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

education

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If you google ‘chiropractic’ you might get the impression that an unusual number of US chiros are outright perverts. Here are four current cases that I found instantly without any in-depth seraching:

Case No 1

A “Christian chiropractor” is facing several criminal charges after at least eight former clients have accused him of rape and sexual assault. Roc Byrd, 61, of Danville, who worked as a chiropractor for Cornerstone Chiropractic in Avon, is facing one felony count of rape, five felony counts of sexual battery and four misdemeanor counts of battery. He is accused of raping a client, touching clients inappropriately over and under their clothes during appointments without consent and pressing his genitals up against multiple patients. Byrd identified himself as a practicing Christian and reportedly began each of his chiropractic appointments by praying with clients.

Case No 2

A Warren chiropractor faces significant legal problems and a criminal investigation into how he allegedly treated one of his patients. Officials say he sells himself as one of only a handful of Michigan “Chiropractic Neurologists,” but the former patient claims he is a sexual predator and offers video as apparent proof. The case involves Dr. John Pispidikis of the Spinal Recovery Center. The complaint was filed Friday (April 19) morning, which surprised the doctor. The patient involved remains unnamed in the civil court documents, but she claims the doctor groped her during a physical exam last February. But she had no proof, so she claims she went out and got some.

Case No 3

The Oklahoma Board of Chiropractic Examiners (OBCE) has ordered the Back Stop’s only chiropractor, Mark Kimble to surrender his license by next Monday after several sexual impropriety allegations against him have surfaced. Oklahoma Board of Chiropractic Examiners confirmed with KFOR that there are seven alleged victims of Kimble’s who have come forward.

Case No 4

The Los Angeles County Sheriff’s Department is looking for possible victims of a chiropractor accused of sexual assault. Richard Carnow, 65, was arrested by authorities on March 13 on four felony counts of sexual battery. Carnow is a chiropractor in San Dimas in the San Gabriel Valley, the Sheriff’s Department says. He’s accused of sexually assaulting multiple adult women between June 2023 and August 2023. Officials did not say if his alleged victims were current or former patients. Investigators say the nature of the alleged crimes have led them to believe there may be additional victims and they are asking for the public’s help to find them.

Yes, I know, these are (according to chiros’ assurances) regrettable, isolated cases – nothing to worry about!

But perhaps these assertions are wrong and there is a problem after all?

I am reminded of my post from 2021; let me refresh your memory:

Two chiropractors conducted a retrospective review of publicly available data from the California Board of Chiropractic Examiners. Their aim was to determine categories of offense, experience, and gender of disciplined doctors of chiropractic (DC) in California and compare them with disciplined medical physicians in California. The DC disciplinary categories, in descending order, were

  • fraud (44%),
  • sexual boundary issues (22%),
  • other offences (13%),
  • abuse of alcohol or drugs (10%),
  • negligence or incompetence (6%),
  • poor supervision (2%),
  • mental impairment (.3%).

The authors concluded that the professions differ in the major reasons for disciplinary actions. Two thirds (67%) of the doctors of chiropractic were disciplined for fraud and sexual boundary issues, compared with 59% for negligence and substance misuse for medical physicians. Additional study in each profession may reveal methods to identify causes and possible intervention for those who are at high risk.

The abstract of the paper does not provide comparisons to with the medical profession. Here they are; relative to doctors, chiropractors are:

  • 2 x more likely to be involved in malpractice,
  • 9 x more likely to commit  fraud,
  • 2 x more likely to transgress sexual boundaries.

________________________

Could it be, I askmyself, that there is something deeply wrong with the chiropractic profession? Could it perhaps be that chiro schools do not have a good hand when it comes to student recruitment? Could it be that chiro schools teach too little medical ethics, or none at all?

Acute tonsillitis, which includes tonsillopharyngitis, is a common condition, particularly in childhood. It is mostly caused by a viral infection. Symptomatic treatment is of high importance. But which treatment is effective and which isn’t?

For this expert consensus, 53 physicians from Germany, Spain, Netherlands, Switzerland, Austria, and Hungary with at least one year of experience in anthroposophic paediatric medicine were invited to participate in an online Delphi process. The process comprised 5 survey rounds starting with open-ended questions and ending with final statements, which need 75% agreement of experts to reach consensus. Expert answers were evaluated by two independent reviewers using MAXQDA and Excel.

Response rate was between 28% and 45%. The developed recommendation included 15 subtopics. These covered clinical, diagnostic, therapeutic and psychosocial aspects of acute tonsillitis. Six subtopics achieved a high consensus (>90%) and nine subtopics achieved consensus (75-90%). The panel felt that AM was an adequate therapy for acute tonsillitis.

The authors of this paper concluded that the clinical recommendation for acute tonsillitis in children aims to simplify everyday patient care and provide decision-making support when considering and prescribing anthroposophic therapies. Moreover, the recommendation makes AM more transparent for physicians, parents, and maybe political stakeholders as well.

I found it hard to decide whether to cry or to laugh while reading this paper.

Experience in anthroposophic paediatric medicine does not make anyone an expert in anything other than BS.

Expert consensus and clinical guidelines are not conducted by assembling a few people who all are in favour of a certain therapy while ignoring the scientific evidence.

AM for acute tonsillitis in children is nonsense, whatever these pseudo-experts claim.

Imagine we run a Delphi process with a few long-standing members of ‘the flat earth society’ and ask them to tell us about the shape of the earth …

…I rest my case.

We all have heard of so-called alternative therapies but few of us are aware of the fact that there are also alternative diagnoses. These are diagnoses used regularly by practitioners of so-called alternative medicine (SCAM) that have no basis on science, or – to put it simply – that do not exist. They are nonetheless popular with SCAM practitioners and allegedly cause a wide range of non-specific symptoms such as:

  • anxiety,
  • brain fog,
  • constipation,
  • depression,
  • dizziness,
  • fatigue,
  • headaches,
  • heart palpitations,
  • insomnia,
  • irritability,
  • muscle and joint pain,
  • loss of appetite,
  • loss of libido,
  • weight gain.

In this series of posts, I will briefly discuss some of these diagnoses and list the treatments that SCAM practitioners might recommend for them.

Adrenal Fatigue

Adrenal fatigue is not the same as adrenal insufficiency or Addison’s disease; it is a term coined by a chiropractor who claimed that the stresses of modern life tire out the adrenal glands. In turn, this phenomenon allegedly leads to generalised weariness.

There is not evidence that this is true, nor that adrenal fatigue even exists. A systematic review of the evidence concluded that “there is no substantiation that adrenal fatigue is an actual medical condition.”

Yet, SCAM practitioners advise to cure adrenal fatigue with a range of dietary supplements (e.g. fish oil, ashwagandha, rhodiola rosea, schisandra and holy basil, licorice, magnesium, various vitamins), special diets, lifestyle adjustments, stress management and many other SCAMs. They all have in common that their effectiveness is not supported by convincing evidence from rigorous clinical trials.

Candidiasis hypersensitivity

Most of us are infected by the fungus Candida albicans without being affected by it in any way. Yet, many SCAM practitioners claim that candidiasis hypersensitivity is a condition that causes symptoms like fatigue, premenstrual tension, gastrointestinal symptoms, and depression and therefore needs treating.

But, candidiasis hypersensitivity does not exist. An RCT concluded that, “in women with presumed candidiasis hypersensitivity syndrome, nystatin does not reduce systemic or psychological symptoms significantly more than placebo.”

This, however, does not stop SCAM practitioners to recommend numerous forms of SCAM to treat the condition, e.g.: dietary supplements containing probiotics, milk thistle, red thyme, barberry, garlic, or external applications of coconut oil, essential oils of peppermint oil, lavender oil, oregano oil,  and tea tree. No sound evidence exists to show that ant of these SCAMs can successfully treat the condition.

Chronic intoxications

Chronic intoxications do ecist, of course. But in the realm of SCAM, they are diagosed for the sole putpose of selling their various  ‘detox’ treatments. The alleged rationale is that our bodies are overloaded with all sorts ot harmful substances, for instance, from the environment, from our food, from modern drugs, or from our own metabolism.

To eliminate them, we need to ‘detox’. For that purpose, SCAM practitioners recommend a very wide range of SCAMs; in fact, it is hardly possible to identify a single form of SCAM that is not said to detoxify our bodies. Yet, for none of them is there compelling evidence that it eliminates toxins from our body. Some of the most popular detox regimen include:

Interim conclusion: non-existing diagnoses are perfect opportunities for SCAM practitioners to rip off gullible patients.

 

The Academy of Homeopathy Education is a US-based accredited teaching institution offering homeopathy education services to professional and medically licensed homeopathy students. This study reports on clinical outcomes from the teaching clinic from 2020 to 2021.

Data were collected using the patient-generated outcome measure, the Measure Yourself Concerns and Wellbeing (MYCaW). Mean MYCaW values for initial and subsequent consultations were analyzed for the degree of change across the intervention period in 38 clients. Each client listed up to two complaints. MYCaW scores between initial and subsequent consultations were analyzed for the degree of change (delta) across the intervention period.

A total of 95 body system-related symptoms were analyzed for change in intensity following the homeopathic intervention. Statistically significant improvements in the intensity of main symptoms were observed between initial and subsequent follow-ups. The main symptom scores showed a mean change in intensity (delta MYCaW) of −0.79 points (95% confidence interval (CI), −1.29 to −0.29; p = 0.003) at first follow-up, a mean change of −1.67 points (95% CI, −2.34 to −0.99; p = 0.001) at second follow-up compared with the initial visit, and a mean change of −1.93 points (95% CI, −3.0 to −0.86; p = 0.008) at third follow-up compared with the initial visit. For clients with four or more follow-ups, the mean delta MYCaW was −1.57 points (95% CI, −2.86 to −0.28; p = 0.039).

The authors concluded that statistically significant improvements as well as some clinically meaningful changes in symptom intensity were found across a diverse group of individuals with a variety of long-term chronic conditions. The improvement was evident across different body systems and different levels of chronicity. There are limitations to the generalizability of the study due to the research design. Further research and investigation are warranted given the promising results of this work.

There are, of course, not just limits to the generalizability of this study! I’d say there are limits to the interpretation of any of its findings.

What was the cause of the improvements?

Here are just a few questions that I asked myself while reading this paper:

  • Are the guys from the Academy of Homeopathy Education not aware of the fact that even chronic conditions often get better by themselves?
  • Have they heard of the placebo effect?
  • Are they trying to tell us that the patients did not also use conventional treatments for their chronic conditions?
  • What about regression towards the mean?
  • What about social desirability?
  • Why do they think that further research is needed?
  • Are these really results that look ‘promising for homeopathy?

To answer just the last question: No, these findings are in perfect agreement with the fact that highly diluted homeopathic remedies are pure placebos (to be honest, they would even be in agreement with such remedies being mildly harmful).

 

‘WORLD HOMEOPATHY DAY’ is upon us and the Internet is awash with pro-homeopathy comments, e.g.:

  • World Homeopathy Day is observed annually on April 10th to commemorate the birth anniversary of Samuel Hahnemann, a prominent figure in the development of homeopathy. This day celebrates the principles and practices of homeopathy, an alternative medicinal approach that emphasizes treating ailments by utilizing natural substances and stimulating the body’s inherent healing abilities.
  • The theme for World Homeopathy Day 2024 is ‘Empowering Research, Enhancing Proficiency: A Homeopathy Symposium”. This theme underscores the significance of continuous research in homeopathy and the need to upgrade capability in its training to give better medical care results.

Even slightly less biased sources cannot bring themselves to a more realistic approach, e.g.:

The significance of the World Homeopathy Day is said to be as follows:

  • Raising Awareness: World Homeopathy Day has successfully brought homeopathy to the forefront of public attention, generating dialogue and interest in its principles and practices.
  • Bridging Communities: The Day serves as a platform for bringing together homeopaths, practitioners, researchers, and individuals interested in alternative medicine, fostering collaboration and knowledge exchange.
  • Focus on Education: World Homeopathy Day emphasizes the importance of education and ethical practices within the field, promoting responsible usage and informed choices for individuals seeking homeopathic care.

World Homeopathy Day is about understanding and exploring the potential of this alternative medicine system while keeping an open mind and prioritizing evidence-based healthcare practices.

So, let me try to counter-balance these texts by showing you what my recently published 7 key points about homeopathy tell us:

Homeopathy is popular, particularly in India, Germany, France and parts of South America. It was invented more than 200 years ago and still divides opinions like few other subjects in alternative medicine.

  1. Homeopathy was invented by the German physician, Samuel Hahnemann (1755–1843). At the time, our understanding of the laws of nature was woefully incomplete, and therefore Hahnemann’s ideas seemed less implausible than today. The conventional treatments of this period were often more dangerous than the disease they were supposed to cure. Consequently, homeopathy was repeatedly shown to be superior to ‘allopathy’ (a term coined by Hahnemann to denigrate conventional medicine) and Hahnemann’s treatments were an almost instant, worldwide success.[1]
  2. Many consumers confuse homeopathy with herbal medicine; yet the two are fundamentally different. Herbal medicines are plant extracts that contain potentially active ingredients. Homeopathic remedies are based on plants or any other material and they are typically so dilute that they contain not a single molecule of the substance advertised on the bottle. The most frequently used dilution (homeopaths call them ‘potencies’) is a ‘C30’; a C30-potency has been diluted 30 times at a ratio of 1:100. This means that one drop of the staring material is dissolved in 1 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 000 drops of diluent (usually a water/alcohol mixture)—and that equates to less than one molecule of the original substance per all the molecules of the universe.
  3. Homeopaths claim that their remedies work via some ‘energy’ or ‘vital force’ and that the process of preparing the homeopathic dilutions (it involves vigorous shaking the mixtures at each dilution step) transfers this ‘energy’ or information from one to the next dilution. They also believe that the process of diluting and agitating their remedies, which they call potentisation, renders them not less or not more potent. Homeopathic remedies are usually prescribed according to the ‘like cures like’ principle: if, for instance, a patient suffers from runny eyes, a homeopath might prescribe a remedy made of onion, because onion make a healthy person’s eyes water. This and all other assumptions of homeopathy contradict the known laws of nature. In other words, we do not fail to comprehend how homeopathy works, but we understand that it cannot work unless the known laws of nature are wrong.
  4. According to Hahnemann’s classical homeopathy, homeopaths are focussed on the symptoms and characteristics of the patient. They conduct a lengthy medical history, and they show little or no interest in a physical examination of their patient or other diagnostic procedures. Once they are confident to have all the information they need, they try to find the optimal homeopathic remedy. This is done by matching the symptoms with the drug pictures of homeopathic remedies. Any homeopathic drug picture is essentially based on what has been noted in homeopathic provings where healthy volunteers take a remedy and monitor all that symptoms, sensations and feelings they experience subsequently. Thus, the optimal homeopathic remedy can be seen as a diagnosis which makes homeopathy also a diagnostic method.[2]
  1. Today, around 500 clinical trials of homeopathy have been published. The totality of this evidence fails to show that homeopathic remedies are more than placebos.[3] Numerous official statements from various countries confirm the absurdity of homeopathy, for instance:
  • “The principles of homeopathy contradict known chemical, physical and biological laws and persuasive scientific trials proving its effectiveness are not available” (Russian Academy of Sciences, Russia)
  • “Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.” (National Health and Medical Research Council, Australia)
  • “Homeopathic remedies don’t meet the criteria of evidence-based medicine.” (Hungarian Academy of Sciences, Hungary)
  • “The incorporation of anthroposophical and homeopathic products in the Swedish directive on medicinal products would run counter to several of the fundamental principles regarding medicinal products and evidence-based medicine.” (Swedish Academy of Sciences, Sweden)
  • “There is no good-quality evidence that homeopathy is effective as a treatment for any health condition” (National Health Service, England)
  1. Yet, many patients undeniably do get better after taking homeopathic remedies. The best evidence available today clearly shows that this improvement is unrelated to the homeopathic remedy per se. It is the result of a lengthy, empathetic, compassionate encounter with a homeopath, a placebo-response or other factors which experts often call ‘context effects’.[4]
  2. Whenever homeopaths advise their patients (as they often do) to forgo effective conventional treatments, they are likely to do harm. This phenomenon is best documented in relation to the advice of many homeopaths against immunisations.[5]
[For references, see the original text]

I do not expect fans of homeopathy to be impressed by my evidence-based assessment of their cult. In fact, just looking what is currently being posted on ‘X’ today about the ‘WORLD HOMEOPATHY DAY’ seems to justify my expectation. Here are the 10 first postings that appeared on my screen about an hour ago:

  1. Today, on #WorldHomeopathyDay, we celebrate the birth anniversary of Dr. Samuel Hahnemann, the founder of homeopathy. Let’s embrace the principles of natural healing and holistic well-being.
  2. On #WorldHomeopathyDay President #DroupadiMurmu to inaugurate 2-day Homeopathic Symposium at Yashobhoomi Convention Centre Dwarka, New Delhi. Organized by Central Council for Research in Homoeopathy (CCRH) based on theme of ‘Empowering Research, Enhancing Proficiency.’
  3. Dr. Ashvini Kumar Dwivedi, Member, Scientific Advisory Board, Central Council for Research in Homeopathy, Ministry of Ayush, Government of India, and #ASSOCHAM Ayush task force member, underlined the significance of #WorldHomeopathyDay, observed on April 10th each year
  4. Today, we celebrate #WorldHomeopathyDay 2024, embracing the gentle healing power of nature.
  5. Happy #WorldHomeopathyDay!  Let’s celebrate the holistic approach to health that homeopathy offers, honoring its contributions to alternative medicine and its focus on individualized care. Here’s to exploring natural remedies and supporting wellness for all! #HolisticHealth
  6. Happy World Homeopathy Day Embracing the gentle yet powerful healing of homeopathy, let’s cherish its holistic essence, promoting balance and well-being worldwide. Here’s to the harmony it brings to mind, body, and spirit.
  7. #WorldHomeopathyDay: President #DroupadiMurmu to inaugurate 2-day Homeopathic Symposium at Yashobhoomi Convention Centre Dwarka, New Delhi. Organized by Central Council for Research in Homoeopathy (CCRH) based on theme of ‘Empowering Research, Enhancing Proficiency.’
  8. Celebrate #WorldHomeopathyDay with us & enter to win these two enlightening reads by renowned homeopath Dr. Mukesh Batra. What inspired you to explore homeopathy? Share your story in the comments section & get a chance to win a copy of #HealWithHomeopathy and #FeelGoodHealGood!
  9. #WorldHomeopathyDay is celebrated on April 10th, promoting awareness of the principles and benefits of homeopathic medicine. It aims to address the whole body, including hereditary predispositions and disease history, and encourages people to pursue homeopathy as a profession.…
  10. On World Homeopathy Day, we celebrate Dr. Samuel Hahnemann, the pioneer of homeopathy. His gentle remedies, made from natural substances, have helped countless people heal without side effects.

_______________________

In view of this volume of pure BS, I encourage everyone to post (here, or on ‘X’, or elsewhere) some evidence-based comments on homeopathy, Hahnemann and the ‘World Homeopathy Day’.

Let me make a start:

Homeopaths are as deluded as their remedies are diluted

Spinal manipulation is usually performed by a therapist (chiropractor, osteopath, physiotherpist, doctor, etc.). But many people do it themselves. Self-manipulation is by no means safer than the treatment by a therapist, it seems. We have previously seen cases where the results were dramatic:

Now, a further case has been reported. In this paper, American pathologists present a tragic case of fatal vertebral artery dissection that occurred as the result of self-manipulation of the cervical spine.

The decedent was a 40-year-old man with no significant past medical history. He was observed to “crack his neck” while at work. Soon after, he began experiencing neck pain, then developed stroke-like symptoms and became unresponsive. He was transported to a local medical center, where imaging showed bilateral vertebral artery dissection. His neurological status continued to decline, and brain death was pronounced several days later.

An autopsy examination showed evidence of cerebellar and brainstem infarcts, herniation, and diffuse hypoxic-ischemic injury. A posterior neck dissection was performed to expose the vertebral arteries, which showed grossly visible hemorrhage and dilation. There was no evidence of traumatic injury to the bone or soft tissue of the head or neck. Bilateral dissection tracts were readily appreciated on microscopic examination. Death was attributed to self-manipulation of the neck, which in turn led to bilateral vertebral artery dissection, cerebellar and brainstem infarcts, herniation, hypoxic-ischemic injury, and ultimately brain death.

It seems clear to me that only few and spectacular cases of this nature are being published. In other words, the under-reporting of adverse effects of self-manipulation must be close to 100%. It follows that the risk of sel-manipulation is impossible to quantify. I suspect it is substancial. In any case, the precautionary principle compells me to re-issue my warning:

do not allow anybody to manipulate your neck, not even yourself!

In the realm of so-called alternative medicine (SCAM), we see a lot of papers that are bizarre to the point of being disturbing and often dangerous nonsense. Yesterday, I came across an article that fits this bill well; in fact, I have not seen such misleading BS for quite a while. Let me present to you the abstract of this paper:

Introduction

There has been accumulating interest in the application of biofield therapy as complementary and alternative medicine (CAM) to treat various diseases. The practices include reiki, qigong, blessing, prayer, distant healing, known as biofield therapies. This paper aims to state scientific knowledge on preclinical and clinical studies to validate its potential use as an alternative medicine in the clinic. It also provides a more in-depth context for understanding the potential role of quantum entanglement in the effect of biofield energy therapy.

Content

A comprehensive literature search was performed using the different databases (PubMed, Scopus, Medline, etc.). The published English articles relevant to the scope of this review were considered. The review gathered 45 papers that were considered suitable for the purpose. Based on the results of these papers, it was concluded that biofield energy therapy was effective in treating different disease symptoms in preclinical and clinical studies.

Summary

Biofield therapies offer therapeutic benefits for different human health disorders, and can be used as alternative medicine in clinics for the medically pluralistic world due to the growing interest in CAM worldwide.

Outlook

The effects of the biofield energy therapies are observed due to the healer’s quantum thinking, and transmission of the quantum energy to the subject leads to the healing that occurs spiritually through instantaneous communication at the quantum level via quantum entanglement.

The authors of this article are affiliated with Trivedi Global, an organisation that states this about ‘biofield energy’:

Human Biofield EBnergy has subtle energy that has the capacity to work in an effective manner. This energy can be harnessed and transmitted by the gifted into living and non-living things via the process of a Biofield Energy Healing Treatment or Therapy.

If they aleady know that “Biofield EBnergy has subtle energy that has the capacity to work in an effective manner”, I wonder why they felt the need to conduct this review. Even more wonderous is the fact that their review showed such a positive result.

How did they manage this?

The answer might lie in their methodology: they “gathered 45 papers that were considered suitable”. While scientists gather the totality of the available evidence (and assess it critically), they merely selected what was suitable for the purpose of generating a positive result. This must be the reason our two studies on the subject were discretely omitted:

Our 1st study

Purpose: Distant healing, a treatment that is transmitted by a healer to a patient at another location, is widely used, although good scientific evidence of its efficacy is sparse. This trial was aimed at assessing the efficacy of one form of distant healing on common skin warts.

Subjects and methods: A total of 84 patients with warts were randomly assigned either to a group that received 6 weeks of distant healing by one of 10 experienced healers or to a control group that received a similar preliminary assessment but no distant healing. The primary outcomes were the number of warts and their mean size at the end of the treatment period. Secondary outcomes were the change in Hospital Anxiety and Depression Scale and patients’ subjective experiences. Both the patients and the evaluator were blinded to group assignment.

Results: The baseline characteristics of the patients were similar in the distant healing (n = 41) and control groups (n = 43). The mean number and size of warts per person did not change significantly during the study. The number of warts increased by 0.2 in the healing group and decreased by 1.1 in the control group (difference [healing to control] = -1.3; 95% confidence interval = -1.0 to 3.6, P = 0.25). Six patients in the distant healing group and 8 in the control group reported a subjective improvement (P = 0.63). There were no significant between-group differences in the depression and anxiety scores.

Conclusion: Distant healing from experienced healers had no effect on the number or size of patients’ warts.

Our 2nd study

Spiritual healing is a popular complementary and alternative therapy; in the UK almost 13000 members are registered in nine separate healing organisations. The present randomized clinical trial was designed to investigate the efficacy of healing in the treatment of chronic pain. One hundred and twenty patients suffering from chronic pain, predominantly of neuropathic and nociceptive origin resistant to conventional treatments, were recruited from a Pain Management Clinic. The trial had two parts: face-to-face healing or simulated face-to-face healing for 30 min per week for 8 weeks (part I); and distant healing or no healing for 30 min per week for 8 weeks (part II). The McGill Pain Questionnaire was pre-defined as the primary outcome measure, and sample size was calculated to detect a difference of 8 units on the total pain rating index of this instrument after 8 weeks of healing. VASs for pain, SF36, HAD scale, MYMOP and patient subjective experiences at week 8 were employed as secondary outcome measures. Data from all patients who reached the pre-defined mid-point of 4 weeks (50 subjects in part I and 55 subjects in part II) were included in the analysis. Two baseline measurements of outcome measures were made, 3 weeks apart, and no significant differences were observed between them. After eight sessions there were significant decreases from baseline in McGill Pain Questionnaire total pain rating index score for both groups in part I and for the control group in part II. However, there were no statistically significant differences between healing and control groups in either part. In part I the primary outcome measure decreased from 32.8 (95% CI 28.5-37.0) to 23.3 (16.8-29.7) in the healing group and from 33.1 (27.2-38.9) to 26.1 (19.3-32.9) in the simulated healing group. In part II it changed from 29.6 (24.8-34.4) to 24.0 (18.7-29.4) in the distant healing group and from 31.0 (25.8-36.2) to 21.0 (15.7-26.2) in the no healing group. Subjects in healing groups in both parts I and II reported significantly more ‘unusual experiences’ during the sessions, but the clinical relevance of this is unclear. It was concluded that a specific effect of face-to-face or distant healing on chronic pain could not be demonstrated over eight treatment sessions in these patients.

In addition, they, of course, also omitted many further studies by other investigators that failed to be positive. Considering this amount of cherry-picking, it is easy to understand how they arrived at their conclusion. It is all a question of chosing the right methodology!

A few decades ago, the cigarette industry employed this technique to show that smoking did not cause cancer! Luckily, we have since moved away from such pseudo-scientific ‘research’ – except, of course, in the realm of SCAM where it is still hughely popular.

An interesting and fully referenced (205 references) article caught my attention; it seems highly relevant to the discussions we are having on this blog. Let me show you the abstract:

Medical misinformation has always existed, but it has recently become more frequent due to the development of the internet and social media. Medical misinformation can cover a wide variety of topics, and studies show that some groups are more likely to be affected by medical misinformation than others, like those with less trust in health care, less health literacy, and a more positive attitude toward alternative medicines. Aspects of the internet, like echo chambers and algorithms, have contributed to the rise of medical misinformation, along with belief in anecdotal evidence and alternative remedies that are not backed by science. Some personal beliefs and a lack of media literacy skills are also contributing to medical misinformation. Medical misinformation causes higher rates of death and negative health outcomes, a lack of trust in medical professionals, and more racism and hate crimes. One possible way to combat the spread of misinformation is education surrounding media literacy. Still, there are gaps in this practice that must be addressed like a lack of high-quality research about different educational programs.

The author also offers the following key points:

  • Medical misinformation is becoming an urgent issue for United States citizens—leading to increased deaths,
    a lack of trust in health professionals, and hate crimes and racism.
  • Although this is a worldwide issue, the United States has the second highest rate of misinformation of any
    country, behind India.
  • One piece of misinformation during the COVID-19 pandemic stated that highly concentrated alcohol could
    disinfect the body and kill the virus. Studies show that 800 people died, 5,876 were hospitalized, and 60
    became completely blind from drinking methanol, thinking it would cure coronavirus.
  • Studies estimate that only 14% of the United States population has proficient health literacy, which makes it difficult to recognize medical misinformation.
  • Media literacy education is being pursued in order to combat the spread of misinformation, but more research is needed in order to understand the long-term effects of this education and what programs are best.

__________________

I would like to stress, as indeeed the author does as well, that medical misinformation is a phenomenon that is by no means confined to the US. Like most information, misinformation has become a global issue. Its dangers cannot be under-estimated. My blog offers an abundance of reports where misinformation in the realm of so-called alternative medicine (SCAM) has caused harm and even death. The author advocates media literacy as a remedy for the problem. I would argue that even more important would be to teach CRITICAL THINKING, a task that has to start at school and must continue well into adult life.

This conclusion is so very obvious that it begs an important question: WHY HAS IT NOT BEEN DONE YEARS AGO? The answer, I fear, is simple: for reasons that are self-evident, governments have little interst in the public being able to think critically. On the contrary, governments across the world foremost want to be re-elected, and critical thinking would be a major obstacle to this aim.

 

In spite of the safety and efficiency of the COVID-19 vaccines and the many promotion efforts of political and expert authorities, a fair portion of the population remained hesitant if not opposed to vaccination. Public debate and the available literature point to the possible role of people’s attitudes towards medical institutions as well as their preference for so-called alternative medicine (SCAM) on their motivations and intentions to be vaccinated. Other potential ideological factors are beliefs about environmental laissez-faire and divine providence insofar as they encourage people to let the pandemic unfold without human interference.

In three cross-sectional samples (total N = 8214), collected at successive moments during the Belgian vaccination campaign, the present research examines the distal role of these psychological and ideological factors on vaccination intentions via motivational processes.

  • Study 1 gauges the relation between trust in medical institutions and preference for SCAM on intentions to get vaccinated via motivations.
  • Study 2 examines the role of beliefs in the desirability of letting nature take its course (‘environmental laissez-faire beliefs’) on vaccination intention via motivations.
  • Study 3 tests whether people’s adherence to environmental laissez-faire and beliefs about divine providence are linked to their motivations for vaccination via trust in the medical institutions and SCAM.

The results show that adherence to SCAM has a deleterious effect on vaccination intentions, whereas trust in medical institutions has a positive effect. Both ideological factors pertaining to external control are only moderately related, with environmental laissez-faire beliefs having stronger effects on SCAM, medical trust and vaccination motivations.

The evidence of an association between SCAM and willingness to get vaccinated is undeniable. On this blog, we have discussed it repeatedly, e.g.:

But what exactly is the nature of this association?

  • Does SCAM-use predispose to vaccination hesitancy?
  • Does Vaccination hesitancy predispose to SCAM use?
  • Is both true?

After reading all this research that has emerged on the subject, I get the impression that we are mostly dealing here with a cross-correlation where a certain mind-set of being

  • prone to conspiracy theories,
  • anti-establishment,
  • anti-science,
  • irrational,
  • of low intelligence,
  • unable of critical thinking,
  • etc., etc,

determines both the SCAM-use and the vaccination hesitancy.

 

It does not happen often, but when it does, it should be aknowledged. I am speaking of papers from chiropractors that make sense. If you are interested in chiropractic, I do encourage you to read the articles of which I will here only present bits of the conclusions:

Part 1

The chiropractic profession is weighed down by the burden of historical theories regarding spinal manipulative therapy (SMT), which, for some in the profession, have all the characteristics of dogmatic articles of faith. In our opinion, the unlimited scope of practice, which is still advocated by some chiropractors, and which has not been met with unequivocal political rejection, an over-reliance on SMT in the management of MSK disorders, and an over-emphasis on the technical intricacies of SMT represent weaknesses within chiropractic. We argue that these are obstacles to professional development and the major causes of professional stagnation both intellectually and in the market place.

We also discussed what we consider to be threats to the chiropractic profession. Science, the impact of EBM, and accountability to authorities and third party-payers all pose threats to the traditional chiropractic paradigm and, thus, to those within the profession, who practice within such a paradigm. In the marketplace, competition from other professions that provide care of patients with MSK disorders, including SMT, and are better positioned to be integrated into the wider health-care system/market represent a threat. Moreover, finally, the internal schism in chiropractic represents a threat to professional development, as it prevents the profession moving forward in unison with a coherent external message.

We have described those weaknesses and threats, knowing full well, that we do so from our perspective of chiropractic as EBM with a limited MSK scope of practice, i.e. from outside the subluxation frame of reference.

We recognize that for those who look at SMT from the perspective of traditional, subluxation-based chiropractic, things will look very different: What we identify as weaknesses may be seen by others as the pillars of chiropractic practice, and what we see as threats could appear as just peripheral and ephemeral distractions to the enduring core of chiropractic ideas. Such is the character of the schism at the heart of chiropractic.

None-the-less, having described what we identify as serious weaknesses and threats arising from the profession’s relationship to SMT, it has not escaped our attention that it also gives rise to several strengths, which serve the profession and its patients well. In turn, it follows that a number of opportunities are presenting themselves for the future of SMT and chiropractic.

Part 2

The onus is now on the chiropractic profession itself to redefine its raison d’être in a way that plays to those strengths and delivers in terms of the needs of patients and the wider healthcare system/market. We suggest chiropractors embrace and cultivate a role as coordinators of long-term and broad-focused management of musculoskeletal disorders. We make specific recommendations about how the profession, from individual clinicians to political organizations, can promote such a development.

___________________________

For readers in a hurry:

Progress is an inevitable threat to obsolete and useless practices of any kind. In that, chiropractic is no exception.

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