diagnostic method
I came across an interesting paper entitled “The Ethics of Tawas and Other Rituals in Medical Practices“. Here is its abstract:
Rituals in medical practice have either been seen as an anthropological aspect of current biomedical processes or as a pre-scientific aspect of complementary and alternative medicine (CAM). In either tendency, the literature has since failed to account for these rituals as rituals—conveyors of meaning, expressions of identity, and even as a rite of passage from illness to wellness. As an alternative to current discussions, this paper presents the case study of tawas, a diagnostic ritual from Philippine traditional medicine that determines personalistic and mystical causes of illnesses. As a non-intrusive procedure, tawas involves incantations and some ritual objects, e.g., rice, candle, axe, etc., that do not pose any direct harm nor benefit to the patient. While complete reliance on tawas at the expense of proper medical procedures could harm patients, the very ritual of tawas itself occupies a limbo within non-beneficence and non-maleficence. Following a Wittgensteinian perspective of treating rituals as meaning-laden human activities, this paper argues that rituals like tawas, much like other rituals embedded in biomedical practices, should be understood as rituals and not as empirical cures, thereby allowing their tolerance in medical practice in general.
The author seems to advocate for the cultural integration of traditional practices like tawas into a broader medical framework. They categorize tawas not as a physiological intervention, but define it as a conveyor of meaning. By addressing the “meaning-laden” aspect of illness, the ritual may address the psychological and social dimensions of a patient’s health, even if it has no effect on their physical pathology.
It is claimed that, since tawas involves non-intrusive objects (candles, rice), it is physically benign. At the same time it is acknowledged that “complete reliance” on tawas could harm patients. From a clinical safety standpoint, the “limbo” is only maintained if the ritual is strictly adjunctive rather than alternative.
The text uses a Wittgensteinian perspective, focusing on rituals as expressions rather than theories. Modern neuroscience suggests that the “ritual” of care—the white coat, the focused attention, the diagnostic process—triggers real neurobiological changes (e.g., dopamine and endorphin release). Aacknowledging the symbolic healing power that rituals have on patient anxiety and the “meaning response,” which can objectively improve health outcomes by reducing cortisol and stress.
The author identifies tawas as a diagnostic ritual which might well be the most contentious point. In science, a “diagnosis” must be reliable and valid. Tawas clearly fails the scientific criteria for validity. The author’s defence is that tawas shouldn’t be judged by those criteria at all. While this might be philosophically sound, in a clinical setting, a “mystical diagnosis” must conflict with a biological one, potentially leading to patient non-compliance with life-saving treatments.
The case of the 14-year-old girl who died of cancer is now occupying the Klagenfurt Regional Court for the second time. The girl’s parent elected to trust miracle healers and esoteric practitioners. Ultimately, the 14-year-old arrived at the hospital far too late—the cancer was already so advanced that the girl died less than two days later.
The parents have already been convicted of torture and neglect. During their criminal trial, the doctor came into the prosecution’s focus. He had administered four infusions of “cat’s claw” to the 14-year-old. The doctor admitted to this last year during his testimony as a witness, where he raved about the “miracle plant” cat’s claw, claiming it could heal almost anything.
He was also accused of using a pendulum to “test” the girl’s tumor and certifying it as benign. His response at the time was that he does not use a pendulum; rather, he had “dowsed” the tumor using a biotensor—a small metal spring. He claimed that when he failed to get a clear result, he urgently recommended the parents seek a biopsy, which they strictly refused. He alleged they eventually broke off treatment with him.
According to the indictment, the doctor is allegedly responsible for a further patient’s death by administering the herbal infusion. The man had collapsed after receiving it, suffered a heart attack and a stroke, and died weeks later from the consequences.
Furthermore, the doctor is accused of “grossly negligently causing a danger to the life and health of at least 6,550 people from May 2007 to May 2025.” Contrary to the standards of medical practice, he is said to have intravenously administered essences that were only approved as food products. The prosecutor referred to an analysis of the infusion solutions: “These were not pure; they contained soil and ash particles.” They were reportedly “brewed together in a backyard” – the contamination, she noted, could lead to the formation of blood clots. During his questioning, the trained intensive care physician rejected all guilt: “I feel in no way responsible.” He stated he had treated numerous cancer patients—for example, with cat’s claw or high-dose vitamin C.
In the case of the 14-year-old, the doctor insisted he was able to “see that something was not right” using the device. He claimed he only learned much later that the parents had canceled a biopsy appointment after their session with him. Furthermore: “Father and daughter always rejected any conventional medical therapy or diagnostics.” He maintained that he always noted his infusions could only boost the immune system and improve well-being, but never promised anything.
Regarding the case of the other deceased man, the doctor argued that the patient had already received 17 infusions from him prior to the incident in question and had always felt better afterward. After the final infusion, the patient felt unwell for a while, but his condition supposedly improved. The doctor claimed it was absolutely not anaphylactic shock: “Otherwise, I wouldn’t have let him go home.”
The defendant questioned each and every expert opinion obtained for the case. Regarding the statement that it is impossible for a tumor to shrink due to his infusions, he said, “I wouldn’t sign off on that.” As for the infusions, he claimed they were filtered multiple times and specially prepared for intravenous use.
A date for this has not yet been set. So, watch this space!
Ita Wegman (22 February 1876 – 4 March 1943) was born 150 years ago today. Together with Rudolf Steiner, she was a central figure in the development of anthroposophic medicine, an approach that interprets illness through spiritual–cosmological concepts. In 1921, Wegman founded the Klinisch-Therapeutisches Institut in Arlesheim, Switzerland—today the Ita Wegman Clinic—the first hospital dedicated to anthroposophic medicine. Practices developed there included rhythmical massage, a gentle bodywork technique intended to “harmonize” physiological rhythms, and mistletoe-based cancer therapy derived from Viscum album, later marketed as Iscador, as well as many other remedies influences by homeopathy. Wegman also co-founded Weleda, which remains a major producer of anthroposophic remedies and cosmetics.
Despite its continued use in parts of Europe, mistletoe therapy (including Iscador) has not demonstrated reliable clinical efficacy in improving cancer survival or tumor outcomes in well-controlled trials. Major systematic reviews conclude that evidence for benefit is inconsistent, methodologically weak, and often biased, with any reported improvements largely limited to subjective quality-of-life measures. It is therefore regarded by mainstream oncology as an unproven therapy rather than an evidence-based treatment. For Wegman’s other therapeutic innovations the evidence is even less convincing.
Her collaboration with Steiner was both professionally formative and personally intense. They met in the early 1900s, and Wegman later credited Steiner with inspiring her decision to pursue medicine relatively late, enrolling at the University of Zurich. From 1919 onward, their cooperation deepened: Steiner supplied esoteric frameworks derived from anthroposophy, while Wegman sought to translate these ideas into clinical practice. Their collaboration culminated in the book “Fundamentals of Therapy” (1925), published shortly after Steiner’s death.
Speculation about a romantic relationship between Wegman and Steiner has persisted for decades. Purported “love letters” dated to 1924 describe expressions of affection, but most scholars regard them as forgeries, citing factual errors, the absence of originals from Steiner archives, and stylistic inconsistencies with Steiner’s documented correspondence. Steiner himself described their bond in karmic terms, claiming a debt from a past incarnation that explained their closeness despite his marriage to Marie von Sivers. Historian Peter Selg and others interpret the relationship as an intense spiritual and intellectual partnership rather than a conventional affair, though contemporaries did circulate rumors.
Steiner died on March 30, 1925, after a prolonged illness. The exact cause remains uncertain and not definitively confirmed as stomach cancer. Wegman provided Steiner’s main care from September 1924 until his death, leaving her clinic to nurse him in his studio at the Goetheanum in Dornach, Switzerland. She is said to have employed anthroposophic approaches, but specific treatments remain sparsely documented in available accounts.
Following Steiner’s death, Wegman’s authority within the movement became increasingly contested. In 1935 she was expelled from the Anthroposophical Society amid internal power struggles and accusations of doctrinal deviation; this expulsion was formally reversed in 2018. Wegman’s political stance during the Nazi period remains controversial. While anthroposophy as a movement was partially suppressed in Nazi Germany, several leading anthroposophists – including Wegman – sought accommodation rather than resistance. Wegman expressed hopes in the early 1930s that National Socialism might support a spiritual renewal of society and did not publicly oppose the regime. Although she was not a member of the Nazi Party and later faced restrictions, her posture is best described as opportunistic accommodation and ideological ambiguity.
Wegman’s collaboration with Steiner created the foundations of anthroposophic medicine. It also generated enduring scientific, ethical, and political controversies – particularly regarding the medical validity of its treatments and its leaders’ responses to authoritarian power after Steiner’s death.
Iridology is an assessment technique that involves examining the iris allegedly to identify potential pathological disorders. Despite being practised for centuries, the effectiveness of iris diagnosis as a diagnostic tool remains doubtful, primarily due to limited empirical evidence supporting its claims. Thus, there is a need for scientific studies to test the efficacy of iridology assessment.
This study aimed to determine the sensitivity and specificity of iridology assessment in detecting abnormalities in the female reproductive system.
This cross-sectional observational study included 100 female participants. All participants underwent an iris examination, a clinical assessment, and ultrasonography. The results from these investigations were compared, and sensitivity and specificity rates were calculated using standard formulas.
The study found that iridology assessment demonstrated a sensitivity of 92% and a specificity of 56% in detecting abnormalities within the female reproductive system.
The authors concluded that their findings suggest that iridology assessment may serve as a potentially useful complementary tool for detecting abnormalities in the female reproductive system. However, further research is essential to confirm the effectiveness of this method and to explore its potential benefits and limitations in gynecological diagnosis. Continued scientific investigation is crucial to establish the role of iridology assessment in enhancing gynecological healthcare.
The authors of this study published in “Advances in Integrative Medicine” list the following affiliations:
- Department of Naturopathy, Government Yoga and Naturopathy Medical College, The Tamilnadu Dr. MGR Medical University, Chennai, Tamilnadu, India
- Department of Research, Government Yoga and Naturopathy Medical College, The Tamilnadu Dr. MGR Medical University, Chennai, Tamilnadu, India
- Department of Yoga, Government Yoga and Naturopathy Medical College, The Tamilnadu Dr. MGR Medical University, Chennai, Tamilnadu, India
- Department of Women and Child Care, National Institute of Naturopathy, Pune, Ministry of AYUSH, Government of India, India
I fear that this does not inspire me with confidence. But let’s have a look at the actual study.
The first thing that strikes me is the fact that there are many dozens of abnormalities in the female reproductive system. It seems oddly unscientific that the Indian researchers did not bother to define one single disorder. This gets even weirder when we realize that many of the abnormalities in the female reproductive system are easily recognisable or guessable without any diagnostic procedure upon first encountering the patient.
What I am trying to explain: the iridologists probably used all sorts of clues to guess which group each patient belonged to. In any case, the study is so poorly conceived and described that we really cannot be sure what happened.
But why am I so critical? Perhaps iridology is a useful diagnostic tool after all?
I find this possibility highly unlikely, and here is why:
Iridology was invented by a Hungarian homeopath in the late 19th century who thought to observe changes in the iris of an owl during the recovery of the animal after it had broken a leg. Iridologists believe that the iris is a ‘mirror of our body’. Any relevant abnormality on the right half of the body will reveal itself on the right iris and problems on the left side will show up on the left iris. They assume that the iris is linked via multiple nerve connections to all organs and believe that any bodily malfunction will thus be represented as abnormalities of pigmentation on the iris. These assumptions are not in keeping with basic anatomy or physiology and thus lack plausibility.
Iridologists have produced detailed maps of the iris where each iris is divided in 60 sectors (much like the face of a clock) and each segment is related to an inner organ or bodily function (for instance, heart diseases are thus seen in the left iris somewhere between two and three o’clock). Iridologists either study the iris in situ or they produce high-quality colour photographs of both irides for detailed inspection. Several studies have tested the validity of iridology. My systematic review of these data concluded that “the validity of iridology as a diagnostic tool is not supported by scientific evaluations. Patients and therapists should be discouraged from using this method.”
A final thought: if iridology were a valid diagnostic tool, this would be a scientific sensation, and the study proving it would get published in journals like SCIENCE or NATURE and not in s 3rd class SCAM journal.
I REST MY CASE.
It is not often that you find me laughing out loudly while reading a medical paper. This study, entitled “The Application of Artificial Intelligence in Acute Prescribing in Homeopathy: A Comparative Retrospective Study” achieves exactly that. Allow me to share its abstract with you:
The use of artificial intelligence to assist in medical applications is an emerging area of investigation and discussion. The researchers studied whether there was a difference between homeopathy guidance provided by artificial intelligence (AI) (automated) and live professional practitioners (live) for acute illnesses. Additionally, the study explored the practical challenges associated with validating AI tools used for homeopathy and sought to generate insights on the potential value and limitations of these tools in the management of acute health complaints. Method: Randomly selected cases at a homeopathy teaching clinic (n = 100) were entered into a commercially available homeopathic remedy finder to investigate the consistency between automated and live recommendations. Client symptoms, medical disclaimers, remedies, and posology were compared. The findings of this study show that the purpose-built homeopathic remedy finder is not a one-to-one replacement for a live practitioner. Result: In the 100 cases compared, the automated online remedy finder provided between 1 and 20 prioritized remedy recommendations for each complaint, leaving the user to make the final remedy decision based on how well their characteristic symptoms were covered by each potential remedy. The live practitioner-recommended remedy was included somewhere among the auto-mated results in 59% of the cases, appeared in the top three results in 37% of the cases, and was a top remedy match in 17% of the cases. There was no guidance for managing remedy responses found in live clinical settings.
In true homeopathic fashion, the authors drew concise conclusions:
Limitations aside, this study is the first to compare the recommendations of live homeopathy practitioners to an online automated remedy finder. Overall, the automated remedy finder provided a clear framework for acute prescribing by asking targeted questions for a limited set of acute complaints that can safely be treated at home, with basic guidance on how to take the remedy and built-in warnings for when to seek care from a licensed health care provider. The automated remedy finder was not able to go beyond basic recommendations in these areas, however, so commonly encountered situations in ‘real-world’ acute case management—such as remedy aggravations and potency stalls—were not covered.
The primary aim of this study, which was to compare remedy recommendations between an automated remedy finder and a live practitioner, showed significant gaps between live and automated remedy recommendations. Even in cases of remedy overlap, the final remedy differentiation is left to the user, who is asked to analyze his/her symptoms against the characteristics of anywhere between 1 and 20 remedy recommendations. This finding—let alone the additional skills necessary to successfully manage a case once a remedy is chosen—demonstrates that at present there is no equivalent substitute for a guided homeopathic interview from a live practitioner that results in a single remedy recommendation that can be altered as needed depending on the remedy response.
There is a potential role for more advanced AI tools to be employed in homeopathic prescribing. Emerging AI technology has the potential to compile feedback from real-world remedy responses, providing for the possibility of validation. The potential of emerging AI technology to assist in sifting through large amounts of literature and to “learn” based on feedback from remedy recommendations provides the possibility for evidence-based prescribing that could move the profession forward, most likely in the context of acute complaints. As a consequence, there are innumerable further future research investigations that emerge. Replicating the aim of this research using large language models is an obvious next step. Investigating the challenges of training of LLMs is another. The privacy concerns of using real world health data are a clear challenge.
The investigators did not assume that the online remedy finder used for this study is comparable to other commercially available remedy finders. Future investigations could reveal significant differences between different commercial products. However, the structural questions about the nature of complaints covered, how to elicit valuable answers to questions in a way that points to potentially supportive remedies, how to incorporate feedback to improve model accuracy, and patient safety/case management limitations would have been applicable to any model investigated. The purpose of this study, therefore, was not to evaluate a specific remedy finder but rather to explore the phenomenon of AI in homeopathy and begin a discussion.
As artificial intelligence tools continue to evolve, there are important considerations for homeopathic prescribing. While there are exciting possibilities, it will be important to find ways to take advantage of the things that AI tools can do well without sacrificing the things that only homeopathic practitioners are uniquely positioned to do.
Allow me to suggest a conclusion that is a little shorter and more relevant:
Whether performed by a homeopaths, AI or anything else, homeopathic remedy finding is a process that is random, irreproducible, unscientific, implausible and meaningless. In terms of its accuracy, it is comparable to tea leaf readings, palmistry, iridology, astrology, etc. This fact highlights yet again the utter absurdity of homeopathy as a form of healthcare.
Common Harms of CSM
- Musculoskeletal discomfort: Temporary soreness, stiffness, or pain in the muscles or joints after treatment.
- Headaches: Some individuals may experience headaches following spinal manipulation.
- Fatigue: Feeling tired or experiencing fatigue after treatment.
These harms occur after CSM in about 50% of all patients. They impact on their quality of life and usually last 1-3 days.
Serious Harms of CSM
- Vertebral artery dissection (VAD) and stroke: A tear in the vertebral artery can lead to stroke; the harm can be permanent.
- Death: A stroke can be fatal.
- Atlantoaxial dislocation
- Spinal cord injury: Damage to the spinal cord, potentially resulting in numbness, weakness, or paralysis.
- Herniated discs: Manipulation can exacerbate existing disc issues or cause a new disc herniation.
- Fractures: Osteoporotic patients or those with bone conditions are at risk of vertebral fractures.
- Cauda equina syndrome: Compression of nerves in the lower spine, potentially causing bowel or bladder dysfunction.
- Nerve damage: Injury to spinal nerves, leading to numbness, tingling, or weakness.
- Eye Injuries: these include central retinal artery occlusion, nystagmus, Wallenberg syndrome, ptosis, loss of vision, ophthalmoplegia, dipiopia and Horner’s syndrome.
The frequency of these harms is not known.
Other Risks
- Neglect: This happens whenever a chiropractor treats a condition that can more effectively be treated with another therapy.
- Misleading advice: This occurs whenever a chiropractor gives advice outside his area of competence, for instance, a recommendation against immunisations.
- False diagnoses: Chiropractors often diagnose a ‘vertebral subluxation’, a condition that exists only in their fantasy.
- Worsening of existing conditions: Manipulation may exacerbate underlying spinal problems or conditions like spinal instability.
- Waste of money: This occurs each time a patient pays for ineffective CSM.
The frequency of these risks is not well-documented but can be estimated to be very high.
_____________________________
I have often pointed out that the value of a therapy is not solely determined by its potential for harm. It depends crucially on the risk/benefit profile. The benefits of CSM are few and mostly uncertain. Thus the question arises:
DO THE BENEFITS OF CSM OUTWEIGH ITS RISKS?
I let you, the reader, answer this question.
PS
References for the above statements can be found in my book.
This story of a woman suffering from early-stage breast cancer is in many ways remarkable. After being diagnosed, she scheduled consultations with surgeons but, because it was the holiday season, appointments were delayed. She therefore decided to use the time proactively and arranged a consultation with ‘Dr. T,’ an integrative medical doctor. She wanted to explore if supplements could support her health while I waited for treatment.
Dr. T mentioned another holistic practitioner, ‘Dr. D’, who specialized in thermography, a thermal imaging technique that maps blood flow on the breast’s surface. Dr. D had allegedly “healed” a breast cancer patient without surgery, radiation or chemotherapy. The patient was intrigued and made an appointment with Dr. D. and had a thermogram.
This involved nine thermal images taken with a special camera, followed by a “cold challenge” where the patient submerged her hands in icy water. She was told that healthy tissue cools in sync with the brain’s signals, while cancerous tumors show up as hot spots.
Discussing the findings with the patient, Dr, D. explained that the thermography had not detected a breast cancer; it it had only revealed “extra heat” in the area. This, the doctor explained, would put her in the “high-risk” category. He explained further that cancer was caused by “too many COVID vaccines,” and therefore the patient shouldn’t get another. “What about the fact that my mom had the same type of cancer, in the same breast, at the same age?” She asked in disbelief. “No, it’s definitely the vaccines,” the doctor insisted, before pivoting to his next pitch: Super Mineral Water, a product he sold in his clinic, which he claimed could “detox” the patient’s body and possibly help cure her.
At this point, the patient, who happened to be a science writer by profession, was horrified and embarrassed — not just by the quackery, but also by her own naiveté for walking into this mess. She took the only sensible action possible: she grabbed her things and left as quickly as she could.
____________________
When we discuss so-called alternative medicine (SCAM), we regularly forget alternative diagnostic methods. Thermography might be counted as one of them, particularly when it is used for diagnosing cancer. A systematic review of the evidence concluded that currently there is not sufficient evidence to support the use of thermography in breast cancer screening, nor is there sufficient evidence to show that thermography provides benefit to patients as an adjunctive tool to mammography or to suspicious clinical findings in diagnosing breast cancer.
The danger with alternative diagnostic methods are mainly twofold.
- False positive diagnoses (FPD): this means a clinician uses an alternative diagnostic technique and concludes that the patient is suffering from disease xy, while she is, in fact, healthy. FPDs usually prompt lengthy treatments. They thus cause harm by firstly prompting worries and secondly expence.
- False negative diagnoses (FND): this means a clinician uses an alternative diagnostic technique and concludes that the patient is healthy, while she is, in fact, ill. FNDs prompt the patient to no treat her condition in a timely fashion. This can cause untold harm, in extreme cases even death.
In the case above, Dr, D. tried to combine the two options. He issued a FND that could have cost the patient’s life. Simultaneously, he made a FPD that was aimed at filling his pocket.
The story has fortunately a happy ending. After escaping the quack doctor, the patient received proper treatment and made a full recovery.
The comment sections of this blog have provided plenty of reason to suspect that chiropractic is a cult, a health cult to be precise. A health cult is defined as a system for the cure of disease based on dogma set forth by its promulgator. The promulgator, in this case, is DD Palmer. As discussed previously, he ‘invented’ chiropractic and promoted many extraordinary claims and ideas, e.g.:
- I was the first to adjust the cause of disease
- Chiropractors adjust causes instead of treating effects
- 95% of all diseases are caused by subluxations of the spine
- Vaccination and inoculation are pathological; chiropractic is physiological
- It was my ingenious brain which discovered [chiropractic’s] first principle; I was its source; I gave it birth; to me all chiropractors trace their chiropractic lineage
- Among the wonderful achievements of this century, the discovery and development of chiropractic is preeminent; it is destined to replace all methods which treat effects
- Dis-ease is a condition of not ease, lack of ease
- His magnetic cure for cancer involved freeing the stomach and spleen of poisons
- Chiropractic is a science of healing without drugs
- Wants to turn chiropractic into a religion (as this would avoid chiropractors being sued for practising medicine without a license)
Since DD Palmer, the chiro-cult has changed. In fact, it has split into two camps. The ‘straights’ have become a Palmer worship cult, while the rest delude themselves of being based on evidence. That the former are cultists is impossible to deny. The latter reject such allegations but, in my mind, they too belong to a cult.
Let me explain.
The criteria for a cult can be defines as follows:
- Charismatic Leader: the ‘mixers’ might no longer worship Palmer, yet they are far from free of his ‘philosophy’; after all, they went to chiro-school where they were educated in the Palmer tradition.
- Isolation: chiropractors seek surprisingly little co-operation with other healthcare professionals and thus tend to be isolated.
- Control: chiropractors are under tight control of their professional bodies, peers, journals, etc. which all make sure that heretic ideas are kept at bay.
- Deception: chiropractors are masters of deception in persuading the public and their patients of the value of spinal manipulations, regardless of the actual evidence.
- Us vs. Them Mentality: chiropractors tend to create an “us vs. them” mentality, demonizing real doctors and promoting group cohesion.
- Exploitation: chiropractors have a long history of exploiting their patients; maintenance care is just one of many examples.
- Fear Tactics: chiropractors are scare mongers, for instance, when they diagnose subluxations even in perfectly healthy people and claim that this invented diagnosis needs urgent adjustments.
What, you don’t agree with these arguments?
In this case let me quote a different set criteria that might help to decide whether chiropractic might be a cult. Here they are:
- Absolute authoritarianism without accountability
- Zero tolerance for criticism or questions
- Lack of meaningful financial disclosure regarding budget
- Unreasonable fears about the outside world that often involve evil conspiracies and persecutions
- A belief that former followers are always wrong for leaving and there is never a legitimate reason for anyone else to leave
- Abuse of members
- Records, books, articles, or programs documenting the abuses of the leader or group
- Followers feeling they are never able to be “good enough”
- A belief that the leader is right at all times
- A belief that the leader is the exclusive means of knowing “truth” or giving validation
Bearing in mind that not all of the 10 criteria need to be fulfilled, I ask you: is chiropractic a cult?
The over-use of X-ray diagnostics by chiropractors has been the topic of previous posts, e.g.:
- The benefits of chiropractic X-rays do not outweigh the risks
- Chiropractors’ use of X-rays
- Strong support for routine use of radiological imaging in chiropractic?
The authors of this review state that many clinicians use radiological imaging in efforts to locate and diagnose the cause of their patient’s pain, relying on X-rays as a leading tool in clinical evaluation. This is fundamentally flawed because an X-ray represents a “snapshot” of the structural appearance of the spine and gives no indication of the current function of the spine. The health and well-being of any system, including the spinal motion segments, depend on the inter-relationship between structure and function. Pain, tissue damage, and injury are not always directly correlated. Due to such a high incidence of abnormalities found in asymptomatic patients, the diagnostic validity of X-rays can be questioned, especially when used in isolation of history and/or proper clinical assessment. The utility of routine X-rays is, therefore, questionable. One may posit that their application promotes overdiagnosis, and unvalidated treatment of X-ray findings (such as changes in postural curvature), which may mislead patients into believing these changes are directly responsible for their pain. A substantial amount of research has shown that there is no association between pain and reversed cervical curves. Accuracy can also be questioned, as X-ray measurements can vary based on the patient’s standing position, which research shows is influenced by an overwhelming number of factors, such as patient positioning, patient physical and morphological changes over time, doctor interreliability, stress, pain, the patient’s previous night’s sleep or physical activity, hydration, and/or emotional state. Furthermore, research has concluded that strong evidence links various potential harms with routine, repeated X-rays, such as altered treatment procedures, overdiagnosis, radiation exposure, and unnecessary costs. Over the past two decades, medical boards and health associations worldwide have made a substantial effort to communicate better “when” imaging is required, with most education around reducing radiographic imaging. In this review, we describe concerns relating to the high-frequency, routine use of spinal X-rays in the primary care setting for spine-related pain in the absence of red-flag clinical signs.
Many chiropractors over-use X-rays (not least because it is a significant source of income) and claim to be able diagnose subluxations with X-ray diagnostics. The authors of the review state are unimpressed by this habit:
Spinal X-rays can lead to the detection of radiographic findings that can be used as an overdiagnosis for the patient, even though they may be asymptomatic. These include spinal anomalies, osteophytes, reduced disc heights, low-grade spondylolisthesis, transitional segments, and spina bifida occulta. The chiropractor can use all radiographic findings as “scare tactics” or “fear-mongering” to retain a patient under a specific frequency of care, thus creating unnecessary concern for the patient. Multiple studies have concluded that radiographic findings do not always correlate with a patient’s symptomatology. Brinjikji et al. (2015) concluded that disc degeneration was present in asymptomatic individuals, ranging from 37% in 20 year olds to 96% in 80 year olds.
Many chiropractors use “phases of degeneration” as a method of communication in order for patients to adhere to excessive treatment plans. It is unnecessary and unethical to scare patients to obtain compliance with chiropractic care. These “scare tactics” can negatively influence patients’ behavior, especially those who already experience reduced levels of self-efficacy. This unnecessary use of communication can cause negative thoughts, leading to fear of avoidance of physical activity and management advice as there is a concern for further damage. In addition, the likelihood that a patient will experience chronic pain may arise due to the belief that they won’t get better until the radiographic findings are resolved.
Vertebral subluxation is a term and condition created by chiropractors that refers to misalignment of the vertebra, a bone out of place, causing pressure on the spinal nerve and interference with mental impulses. Subluxation is a legitimate medical condition; however, this completely differs from the condition used by chiropractors. Over the years, there have been numerous definitions and takes on what “vertebral subluxation” is – even though the term and concept date back to 1902, it is still commonly used in the chiropractic community. It has been described that the misalignment of the vertebra causes occlusion of where the spinal nerve travels, thus causing nerve pressure and disrupting the “mental impulse,” which is part “intelligence,” a synonym for “spirit” and part of the “mental realm,” and part neural impulse; which is part of the physical realm. Many chiropractors believe that when bones press on nerves, the corresponding organ on the other end of the nerve will suffer disease. At this point, it appears more like religion; however, it is crucial that we include this as many clinicians use this “condition” as grounds to order unnecessary radiographic imaging. Extensive medical research has shown that bones do not slip out of place, squishing nerves causing various and different pathologies – and there is certainly no way to scientifically prove the interference of a “spirit” or life force. Nonetheless, none of this is grounds for ordering an X-ray and does not qualify as any type of “red flag,” raising concern about how and when chiropractors are using radiographic imaging.
The authors conclude that the importance of medical imaging cannot be overstated. Medical professionals, on the other hand, must adhere to ethical and responsible standards. These guidelines may be ambiguous in some situations, professions, and countries, resulting in many gray areas of practice. As discussed in this review, the ongoing justification many use to justify the excessive, repetitive, and ongoing use of X-rays for reasons that research does not support is highly concerning. This article highlights potential unvalidated practices within the chiropractic field relating to poor utility imaging.
We all have heard of so-called alternative therapies but few of us are aware of the fact that there are also alternative diagnoses. These are diagnoses used regularly by practitioners of so-called alternative medicine (SCAM) that have no basis on science, or – to put it simply – that do not exist. They are nonetheless popular with SCAM practitioners and allegedly cause a wide range of non-specific symptoms such as:
- anxiety,
- brain fog,
- constipation,
- depression,
- dizziness,
- fatigue,
- headaches,
- heart palpitations,
- insomnia,
- irritability,
- muscle and joint pain,
- loss of appetite,
- loss of libido,
- weight gain.
In this series of posts, I will briefly discuss some of these diagnoses and list the treatments that SCAM practitioners might recommend for them.
Adrenal Fatigue
Adrenal fatigue is not the same as adrenal insufficiency or Addison’s disease; it is a term coined by a chiropractor who claimed that the stresses of modern life tire out the adrenal glands. In turn, this phenomenon allegedly leads to generalised weariness.
There is not evidence that this is true, nor that adrenal fatigue even exists. A systematic review of the evidence concluded that “there is no substantiation that adrenal fatigue is an actual medical condition.”
Yet, SCAM practitioners advise to cure adrenal fatigue with a range of dietary supplements (e.g. fish oil, ashwagandha, rhodiola rosea, schisandra and holy basil, licorice, magnesium, various vitamins), special diets, lifestyle adjustments, stress management and many other SCAMs. They all have in common that their effectiveness is not supported by convincing evidence from rigorous clinical trials.
Candidiasis hypersensitivity
Most of us are infected by the fungus Candida albicans without being affected by it in any way. Yet, many SCAM practitioners claim that candidiasis hypersensitivity is a condition that causes symptoms like fatigue, premenstrual tension, gastrointestinal symptoms, and depression and therefore needs treating.
But, candidiasis hypersensitivity does not exist. An RCT concluded that, “in women with presumed candidiasis hypersensitivity syndrome, nystatin does not reduce systemic or psychological symptoms significantly more than placebo.”
This, however, does not stop SCAM practitioners to recommend numerous forms of SCAM to treat the condition, e.g.: dietary supplements containing probiotics, milk thistle, red thyme, barberry, garlic, or external applications of coconut oil, essential oils of peppermint oil, lavender oil, oregano oil, and tea tree. No sound evidence exists to show that ant of these SCAMs can successfully treat the condition.
Chronic intoxications
Chronic intoxications do ecist, of course. But in the realm of SCAM, they are diagosed for the sole putpose of selling their various ‘detox’ treatments. The alleged rationale is that our bodies are overloaded with all sorts ot harmful substances, for instance, from the environment, from our food, from modern drugs, or from our own metabolism.
To eliminate them, we need to ‘detox’. For that purpose, SCAM practitioners recommend a very wide range of SCAMs; in fact, it is hardly possible to identify a single form of SCAM that is not said to detoxify our bodies. Yet, for none of them is there compelling evidence that it eliminates toxins from our body. Some of the most popular detox regimen include:
- acupuncture;
- CEASE therapy;
- chelation therapy;
- crystal healing;
- cupping;
- detox diets;
- detox supplements;
- gua sha;
- homeopathy;
- homotoxicology;
- Kombucha;
- oil pulling;
- vaginal steaming.
Interim conclusion: non-existing diagnoses are perfect opportunities for SCAM practitioners to rip off gullible patients.
