack of evidence for a difference is not the same as evidence of no difference.

CHOICES:

What to do depends on judgements about the problem, the relevance (applicability or transferability) of evidence available and the balance of expected benefits, harm and costs.

Problems, goals and options should be defined.

  • The problem should be diagnosed or described correctly.
  • The goals and options should be acceptable and feasible.

Available evidence should be relevant.

  • Attention should focus on important, not surrogate, outcomes of interventions.
  • There should not be important differences between the people in studies and those to whom the study results will be applied.
  • The interventions compared should be similar to those of interest.
  • The circumstances in which the interventions were compared should be similar to those of interest.

Expected pros should outweigh cons.

  • Weigh the benefits and savings against the harm and costs of acting or not.
  • Consider how these are valued, their certainty and how they are distributed.
  • Important uncertainties about the effects of interventions should be reduced by further fair comparisons.

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END OF QUOTE

I have nothing to add to this, except perhaps to point out how very relevant all of this, of course, is for SCAM and to warmly recommend you study the full text of this brilliant paper.

The ‘College of Medicine and Integrated Health’ (CMIH) has been the subject of several previous blog posts (see for instance here, here and here). Recently, they have come up with something new that, in my view, deserves a further comment.

The new ‘SELF CARE TOOL KIT’ began, according to the CMIH, in 2009 with a national multi-centre project commissioned by the UK Department of Health, to consider the best way to integrate self care into family practice. The project involved two large family health centres and two university departments. One output was the Self Care Library (SCL).

The Self Care Library (SCL) is an online patient resource providing free evidence-based information about self-care.  The funding for the SCL did, however, not survive, and the facility was assigned to the CMIH. Thanks to funding from ‘Pukka Herbs Vitamins, Herbal Remedies & Health Supplements‘, the CMIH was able to transfer the content and to begin updating entries. Simon Mills, the coordinator of the original project who is now employed by Pukka, has led this transformation and helped the College set up the new parent portal, Our Health Directory.

The Self Care Toolkit is thus the new SCL. All concerned with this project are experienced in clinical practice and can separate the theory from real life needs. We all have academic lives as well so can be hard-nosed with the evidence base as well.

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The above text is essentially based on the information provided by the CMIH. A few critical remarks and clarifications might therefore be in order:

  • What does ‘separate the theory from real life needs’ mean? Does it mean that the scientific evidence can be interpreted liberally (see below)?
  • Is it a good idea to have a commercial sponsor for such a project?
  • Is it wise that the main person in charge is on the payroll of a manufacturer of dietary supplements?
  • Is there any oversight to minimise undue bias and prevent the public from being misled?
  • Is it really true that all people involved have academic lives? Simon Mills (who once was a member of my team) has no longer an academic appointment, as far as I know.

But, you are right, these are perhaps mere trivialities. Let’s see what the ‘Self Care Tool Kit’ actually delivers. I have chosen the entry on DEPRESSION to check its validity. Here it is:

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It isn’t likely that taking extra vitamins will make much difference to low mood or depression. It is true that many people don’t get quite enough B, C and D vitamins in their food. And it’s also true that the brain and nervous system need these vitamins. Because they don’t get stored in the body, our daily diet has to supply them. Research has shown that people with low blood levels of the B vitamin folic acid are more likely to be depressed and less likely to do well on anti-depressant medicines. So, if you are eating a very poor diet, taking extra vitamins just might help. It’s also worth remembering that alcohol, refined sugars, nicotine and caffeine all take these vitamins out of the body. Yet most people who feel depressed probably won’t benefit from taking vitamins alone. To ensure that you get a good balance of these vitamins, try to eat more whole-foods, fruits, vegetables, nuts and seeds.

Some people say that taking high doses of vitamin C (1-2 g and more a day) helps lift their mood. There is a little research to support this and none showing that high doses of vitamin C actually help clinical depression. Vitamin C levels fall after surgery or inflammatory disease. The body needs more vitamin C when coping with stress, pregnancy and breast feeding. Aspirin, tetracycline and contraceptive pills take vitamin C out of the body. Smokers also need extra vitamin C because nicotine removes it. Fresh fruit and vegetables are the best sources of vitamin C.

Doctors are increasingly concerned about low vitamin D, especially in the Asian community. A lack of vitamin D can lead to depression. Oily fish and dairy products are good sources of vitamin D, and sunlight helps the body make vitamin D. Do you get enough sunshine and eat a good diet? It is estimated that worldwide over 1 billion people get too little vitamin D.

Evidence
Taking supplements of vitamins B and D might help some people, whose diet is poor, but more research is needed.

Safety
Very high doses of vitamins and minerals can upset the body and cause side-effects. Get medical advice if you intend to take large doses. To ensure that you get a good balance of these vitamins, try to eat more whole-foods, fruits, vegetables, nuts and seeds.

Cost
If your diet is poor and you don’t get into the sun, ask your doctor about a vitamin D blood test. If it’s normal, there’s no point in taking vitamin D. If it’s low, your GP will prescribe it for you or you can buy a vitamin D supplement.

___________________________________________________________________

In my view, this text begs several questions:

1) Am I right in thinking that phraseology such as the one below will encourage patients suffering from depression to try the supplements mentioned?

  • people with low blood levels of the B vitamin folic acid are more likely to be depressed and less likely to do well on anti-depressant medicines..
  • Some people say that taking high doses of vitamin C (1-2 g and more a day) helps lift their mood…
  • There is a little research to support this and none showing that high doses of vitamin C actually help clinical depression…
  • A lack of vitamin D can lead to depression.
  • Taking supplements of vitamins B and D might help some people…
  • … your GP will prescribe it for you or you can buy a vitamin D supplement.

2) How does that tally with the latest evidence? For instance:

3) The CMIH state: ‘This site gives you information NOT medical advice.’  But, in view of the actual text above, is this true?

4) Depression is a life-threatening condition. Is there a risk that patients trust the CMHI’s (non-) advice and commit suicide because of its ineffectiveness?

5) Do Pukka, the sponsor of all this, happen to supply most of the self care remedies promoted in the ‘Self Care Tool Kit’?

The answer to the last question, I am afraid, is YES!

Leprosy can be a devastating infection. But, since many years, it is treatable. The WHO developed a multidrug therapyTrusted Source in 1995 to cure all types of leprosy. It’s available free of charge worldwide. Additionally, several antibiotics are used to kill the bacteria that causes leprosy, e.g.:

  • dapsone
  • rifampin
  • clofazimine
  • minocycline
  • ofloxacin

Yes, leprosy is treatable … that is, unless you follow the advice issued in this article and treat it with homeopathy:

Homoeopathy remedies are given on the basis of similar signs and symptoms along with the miasmatic classification of diseases. Homoeopathy physicians said that leprosy is characteristics of syphilis miasm due to their mental and physical conditions. Mentally person thinks that he/she may be isolated and left alone in a corner of society due to dirty looking of the skin and tendency to spread of disease from direct contact. They feel alone and make hypothesis that the society needs outbreak from me because of physical disabilities like paralysis, and loss of controls on body functions. A well selected homoeopathy remedy helps out patient to come out from this condition and make possible to live in society from permanent restoration of health.

  • SULPHUR – ‘It is mainly known as king of anti-psoric’ in wide range of homoeopathy. Hahnemann says that sulphur has reputation as a remedy against itch perhaps as old medicine i.e., as early as 2000 years ago. Skin of sulphur indicates vesicular skin eruptions and skin may treated by medicated soaps and washes. Clinical trials says that sulphur have similar signs and symptoms as indicated by disease.
  • GRAPHITES – It is a great remedy for all sorts of skin eruptions with a tendency towards malignancy. It also indicates various symptoms of leprosy and may be used in treatment.
  • PETROLEUM – The skin of petroleum has cracks and fissures all over the body and indicates various similar symptoms as of disease condition.
  • RHUS TOXICODENDRON – Skin shows erysipelas vesicular eruptions, vesicles are yellow, from left to right with much swelling, inflammation, burning, itching and stinging that are very much similar to leprosy sign and symptoms, so it may be prescribed.
  • CICUTA VIROSA – This homoeopathic medicine used in the conditions when patients are anxious about their future and epileptic attacks with spasmodic movements of the limbs.
  • ALOE SOCOTRINA – This homoeopathy medicine works when the patients are fear of death and angry from themselves for their conditions. This medicine have tendency to acts upon the abdominal and lumbar region of the patient.
  • BLATTA ORIENTALIS – It is used when the patient is anxious about their skin and health. Patient suffers from the chronic inflammations of the chest and other lung infections that are also found in disease.

Leprosy is a non-fatal infectious disease caused by bacteria Myobacterium leprae and spread by direct contact and other mode of transmissions. It may be treated with homoeopathic medicines if well selected medicine related to mental and physical symptoms is taken by patients. Homoeopathy medicines help out patients to rearrange the vital force to fight against infectious bacteria and makes possible that the body itself fight against the disease.

To be sure, I ran a quick Medline search. You guessed the result, I suppose: not a single hint from anything resembling a clinical trial that homeopathy might be an effective therapy of leprosy.

One question, however, does remain open: how do homeopaths who claim such irresponsible nonsense sleep?

(And in case you think that the above post is a rare exception, you have not recently searched the Internet!)

Before a scientific paper gets published in a journal, it is submitted to the process of peer-review. Essentially, this means that the editor sends it to 2 or 3 experts in the field asking them to review the submission. Reviewers usually do not get any reward for this, yet the task they are asked to do can be tedious, difficult and time-consuming. Therefore, most reviewers think carefully before accepting it.

My friend Timothy Caulfield was recently invited by a medical journal to review a study of homeopathy. Here is his response to the editor as posted on Twitter:

I find myself regularly in similar situations. Yet, I have never responded in this way. Here is what I normally do:

  1. I have a look at the journal itself. If it is one of those SCAM publications, I tend to politely reject the invitation because, in my experience, their review process is farcical and not worth the effort. All too often it has happened that I reviewed a paper that was of very poor quality and thus recommended rejecting it. Yet the editor ignored my expert opinion and published the article nevertheless. This is why, several years ago, I decided enough is enough and no longer consider investing my time is such frustrating work.
  2. If the journal is of decent standing, I would have a look at the submission the editor sent me. If it makes any sense at all I would consider reviewing it (obviously depending on whether I have the time and the expertise).
  3. If a decent journal invites me to review a nonsensical paper (I assume that was the case Timothy referred to), I find myself in the same position as my friend Timothy. But, contrary to Timothy, I normally take the trouble to write a critical review of a nonsensical submission. Why? The reason is simple: if I don’t do it, the editor will simply send it to another reviewer. Many journals allow authors to suggest reviewers of their choice. Thus, the editor might send the submission next to the person suggested by the author who most likely will write a favourable review, thus hugely increasing the chances that the paper will be published in a decent journal.

On this blog, we have seen repeatedly that even top journal occasionally publish rubbish papers. Perhaps they do so because well-intentioned experts react in the way my friend Timothy did above (as he failed to tell us what journal invited him, I might be wrong).

If we want pseudoscience to disappear, we are fighting a lost battle. It will always rear its ugly head in third class journals. This is lamentable, but perhaps not so disastrous: by publishing little else than rubbish, these SCAM journals discredit themselves and will eventually be read only by pseudoscientists.

But we can do our bit to get rid of pseudoscience in decent journals. For this to happen, I think, rational thinkers need to accept invitations from such journals and do a proper review. And, of course, they can add to it a sentence or two about the futility of reviewing nonsense.

I am sure Timothy and I both want to eliminate pseudoscience as much as possible. In other words, we are in agreement about the aim, yet we differ in our approach. The question is: which is more effective?

… Many proponents of so-called alternative medicine (SCAM) are keen to point out that, while mainstream medicine may be good at treatment of diseases, particularly acute conditions, SCAM’s forte lies in the prevention of disease. Patients seem to have intuitively accepted this notion; a recent survey suggest that more than 50% of those Americans who use SCAM do so not to treat ailments but to remain healthy, i.e. to prevent disease and illness. If one looks closer at the evidence for or against SCAM’s role in disease prevention, one is stunned by the contrast of firmly held beliefs and the lack of reliable evidence to support them…

… Unfortunately the subject is more complex than normally appreciated within SCAM. Until we have convincing data, it is not possible to state with confidence that a given form of SCAM is effective in preventing a given condition. It follows

  1. that we now should prepare to carry out the much needed (but difficult) research related
    to preventative,
  2. that we should be cautious and abstain from overstating the largely unproven role of SCAM in the prevention of disease and illness.

These lines were written by me and published exactly 20 years ago. As far as I can see, very little has changed since.

  • SCAM providers continue to make big claims about disease prevention.
  • Many consumers continue to believe them.
  • And the evidence continues to be absent or flimsy.

It follows, I fear, that charlatans who advocate their SCAM as a means to prevent disease are dishonestly defrauding the public.

I do hope that someone disagrees with me and shows me the evidence proving me wrong!

The World Federation of Chiropractic, Strategic Plan 2019-2022 has just been published. It is an odd document that holds many surprises. Sadly, none of them are positive.

As the efficacy and safety of chiropractic spinal manipulations, the hallmark treatment that close to 100% of all chiropractic patients receive, are more than a little doubtful, one would expect that such a strategy would focus on the promotion of rigorous clinical research to create more certainty in these two important areas. If you are like me and were hoping for a firm commitment to such activities, you will be harshly disappointed.

Already in the introduction, the WFC sets an entirely different agenda:

We believe that everyone deserves access to chiropractic. We believe in chiropractors being accessible throughout the world. We believe that societies can thrive where chiropractors are available as a part of people’s health care teams.

If you are not put off by such self-serving, nauseous nonsense and read on, you find what the WFC call the ‘FOUR STRATEGIC PILLARS’

  1. SUPPORT
  2. EMPOWERMENT
  3. PROMOTION
  4. ADVANCEMENT

The text supporting the first three pillars consists of insufferable platitudes, and I will therefore not burden you with it. But the title of No4 did raise my hopes of finding something along the lines of an advancement of the evidence-base of chiropractic. Sadly, this turned out to be over-optimistic. Here is the 4th pillar in its full beauty:

Advancing the chiropractic profession together under the banner of evidence-based, people-centered, interprofessional and collaborative care.

Around the world health is delivered according to prevailing societal, cultural and political factors. These social determinants mean that chiropractors must adapt to the environment in which they practice.

As a global federation we must continuously strive to advance awareness of chiropractic under a banner of ethical, evidence-based, people-centered care.

Through consensus-building, shared understanding and respectful dialogue with partners in the health system, chiropractic should become a valued partner in contributing enhanced population health.

Throughout our 7 world regions, we must advance public utilization of chiropractors to optimize the health of nations.

Through the identification of common values and a commitment to patient-centered care, we can advance the identity of chiropractors as spinal health care experts in the health care system.

The WFC will:

– Advance awareness of chiropractic among the general public, within health systems and among health professionals.

– Advance access to chiropractors for all people and broaden the integration of chiropractic services

– Advance interprofessional collaboration and the integration of chiropractic into health systems

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END OF QUOTE

The essence of the WFC strategy for the next 3 years thus seems to be as follows:

  1. Avoid any discussion about the lack of evidence of chiropractic.
  2. Promote chiropractic to the unsuspecting public at all cost.
  3. Make sure chiropractors’ cash flow is healthy.

There are some commentators on this blog who regularly try to make us believe that chiropractic is about to reform, leave obsolete concepts behind, and become a respectable, ethical and evidence-based healthcare profession. After reading the appalling drivel the WFC call their ‘strategic plan’, I am not optimistic that they are correct.

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