Guest post by Ken McLeod
‘Ayurvedic Medicine,’ or Ayurveda, is an alternative medicine system which originated in India as long as 5,000 years ago, according to its proponents. Science-based medicine refers to it as pseudoscientific and the Indian Medical Association (IMA) characterises it as quackery.  Ayurvedic practitioners claim that its popularity through the ages vindicates it as safe and effective.
That last bit is of course the appeal to antiquity, or the appeal to tradition (also known as argumentum ad antiquitatem.  This proposes that if something was supported by people for a long time it must be valid. That is bunkum; many ancient ideas have long since been discredited; the Earth is not flat, no matter for how long people thought it was.
Nevertheless, ‘Ayurvedic Medicine’ has many practitioners and supporters in the supposedly rational West, including Bondi Junction here in Australia. Despite the many warnings about it,  people still go to practitioners, and occasionally they are injured.
One such injury and the consequent complaint to the New South Wales regulator, the Health Care Complaints Commission, (HCCC), has resulted in a Public Warning dated 18 September concerning levels of heavy metals in Ayurvedic Medication. 
The HCCC said:
‘The NSW Health Care Complaints Commission is concerned about a complaint received regarding the prescription of “Manasamithra Vatika,” (Manasamitram Pills) an Ayurvedic medication.
‘The complaint related to prescription of this medication to a child for treatment of autism.
‘This medication was found to contain concerning levels of lead and other heavy metals.’
That’s all very bland, no headlines there. But then it got into:
“The Commission strongly urges those individuals seeking alternative therapies to be vigilant in their research prior to proceeding with any natural therapy medications or medicines and to discuss any such proposed therapies with their treating registered health practitioner.”
Not so bland there; that’s very comprehensive; ‘any natural therapy medications or medicines’ and ‘discuss any such proposed therapies with their treating registered health practitioner.” ‘Note the HCCC’s emphasis on “registered.” That rules out Ayurvedic Medicine practitioners, homeopaths, and other assorted cranks; go to a real doctor.
Surely that is headline material; a regulator responsible for promoting the health of citizens warns them to go to real doctors before going to these quacks.
Then it gets better, (or worse if you are an Ayurvedic Medicine practitioner). At the same time the HCCC issued an Interim Prohibition Order against Mr Rama Prasad (“Ayurveda Doctor Rama Prasad.”)  The HCCC’s Order says:
‘The NSW Health Care Complaints Commission (“the Commission”) is currently investigating Mr Rama Prasad in relation to his prescribing of the Ayurvedic Medication “Manasamithra Vatika” (Manasamitram Pills) to both children and adults and about his claims that his treatments can reverse several aspects of autism in children.
‘The Ayurvedic Medication “Manasmithra Vatika” (Manasamitram Pills) was found to contain elevated levels of lead and other heavy metals.
‘One case with mildly elevated blood level was notified to the South Eastern Sydney Public Health Unit after consuming this product.
‘Clients residing in NSW who are considered to have been placed at possible risk have now been contacted by NSW Health public health personnel.
‘The Commission has issued an interim prohibition order in relation to Mr Rama Prasad, under section 41AA of the Health Care Complaints Act 1993 (‘The Act’). Mr Prasad is currently prohibited from providing any health services, either in paid employment or voluntarily, to any member of the public.
‘This interim prohibition order will remain in force for a period of eight weeks and may be renewed where appropriate in order to protect the health or safety of the public.’
That should send chills down the spine of any Ayurvedic Medicine practitioner. A complete Prohibition Order ordering Prasad not to engage in providing any health service as defined in the Act  for eight weeks, which may be renewed or even made permanent, depending on what the investigation finds. The Act includes a comprehensive list of activities that comprise a ‘health service’:
‘health service includes the following services, whether provided as public or private services:
- (a) medical, hospital, nursing and midwifery services,
- (b) dental services,
- (c) mental health services,
- (d) pharmaceutical services,
- (e) ambulance services,
- (f) community health services,
- (g) health education services,
- (h) welfare services necessary to implement any services referred to in paragraphs (a)–(g),
- (i) services provided in connection with Aboriginal and Torres Strait Islander health practices and medical radiation practices,
- (j) Chinese medicine, chiropractic, occupational therapy, optometry, osteopathy, physiotherapy, podiatry and psychology services,
- (j1) optical dispensing, dietitian, massage therapy, naturopathy, acupuncture, speech therapy, audiology and audiometry services,
- (k) services provided in other alternative health care fields,
- (k1) forensic pathology services,’
Note the inclusion of ‘health education.’ This is where so many cranks fall foul of the law; setting yourself up as a health educator makes you subject to the Act. Even if you claim to be a master chef, homeopath or Ayurvedic Medicine Practitioner, you are not exempt.
It’s early days yet in this particular saga, and there are many questions to be answered, for example:
- – How did this “medicine” get past Australia’s Therapeutic Goods Administration, (Australia’s equivalent to the US FDA)?
- – Did the TGA list or register it?
- – If not why not? If it was who is responsible?
- – Was this detected only after a child was so sickened that they were taken to hospital?
- – Why is the practitioner concerned still advertising his Ayurvedic medicine courses?  Is this a breach of his Prohibition Order which prohibits ‘health education services’?’
So stay tuned for updates as this case progresses. In the meantime note that an Australian Health regulator is advising the public to seek advice from real doctors before going to alternative therapists, including ‘Ayurvedic Medicine’ practitioners. That is a real headline.
 Such as from the Victoria Dept of Health at https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ayurveda
 Health Care Complaints Act 1993 https://www.legislation.nsw.gov.au/view/html/inforce/current/act-1993-105
Sorry, I have been neglecting my ‘heedless homeopathy’ series of articles – it’s all too human to forget, I suppose. Here are a few remedies which also seem ‘all to human’, but in a very different sense. As far as I can see, they all originate from human tissues or materials.
I was tempted to call these products cannibalistic homeopathy, but then I decided against it; after all, the remedies contain nothing at all, only their mother tinctures are based on human materials.
In any case, I thought you might be amused (or perhaps mildly disgusted?) by my list:
- Dental Plaque
- Lac Humanum (Human milk)
- Lac Humanum (Divya) (Human milk)
- Lac Maternum (Human milk)
- Lumbar disc
- Mastitis milk
- Medorrhinum americana
- Placenta (Eberle) (Placenta Humana)
- Placenta Humana (Placenta Humana (welsh))
- Retina (Retine)
- Semen humanum
- Sigmoid Colon
- Umbilical cord (Guild)
- Umbilicus humanus (Umbilical Cord Humanus)
- Vertebral disc
Looking at the list, I cannot help asking what these remedies might be used for. Applying the twisted logic of homeopathy, while mixing it with that of isopathy, I can just about understand that:
- MASTITIS MILK is for treating mastitis,
- LAC HUMANUM might be for a mother wanting to stop breast feeding,
- DENTAL PLAQUE could be against … yes, dental plaque!
But what might some of the other remedies on the list be for? Assuming that the human tissues are from biopsies or cadaveric material of (formerly) healthy individuals, I have to conclude that:
- VERTEBRAL DISC is for someone who is keen to have back problems.
- UTERUS is for a woman who wants to see more of her gynaecologist.
- SEMEN HUMANUM could be an anti-baby pill for men.
- MENSES might be an alternative for an oral contraceptive.
- etc. etc.
As many homeopathy-fans have been pointing out endlessly, I am not a truly qualified homeopath. This means that I am merely guessing here.
So, could a member of the homeopathic fraternity PLEASE enlighten me?
‘Infodemics’ are outbreaks of false information including rumours, stigma, and conspiracy theories. All of these have been common during the COVID-19 pandemic. The detection, assessment, and response to rumours, stigma, and conspiracy theories in real time are a challenge.
An international team of researchers followed and examined COVID-19-related rumours, stigma, and conspiracy theories circulating on online platforms, including fact-checking agency websites, Facebook, Twitter, and online newspapers, and their impacts on public health. Information was extracted between December 31, 2019 and April 5, 2020, and descriptively analysed. The team performed a content analysis of the news articles to compare and contrast data collected from other sources.
The researchers identified 2,311 reports of rumours, stigma, and conspiracy theories in 25 languages from 87 countries. Claims were related to:
- illness, transmission and mortality (24%),
- control measures (21%),
- treatment and cure (19%),
- cause of disease including the origin (15%),
- violence (1%),
- and miscellaneous (20%).
Of the 2,276 reports for which text ratings were available, 1,856 claims were false (82%).
The authors concluded that misinformation fuelled by rumours, stigma, and conspiracy theories can have potentially serious implications on the individual and community if prioritized over evidence-based guidelines. Health agencies must track misinformation associated with the COVID-19 in real time, and engage local communities and government stakeholders to debunk misinformation.
These findings are as perplexing as they are frightening. On this blog, we have since the beginning of the pandemic focussed on the SCAM for COVID-19. We have seen that this health crisis provided an occasion for almost any quackery on the planet:
- supplement salesmen,
- essential oil salesmen.
They all crept out of the woodwork. Their methods may differ, but their aim seems to be the same: to make a fast buck regardless of how many people their activities might kill.
… The global market for alternative and complementary medicines is projected to experience substantial growth in the next few years. The rising expenditure of the healthcare facilities is considered as the major factor that is likely to encourage the growth of the overall market in the coming years. In addition, the increasing number of initiatives being taken by Governments across the globe to promote alternative and complementary medicines is projected to accelerate the market’s growth. Thanks to these factors, the global alternative and complementary medicine market is likely to exhibit a promising growth rate in the near future.
A significant rise in the number of initiatives by NGOs and government organizations to encourage the use of alternative and complementary medicines is estimated to bolster global market in the near future. In addition to this, technological advancements in this field and the rising inclination of consumers towards these medicines and practices are likely to offer lucrative growth opportunities for the leading players operating in the alternative and complementary medicine market across the globe. However, the lack of scientific results is expected to hamper the overall growth of the market in the next few years…
From a regional perspective, Europe is considered as one of the leading segment, thanks to the significant revenue contribution in the last few years. This region is expected to account for a large share of the global alternative and complementary medicine market with the rising use of botanicals. In addition to this, the increasing awareness among consumers regarding the availability of effective alternative and complementary medicines and the benefits they offers are expected to encourage the growth of the Europe market in the coming years.
Furthermore, with the rising popularity of medical tourism, the alternative and complementary medicine market in Asia Pacific is projected to witness a steady growth in the next few years. Moreover, the presence of a large number of new players operating in this region is likely to offer promising growth opportunities over the forecast period. The Middle East and Africa segment is anticipated to experience a healthy growth in the alternative and complementary medicine market in the near future.
The global market for alternative and complementary medicines is presently at a highly competitive stage and is predicted to experience an intense level of competition among the leading players in the coming years. The prominent players in the market are focusing on the expansion of the product portfolio so as to attract a large number of consumers across the globe. This is likely to help them in creating a brand name and acquiring a leading position in the global market. Some of the leading players operating in the alternative and complementary medicine market across the globe are Herb Pharm, Yoga Tree, Quantum Touch Inc., Helio USA Inc., Pure encapsulations, Inc., Pacific Nutritional Inc., Deepure Plus, Herbal Hills, Iyengar Yoga Institute, The Healing Company, and Nordic Naturals.
Yes, I know, this is little more than hot air mixed with platitudes and advertisements to purchase the full report. I used to buy such documents for my department and research but was invariably disappointed. They provide are expensive and of very little of value.
Yet, one thing has been confirmed over the years: the prediction of steady growth of the SCAM-industry is rarely wrong (certain sections, such as homeopathy, have been shrinking in some regions, but the industry as a whole is financially healthy). The scientific evidence seems to get less and less convincing, yet consumers buy more and more of these products. They may do little good and have the potential to cause quite a bit of harm, but consumers continue to waste their money on them.
The question is: why?
There are, of course, many reasons. An important one is that the gullible public wants to believe in SCAM, and the SCAM-industry is highly skilled in misleading us. What is worse: many governments, instead of limiting the damage, are mildly or even overtly supportive of the SCAM-industry.
Whenever I contemplate this depressing state of affairs, I realise that my blog is important. It is only a drop in the ocean, I know, but still…
The definitions of a quack as used in healthcare vary somewhat:
- ignorant, misinformed, or dishonest practitioner of medicine
- untrained person who pretends to be a physician and dispenses medical advice and treatment
- people who claim to be skilled in medicine but are not
- person who dishonestly pretends to have medical skills or knowledge
- one who misrepresents ability and experience in diagnosis and treatment of disease or the effects to be achieved by treatment
Richard Lanigan, in his post entitled Skeptics like Edzard Ernst remind me of Humpty Dumpty in their use of words. They make them up as they go along prefers the the definition from the Oxford dictionary: “a person who dishonestly claims to have special knowledge and skill in some field, typically medicine” (actually, the version of the Oxford dictionary I accessed defines a quack not quite like this but as a person who dishonestly claims to have medical knowledge or skills).
More importantly, Richard claims in an oddly incoherent post that not the chiropractors but the critics of chiropractic are are the true quacks:
It would appear “quacks” are people who pretend to have expertise in subjects they know little about, presumably subjects like, chiropractic medicine or acupuncture. I practice chiropractic, I dont diagnose or treat illness or disease, I dont make medical claims. You may not like chiropractic or understand it, however practicing chiropractic would not appear to conform to the definition of “quackery”, however claiming to have “special knowledge” about chiropractic and having only been trained as a medical practitioner may in fact make you a “quack” professor Ernst. All I do is maintain movement in spinal joints that become stiff from sedentary lifestyles, movement effects function of mechano receptors(nerves) in spinal joints. You may not believe that is possible, you may not believe maintaining joint function is important or that it effects wellbeing, you are perfectly entitled to your opinion, however I am not so confident of you depth and breath knowledge in anatomy and physiology. You might start by asking, why joints were immobility post surgery in the 80s and now post surgical treatment is all about maintaining joint motion as chiropractors have been advocating for years.
If I understand this correctly, this means: any non-chiropractor who criticises chiropractic is a quack. Moreover, it means that, as chiropractic is very rarely criticised by a chiropractor, chiropractors cannot be quacks.
I find this fascinating. It amounts to the legitimisation of any healthcare profession, however bizarre, unproven, disproven or dangerous their practice might be:
- crystal therapists cannot be accused of quackery, because only their kind understand their business;
- rebirthing practitioners cannot be accused of quackery, because only their kind understand their business;
- applied kinesiologists cannot be accused of quackery, because only their kind understand their business;
- bioresonance practitioners cannot be accused of quackery, because only their kind understand their business;
- Bach flower therapists therapists cannot be accused of quackery, because only their kind understand their business;
- colour therapists cannot be accused of quackery, because only their kind understand their business;
- colon therapists cannot be accused of quackery, because only their kind understand their business;
- dowsers cannot be accused of quackery, because only their kind understand their business;
- ear candle practitioners cannot be accused of quackery, because only their kind understand their business;
- feng shui practitioners cannot be accused of quackery, because only their kind understand their business;
- faith healers cannot be accused of quackery, because only their kind understand their business;
- gua sha practitioners cannot be accused of quackery, because only their kind understand their business;
- iridologists cannot be accused of quackery, because only their kind understand their business;
- homeopaths cannot be accused of quackery, because only their kind understand their business;
- naprapathy therapists cannot be accused of quackery, because only their kind understand their business;
- neurolinguistic programmers cannot be accused of quackery, because only their kind understand their business;
- osteopaths cannot be accused of quackery, because only their kind understand their business;
- pranic healers cannot be accused of quackery, because only their kind understand their business;
- psychic surgeons cannot be accused of quackery, because only their kind understand their business;
- radionics practitioners cannot be accused of quackery, because only their kind understand their business;
- reflexologists cannot be accused of quackery, because only their kind understand their business;
- Reiki masters cannot be accused of quackery, because only their kind understand their business;
- shiatsu practitioners cannot be accused of quackery, because only their kind understand their business;
- therapeutic touchers cannot be accused of quackery, because only their kind understand their business;
- vaginal steamers cannot be accused of quackery, because only their kind understand their business;
- etc, etc.
I can, of course, easily see why Richard Lanigan would like this concept to be true. Alas, Richard (and all the other SCAM-enthusiasts who make similar arguments), it does not work like this! A quack might be defined as listed above or in many other ways. But, in so-called alternative medicine (SCAM), a quack foremost is a person who habitually misleads the public by making claims that are not supported by sound evidence. And as some wise guy once observed: honest conviction renders a quack only more dangerous. As to the professional background of a quack:
I do not care a hoot!
I have done my best to disclose quackery no matter whether it came from a medic or a SCAM-practitioner, a physio or a nurse, an entrepreneur or a fruitcake, an evangelist or a politician, royalty or commoner. And, believe me, Richard (plus all the other SCAM-enthusiasts who make similar arguments), I will carry on doing so, whether it fits into your little scheme of wishful thinking or not.
My new book has just been published. Allow me to try and whet your appetite by showing you the book’s introduction:
“There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking.” These words of Fontanarosa and Lundberg were published 22 years ago. Today, they are as relevant as ever, particularly to the type of healthcare I often call ‘so-called alternative medicine’ (SCAM), and they certainly are relevant to chiropractic.
Invented more than 120 years ago by the magnetic healer DD Palmer, chiropractic has had a colourful history. It has now grown into one of the most popular of all SCAMs. Its general acceptance might give the impression that chiropractic, the art of adjusting by hand all subluxations of the three hundred articulations of the human skeletal frame, is solidly based on evidence. It is therefore easy to forget that a plethora of fundamental questions about chiropractic remain unanswered.
I wrote this book because I feel that the amount of misinformation on chiropractic is scandalous and demands a critical evaluation of the evidence. The book deals with many questions that consumers often ask:
- How well-established is chiropractic?
- What treatments do chiropractors use?
- What conditions do they treat?
- What claims do they make?
- Are their assumptions reasonable?
- Are chiropractic spinal manipulations effective?
- Are these manipulations safe?
- Do chiropractors behave professionally and ethically?
Am I up to this task, and can you trust my assessments? These are justified questions; let me try to answer them by giving you a brief summary of my professional background.
I grew up in Germany where SCAM is hugely popular. I studied medicine and, as a young doctor, was enthusiastic about SCAM. After several years in basic research, I returned to clinical medicine, became professor of rehabilitation medicine first in Hanover, Germany, and then in Vienna, Austria. In 1993, I was appointed as Chair in Complementary Medicine at the University of Exeter. In this capacity, I built up a multidisciplinary team of scientists conducting research into all sorts of SCAM with one focus on chiropractic. I retired in 2012 and am now an emeritus professor. I have published many peer-reviewed articles on the subject, and I have no conflicts of interest. If my long career has taught me anything, it is this: in the best interest of consumers and patients, we must insist on sound evidence; not opinion, not wishful thinking; evidence.
In critically assessing the issues related to chiropractic, I am guided by the most reliable and up-to-date scientific evidence. The conclusions I reach often suggest that chiropractic is not what it is often cracked up to be. Hundreds of books have been published that disagree. If you are in doubt who to trust, the promoter or the critic of chiropractic, I suggest you ask yourself a simple question: who is more likely to provide impartial information, the chiropractor who makes a living by his trade, or the academic who has researched the subject for the last 30 years?
This book offers an easy to understand, concise and dependable evaluation of chiropractic. It enables you to make up your own mind. I want you to take therapeutic decisions that are reasonable and based on solid evidence. My book should empower you to do just that.
I have to admit that the ‘Asian Journal of Pharmaceutical Research and Development‘ did not formerly belong to my reading list. This will have to change, I guess, because any journal capable of publishing such a hilarious spoof ought to be read regularly.
The article in question is entitled ‘An Integrative Medicine Is Prudential Hope for Covid-19 Therapeutics‘ and is authored by Mayank dimri, Rajendra Singh Pawar, Virbal Singh Rajwar, Luv Kush from the SBS University Balawala, Dehradun- Uttarakhand, India. The paper is so unique that I simply could not resist showing you an excerpt. I hope you have as much fun reading it as I had when I was alerted to this masterpiece.
Antiviral Astrological Rationality The viral infectivity is governed by Saturn, Rahu and Ketu. COVID-19 is geminian virus, ruled by mercury. It rules lungs / respiratory system and also health/ nutrition house (6th). Antiviral astrological advices are: Stay away from crowds, maintain maximum cleanness and personal hygiene, dietary regimens should be enriched by vitamins, vegetables, nuts and fruits. The foods and drinking water should be warm. The cold and unhealthy environment may be avoided.
The complimentary / alternative integrative medicine conceptualized ethical use of traditional re- medies with
self-responsibility. The concept of herd immunity (epidemological) relates to population. The orthomolecular
medicine10prescribe nutritional supplements for restoration of antiviral immunity. Both have antiviral benefits for fighting global pandemic of COVID-19.
The desirable antiviral activities are anti-replicating to block viral replication, anti-inflammatory for preventing
viral inflammation. Immune stimulatory for strengthening innate immunity and anti-mutagenic for curbing viral mutations.
The ayurvedic herbs have antiviral phytochemicals. Some of them are listed here: Ursolic acid, Apigenin, Rosmarinic acid, Oleanolic acid, Elenoic acid, Hypercin,Liquiritigenin, Acetoside, Glycyrrhizin etc. They have anti RSV activity and possibly prevent viral entry to host cells. The plant extract of Plantago asiatica and Clerodendrum trichotomum proved to be effective antiviral. Fifatrol is an ayurvedic prized medicine against viruses. It is useful in treatment of viral upper respiratory infections and relief from nasal congestion. It is a supportive therapy against COVID-19 virus.
The synergism of vitamins (A, C, D, E) acts as revitaler for fighting against COVID-19. Vitamin C has great potential
as antiviral for respiratory infections. It prevents cytokine induced lung damage and natural immune booster.
Eucalyptus oil has multiple benefits.It is supporter of respiratory system, immune booster and anti-inflammatory. Aromadendrene is an aroma therapeutical, present in oil and moderate antiviral….
I know that the last few months have not been easy for many of us. Therefore, we should be all the more thankful for those who lighten our spirits with some comic relief…
… or did they actually mean what they wrote?
The purpose of this feasibility study was to:
(1) educate participants about the concept of Reiki,
(2) give participants the opportunity to experience six Reiki therapy sessions and subsequently assess outcomes on chronic pain,
(3) assess participants’ impression of and willingness to continue using and recommending Reiki therapy as adjunct for the treatment of chronic pain.
Using a prospective repeated measures pre- and postintervention design, a convenience sample of 30 military health care beneficiaries with chronic pain were educated about Reiki and received six 30-minute Reiki sessions over 2 to 3 weeks. Pain was assessed using a battery of pain assessment tools as well as assessment of impression of and willingness to share the concept of Reiki.
Repeated measures ANOVA analyses showed that there was significant decrease (P < 0.001) in present, average, and worst pain over the course of the six sessions with the most significant effect occurring up to the fourth session. When a variety of descriptor of pain was assessed, Reiki had a significant effect on 12 out of the 22 assessed, with the most significant effect on pain that was described as tingling/pins and needles (P = 0.001), sharp (P = 0.001), and aching (P = 0.001). Pain’s interference with general activity, walking, relationships, sleep, enjoyment of life, and stress significantly decreased (P < 0.001 to P = 0.002). Impression of improvement scores increased 27 % by session 6, and one’s knowledge about Reiki improved 43%. Eighty-one percent of the participants stated that they would consider scheduling Reiki sessions if they were offered with 70% desiring at least four sessions per month.
The authors concluded that 30-minute Reiki session, performed by a trained Reiki practitioner, is feasible in an outpatient setting with possible positive outcomes for participants who are willing to try at least four consecutive sessions. Reiki has the ability to impact a variety of types of pain as well as positively impacting those activities of life that pain often interferes with. However, education and the opportunity to experience this energy healing modality are key for its acceptance in military health care facilities as well as more robust clinical studies within the military health care system to further assess its validity and efficacy.
Where to begin?
- As a feasibility study, this trial should not evaluate outcome data; yet the paper focusses on them.
- To educate people one does certainly not require to conduct a study.
- That Reiki ‘is feasible in an outpatient setting‘ is obvious and does not need a study either.
- The finding that ‘Reiki had a significant effect’ is an unjustified and impermissible extrapolation; without a control group, it is not possible to determine whether the treatment or placebo-effects, or the regression towards the mean, or the natural history of the condition, or a mixture of these phenomena caused the observed outcome.
- The conclusion that ‘Reiki has the ability to impact a variety of types of pain as well as positively impacting those activities of life that pain often interferes with’ is quite simply wrong.
- The authors mention that ‘This study was approved by the U.S. Army Medical Research and Materiel Command Institutional Review Board’; I would argue that the review board must have been fast asleep.
Steiner with his wife (right) and Ita Wegman, his lover (left).
Anthroposophic medicine was founded by Steiner and Ita Wegman in the early 20th century. Currently, it is being promoted as an extension of conventional medicine. Proponents claim that “its unique understanding of the interplay among physiological, soul and spiritual processes in healing and illness serves to bridge allopathy with naturopathy, homeopathy, functional/nutritional medicine and other healing systems.” Its value has repeatedly been questioned, and clinical research in this area is often less than rigorous.
Anthroposophic education was developed in the Waldorf school that was founded by Steiner in 1919 to serve the children of employees of the Waldorf-Astoria cigarette factory in Stuttgart, Germany. Pupils of Waldorf or Steiner schools, as they are also frequently called, are encouraged to develop independent thinking and creativity, social responsibility, respect, and compassion.
Waldorf schools implicitly infuse spiritual and mystic concepts into their curriculum. Like some other alternative healthcare practitioners – for instance, doctors promoting integrative medicine, chiropractors, homeopaths and naturopaths – some doctors of anthroposophic medicine take a stance against childhood immunizations. In a 2011 paper, I summarised the evidence which showed that in the UK, the Netherlands, Austria and Germany, Waldorf schools have been at the centre of measles outbreaks due to their stance regarding immunisations.
More recently, a study evaluated trends in rates of personal belief exemptions (PBEs) to immunization requirements for private kindergartens in California that practice alternative educational methods. The investigators used California Department of Public Health data on kindergarten PBE rates from 2000 to 2014 to compare annual average increases in PBE rates between schools.
Alternative schools had an average PBE rate of 8.7%, compared with 2.1% among public schools. Waldorf schools had the highest average PBE rate of 45.1%, which was 19 times higher than in public schools (incidence rate ratio = 19.1; 95% confidence interval = 16.4, 22.2). Montessori and holistic schools had the highest average annual increases in PBE rates, slightly higher than Waldorf schools (Montessori: 8.8%; holistic: 7.1%; Waldorf: 3.6%).
The authors concluded that Waldorf schools had exceptionally high average PBE rates, and Montessori and holistic schools had higher annual increases in PBE rates. Children in these schools may be at higher risk for spreading vaccine-preventable diseases if trends are not reversed.
As the world is hoping for the arrival of an effective vaccine against the corona virus, these figures should concern us.
I have long cautioned that chiropractic overuse of X-rays is a safety problem. Is this still an issue? A recent paper was aimed at finding out.
The objective of this review was to determine the diagnostic and therapeutic utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. Investigate whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. The research objectives required that the researchers determine the validity, diagnostic accuracy and reliability of radiographs for the structural and functional evaluation of the spine.
The investigators searched MEDLINE, CINAHL, and Index to Chiropractic Literature from inception to November 25, 2019. They used rapid review methodology recommended by the World Health Organization. Eligible studies (cross-sectional, case-control, cohort, randomized controlled trials, diagnostic and reliability) were critically appraised. Studies of acceptable quality were included in our synthesis.
Twenty-three papers were critically appraised. No relevant studies assessed the clinical utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. No studies investigated whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. Nine low risk of bias studies investigated the validity (n = 2) and reliability (n = 8) of routine or repeat radiographs. These studies provided no evidence of clinical utility.
The authors’ conclusions are clear: We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients. Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine.
In the paper, the authors provided further valuable information and background:
In the United States in 2010, the rate of spine radiographs within 5 days of presenting to a chiropractor was 204 per 1000 new patients. An analysis of national trends in the United States suggests that the rate of spinal radiography by chiropractors and podiatrists increased by 14.4% between 2003 and 2015. This increase occurred despite the publication of several evidence-based clinical practice guidelines and clinical prediction rules to assist chiropractors in determining the indication for spine radiographs to assist with diagnosing a pathology. Overall, guidelines suggest that radiographs are indicated when signs and symptoms of potentially serious underlying pathology (red flags) are identified through the clinical history and physical examination. However, on its own, an isolated “red flag” may have a high false positive rate for the diagnosis of underlying spinal pathology, such as cancer. For example, the presence of a solitary “red flag” such as age over 50 years may not be sufficient to warrant taking spine radiographs. Therefore, clinicians are encouraged to combine sound clinical judgement and the assessment of red flags when ordering radiographs.
In the absence of “red flags”, the use of spinal radiographs is not recommended. Nevertheless, factions of chiropractors, including the International Chiropractic Association promote the use of routine or repeat radiographs to assess the structure and function of the spine. This practice which dates back to 1910 was initiated when no evidence was available to guide the judicious use of spine radiographs. Historically, these groups of chiropractors have argued that radiographs are helpful to measure postural abnormalities, identify vertebral misalignment or subluxation and guide treatment with spinal manipulative therapy. The belief that radiographs are useful to detect and correct spine structure and function provides the foundation for many chiropractic technique systems that are still in use today. To our knowledge, approximately 23 chiropractic techniques use spine radiography (including full spine radiography) to guide the clinical management of patients. These include the Gonstead, Chiropractic BioPhysics®, Toggle-Recoil, and National Upper Cervical Chiropractic Association (NUCCA) techniques. Proponents of these techniques claim that the use of routine and repeat radiographs is supported by scientific evidence and have published a guideline to assist clinicians with the biomechanical assessment of spinal subluxation in chiropractic clinical practice using radiography. However, these claims have not yet been evaluated for their clinical utility, the benefit a patient gains from a test or treatment. This was a particular concern for the College of Chiropractors of British Columbia (CCBC) which regulates the practice of chiropractic in the province of British Columbia, Canada. The mission of the CCBC is to protect the public by regulating British Columbia’s doctors of chiropractic to ensure safe, qualified and ethical delivery of care.
The references from these two paragraphs can be found in the original paper. One reference the authors did not include was my article of 1998 which, at the time, received plenty of angry responses from chiropractors. Here is its conclusion: DATA SUGGEST AN OVERUSE OF RADIOGRAPHY BY THE CHIROPRACTIC PROFESSION. THIS CONSTITUTES A SAFETY PROBLEM THAT DESERVES TO BE TAKEN SERIOUSLY AND REQUIRES FURTHER RESEARCH.
Twenty-two years later, do I get the impression that the chiropractic profession might not be the fastest in getting its act together?