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

EBM

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‘HOMEOPATHY360’ are fiercely decided to defend homeopathy, no matter what. They state that we promise to stand by your side always to fight against the critical attacks on Homeopathy… Therefore, I was not really surprised when, a couple of days ago, I received an email by them urging me to support US homeopaths against the threat by the FDA. Here is part of this correspondence:

… If you want to know more about the FDA’s proposed new rules for homeopathic medicines, here’s a summary of the most important points:

  • The new rules, if adopted, will allow the FDA to withdraw even properly manufactured and labeled homeopathic medicines from the marketplace. This is puzzling because these have never posed any sort of safety concern according to an initial review of public FDA records by Americans for Homeopathy Choice.
  • It is clear that the FDA intends to use this authority and has even mentioned specific medicines such as Belladonna, Nux vomica and Lachesis muta in its public statements regarding enforcement.
  • The authority for this kind of assault on homeopathy will result from the declaration by the FDA that all homeopathic medicines are “new drugs.” We all know this is nonsense. Homeopathic medicines have been around for 200 years.
  • But this nonsense declaration means that under U.S. law all homeopathic remedies will become technically “illegal” and subject to withdrawal from the marketplace. If the FDA just thinks there is a problem with a homeopathic medicine, it can withdraw it forever without conducting any sort of investigation.
  • Since the agency has already said that it thinks that Belladonna, Nux vomica, Lachesis muta and several other remedies are dangerous, we can anticipate that it will try to remove them from the marketplace as soon as its new rules are adopted.
  • But, it won’t be possible for Americans to get remedies that are banned sent to them from abroad. The FDA will simply stop these remedies at the border.

I could tell you more, but what I’ve told you so far should convince you that we ought to help the American homeopathy community defeat these unreasonable and misinformed rules. The rules simply do not reflect the realities of homeopathic medicines, namely, that they are nontoxic, mild, effective and have few, if any, side-effects. And, homeopaths use them in ways that individualize treatment. That this is the best way to treat patients was discovered by Samuel Hahnemann 200 years ago.

The enemies of homeopathy are everywhere and they appear to be stepping up their attacks. That’s why the world homeopathy community must work together to stand up to them…

_________________________________________________________________

I have reported about the FDA initiatives on homeopathy before. In 2015, they started it with a public hearing. Since then, the FDA also issued several warnings to manufacturers who were putting consumers at risk (see, for instance, here, here, and here).

What the FDA seem to be trying to do is nothing else but meeting their ethical, moral and legal responsibility vis a vis consumer safety. Homeopathy has had a free ride for far too long. It is high time that this sector joins the 21st century.

The above quote, with its bonanza of bogus claims and falsehoods, shows the urgency of this task. The defenders of homeopathy seem to live on a different planet where rationality, facts and evidence can easily be over-ruled by creed, dogma and wishful thinking. If homeopaths want their trade to join the realm of real medicine they need, at the very minimum, to show with sound evidence:

  1. that their remedies generate more good than harm,
  2. that they adhere to acceptable quality standards.

Failing this – and so far, homeopaths not only failed at this task but continue bombarding us with an incessant flow of bogus and dangerous claims – homeopathics cannot be considered to be medicines, and homeopaths cannot be called responsible healthcare professionals. It is high time to stop turning a blind eye to the double standards that have been applied for 200 years.

As reported previously the NHS NATURAL HEALTH SCHOOL in Harrogate, is a service that offered a range of free complementary therapy treatments to patients and their relatives who are affected by a cancer diagnosis and are either receiving their cancer treatment at Harrogate or live in the Harrogate and Rural District.

This NHS school offered alternative treatments to cancer patients and claim that they know from experience, that when Complementary Therapies are integrated into patient care we are able to deliver safe, high quality care which fulfils the needs of even the most complex of patients.

In addition, they also ran courses for alternative practitioners. Their reflexology course, for instance, covered all of the following:

  • Explore the history and origins of Reflexology
  • Explore the use of various mediums used in treatment including waxes, balms, powders and oils
  • Explore the philosophy of holism and its role within western bio medicine
  • Reading the feet/hands and mapping the reflex points
  • Relevant anatomy, physiology and pathology
  • Managing a wide range of conditions
  • Legal implications
  • Cautions and contraindications
  • Assessment and client care
  • Practical reflexology skills and routines
  • Treatment planning

I imagine that the initiators of the school are full of the very best, altruistic intentions. I therefore had considerable difficulties in criticising them. Yet, I do strongly feel that the NHS should be based on good evidence; and that much of the school’s offerings seemed to be the exact opposite. In fact, the NHS-label was being abused for giving undeserved credibility to outright quackery.

Therefore, I did something I do rarely: I filed an official complaint in September 2019.

What happened next?

Nothing!

I sent several reminders; and what happened then?

Almost nothing!

I got several assurances that a response was imminent.

And then I forgot all about it.

So, I was surprised to receive this email yesterday from the chief executive of the HARROGATE AND DISTRICT NHS FOUNDATION TRUST (I did not change or correct anything):

Dear Professor Ernst

Thank you for contacting our Chair about the Natural Health School and my apologies for the extended delay in replying to you.   We have reflected on the points you raised and I have set out a summary of this below in respect of the key issues.

  1. As a result of colleagues who set up the service having moved on to other posts outside of the Trust we have not been able to understand how the service was named.  However, I agree that the terminology “NHS Natural Health School” could be interpreted in a certain way and as such we have agreed it should instead be referred to as the Natural Health School only to avoid any interpretation that it has national NHS endorsement.  We will amend the information on the website and other material to reflect that the service is endorsed by the Trust.
  1. The service is hosted by HDFT, in that staff are employed by the Trust, but it is funded through charitable contributions.  No NHS resources are used in providing the school, or the complementary therapies which are provided to patients receiving treatment at the Sir Robert Ogden Centre.
  1. There is no intention to assert that the services provided (ie the complementary therapies) are treatment for cancer.  The ‘treatments’ referred to are complementary therapy treatments and are described as such.  They are focused on wellbeing concurrently to the medical treatment of cancer, and we are satisfied that this is clear in the current description.
  1. Whilst recognising the differences of views on the complementary therapy treatments, the service regularly secures feedback from patients and this has been positive and as such we continue to offer it to those patients who would wish to take it up.
  1. The school provides training to allow participants to achieve a qualification which is awarded at level 3 by the International Therapies Examination Council.

I hope this provides clarity on the context to the service.

Best wishes

… … …

___________________________________________________________________

I find this response more than a little unsatisfactory; here are just a few points I find worth mentioning:

  • As far as I can see, apart of the actual name of the school (it is now called ‘NATURAL HEALTH SCHOOL’), very little has changed. In particular, a NHS link is still implied in multiple different ways.
  • To claim that ‘we have not been able to understand how the service was named’ seems like someone is taking the Mikey.
  • So is the remark that ‘the terminology “NHS Natural Health School” could be interpreted in a certain way’.
  • The statement ‘there is no intention to assert that the services provided (ie the complementary therapies) are treatment for cancer’ is simply untrue; symptomatic treatment of cancer is still a treatment for cancer!
  • If the treatments are focussed on wellbeing, they nevertheless should be backed by evidence to show that they improve wellbeing. The label ‘complementary’ does not absolve a therapy from the need to be evidence-based.
  • There may be ‘different views’ on complementary therapies; yet, there is only one set of evidence – and that fails to support several of the treatments on offer.
  • Positive feedback from patients is no substitute for evidence.

I am not sure whether I should reply to the above letter. I take little pleasure in embarrassing chief excecutives.

WHAT DO YOU THINK I SHOULD DO?

 

 

I published this article 20 years ago! Yet, it is, I think, still relevant today. For the purpose of this blog, I have altered it marginally (mainly by using the acromym SCAM):

Whatever SCAM is, it is not an alternative to conventional medicine. Nevertheless, one might still ask why so many people pay for ‘unproven’ SCAM when they can have scientifically backed medicine at no extra expense. Chandola et al suggest that 44% who use CM hope for a cure, 30% fear adverse effects of mainstream drugs, and 27% are dissatisfied with conventional care. In a much larger survey conducted in the USA, Astin found that dissatisfaction with orthodox medicine was prevalent but did not predict use of SCAM. SCAM users tended to be better educated and to subscribe to a more ‘holistic’ philosophy of healthcare. Interestingly, they reported poorer health status than non-users. Moreover, SCAM attracts patients because it offers more personal autonomy or control and is less impersonal or high-tech than mainstream medicine. Finally patients, particularly those with chronic conditions, may simply try SCAM so as to leave no stone unturned.

‘Scientifically backed’ medicine may not be quite as helpful as one tends to assume at least not in the eyes of the patient. A survey of 1420 (mostly musculoskeletal) pain sufferers suggested that SCAMs were perceived as more successful than mainstream drugs. In fact, orthodox therapies such as parenteral injections and oral medications ranked only 8th and 11th, respectively. Perhaps more disturbingly, patients seem to experience the therapeutic encounter with SCAM practitioners as more satisfying, empathetic and informative than that with their general practitioners. While many physicians (rightly or wrongly) continue to see SCAM as a nuisance, maybe we should think again: SCAM’s popularity amounts to a biting criticism of mainstream medicine that ought to be taken seriously.

How are clinicians to reconcile the public demand for SCAM with the new zeal for evidence-based medicine? The apparently easy answer is to pursue a strategy of evidence-based SCAM. This is precisely what my department is doing. There are now about 2000 clinical trials in this diverse area. But clinical trials are often full of contradictions and seldom clarify clinical questions adequately. A US study, for instance, has contributed to increasing doubts about whether chiropractic is helpful for acute uncomplicated low back pain in a clinically relevant way. What we really need for informing clinicians’ decisions are systematic reviews incorporating the totality of the available data. For the past 5 years this has been the focus of my department’s work, and we have published a considerable number of such papers. The notion that SCAM is totally devoid of evidence is a cliché which, like many clichés, is not entirely true.

Undoubtedly, vast areas of uncertainty do remain. The more difficult question is, therefore, how should clinicians deal with their patients’ desire for SCAM in the absence of evidence? Embarrassingly few convincing answers are on offer. Physicians have become experts in dealing with uncertainty in many aspects of their work. A dose of common sense will usually go quite far. At the very least, doctors should know what type of treatments their patients are trying. Taking a detailed history should nowadays include asking specifically about use of SCAM. In order not to alienate patients, one should resist the temptation to be dismissive. If there are good reasons to warn of a certain form of SCAM, these are best offered in an objective manner. To give evidence-based advice, clinicians obviously have to be informed about the facts, and impartial information is hard to find. One ray of light in this relative darkness is the Cochrane Collaboration, which now has a ‘field’ working on SCAM. The number of systematic reviews available from the Cochrane database is growing rapidly.

Once a patient is using SCAM (with or against the doctor’s advice), it makes sense to monitor the effects. This increases the safety of the patient and contributes to the physician’s knowledge of and experience with SCAM. There is also a good argument for establishing working relationships with a selection of local SCAM therapists who have a good track record and adequate training. At present, communication between doctors and therapists is often poor or even non-existent. Surely this cannot be to the benefit of the patient.

For SCAM, the best chance of survival in a harsh climate of evidence-based medicine and increasing rationing of resources is to come up with the goods and demonstrate what treatments are effective, safe and cost-effective for which condition. For physicians, the best way of reconciling the ‘two worlds’ is to inform themselves adequately and guide their patients through the ‘SCAM maze’ with a generous helping of good common sense. For patients, last but not least, the best approach is to be cautious and remember that, if it sounds too good to be true, it probably is.

END OF QUOTE

Twenty years, and little has changed:

  1. There still are vast areas of uncertainty.
  2. Imparcial information about SCAM is still scarce.
  3. Patient demand for SCAM is still considerable.
  4. The implied criticism of conventional medicine is still not taken seriously.
  5. The communication between doctors and SCAM practitioners is still lamentable.
  6. Most doctors still do not include questions about SCAM in their medical history taking.
  7. Arguably, SCAM has become even less evidence-based.
  8. Most doctors remain blissfully uninformed about SCAM.
  9. Most of the claims made for SCAM are too good to be true.
  10.  …
  11. etc.

I think you get the gist.

So-called alternative medicine (SCAM) could easily be described as a business that exists mainly because it profits from the flaws of conventional medicine. I know, this is not a good definition, and I don’t want to suggest it as one, but I think it highlights an important aspect of SCAM.

Let me explain.

If we ask ourselves why consumers feel attracted to SCAM, we can identify a range of reasons, and several of them relate to the weaknesses of conventional medicine as it is practised today. For instance:

  1.  People feel the need to have more time with their clinician in order to discuss their problems more fully. This means that their GP does not offer them sufficient time, empathy and compassion they crave.
  2.  Patients are weary of the side-effects of drugs and prefer treatments that are gentle and safe. This shows that they realise that conventional medicine can cause harm and they hope to avoid this risk.
  3.  Patients find it often hard to accept that their symptoms are ‘nothing to worry about’ and does not require any treatment at all. They prefer to hear that the clinician knows exactly what is wrong and can offer a therapy that puts it right.

Conventional medicine and the professionals who administer it have many flaws. Most doctors have such busy schedules that there is little time for building an empathetic therapeutic relationship with their patients. Thus they often palm them off with a prescription and fail to discuss the risks in sufficient detail. Even worse, they sometimes prescribe drugs in situations where none are needed and where a reassuring discussion would be more helpful. It is too easy to excuse such behaviours with work pressures; such flaws are serious and cannot be brushed under the carpet in this way.

Recently, the flawed behaviour of doctors has become the focus of media attention in the form of

  • opioid over-prescribing
  • over-use of anti-biotics.

In both cases, SCAM providers were quick to offer the solution.

  • Acupuncturists and chiropractors claim that their treatments are sensible alternatives to opioids. Yet, there is no good evidence that either acupuncture or chiropractic have analgesic effects that are remotely comparable to those of opioids. They only are seemingly successful in cases where opioids were not needed in the first place.
  • Homeopaths claim that their remedies can easily replace antibiotics. Yet, there is not a jot of evidence that homeopathics have antibiotic activity. They only are seemingly successful in cases where the antibiotic was not needed in the first place.

In both instances, SCAM is trying to profit from the weaknesses of conventional medicine. In both cases, the offered solutions are clearly bogus. Yet, in both cases, scientifically illiterate politicians are seriously considering the alleged solutions. Few seem to be smart enough to take a step backwards and contemplate the only viable solution to these problems. If doctors over-prescribe, they need to be stopped; and the best way to stop them is to give them adequate support, more time with their patients and adequate recognition of the importance of reassuring and talking to patients when they need it.

To put it differently:

The best way to reduce the use of bogus SCAMs is to make conventional medicine less flawed.

This letter (dated 21 June 2019) to the Safer Care Victoria review team represents a statement by the Australian Medical Association of Victoria on chiropractic for children. As it is highly relevant to many of the discussions we had on this blog, I take the liberty of copying it here in full:

RE: Review of chiropractic spinal care for children under 12 years

The Australian Medical Association (AMA Victoria) appreciates the opportunity to respond to the Safer Care Victoria (SCV) consultation on chiropractic manipulation of children under 12 years.

The AMA is pleased that SCV has decided to review this practice which is manifestly unsafe and unwarranted.

Chiropractic spinal manipulation on children has received recent media attention and prompted community concerns about its safety, appropriateness and the professional duties of those undertaking it.  Most notably, in February this year medical experts and the Victorian Government condemned the controversial practice of infant spine manipulation after footage emerged of a Melbourne chiropractor treating a two-week old baby on the chiropractor’s own site.

Treatment of infants and very young children

We are aware that chiropractors are treating children for problems such as “infantile colic” by manipulative therapies.  There is no credible evidence for this, it is a dangerous practice in itself and it potentially impedes the proper assessment and management of an infant.  Additionally, it preys on often tired parents by the promise of a frequently false unequivocal diagnosis and false “quick fix”. This is plainly unconscionable and dangerous behaviour.

In preparing our response, we engaged with doctors across many specialities who have offered valuable insights into the matters being considered as part of this review.  It is our very firm view that the risk of undertaking spinal manipulation on small infants is of no benefit and is potentially extremely dangerous.  Newborn babies are extremely fragile and AMA Victoria warns that damage done to a baby or infant may not be immediately obvious to parents, and may not manifest until many years later.  This is supported by a study conducted by the American Academy of Pediatrics [1] which found serious adverse events may be associated with paediatric spinal manipulation.1

Another critical issue is that it is very unlikely that parents are providing informed consent to such procedures.  For parents to provide informed consent, they would need to be fully advised of the risks including, for example:

• the diagnosis of “infant colic” is a catch all for a range of symptoms with different aetiologies;

• the potential drastic short and long term consequences of spinal manipulation on their baby;

• there are no scientific safety and efficacy studies undertaken; and

• there is no credible scientific evidence for manipulation.

Chiropractors should also be directing parents to general practitioners for the proper holistic assessment and care of the child and family.

Additionally, infants and very young children cannot provide assent for a procedure for which there is no evidence they require and which may leave them with long term consequences.  Consideration of whether such potentially dangerous therapies, which are not underpinned by a strong evidence-base, should be supported by private health insurance rebates is also warranted.

Treatment of children under 12 years of age

Although there is limited evidence that some musculoskeletal treatments are effective in adults, there is no credible scientific evidence that manipulation, mobilisation or any applied spinal therapy in children under 12 years of age is warranted or safe.

AMA Victoria does not support clinical interventions unless there is scientific evidence that such treatments are useful in treating the illness.  AMA Victoria also supports patients being fully informed on the illness and the risks and benefits to any treatment. When the risks are to be borne by a non-assenting child, the requirement of evidence and consent is especially important.

AMA Victoria strongly advocates that chiropractic (and other health professionals) spinal care for children under 12 years of age is dangerous, unwarranted and must cease immediately.

If you would like to discuss any aspect of our response, please contact Ms Nada Martinovic, Senior Policy Advisor on (03) 9280 8773 or nadam@amavic.com.au.

Yours sincerely

Associate Professor Julian Rait OAM AMA VICTORIA PRESIDENT

1 Sunita, V., et al., Adverse Events Associated with Pediatric Spinal Manipulation: A Systemic Review, Pediatrics, 2007: 119; 275-283.

___________________________________________________________

I am truly delighted that the AMA Victoria agrees with many points I have tried to make previously (see for instance here, here and here). The statement is unsurpassed in its directness and strength. My congratulations to Prof Raith – very well done!

Let’s hope that professional bodies of other regions and counties will swiftly follow suit with equal clarity.

As reported, the Bavarian government has set aside almost half a million Euros for research to determine whether the over-use of antibiotics can be reduced by replacing them with homeopathic remedies. Homeopaths in and beyond Germany were delighted, of course, but many experts were bewildered (see also this or this, if you read German).

While the Bavarians are entering the planning stage of this research, I want to elaborate on the question what methodology might be employed for this task. As far as I can see, there are, depending on the precise research questions, various options.

IN VITRO TESTS OF HOMEOPATHICS

The most straight forward way to find out whether homeopathics are an alternative to antibiotics would be to screen them for antibiotic activity. For this, we would take all homeopathic remedies in several potencies that are commonly used, for instance D12 and C30, and add them to bacterial cultures. To cover even part of the range of homeopathic remedies, several thousand such tests would be required. The remedies that show activity in vitro would then be candidates for further clinical tests.

I doubt that this will generate meaningful findings. As homeopaths would probably point out quickly, they never claimed that their remedies have any antibiotic effects. Homeopathics work not via pharmacological mechanisms (there is none), they stimulate the vital force, the immune system, or whatever mystical force you fancy. Faced with the inevitably negative results of in vitro tests, homeopaths would merely shrug their shoulders and say: ‘we told you so’.

ANIMAL MODELS

Thus it might be more constructive to go directly into animal models. Such tests could take several shapes and forms. For instance, scientists could infect animals with a bacterium and subsequently treat one group with a high potency homeopathic remedy and the control group with a placebo. If the homeopathic animals survive, while the controls die, the homeopathic treatment was effective.

Such concepts would run into problems on at least two levels. Firstly, any ethics committee worth its name would refuse to pass such a protocol and argue that it is not ethical to infect and then treat animals with two different types of placebo. Secondly, the homeopathic fraternity would explain that homeopathy must be individualised which cannot be done properly in animals. Faced with the inevitably negative results of such animal studies, homeopaths would merely shrug their shoulders and say: ‘we told you so’.

CLINICAL TRIALS

Homeopathy may, according to some homeopaths, defy in vitro and animal tests, but it is most certainly amenable to being tested in clinical trials. The simplest version of a clinical study would entail randomising a group of patients with bacterial infections – say pneumonia – into receiving either individualised homeopathy or placebo. Possibly, one could add a third group of patients being treated with appropriate antibiotics.

The problem here would again be the ethics; no proper ethic committee would pass such a concept (see above). Another problem might be that even the homeopathic fraternity would oppose such a study. Why? Because all but the most deluded homeopaths know only too well that the result of such a trial would be devastatingly negative for homeopathy.

Therefore, homeopaths are likely to go for a different study design, for instance, one where patients suspected to have a bacterial infection are randomised to two groups of GPs. One group of ‘normal’ GPs would proceed as usual, while the other group are also trained in homeopathy and would be free to give whatever they feel is right for each individual patient. With a bit of luck, the ‘normal’ GPs would over-prescribe antibiotics (because that’s what they are apparently doing routinely), while the homeopathic GPs would often use homeopathics instead.

Such a study would indeed generate a result alleging that the use of homeopathy reduces the use of antibiotics. Of course, to be truly ‘positive’ it would need to exclude any clinical outcome such as time to recovery, because that might not be in favour of homeopathy.

The problem might again be the ethics committee. Assuming they are scientifically switched on, they will see through the futility of a trial designed to produce the desired result. They might also argue that science is not for testing one faulty approach (over-prescribing) against another (homeopathy) and insist that science is about finding the best treatment (which is neither of the two).

There are, of course, many other study designs that could be considered. Generally, they fall into two different categories: if they are rigorous tests of a hypothesis, they are sure to produce a result unfavourable to homeopathy. Such studies will therefore be opposed to by the powerful homeopathic fraternity. If, however, studies are flimsily designed to generate a positive finding, they might be liked by homeopaths, yet rejected by scientists and ethicists.

SURVEYS

A much easier solution to the question ‘does the use of homeopathy reduce the use of antibiotics’ might be to not do a trial at all, but to run a simple survey. For instance, one could retrospectively assess how many antibiotics 100 homeopathic GPs have prescribed during the last year and compare this to the figure of 100 over-prescribing, ‘normal’ GPs. This type of ‘research’ is a sure winner for the homeopaths. Therefore, I predict that they will advocate this or a similarly flawed concept.

Most politicians are scientifically illiterate to such a degree that they might actually agree to finance such a survey and then confuse correlation with causation by triumphantly stating that the use of homeopathy reduces over-prescribing of antibiotics. Few, I fear, will realise that there is only one method for reducing the over-prescribing of antibiotics: remind doctors what they all learnt in medical school, namely to prescribe antibiotics only in cases where they are indicated. And for that we evidently need no homeopathy or other SCAM.

I almost forgot!

This would have been no good, after all, Charles has for decades been the most influential supporter of so-called alternative medicine (SCAM) in the UK. He is one of SCAM’s greatest proponent.

So, here is my up-dated, extended and illustrated summary of his achievements in this area.

HAPPY BIRTHDAY CHARLES!

Charles went on a journey of ‘spiritual discovery’ into the wilderness of northern Kenya. His guru and guide at the time was Laurens van der Post (later discovered to be a fraud and compulsive fantasist and to have fathered a child with a 14-year old girl entrusted to him during a sea voyage).

Van der Post wanted to awake Charles’ mind and attune it to the vitalistic  ideas of Carl Jung’s ‘collective unconscious’, and it is this belief in vitalism that provides the crucial link to alternative medicine: virtually every form of alternative therapies is based on the assumption that some sort of vital force exists. Charles was so taken by van der Post that he made him the godfather of Prince William. After Post’s death, he established an annual lecture in his honour (the lecture series was discontinued after Van der Post was discovered to be a fraud).

Some time in the 1970s, Charles met Jimmy Saville and befriended him. Apparently, Saville later advised Charles on several occasions in various health-related matters.

Throughout the 1980s, Charles lobbied for the statutory regulation of chiropractors and osteopaths in the UK. In 1993, this finally became reality. These two SCAM professions are to this day the only ones regulated by statute in the UK.

Osteopathy has strong Royal links: Prince Charles is the President of the GOsC; Princess Diana was the President of the GCRO; and Princess Anne is the patron of the British School of Osteopathy (statement dated 2011).

In 1982, Prince Charles was elected as President of the British Medical Association (BMA) and promptly challenged the medical orthodoxy by advocating alternative medicine. In a speech at his inaugural dinner as President, the Prince lectured the medics: ‘Through the centuries healing has been practised by folk healers who are guided by traditional wisdom which sees illness as a disorder of the whole person, involving not only the patient’s body, but his mind, his self-image, his dependence on the physical and social environment, as well as his relation to the cosmos.’ The BMA-officials ordered a full report on alternative medicine which promptly condemned this area as implausible nonsense.

Six years later, a second report, entitled Complementary Medicine – New Approaches to Good Practice, heralded an astonishing about-turn stating that: “the demand for non-conventional therapies had become so pressing that organised medicine in Britain could no longer ignore its contribution”. At the same time, however, the BMA set in motion a further chapter in the history of SCAM by insisting that it was “unacceptable” to allow the unrestricted practice of non-conventional therapies, irrespective of training or experience.

In 1993, Charles founded his lobby group which, after being re-named several times, ended up being called the ‘Foundation for Integrated Health’ (FIH). It was closed down in 2010 amidst allegations of money laundering and fraud. Its chief executive, George Gray, was later convicted and went to jail. The FIH had repeatedly been a little economical with the truth.

In 2000, Charles wrote an open letter to The Times stating that…It makes good sense to evaluate complementary and alternative therapies. For one thing, since an estimated £1.6 billion is spent each year on them, then we want value for our money. The very popularity of the non-conventional approaches suggests that people are either dissatisfied with their orthodox treatment, or they find genuine relief in such therapies. Whatever the case, if they are proved to work, they should be made more widely available on the NHS…But there remains the cry from the medical establishment of “where’s the proof?” — and clinical trials of the calibre that science demands cost money…The truth is that funding in the UK for research into complementary medicine is pitiful…So where can funding come from?…Figures from the department of complementary medicine at the University of Exeter show that less than 8p out of every £100 of NHS funds for medical research was spent on complementary medicine. In 1998-99 the Medical Research Council spent no money on it at all, and in 1999 only 0.05 per cent of the total research budget of UK medical charities went to this area…

In 2001, Charles worked on plans to help build a model hospital of integrated medicine. It was to train doctors to combine conventional medicine and alternative treatments, such as homeopathy, Ayurvedic medicine and acupuncture, and was to have up to 100 beds. The prince’s intervention marked the culmination of years of campaigning by him for the NHS to assign a greater role to alternative medicine. Teresa Hale, founder of the Hale Clinic in London, said: “Twenty-five years ago people said we were quacks. Now several branches, including homeopathy, acupuncture and osteopathy, have gained official recognition.” The proposed hospital, which was due to open in London in 2003/4, was to be overseen by Mosaraf Ali, who runs the Integrated Medical Centre (IMC) in London. But the hospital never materialised.

This might be due to Mosaraf Ali falling in disrepute: Raj Bathija, 69 and from India, went for a massage at the clinic of Dr Mosaraf Ali and his brother Imran in 2005 after suffering from two strokes. However, he claims that shortly after the treatment, his legs became pale and discoloured. Four days afterwards, Mr Bathija was admitted to hospital, where he had to have both legs amputated below the knee due to a shortage of blood. According to Mr Bathija, Dr Ali and his brother were negligent in that they failed to diagnose his condition and neglected to advise him to go to hospital. His daughter Shibani said: “My father was in a wheelchair but was making progress with his walking. He hoped he might become a bit more independent. With the amputations, that’s all gone.” Dr Ali was sued (if anyone knows the outcome of this case, please let me know).

At the age of 53, Mrs Parker Bowles went on a trek to the Himalayas to ‘re-energise’ her spirits and encourage her to give up smoking. She was in a party of 12 accompanied by the Prince of Wales’s favourite health guru, Dr Mosaraf Ali. Mrs Parker Bowles subsequently became a regular visitor to Dr Ali’s London practice where she has been encouraged to take up yoga both to combat her back pain and to help her give up smoking.

In the same year, Charles published an editorial in the BMJ promoting his ideas around integrative medicine. Its title: THE BEST OF BOTH WORLDS.

In 2003, Prince Charles’ FIH launched a five-year plan which outlined how to improve access to alternative therapies.

In 2004, Charles publicly supported the Gerson diet as a treatment for cancer and Prof Baum, an eminent oncologist, was invited to respond in an open letter to the British Medical Journal: …Over the past 20 years I have treated thousands of patients with cancer and lost some dear friends and relatives to this dreaded disease…The power of my authority comes with knowledge built on 40 years of study and 25 years of active involvement in cancer research. Your power and authority rest on an accident of birth. I don’t begrudge you that authority but I do beg you to exercise your power with extreme caution when advising patients with life-threatening diseases to embrace unproven therapies.

In 2005, the ‘Smallwood-Report’ was published; it had been commissioned by Charles and paid for by Dame Shirley Porter to inform health ministers. It stated that up to 480 million pounds could be saved, if one in 10 family doctors offered homeopathy as an “alternative” to standard drugs for asthma. Savings of up to 3.5 billion pounds could be achieved by offering spinal manipulation rather than drugs to people with back pain. Because I had commented on this report, Prince Charles’ first private secretary asked my vice chancellor to investigate my alleged indiscretion; even though I was found to be not guilty of any wrong-doing, all local support at Exeter stopped which eventually led to my early retirement. ITV later used this incident in a film entitled THE MEDDLING PRINCE, I later published a full account of this sad story in my memoir.

In a 2006 speechPrince Charles told the World Health Organisation in Geneva that alternative medicine should have a more prominent place in health care and urged every country to come up with a plan to integrate conventional and alternative medicine into the mainstream. But British science struck back. Anticipating Prince Charles’s sermon in Geneva, 13 of Britain’s most eminent physicians and scientists wrote an “Open Letter” which expressed concern over “ways in which unproven or disproved treatments are being encouraged for general use in Britain’s National Health Service.” The signatories argued that “it would be highly irresponsible to embrace any medicine as though it were a matter of principle.”

In 2008, The Times published my letter asking the FIH to withdraw two guides promoting alternative medicine, stating: “the majority of alternative therapies appear to be clinically ineffective, and many are downright dangerous.” A speaker for the FIH countered the criticism by stating: “We entirely reject the accusation that our online publication Complementary Healthcare: A Guide contains any misleading or inaccurate claims about the benefits of complementary therapies. On the contrary, it treats people as adults and takes a responsible approach by encouraging people to look at reliable sources of information… so that they can make informed decisions. The foundation does not promote complementary therapies.”

In 2009, the Prince held talks with the health Secretary to persuade him to introduce safeguards amid a crackdown by the EU that could prevent anyone who is not a registered health practitioner from selling remedies. This, it seems, was yet another example of Charles’ disregard of his constitutional role.

In the same year, Charles urged the government to protect alternative medicine because “we fear that we will see a black market in herbal products”, as Dr Michael Dixon (LVO,2015; OBE 2001), then medical director of Charles’ FIH, put it.

In 2009, the health secretary wrote to the prince suggesting a meeting on the possibility of a study on integrating complementary and conventional healthcare approaches in England. The prince had written to Burnham’s predecessor, Alan Johnson, to demand greater access to complementary therapies in the NHS alongside conventional medicine. The prince told him that “despite waves of invective over the years from parts of the medical and scientific establishment” he continued to lobby “because I cannot bear people suffering unnecessarily when a complementary approach could make a real difference”. He opposed “large and threatened cuts” in the funding of homeopathic hospitals and their possible closure. He complained that referrals to the Royal London homeopathic hospital were increasing “until what seems to amount to a recent ‘anti-homeopathic campaign’”. He warned against cuts despite “the fact that these homeopathic hospitals deal with many patients with real health problems who otherwise would require treatment elsewhere, often at greater expense”.

In 2009, it was announced that the ‘College of Integrated Medicine’ (the name was only later changed to ‘College of Medicine’, see below) was to have a second base in India. An Indian spokesman commented: “The second campus of the Royal College will be in Bangalore. We have already proposed the setting up of an All India Institute of Integrated Medicine to the Union health ministry. At a meeting in London last week with Prince Charles, we finalized the project which will kick off in July 2010”.

In 2010, Charles publicly stated that he was proud to be perceived as ‘an enemy of the enlightenment’.

In 2010, ‘Republic’ filed an official complaint about FIH alleging that its trustees allowed the foundation’s staff to pursue a public “vendetta” against a prominent critic of the prince’s support for complementary medicines. It also suggested that the imminent closure of Ernst’s department may be partly down to the charity’s official complaint about him after he publicly attacked its draft guide to complementary medicines as “outrageous and deeply flawed”.

In 2010, former fellows of Charles’ disgraced FIH launched a new organisation, The College of Medicine’ supporting the use of integrated treatments in the NHS. One director of the college is Michael Dixon, a GP in Cullompton, formerly medical director of the Foundation for Integrated Health. My own analysis of the activities of the new college leaves little doubt that it is promoting quackery.

In 2010, Charles published his book HARMONY which is full of praise for even the most absurd forms of alternative therapies and even bogus diagnostic tests used by alternative practitioners.

In 2011, after the launch of Charles’ range of herbal tinctures, I had the audacity to publicly criticise Charles for selling the Duchy Herbals detox tincture which I named ‘Dodgy Originals Detox Tincture’.

In 2011, Charles forged a link between ‘The College of Medicine’ and an Indian holistic health centre (see also above). The collaboration was reported to include clinical training to European and Western doctors in ayurveda and homoeopathy and traditional forms of medicine to integrate them in their practice. The foundation stone for the extended campus of the Royal College known as the International Institution for Holistic and Integrated Medicine was laid by Dr Michael Dixon in collaboration with the Royal College of Medicine.

In 2012, Charles was nominated for ‘THE GOLDEN DUCK AWARD’ for his achievements in promoting quackery. However, Andrew Wakefield beat him to it; Charles certainly was a deserving runner-up.

In 2013, Charles called for society to embrace a broader and more complex concept of health. In his article he described a vision of health that includes the physical and social environment, education, agriculture and architecture.

In 2013, Charles’ Highgrove enterprise offered ‘baby-hampers’ for sale at £195 a piece and made a range of medicinal claims for the products it contained. As these claims were not supported by evidence, there is no way to classify them other than quackery.

By 2013, the ‘Association of Osteomyologists’ were seeking to become regulated by statute, with the help of Prince Charles as their patron. The chairman and founder of this organisation was knighted for services to alternative medicine.  Osteomyologists encourage the use of techniques including cranio-sacral therapy and claim that “we all know that Colleges, Institutions, and Medical Practitioners, are brain washed from the very outset into believing that their discipline is the only way to go.”

In November 2013, Charles invited alternative medicine proponents from across the world, including Dean Ornish, Michael Dixon, chair of College of Medicine, UK and Issac Mathai of Soukya Foundation, Bangalore, to India for a ‘brain storm’ and a subsequent conference on alternative medicine. The prince wanted the experts to collaborate and explore the possibilities of integrating different systems of medicines and to better the healthcare delivery globally, one of the organisers said.

In June 2014, BBC NEWS published the following text about a BBC4 broadcast entitled ‘THE ROYAL ACTIVIST’ aired on the same day: Prince Charles has been a well-known supporter of complementary medicine. According to a… former Labour cabinet minister, Peter Hain, it was a topic they shared an interest in. He had been constantly frustrated at his inability to persuade any health ministers anywhere that that was a good idea, and so he, as he once described it to me, found me unique from this point of view, in being somebody that actually agreed with him on this, and might want to deliver it. Mr Hain added: “When I was Secretary of State for Northern Ireland in 2005-7, he was delighted when I told him that since I was running the place I could more or less do what I wanted to do.*** I was able to introduce a trial for complementary medicine on the NHS, and it had spectacularly good results, that people’s well-being and health was vastly improved. And when he learnt about this he was really enthusiastic and tried to persuade the Welsh government to do the same thing and the government in Whitehall to do the same thing for England, but not successfully,” added Mr Hain. On this blog, I have pointed out that the research in question was fatally flawed and that Charles, once again, overstepped the boundaries of his constitutional role.

In 2015, two books were published which are relevant in this context. My memoir A SCIENTIST IN WONDERLAND recounts most of my dealings with Charles and his sycophants, including how an intervention from his first private secretary eventually led to the closure of my department. The book by Catherine Meyer CHARLES, THE HEART OF A KING is far less critical about our heir to the throne; it nevertheless severely criticises his stance on alternative medicine.

In October 2015, the Guardian obtained the infamous “black spider memos” which revealed that Charles had repeatedly lobbied politicians in favour of alternative medicine (see also above).

In 2016, speaking at a global leaders summit on antimicrobial resistance, Prince Charles warned that Britain faced a “potentially disastrous scenario” because of the “overuse and abuse” of antibiotics. The Prince explained that he had switched to organic farming on his estates because of the growing threat from antibiotic resistance and now treats his cattle with homeopathic remedies rather than conventional medication. “As some of you may be aware, this issue has been a long-standing and acute concern to me,” he told delegates from 20 countries “I have enormous sympathy for those engaged in the vital task of ensuring that, as the world population continues to increase unsustainably and travel becomes easier, antibiotics retain their availability to overcome disease… It must be incredibly frustrating to witness the fact that antibiotics have too often simply acted as a substitute for basic hygiene, or as it would seem, a way of placating a patient who has a viral infection or who actually needs little more than patience to allow a minor bacterial infection to resolve itself.”

In 2017, the ‘College of Medicine’ mentioned above was discretely re-named ‘College of Medicine and Integrated Health’

In the same year, Charles declared that he will open a centre for alternative medicine in the recently purchased Dumfries House in Scotland. Currently, the College of Medicine and Integrated Health is offering two-day Foundation Courses at this iconic location. Gabriel Chiu, a US celebrity cosmetic and reconstructive surgeon, and his wife Christine, joined the Prince of Wales as he opened the integrated health and wellbeing centre on the Dumfries House Estate in East Ayrshire in 2019. As he unveiled a plaque at the event, Prince Charles said: “I’m so glad that all of you have been able to get here today, particularly because I could not be more proud to see the opening of this new integrated health centre at Dumfries House. It’s something I’ve been wanting to do for the last 35 years. I’m also so proud of all the team at Dumfries House who built it, an all in-house team.

“To reach this point where we can now offer a range of social prescribing opportunities is enormously encouraging and I hope it will be able to make some difference to a lot of the health issues that exist in this area.”

Also in 2017, ‘Country News’ published an article about our heir to the throne stating that Prince of Wales has revealed he uses homeopathic treatments for animals on his organic farm at Highgrove to help reduce reliance on antibiotics, the article stated. He said his methods of farming tried wherever possible to ‘‘go with the grain of nature’’ to avoid dependency on antibiotics, pesticides and other forms of chemical intervention.

In 2018, The Prince of Wales accompanied the Prime Minister of India, Narendra Modi, to the Science Museum in London, and praised Asian medicine practices. The heir to the throne and the Indian Prime Minister then jointly unveiled a plaque for the UK’s first centre of excellence for Indian traditional medicine.

In the same year, it was revealed that UK farmers are being taught how to treat their livestock with homeopathy “by kind permission of His Royal Highness, The Prince Of Wales”

In 2019, the Faculty of Homeopathy announced that His Royal Highness The Prince of Wales had accepted to become Patron of the Faculty of Homeopathy. Dr Gary Smyth, President of the Faculty of Homeopathy comments, “As the Faculty celebrates its 175th anniversary this year, it is an enormous honour for us to receive the Patronage of His Royal Highness The Prince of Wales and I am delighted to announce this news today.” Charles’ move amazed observers who saw it as a deliberate protest against the discontinuation of reimbursement of homeopathy by the NHS.

In 2019, Prince Charles said that yoga had “proven beneficial effects on both body and mind,” and has “tremendous social benefits” that help build “discipline, self-reliance and self-care.”

___________________________________________________________________

So again, Happy Birthday Your Royal Highness – and please don’t forget: it’s not too late to start doing good in the realm of healthcare by supporting good science, critical thinking and evidence-based medicine.

Sincerely yours

Edzard Ernst

The Telegraph published an article entitled ‘Crack or quack: what is the truth about chiropractic treatment?’ and is motivated by the story of Mr Lawler, the 80-year-old former bank manager who died after a chiropractic therapy. Here are 10 short quotes from this article which, in the context of this blog and the previous discussions on the Lawler case, are worthy further comment:

1. … [chiropractic] was established in the late 19th century by D.D. Palmer, an American magnetic healer.
“A lot of people don’t realise it’s a form of alternative medicine with some pretty strange beliefs at heart,” says Michael Marshall, project director at the ‘anti-quack’ charity the Good Thinking Society. “Palmer came to believe he was able to cure deafness through the spine, by adjusting it. The theory behind chiropractic is that all disease and ill health is caused by blockages in the flow of energy through the spine, and by adjusting the spine with these grotesque popping sounds, you can remove blockages, allowing the innate energy to flow freely.” Marshall says this doesn’t really chime with much of what we know about human biology…“There is no reason to believe there’s any possible benefit from twisting vertebra. There is no connection between the spine and conditions such as deafness and measles.”…

Michael Marshall is right, chiropractic was built on sand by Palmer who was little more than a charlatan. The problem with this fact is that today’s chiros have utterly failed to leave Palmer’s heritage behind.

2. According to the British Chiropractic Association (BCA), the industry body, “chiropractors are well placed to deliver high quality evidence-based care for back and neck pain.” …

They would say so, wouldn’t they? The BCA has a long history of problems with knowing what high quality evidence-based care is.

3. But it [chiropractic] isn’t always harmless – as with almost any medical treatment, there are possible side effects. The NHS lists these as aches and pains, stiffness, and tiredness; and then mentions the “risk of more serious problems, such as stroke”….

Considering that 50% of patients suffer adverse effects after chiropractic spinal manipulations, this seems somewhat of an understatement.

4. According to one systematic review, spinal manipulation, “particularly when performed on the upper body, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke.” …

Arterial dissection followed by a stroke probably is the most frequent serious complication. But there are many other risks, as the tragic case of Mr Lawler demonstrates. He had his neck broken by the chiropractor which resulted in paraplegia and death.

5. “There have been virtually hundreds of published cases where neck manipulations have led to vascular accidents, stroke and sometimes death,” says Prof Ernst. “As there is no monitoring system, this is merely the tip of a much bigger iceberg. According to our own UK survey, under-reporting is close to 100 per cent.” …

The call for an effective monitoring system has been loud and clear since many years. It is nothing short of a scandal that chiros have managed to resist it against the best interest of their patients and society at large.

6. Chiropractors are regulated by the General Chiropractic Council (GCC). Marshall says the Good Thinking Society has looked into claims made on chiropractors’ websites, and found that 82 per cent are not compliant with advertising law, for example by saying they can treat colic or by using the misleading term ‘doctor’…

Yes, and that is yet another scandal. It shows how serious chiropractors are about the ‘evidence-based care’ mentioned above.

7. According to GCC guidelines, “if you use the courtesy title ‘doctor’ you must make it clear within the text of any information you put into the public domain that you are not a registered medical practitioner but that you are a ‘Doctor of Chiropractic’.”…

True, and the fact that many chiropractors continue to ignore this demand presenting themselves as doctors and thus misleading the public is the third scandal, in my view.

8. A spokesperson for the BCA said “Chiropractic is a registered primary healthcare profession and a safe form of treatment. In the UK, chiropractors are regulated by law and required to adhere to strict codes of practice, in exactly the same ways as dentists and doctors. Chiropractors are trained to diagnose, treat, manage and prevent disorders of the musculoskeletal system, specialising in neck and back pain.”…

Chiropractors also like to confuse the public by claiming they are primary care physicians. If we understand this term as describing a clinician who is a ‘specialist in Family Medicine, Internal Medicine or Paediatrics who provides definitive care to the undifferentiated patient at the point of first contact, and takes continuing responsibility for providing the patient’s comprehensive care’, we realise that chiropractors fail to fulfil these criteria. The fact that they nevertheless try to mislead the public by calling themselves ‘primary healthcare professionals’ and ‘doctors’ is yet another scandal, in my opinion.

9. The spokesperson said, “medication, routine imaging and invasive surgeries are all commonly used to manage low back pain, despite limited evidence that these methods are effective treatments. Therefore, ensuring there are other options available for patients is paramount.”…

Here the spokesperson misrepresents mainstream medicine to make chiropractic look good. He should know that imaging is used also by chiros for diagnosing back problems (but not for managing them). And he must know that surgery is never used for the type of non-specific back pain that chiros tend to treat. Finally, he should know that exercise is a cheap, safe and effective therapy which is the main conventional option to treat and prevent back pain.

10. According to the European Chiropractors’ Union, “serious harm from chiropractic treatment is extremely rare.”

How do they know, if there is no system to capture cases of adverse effects?

_________________________________________________________

So, what needs to be done? How can we make progress? I think the following five steps would be a good start in the interest of public health:

  1.  Establish an effective monitoring system for adverse effects that is accessible to the public.
  2. Make sure all chiros are sufficiently well trained to know about the contra-indications of spinal manipulation, including those that apply to elderly patients and infants.
  3. Change the GCC from a body defending chiros and their interests to one regulating, controlling and, if necessary, reprimanding chiros.
  4. Make written informed consent compulsory for neck manipulations, and make sure it contains the information that neck manipulations can result in serious harm and are of doubtful efficacy.
  5. Prevent chiros from making therapeutic claims that are not based on sound evidence.

If these measures had been in place, Mr Lawler might still be alive today.

 

 

This came a few days ago, completely out of the blue. To be honest, I did not even know what the BOOK AUTHORITY is. So, I looked them up; this is what they say about themselves:

BookAuthority is the world’s leading site for nonfiction book recommendations, helping you find the best books on various topics to develop your skills

It covers topics that range from startups, marketing and finance, through javascript, artificial intelligence and bitcoin, to fitness, history and personal development.

BookAuthority uses a proprietary technology to identify and rate the best nonfiction books, using dozens of different signals, including public mentions, recommendations, ratings, sentiment, popularity and sales history. This includes maintaining the most comprehensive collection of book recommendations from domain experts such as Elon Musk, Warren Buffett, Prof. Daniel Kahneman, Sheryl Sandberg, and David Allen.

Only the very best books are featured on BookAuthority. To keep our site objective and unbiased, ratings are calculated purely based on data. We do not accept requests to feature a book, nor are we doing business with publishers or authors.

BookAuthority serves millions of book recommendations every month, was ranked #1 on ProductHunt, and has been featured on CNN, Forbes and Inc.
If you are a blogger, feel free to check out our tools for bloggers.

It does not happen often but, today, I am speechless.

systematic review of the evidence for effectiveness and harms of specific spinal manipulation therapy (SMT) techniques for infants, children and adolescents has been published by Dutch researchers. I find it important to stress from the outset that the authors are not affiliated with chiropractic institutions and thus free from such conflicts of interest.

They searched electronic databases up to December 2017. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1–18 years), were included to determine effectiveness. Controlled and observational studies and case reports were included to examine harms. One author screened titles and abstracts and two authors independently screened the full text of potentially eligible studies for inclusion. Two authors assessed risk of bias of included studies and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines and CONSORT and TIDieR checklists. If appropriate, random-effects meta-analysis was performed.

Of the 1,236 identified studies, 26 studies were eligible. In all but 3 studies, the therapists were chiropractors. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication and treatment comparison were scarce. Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis. Five case reports described severe harms after HVLA manipulations in 4 infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of treatment.

The authors concluded that, based on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents. Outcomes in the included studies were mostly parent or patient-reported; studies did not report on intermediate outcomes to assess the effectiveness of SMT techniques in relation to the hypothesized spinal dysfunction. Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents. We encourage future research to describe effectiveness and safety of specific SMT techniques instead of SMT as a general treatment approach.

We have often noted that, in chiropractic trials, harms are often not mentioned (a fact that constitutes a violation of research ethics). This was again confirmed in the present review; only 4 of the controlled clinical trials reported such information. This means harms cannot be evaluated by reviewing such studies. One important strength of this review is that the authors realised this problem and thus included other research papers for assessing the risks of SMT. Consequently, they found considerable potential for harm and stress that under-reporting remains a serious issue.

Another problem with SMT papers is their often very poor methodological quality. The authors of the new review make this point very clearly and call for more rigorous research. On this blog, I have repeatedly shown that research by chiropractors resembles more a promotional exercise than science. If this field wants to ever go anywhere, if needs to adopt rigorous science and forget about its determination to advance the business of chiropractors.

I feel it is important to point out that all of this has been known for at least one decade (even though it has never been documented so scholarly as in this new review). In fact, when in 2008, my friend and co-author Simon Singh, published that chiropractors ‘happily promote bogus treatments’ for children, he was sued for libel. Since then, I have been legally challenged twice by chiropractors for my continued critical stance on chiropractic. So, essentially nothing has changed; I certainly do not see the will of leading chiropractic bodies to bring their house in order.

May I therefore once again suggest that chiropractors (and other spinal manipulators) across the world, instead of aggressing their critics, finally get their act together. Until we have conclusive data showing that SMT does more good than harm to kids, the right thing to do is this: BEHAVE LIKE ETHICAL HEALTHCARE PROFESSIONALS: BE HONEST ABOUT THE EVIDENCE, STOP MISLEADING PARENTS AND STOP TREATING THEIR CHILDREN!

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