critical thinking
How often have we seen it stated on this blog and elsewhere by enthusiasts of so-called alternative medicine (SCAM) that COVID vaccinations were useless or even harmful? Here is some rather compelling evidence that should make them think again.
This population based cohort study investigated the effectiveness of primary covid-19 vaccination (first two doses and first booster dose within the recommended schedule) against post-covid-19 condition (PCC).
All adults (≥18 years) participated from the Swedish Covid-19 Investigation for Future Insights (a Population Epidemiology Approach using Register Linkage (SCIFI-PEARL) project, a register based cohort study in Sweden) with covid-19 first registered between 27 December 2020 and 9 February 2022 (n=589 722) in the two largest regions of Sweden. Individuals were followed from a first infection until death, emigration, vaccination, reinfection, a PCC diagnosis (ICD-10 diagnosis code U09.9), or end of follow-up (30 November 2022), whichever came first. Individuals who had received at least one dose of a covid-19 vaccine before infection were considered vaccinated.
The primary outcome was a clinical diagnosis of PCC. Vaccine effectiveness against PCC was estimated using Cox regressions adjusted for age, sex, comorbidities (diabetes and cardiovascular, respiratory, and psychiatric disease), number of healthcare contacts during 2019, socioeconomic factors, and dominant virus variant at time of infection.
Of 299 692 vaccinated individuals with covid-19, 1201 (0.4%) had a diagnosis of PCC during follow-up, compared with 4118 (1.4%) of 290 030 unvaccinated individuals. Covid-19 vaccination with any number of doses before infection was associated with a reduced risk of PCC (adjusted hazard ratio 0.42, 95% confidence interval 0.38 to 0.46), with a vaccine effectiveness of 58%. Of the vaccinated individuals, 21 111 received one dose only, 205 650 received two doses, and 72 931 received three or more doses. Vaccine effectiveness against PCC for one dose, two doses, and three or more doses was 21%, 59%, and 73%, respectively.
The authors concluded that the results of this study suggest a strong association between covid-19 vaccination before infection and reduced risk of receiving a diagnosis of PCC. The findings highlight the importance of primary vaccination against covid-19 to reduce the population burden of PCC.
This study should make the anti-vaxers re-consider their views. Sadly, I have little hope that they will. If they don’t, they provide rational thinkers with yet further evidence that they are cultists who are beyond learning from compelling data.
I was alerted to a new book entitled “Handbook of Space Pharmaceuticals“. It contains a chapter on “Homeopathy as a Therapeutic Option in Space” (yes, I am not kidding!). Here is its abstract (the numbers were inserted by me and refer to the short comments below):
Homeopathy is one of the largest used unorthodox medicinal systems having a wide number of principles and logic to treat and cure various diseases [1]. Many successful concepts like severe dilution to high agitation have been applied in the homeopathic system [2]. Though many concepts like different treatment for same diseases and many more are contradictory to the allopathic system [3], homeopathy has proved its worth in decreasing drug-related side effects in many arenas [4]. Various treatments and researches are carried out on various diseases; mostly homeopathic treatment is used in joint diseases, respiratory diseases, cancer, and gastrointestinal tract diseases [5]. In this chapter, readers will have a brief idea about many meta-analysis results of most common respiratory diseases, i.e., asthma, incurable hypertension condition, rheumatoid arthritis, and diarrhea and a megareview of all the diseases to see their unwanted effects, uses of drugs, concepts, and issues related to homeopathy [6]. Various limitations of homeopathic treatments are also highlighted which can give a clear idea about the future scope of research [7]. Overall, it can be concluded that placebo and homeopathic treatments give almost the same effect [8], but the less severe side effects of homeopathic drugs in comparison to all other treatment groups catch great attention [9].
Apart from the very poor English of the text and the fact that it has as good as nothing to do with the subject of ‘Homeopathy as a Therapeutic Option in Space’, I have the following brief comments:
- I did not know that homeopathy has ‘a wide number of logic’ and had alwas assumed that there is only one logic.
- Successful concepts? Really?
- So, homeopaths believe that the ‘allopathic system’ treats the same diseases uniformly? In this case, they should perhaps read up what conventional medicine really does.
- I am not aware of good evidence showing that homeopathy reduces drug related adverse effects.
- No, homeopathy is used for all symptoms – Hahnemann did not believe in treating disease entities – and mostly for those that are self-limiting.
- I love the term ‘incurable hypertension condition’; can somebody please explain what it is?
- The main limitation is that homeopathy is nonsense and, as such, does not really require further research.
- Not ‘almost’ but ‘exactly’! But thanks for pointing it out.
- Wishful thinking and not true. Firstly, the author forgot about ‘homeopathic aggravations’ in which homeopaths so strongly believe. Secondly, I know of many non-homeopathic treatments that are free of adverse effects when done properly.
Altogether, I am as disappointed by this article as you must be: we were probably all hoping to hear about the discovery showing that homeopathy works splendidly in space – not least because we have known for a while that homeopaths seem to be from a different planet.
NICE helps practitioners and commissioners get the best care to patients, fast, while ensuring value for the taxpayer. Internationally, NICE has a reputation for being reliable and trustworthy. But is that also true for its recommendations regarding the use of acupuncture? NICE currently recommends that patients consider acupuncture as a treatment option for the following conditions:
- chronic (long-term) pain
- chronic tension-type headaches
- migraines
- prostatitis symptoms
- hiccups
Confusingly, on a different site, NICE also recommends acupuncture for retinal migraine, a very specific type of migraine that affect normally just one eye with symptoms such as vision loss lasting up to one hour, a blind spot in the vision, headache, blurred vision and seeing flashing lights, zigzag patterns or coloured spots or lines, as well as feeling nauseous or being sick.
I think this perplexing situation merits a look at the evidence. Here I quote the conclusions of recent, good quality, and (where possible) independent reviews:
- Chronic pain: Acupuncture is efficacious for reducing pain in patients with LBP… Further research needs to be done to evaluate acupuncture’s efficacy in these conditions, especially for abdominal pain, as many of the current studies have a risk of bias due to lack of blinding and small sample size.
- Chronic tension-type headaches (TTH): Acupuncture may be an effective and safe treatment for TTH patients. Due to low or very low certainty of evidence and high heterogeneity, more rigorous RCTs are needed to verify the effect and safety of acupuncture in the management of TTH.
- Migraines: Many studies suggest that acupuncture is a safe, helpful and available alternative therapy that may be beneficial to certain migraine patients. Nevertheless, further large-scale RCTs are warranted to further consolidate these findings and provide further support for the clinical value of acupuncture. Despite previous studies that have analyzed the effects of acupuncture on migraine, there is still a need for further investigation to ensure that the incorporation of acupuncture into migraine treatment management will have a positive outcome on patients.
- Prostatitis: This meta-analysis indicated that acupuncture has measurable benefits on CP/CPPS, and security has also been ensured. However, this meta-analysis only included 10 RCTs; thus, RCTs with a larger sample size and longer-term observation are required to verify the effectiveness of acupuncture further in the future.
- Hiccups: All of these studies sought to determine the effectiveness of different acupuncture techniques in the treatment of persistent and intractable hiccups. All four studies had a high risk of bias, did not compare the intervention with placebo, and failed to report side effects or adverse events for either the treatment or control groups.
- Retinal migraine: no evidence
So, what do we make of this? I think that, on the basis of the evidence:
- a positive recommendation for all types of chromic pain is not warranted;
- a positive recommendation for the treatment of TTH is questionable;
- a positive recommendation for migraine is questionable;
- a positive recommendation for prostatitis is questionable;
- a positive recommendation for hiccups is not warranted;
- a positive recommendation for retinal migraine is not warranted.
But why did NICE issue positive recommendations despite weak or even non-existent evidence?
SEARCH ME!
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Omega-3 fatty acids (fish oil) supplementation reduces the occurrence of cardiovascular disease (CVD) and CVD-related mortality in patients at high-risk of CVD and in patients with elevated plasma triglyceride level. Yet, some studies have found an increased risk of atrial fibrillation (AF). AF is the most common sustained cardiac arrhythmia worldwide. It is associated with high morbidity and mortality rates and significant public health burden. Previous studies of the effect of omega-3 fatty acids on AF occurrence have reported contradictory results.
This review evaluated the effect of omega-3 fatty acids on the risk of AF. The results suggest that omega-3 fatty acids supplementation is associated with increased AF risk, particularly in trials that used high doses. Therefore, several factors should be considered before prescribing omega-3 fatty acids, including their dose, type, and formulation (fish, dietary fish oil supplements, and purified fatty acids), as well as patient-related factors and atrial mechanical milieu. Because the benefits of omega-3 fatty acids are dose-dependent, the associated AF risk should be balanced against the benefit for CVD. Patients who take omega-3 fatty acids, particularly at high doses, should be informed of the risk of AF and followed up for the possible development of this common and potentially hazardous arrhythmia.
Another recent review included 54,799 participants from 17 cohorts. A total of 7,720 incident cases of AF were ascertained after a median 13.3 years of follow-up. In multivariable analysis, EPA levels were not associated with incident AF, HR per interquintile range (ie, the difference between the 90th and 10th percentiles) was 1.00 (95% CI: 0.95-1.05). HRs for higher levels of DPA, DHA, and EPA+DHA, were 0.89 (95% CI: 0.83-0.95), 0.90 (95% CI: 0.85-0.96), and 0.93 (95% CI: 0.87-0.99), respectively.
The authors concluded that in vivo levels of omega-3 fatty acids including EPA, DPA, DHA, and EPA+DHA were not associated with increased risk of incident AF. Our data suggest the safety of habitual dietary intakes of omega-3 fatty acids with respect to AF risk. Coupled with the known benefits of these fatty acids in the prevention of adverse coronary events, our study suggests that current dietary guidelines recommending fish/omega-3 fatty acid consumption can be maintained.
Faced with contradictory results based on non-RCT evidence, we clearly need an RCT. Luckily such a trial has recently been published. It was an ancillary study of a 2 × 2 factorial randomized clinical trial involving 25 119 women and men aged 50 years or older without prior cardiovascular disease, cancer, or AF. Participants were recruited directly by mail between November 2011 and March 2014 from all 50 US states and were followed up until December 31, 2017.
Participants were randomized to receive EPA-DHA (460 mg/d of EPA and 380 mg/d of DHA) and vitamin D3 (2000 IU/d) (n = 6272 analyzed); EPA-DHA and placebo (n = 6270 analyzed); vitamin D3 and placebo (n = 6281 analyzed); or 2 placebos (n = 6296 analyzed). The primary outcome was incident AF confirmed by medical record review.
Among the 25 119 participants who were randomized and included in the analysis (mean age, 66.7 years; 50.8% women), 24 127 (96.1%) completed the trial. Over a median 5.3 years of treatment and follow-up, the primary end point of incident AF occurred in 900 participants (3.6% of study population). For the EPA-DHA vs placebo comparison, incident AF events occurred in 469 (3.7%) vs 431 (3.4%) participants, respectively (hazard ratio, 1.09; 95% CI, 0.96-1.24; P = .19). For the vitamin D3 vs placebo comparison, incident AF events occurred in 469 (3.7%) vs 431 (3.4%) participants, respectively (hazard ratio, 1.09; 95% CI, 0.96-1.25; P = .19). There was no evidence for interaction between the 2 study agents (P = .39).
The authors concluded that among adults aged 50 years or older, treatment with EPA-DHA or vitamin D3, compared with placebo, resulted in no significant difference in the risk of incident AF over a median follow-up of more than 5 years. The findings do not support the use of either agent for the primary prevention of incident AF.
So, does the regular supplementation with omega-3 fatty acids increase the risk of atrial fibrillation? The evidence is not entirely clear but, on balance, I conclude that the risk is low or even non-existent.
The British doctor and outspoken anti-vaxer Aseem Malhotra has featured several times on this blog, e.g.:
- UK Cardiologist Dr. Aseem Malhotra receives a well-deserved award
- Dr Aseem Malhotra and Dr Steven James: candour and complacency
Now, there has been a potentially important new development in his story. The Good Law Project recently announced the following:
During the pandemic, we depended on doctors telling us how we could protect ourselves and our loved ones. We trusted their advice would be based on the most reliable and up-to-date research.
But when the British cardiologist Dr Aseem Malhotra went on television, or posted to his hundreds of thousands of followers on social media, he repeatedly claimed the vaccine was ineffective and posed a greater threat than Covid, causing “horrific unprecedented harms including sudden cardiac death” – suggestions refuted by medical experts and branded false by factcheckers.
The General Medical Council is responsible for regulating doctors in the UK and investigating those whose conduct falls short of the required standards. Despite the clear risk to public health of vaccine misinformation, it has so far refused to launch an investigation into Malhotra’s public pronouncements, originally saying that they “don’t consider that the comments or posts made by the doctor call his fitness to practice into question…” and subsequently upholding that decision after a number of doctors challenged it.
Good Law Project is supporting a doctor who is taking the regulator to the High Court over their failure to investigate whether Malhotra has breached standards. The judicial review has now been given permission to proceed by the High Court, which held that it raises an “issue of general public importance” as to how the GMC exercises its functions.
According to the claimant, Dr Matt Kneale, medical professionals “should not be using their professional status to promote harmful misinformation”.
“When doctors repeatedly say things that are incorrect, misleading and put people’s health at risk – for example by encouraging them to refuse a vaccine – the GMC must hold them to account,” Kneale said.
For the Good Law Project Executive Director, Jo Maugham, the regulator’s failure to investigate doctors spreading misinformation forms part of a wider pattern.
“What we have learned from both the pandemic inquiry and the calamitous economic consequences of Brexit,” Maugham explained, “is quite how serious are the consequences of deciding, as Michael Gove did, that we have ‘had enough of experts’.”
The council may prefer to avoid becoming embroiled in a controversy over free speech, he continued, but “its primary obligation is to protect the public – and it’s really hard to see how its stance delivers on that objective.”
Dr Malhotra is far from the only proponent of vaccine misinformation in the UK. Open Democracy revealed that anti-lockdown MPs, including Tufton Street’s Steve Baker, took large donations from a secretive group called The Recovery Alliance, which has been linked with a fake grassroots organisation that campaigned against the vaccine.
We’re working to stop misinformation from going unchallenged, and to make sure that regulators like the General Medical Council hold dangerous doctors who make unfounded claims accountable.
By helping to fund this case, you’ll be fighting for trust in the medical profession and to make sure public safety is doctors’ first priority. Any support you can give will help us make positive change.
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The ‘Good Law Project’?
Who are they?
Good Law Project is a not for profit campaign organisation that uses the law for a better world. We know that the law, in the right hands, can be a fair and decent force for good. It is a practical tool for positive change and can make amazing things happen. We are proud to be primarily funded by members of the public, which keeps us fiercely independent. We want to inspire hope in difficult times by showing that you can make a difference, with the backing of good law. Our mission is to use the law to hold power to account, protect the environment, and ensure no one is left behind. You can learn more about our organisation and achievements in 2022-23 in our annual report.
You might even decide to support this splendid organization!
I hope you do.
It has just been reported that the Düsseldorf Regional Court has dismissed several lawsuits against vaccine manufacturers for alleged coronavirus vaccine damage as unfounded.
Three women and one man had filed a lawsuit against manufacturers of mRNA vaccines. They claimed to have suffered significant impairment and damage to their health as a result of the coronavirus vaccines. They claimed to have suffered from states of exhaustion, concentration disorders, damage to the immune system, respiratory and lung problems, autoimmune reactions and symptoms of myocarditis. The plaintiffs demanded compensation for pain and suffering of up to 250,000 euros and damages.
The court rejected the claims. The requirements for a claim under the German Medicinal Products Act were not met, the court stated. The plaintiffs had not sufficiently proven a “negative risk-benefit balance” of the vaccine. On the contrary, the European Medicines Agency (EMA) had determined a positive balance for the vaccine during the authorisation process.
Furthermore, the plaintiffs had not provided sufficient evidence that the manufacturer had provided incorrect information regarding the vaccine, the court continued. On the contrary, it follows from the official authorisation by the EMA that the manufacturer’s statements “are not objectionable in terms of content”. The judgements are not yet legally binding.
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I have little doubt that antivazers will now claim that the court is in the pocket of the pharmaceutical industry. To give you a flavour of their mindset, here are examples of recent tweets (Xs) that I picked up on the subject (my translations):
- You stupid arseholes and stupid rabble-rousers, and who is liable for the coronavirus vaccination damage and for the German arms factories in Ukraine?
- More and more vaccines, no long-term studies…not with me!
I make decisions about my body and you can see from the coronavirus vaccine damage that I have done everything right. Even if our government wants us to believe that there are none and pays the lawyers for Biontech. - Corona vaccination damage, disinformation, corona vaccination no protection, disinformation, that’s how it works with the anti-democrats.
- The Corona vaccine damage is also still being covered up. This political cesspit also stinks and needs to be emptied as quickly as possible.
- When the force-financed government TV reports on “vaccine damage”, more and more of the people’s traitors must be getting sick to their stomachs.
- For the “fact checkers”, facts are opinions – often even contradicting government statistics, e.g. in the case of coronavirus vaccinations – that are considered correct by the establishment. Necessary open discussions are not wanted by them.
Congratulations to Joseph Prahlow, MD, who is the winner of the Excellence in Homeopathy Award! Here are the conclusions of his winning essay. Special thanks to Hermeet Singh and Boiron for their prize donation.
Despite the many obstacles and challenges which face homeopathy in the 21st century, the homeopathic community should be emboldened and encouraged by the fact that there are also many opportunities for the advancement of homeopathy as an alternative choice in health care.
Proclaim the Truth: Homeopathy Actually Works
Notwithstanding the challenges involved (especially for a student) in arriving at the correct simillimum for a case, let alone the appropriate follow-up and case management, the truth of the matter is that homeopathy does, in fact, work! Those of us who have been the beneficiaries of homeopathic care, or who have seen the benefits in others, know with no doubt whatsoever that homeopathy represents a truly amazing form of alternative medicine that is able to successfully treat patients having a wide range of health concerns, including some very ill individuals. And it’s not just based on “experience” or “perception,” although such evidence should not be discounted. Numerous studies show the effectiveness of homeopathy.6-9 The fact that homeopathy actually works represents one of the biggest and most important opportunities for homeopathy. The corresponding challenge relates to “getting the word out” into the general community as well as the medical community. Instead of homeopathy being the “last resort,” it should increasingly become the “first choice” amongst patients. Only by “spreading the word” of its success can this become a reality.
What intrigued me here was the evidence that an award-winning homeopath believes might justify the claim that
“Numerous studies show the effectiveness of homeopathy”
6. Mathie RT, Lloyd SM, Legg LA, et al. Randomised placebo-controlled trials of individualized homeopathic treatment: systematic review and meta-analysis. Syst Rev. 2014 Dec 6;3:142. doi: 10.1186/2046-4053-3-142.
As we have discussed previously that meta-analysis is phoney and created a false-positive result by omitting at least two negative studies.
7. Taylor JA, Jacobs J. Homeopathic ear drops as an adjunct in reducing antibiotic usage in children with otitis media. Glob Pediatr Health 2014 Nov 21;1:2333794X14559395. doi: 10.1177/2333794X14559395.
This study had the notorious A+B versus B design and thus was unable to test for specific effects of homeopathy. Moreover, the lead author, Dr Jennifer Jacobs, was a paid consultant to Standard Homeopathic Company.
8. Sorrentino L, Piraneo S, Riggio E, et al. Is there a role for homeopathy in breast cancer surgery? A first randomized clinical trial on treatment with Arnica montana to reduce post-operative seroma and bleeding in patients undergoing total mastectomy. J Intercult Ethnopharmacol 2017 Jan 3;6(1):1-8. doi: 10.5455/jice.20161229055245.
This study showed no significant result in the intention to treat analysis. The positive conclusion seems to be based on data dredging only.
9. Frass M, Lechleitner P, Grundling C, et al. Homeopathic treatment as an add-on therapy may improve quality of life and prolong survival in patients with non-small cell lung cancer: a randomized, placebo-controlled, double-blind, three-arm, multic0-e1955enter study. Oncologist 2020 Dec 25(12):e1930-e1955. doi: 10.1002/onco.13548.
This study is since months under investigation for fraud. The reasons for this have been discussed previously.
Perhaps the award winning author should chance the crucial sentence into something like:
Numerous studies have shown how homeopaths try to mislead the public?
In any case, please do not let this stop you from reading the full paper by the award-winning author. I promise you that it will create much hilarity.
What does homeopathy offer our modern ailing world?
NOTHING!
According to Healthcare.gov, a primary care provider in the US is “a physician (MD or DO), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of healthcare services.” A growing movement exists to expand who can act as a primary care privider (PCP). Chiropractors have been a part of this expansion, but is that wise? This is the question recently asked by Katie Suleta of THE AMERICAN COUNCIL ON SCIENCE AND HEALTH In it, she explains that:
- chiropractors would like to act as PCPs,
- chiropractors are not trained in pharmacology,
- chiropractors receive some training in supplements,
- chiropractors wish to avoid pumping the body full of “synthetic” hormones and substances.
Subsequently, she adresses the chiropractic profession’s stance on vaccines.
First, look at similar professional organizations to establish a reasonable expectation. The American Medical Association has firmly taken a stance on vaccines and provides resources for physicians to help communicate with patients. There is no question about where they stand on the topic, whether it be vaccines in general or COVID-19 vaccines specifically. Ditto the American Osteopathic Association and American Association of Colleges of Osteopathic Medicine. There is a contingent of vaccine-hesitant MDs and DOs. There is also an anti-vax contingent of MDs and DOs. The vaccine hesitant can be considered misguided and cautious, while anti-vaxxers often have more misinformation and an underlying political agenda. The two groups pose a threat but are, thankfully, the minority. They’re also clearly acting against the recommendations of their professional organizations.
Let’s now turn to the American Chiropractic Association (ACA). Unlike the American Medical Association or American Osteopathic Association, they seem to take no stance on vaccines. None. Zip. Zilch. As of this writing, if you go to the ACA website and search for “vaccines,” zero results are returned. Venturing over to the ACA-CDID, there is a category under their “News and Articles” section for ‘Vaccines.’ This seems promising! However, when you click on it, it returns one article on influenza vaccines from Fox News from 2017. It’s not an original article. It’s not a perspective piece. No recommendations are to be found—nothing even on the COVID-19 vaccines. Basically, there is effectively nothing on ACA-CDID’s website either. We’re oh for two.
The last one we’ll try is DABCI University. No, it’s not a professional organization, but it does train DCs. The words ‘university’ and ‘internist’ are involved, so they must talk about vaccines…right? Wrong again. While there is a lot of content available only to paying members and students, the sections of their website that are publicly available are noticeably short on vaccine information. There is a section dedicated to articles, currently including five whole articles, and not a single one talked about vaccines. One report addresses the pharmacokinetics of coffee enemas, but none talks about one of the most fundamental tools PCPs have to help prevent illness.
Why It’s Important
Chiropractic was defined by DD. Palmer, its founder, as “a science of healing without drugs.” It relies on spinal manipulation. In traditional chiropractic, there is no room for medications at all. A rift has developed within the profession, and some chiropractors, those seeking that internal medicine certification, “try to avoid pumping the body with synthetic hormones and other prescriptions.”
During the COVID-19 pandemic, several prominent chiropractors publicly pushed anti-vaccine views. To highlight just a few prominent examples: Vax Con ’21, Mile Hi Chiro, and Ben Tapper. Vax Con ’21 was organized and orchestrated by the Chiropractic Society of Wisconsin. It featured Judy Mikovits, of Plandemic fame, as a speaker and touted her book with a forward written by Robert F. Kennedy Jr. It offered continuing education units (CEUs) to DCs to attend this anti-vaccine conference that peddled misinformation about COVID-19 vaccines and other prevention measures. Healthcare providers are often required to complete a certain number of continuing education units to maintain licensure, ensuring that they stay current and sharp as healthcare evolves or, in this case, devolves.
This conference was not unique in this either. Mile Hi Chiro was just held in Denver in September of this year, had several questionable speakers (including RFK and Ben Tapper of Disinformation Dozen fame), and offered continuing education. If professional conferences offer continuing education units for attendees and push vaccine misinformation, that should concern everyone. Especially if the profession in question wants to act as PCPs.
Despite training in a system that believes “the body has an innate intelligence, and the power to heal itself if it is functioning properly, and that chiropractic care can help it do that,” without medications, but frequently with supplements, roughly 58% of Oregon’s chiropractors were vaccinated against COVID-19. That said, their training and inclination, along with the silence of their professional organizations and the chiropractic conferences featuring anti-vaccine sentiment, make them a profession that, at the very least, doesn’t consider vaccinations or medications viable health alternatives. We’re now talking about an entire profession that wants to be PCPs.
Irrespective of your belief about the efficacy of COVID-19 vaccination, the germ theory of disease remains unchallenged. Anyone unwilling to work to treat and prevent infectious diseases within their community with the most effective means at our disposal should not be allowed to dispense medical advice. Chiropractors lack the basic training that a PCP should have. I’ve said it before and I’ll say it again: I want healthcare accessible for everyone. But, if you’re looking for a PCP, consider going to an MD, DO, NP, or PA – they come fully equipped for your primary care needs.
Regular readers of this blog will be aware that I have discussed the thorny issue of chiros and vaccinations many times before, e.g.:
- Chiropractic and Public Health
- The International Chiropractors Association’s Statement on Vaccination
- The General Chiropractic Council’s ‘Registrant Survey 2020’ has just been published
- Far too many chiropractors believe that vaccinations do not have a positive effect on public health
- Vaccination: chiropractors “espouse views which aren’t evidence based”
- Patients consulting chiropractors, homeopaths, or naturopaths are less likely to agree to the flu jab
- “The uncensored truth” about COVID-19 vaccines” … as told by some chiro loons
- Beliefs and behaviors of US chiropractors
- Media attention forces (some) chiropractors to get their act together
- Ever wondered why so many chiropractors are profoundly anti-vax?
I agree with Katie Suleta that the issue is important and thank her for raising it. I also agree with her conclusion that, if you’re looking for a PCP, consider going to an MD, DO, NP, or PA – they come fully equipped for your primary care needs.
Do not consult chiropractors.
“Acute Fulminant Hepatic Failure in 23-Year-Old Female Taking Homeopathic Remedy” is not a title we see often on a scientific paper. Naturally, it attrackted my interest. In the paper, a US team presented a case of a 23-year-old otherwise healthy woman with body mass index 32.3 and a history of polycystic ovarian syndrome who presented with acute liver failure (ALF) ultimately requiring orthotopic liver transplantation. The patient was originally from India where she reported taking homeopathic medications for various indications for several years without known toxicity. She had no history of alcohol, tobacco, or other drug use. At the time of her presentation, she was living and working in the US and reported she was unable to refill her homeopathic product with the primary ingredient of eggshells from India. She was off of all medications and supplements with the exception of Berberis vulgaris for approximately 1 month before obtaining a similarly named homeopathic product with the primary ingredient of eggshells from Amazon. She reported originally taking 4 pills/d for 10 days, and then increased to 10 pills/d for 10 days as she was unsure of the appropriate dose.
She subsequently developed orange discoloration of her urine and nausea, reportedly without any preceding muscle-related effects or symptoms, and she discontinued all of her medications/supplements. Approximately 2 weeks later, she presented to the emergency department for nausea and malaise, where a blood test revealed abnormal liver enzymes. Mononucleosis screen and hepatitis panel were negative. She had no evidence of hepatic encephalopathy at that time. Ultrasound of the abdomen was notable for hypoechoic liver parenchyma only.
She was discharged home with gastroenterology telehealth follow-up. She was seen 1 week later and reported worsening nausea, vomiting, anorexia, jaundice, and fatigue. She presented to a local emergency department where she received intravenous vitamin K and underwent further laboratory evaluation. She was transferred to another hospital for higher level of care and admitted with acute liver injury. There she received intravenous N-acetylcysteine per institutional protocol, ursodiol, albumin, vitamin K, and fresh frozen plasma transfusions given for coagulopathy. Magnetic resonance cholangiopancreatography was performed and demonstrated no evidence of biliary obstruction or chronic liver disease (no ascites, contour nodularity, mass, or lymphadenopathy), though liver size noted to be small (11.5 cm in span). At 21 to 28 days after the onset of symptoms, her lab results were still highly abnormal and her mental status deteriorated. She was intubated for airway protection given severe encephalopathy, “cooling protocols” were initiated, and she was transferred again to a higher level of care at a center for emergent liver transplant evaluation. She was evaluated and listed as status 1A for acute liver failure. Her clinical status continued to decline and her labs continued to worsen.
An appropriate organ became available 28 hours after listing. At the time of her surgery, her explanted liver was noted to have massive parenchymal loss with hemorrhage, and pathology confirmed near complete collapse of the organ’s framework with only small foci of steatotic hepatocytes remaining. After her initial operation, her hospital course was complicated by coagulopathy, hypotension, leukocytosis, kidney failure requiring temporary dialysis, and multiple operations for completion of biliary anastomoses and delayed complex abdominal wall closure with mesh given large donor size. She was discharged from the hospital 2 weeks after transplant and her outpatient course continues to go well over 1 year after liver transplantation.
The product in this case has not been previously reported to be toxic. Its primary ingredient is calcium from “toasted eggshells,” which is also not generally known to cause liver failure or disease. However, the authors point out that it is not uncommon for supplements such as this one to contain other potentially toxic agents that are not specifically listed on the bottles’ label. For example, toxic metals including lead, mercury, and arsenic have reportedly been discovered in many (almost 20%) naturopathic medicines manufactured in India, particularly those sold by US websites. As such, the authors hypothesize that this patient’s ALF was likely caused by a contaminant (also consumed in higher quantities than intended) in her homeopathic product with the primary ingredient of eggshells.
The authors of this paper repeatedly state that the product was a homeopathic remedy; however, on other occasions they claim that it was a herbal supplement. In their Figure 1, they name the product as ‘OVA TOSTA’; on Amazon USA, I did indeed find a remedy by that name. Sadly, I was unable to obtain any information about its exact ingredients or composition.
Regardless whether the product was herbal or homeopathic, this case report is a poignant reminder that, in so-called alternative medicine (SCAM) many dangerous remedies are offered for sale. Therefore, it is advisible to be cautious and insist on sound information about the quality, safety, and efficacy before trying any such therapy.
The concept that the outcomes of spinal manipulation therapy (SMT) – the hallmark intervention of chiropractors which they use on practically every patient – are optimized when the treatment is aimed at a clinically relevant joint is commonly assumed and central to teaching and clinical use of chiropractic. But is the assumption true?
This systematic review investigated whether clinical effects are superior when this is the case compared to SMT applied elsewhere. Eligible study designs were randomized controlled trials that investigated the effect of SMT applied to candidate versus non-candidate sites for spinal pain.
The authors obtained studies from four different databases. Risk of bias was assessed using an adjusted Cochrane risk of bias tool, adding four items for study quality. Between-group differences were extracted for any reported outcome or, when not reported, calculated from the within-group changes. Outcomes were compared for SMT applied at a ‘relevant’ site to SMT applied elsewhere. The authors prioritized methodologically robust studies when interpreting results.
Ten studies were included. They reported 33 between-group differences; five compared treatments within the same spinal region and five at different spinal regions.
None of the nine studies with low or moderate risk of bias reported statistically significant between-group differences for any outcome. The tenth study reported a small effect on pain (1.2/10, 95%CI – 1.9 to – 0.5) but had a high risk of bias. None of the nine articles of low or moderate risk of bias and acceptable quality reported that “clinically-relevant” SMT has a superior outcome on any outcome compared to “not clinically-relevant” SMT. This finding contrasts with ideas held in educational programs and clinical practice that emphasize the importance of joint-specific application of SMT.
The authors concluded that the current evidence does not support that SMT applied at a supposedly “clinically relevant” candidate site is superior to SMT applied at a supposedly “not clinically relevant” site for individuals with spinal pain.
I came across this study when I searched for the published work of Prof Stephen Perle, a chiropractor and professor at the School of Chiropractic, College of Health Sciences, University of Bridgeport, US, who recently started trolling me on this blog. Against my expectation, I find his study interesting and worthwhile.
His data quite clearly show that the effects of SMT are non-specific and mainly due to a placebo response. That in itself is not hugely remarkable and has been suspected to some time, e.g.:
- Chiropractic manipulation for migraine is a placebo therapy
- Chiropractic treatments are placebos
- Chiropractic spinal manipulation = placebo!
- Manual therapy (mainly chiropractic and osteopathy) does not have clinically relevant effects on back pain compared with sham treatment
- Manual therapies for back pain: not better than a placebo
- Is spinal manipulation a placebo therapy?
What is remarkable, however, is the fact that Perle and his co-authors offer all sorts of other explanation for their findings without even seriously considering what is stareing in their faces:
SPINAL MANIPULATIONS ARE PLACEBOS
CHIROPRACTIC IS A PLACEBO THERAPY
This might be almost acceptable, if chiropractic would not also be burdened with significant risks (as we have discussed ad nauseam on this blog) – another fact of which chiros like Perle are in denial.
What does all that mean for patients?
The practical implication is fairly straight forward: the risk/benefit balance of chiropractic is negative. And this surely means the only responsible advice to patients is this:
NEVER CONSULT A CHIRO!
