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

education

In recent weeks and months, I have been thinking quite a lot about the various types of scientists. This is partly due to me finishing a book entitled: Bizarre Medical Ideas: … and the Strange Men Who Invented Them. Partly it is related to the sorry tale of the GWUP that I have been boring you with repeatedly here. As a consequence of my contemplations, I have added more categories to the usual two types of scientists.

1. SCIENTIST

Scientists gather information through observation and experimentation, formulate hypothesis, and then test them. They work in vastly different areas but have certain attitudes or qualities in common, e.g. critial thinking and an open mind. As scientists tend to publish their findings, a very simple (but not fool-proof) way to identify a scinetist is to look him/her up, for example by finding his/her H-Index. (The H-Index is defined as the maximum value of h such that the given author/journal has published at least h papers that have each been cited at least h times. For instance, if someone has 10 papers that were cited 10 times, his H-Index would be 10. If another scientist has 50 papers that were cited 50 times, his H-Index would be 50.)

2. PSEUDO-SCIENTIST

Pseudo-scientists are people who pretend to produce science but, in fact, they generate pseudoscience. The demarkation of pseudo-science from science is sometimes difficult, as we have seen several times on this blog, e.g.:

The pseudo-scientist does have no or just a few publications in the peer-reviewed literature and no H-Index to speak of.

3. WOULD-BE SCIENTIST

The term ‘would-be scientist’ is not one that is commonly used, nor is it one that has an accepted definition. The way I see it, would-be scientists are aspiring to become scientist. They are on the way to become a scientist but have not quite arrived yet. To the would-be scientist I say: good luck to you; I hope you make it and I look forward to reading about your scientific achievements. The would-be scientist is, however, not the topic of my post.

4. THE PREDEND-SCIENTIST

The predent-scientist (PS) is the one who I want to focus on here. He – yes, the PS is usually male – talks a lot about science; so much so that outsiders would get the impression that he actually is a scientist. Crucially, the PS himself has managed to delude himself to the point where believes to be a scientist.

While scientists tend to be media-shy, the PS enjoys the limelight to generate the impression of being a scientist. He talks eloquently and at length about science. Much of what he says or writes might even be correct. The PS is often quite well-versed and knows (most of) his stuff.

The crucial difference between the PS and the scientist is that the PS produces no or very little science; neither does he intend to. To identify the PS, an easy (but not fool-proof) method is to him look up. Typically, he has published several articles in the popoular press or books for the lay public, but – as he does not conduct scientific research – he does not generate papers in the peer-reviewed scientific literature. This void, however, has never stopped the PS from appearing in the media speaking about science, nor from occupying prominent positions in the world of science, nor from avidly rubbing shoulders with scientists. Few people see anything wrong with that, mainly because the PS has convinced them (most importantly himself) that he actually is a scientist. While the scientist is trained in doing science, the PS is trained in talking about science.

Don’t get me wrong, the PS can have his merits. He often presents science to the public more or less accurately and frequently is rhetorically superior to the scientist. I nevertheless have reservations about the PS (and the recent pandemic has shown us how dangerous PSs can beome). The questions to ask ourselves are the following:

  • Does PS have a truly open mind?
  • Can he set aside ideologies?
  • Will he change his opinion vis a vis new evidence?
  • Is he prepared to consider criticism?
  • Does he avoid ‘black and white’ thinking?
  • Is he sufficiently humble?
  • Is he honest with himself and others?

These questions refer to important attitudes that scientists learn – often the hard way – while doing science. If someone lacks this experience, such attitudes are likely to be under-developed. Perhaps, it all boils down to honesty: if a man who has never done any amount of science to speak of has convinced himself to be a scientist, he arguably is dishonest with himself and the public.

In order to make my points as clearly as possible, I admittedly caricaturized the extremes of a wider spectrum; my appologies for that. In reality, the different types of scientists rarely exist as entirely pure forms. Frequently, people are mixtures of two types, either because they did different things during different periods of their lives, or because they simply are hybrids.

To provide a few examples, let me show you 14 H-Indices (according to ‘Google Scholar’) of people (in alphabetical order) who you might have heard of, for instance, because they have featured on my blog. I leave it up to you to decide how well they fit in any of my three categories and who might qualify to be a PS.

  1. Fabrizio Benedetti – H-Index = 83
  2. David Colquhoun – H-Index = 78
  3. Ian Chalmers – H-Index = 84
  4. Michael Dixon – H-Index = 0
  5. David Gorski – H-Index = 30
  6. Holm Hümmler – H-Index = 0
  7. Ted Kaptchuk – H-Index = 103
  8. Jos Kleinjen – H-Index = 104
  9. Andreas Michalsen – H-Index = 0
  10. Michael Mosely – H-Index = 0
  11. Dana Ullman – H-Index = 0
  12. Dale Thompson (alias DC) – H-Index = 0
  13. Chris van Tulleken – H-Index = 0
  14. Harald Walach – H-Index = 9

My conclusion: the PS, a person who presents himself as a scientist without having done any meaningful amount of science himself, is a man who is not entirely honest. The H-Index can be helpful for identifying PSs. An index of zero, for instance, seems to send out a fairly clear message. In the case low indices, it is advisable to go one step further and study the actual articles That mede up the index. However, the H-Index tells us nothing about whether someone presents himself as a scientist; this information must be gleaned from the person him(her)self.

 

 

 

These days, it has become a rare event – I am speaking of me publishing a paper in the peer-reviewed medical literature. But it has just happened: Spanish researchers and I published a meta-analysis on the effectiveness of craniosacral therapy. Here is its abstract:

The aim of this study was to evaluate the clinical effectiveness of craniosacral therapy (CST) in the management of any conditions. Two independent reviewers searched the PubMed, Physiotherapy Evidence Database, Cochrane Library, Web of Science, and Osteopathic Medicine Digital Library databases in August 2023, and extracted data from randomized controlled trials (RCT) evaluating the clinical effectiveness of CST. The PEDro scale and Cochrane Risk of Bias 2 tool were used to assess the potential risk of bias in the included studies. The certainty of the evidence of each outcome variable was determined using GRADEpro. Quantitative synthesis was carried out with RevMan 5.4 software using random effect models.

Fifteen RCTs were included in the qualitative and seven in the quantitative synthesis. For musculoskeletal disorders, the qualitative and quantitative synthesis suggested that CST produces no statistically significant or clinically relevant changes in pain and/or disability/impact in patients with headache disorders, neck pain, low back pain, pelvic girdle pain, or fibromyalgia. For non-musculoskeletal disorders, the qualitative and quantitative synthesis showed that CST was not effective for managing infant colic, preterm infants, cerebral palsy, or visual function deficits.

We concluded that the qualitative and quantitative synthesis of the evidence suggest that CST produces no benefits in any of the musculoskeletal or non-musculoskeletal conditions assessed. Two RCTs suggested statistically significant benefits of CST in children. However, both studies are seriously flawed, and their findings are thus likely to be false positive.

So, CST is not really an effective option for any condition.

Not a big surprise! After all, the assumptions on which CST is based fly in the face of science.

Since CST is nonetheless being used by many healthcare professionals, it is, I feel, important to state and re-state that CST is an implausible intervention that is not supported by clinical evidence. Hopefully then, one day, these practitioners will remember that their ethical obligation is to treat their patients not according to their beliefs but according to the best available evidence. And, hopefully, our modest paper will have helped rendering healthcare a little less irrational and somewhat more effective.

I had never heard of him – but after getting insulted by ‘Dr. Nick Campos’ I became interested and looked him up. What I found was interesting. Here is how he describes himself.

Dr. Nick Campos is a teacher of universal principles and truths as they pertain to the health, wellness and evolution of body, mind and spirit, particularly as they relate to human growth and potential.

As a healer trained in the art of chiropractic, and as a prominent chiropractic sports physician, he has helped thousands of people overcome physical injury and trauma, allowing them to regain their functional lives.

Dr. Campos believes that wellness encompasses more than just the physical body, so a balanced mental and spiritual life is also necessary for full expression of being. Therefore, Dr. Campos assists people with mental and spiritual challenges and misperceptions, while teaching them tools to empower themselves in all areas of life.

Dr. Campos teaches universal principles of health, wellness, growth and evolution as they pertain to body, mind and spirit. His work is carried out through several media including books, articles and a widely-read, syndicated blog (Optimal Health). His book The Six Keys to Optimal Health is the quintessential guide to achieving and maintaining optimal wellness in the twenty-first century. Dr. Campos’ mission is to inspire people to adopt a new way of thinking and living.

In 2010 Dr. Campos launched his evolutionary personal growth and development consulting business dedicated to helping people tune-into and manifest their most inspired dreams. As the Dream Designer™, Dr. Campos shows people how to uncover their life’s purpose, and how to implement powerful strategies designed to create the life of their dreams.

Dr. Nick Campos has a planetary vision of impacting billions of people for years to come. His inspired mission is to help people tap into their incredible self-healing, self-regulating powers. With certainty and gratitude, he aims to teach the world the power inherent in the human mind, and prepare humankind for the next phase of planetary evolution. As the world changes rapidly, those that adapt steadily and most-balanced will have the greatest advantage to navigating new horizons.

Dr. Campos is committed to discovering, understanding and sharing the tools that human beings will invariably need to be successful in a changing world—health, wellness, financial security, effective communication and interpersonal relations, leadership, business purpose and development, parenting, and education to name a few. Through research, collaborative exchange of information, and mass educational accessibility, Dr. Campos strives to empower human beings to be successful pioneers into a vast technological, informational and explorational age.
After this platitude-overload, I asked myself: what does Dr Campos actually do for a living?
The answer is simple: He is ‘Dream Designer’!
What?
Yes, did you not know? A dream designer helps people define and design their dream lives:

Many people limp through their lives following other people’s standards, and striving for achievement in areas not really inspiring to them. As a result, they end up suffering from frustration, lack of fulfillment and potentially depression. Does this sound like you?

By not following your innermost drives, or by repressing your true heart’s desires, you run the greatest risk of succumbing to physical and mental pressures, strain and ultimately illness. Life can be stressful enough without the added anxiety of not knowing who you are or where you are going.

Chronic fatigue syndrome and fibromyalgia are modern manifestations of this lack of purpose,  but that doesn’t have to be your destiny.

Dream Design consulting services starts by helping you tune-in to your most authentic self—who you are, what you value, and how your body and mind work to direct you down your most inspired path. You will uncover the fears, resentments and infatuations that have been acting as barriers to your personal growth, and learn effective ways to overcome them.

And Dr Campos gives courses. On his website, we currently find Upcoming dates:

January 14, 2023                                                         Burbank, CA

January 26, 2023                                                          Palm Desert, CA

February 11, 2023                                                         Thousand Oaks, CA

February 23, 2023                                                         Palm Desert, CA

March 11, 2023                                                               Burbank, CA

March 25, 2023                                                              Palm Desert, CA

______________________________

Either this line of his business is not doing all that well or he offers time travel as part of the package.

On X 9formally Twitter), ,Dr’ Campos called me a LOSER – perhaps I should return the compliment?

 

 

An article about chiropractic caught my attention. Let me show you its final section which, I think, is relevant to what we often discuss on this blog:

If chiropractic treatment is unscientific, then why do I feel better? Because lots of things alleviate pain. Massage, analgesia and heat – but also a provider who listens, empathises and bothers to examine a patient. Then there is the placebo effect. For centuries, doctors have recognised that different interventions with unclear pathways result in clinical improvement. Among the benefits patients attributed to placebo 100 years ago: “I sleep better; my appetite is improved; my breathing is better; I can walk further without pain in my chest; my nerves are steadier.” Nothing has changed. Pain is a universal assignment; no one has a monopoly on its relief.

The chiropractic industry owes its existence to a ghost. Its founder, David Palmer, wrote in his memoir The Chiropractor that the principles of spinal manipulation were passed on to him during a séance by a doctor who had been dead for half a century. Before this, Palmer was a “magnetic healer”.

Today, chiropractors preside over a multibillion-dollar regulated industry that draws patients for various reasons. Some can’t find or afford a doctor, feel dismissed, or worse, mistreated. Others mistrust the medical establishment and big pharma. Still others want natural healing. But none of these reasons justifies conflating a chiropractor with a doctor. The conflation feels especially hazardous in an environment of health illiteracy, where the mere title of doctor confers upon its bearer strong legitimacy.

Chiropractors don’t have the same training as doctors. They cannot issue prescriptions or order advanced imaging. They do not undergo lifelong peer review or open themselves to monthly morbidity audits.

I know that doctors could do with a dose of humility, but I can’t find any evidence (or the need) for the assertion on one website that chiropractors are “academic overachievers”. Or the ambit claim that most health professionals have no idea how complicated the brain is, but chiropractors do.

Forget doctors, patients deserve more respect.

My friend’s back feels better for now. When it flares, I wonder if she will seek my advice – and I am prepared to hear no. Everyone is entitled to see a chiropractor. But no patient should visit a chiropractor thinking that they are seeing a doctor.

______________________

I would put it more bluntly:

  • chiropractors are poorly trained; in particular, they do not learn to question their own, often ridiculous beliefs;
  • they are poorly regulated; in the UK, the GCC seems to protect the chiros rather than the public;
  • chiropractors regularly disregard essential rules of medical ethics, e.g. informed consent;
  • many try to mislead us by pretending they are physicians;
  • their hallmark intervention, spinal manipulation, can cause considerable harm;
  • it generates hardly any demonstrable benefit for any condition;
  • chiropractors also cause considerable harm, e.g. by interfering with real medicine, e.g. vaccinations;
  • thus, in general, chiropractors do more harm than good;
  • yes, everyone is entitled to see a chiropractor, but before they do, reliable information should be mandatory.

A recent article about ayurvedic medicine caught my eye. Here are a few excerpts:

Imagine if there were a magic pill to ward off COVID-19. Or if you could cure diabetes with vegetable juices and herbal pills instead of controlling it with insulin medication. Or if yoga and breathing exercises were all you need to do to get rid of asthma. These are all claims made by Patanjali Ayurved, one of India’s biggest manufacturers of traditional ayurvedic products…

Many scientists have expressed concerns over the lack of research into the safety and efficacy of ayurvedic products… Nonetheless, Ayurveda enjoys widespread acceptance among Indians. And under India’s Hindu-nationalist government that took power in 2014, ayurveda and other alternative systems of medicine have received unprecedented government support. India’s ministry of alternative medicine gets nearly $500 million a year. The government also promotes ayurveda through its international trade and diplomatic channels. All this set Patanjali’s fortunes soaring.

But now the Supreme Court of India has temporarily banned Patanjali – named after a Hindu mystic best known for his writings on yoga – from advertising some of its products… “The entire country has been taken for a ride,” Ahsanuddin Amanullah, one of the two judges conducting the court hearing, told the lawyer representing the government… The Indian Medical Association had brought the case to court in August 2022, claiming that Patanjali and its brand ambassador Baba Ramdev made a series of false claims against evidence-backed modern medicine and its practitioners, and spread misinformation about COVID-19 vaccines. Their petition also referred to instances where Ramdev lambasted modern medicine as a “stupid and bankrupt science” at a yoga session. The trigger was a series of Patanjali advertisements in Indian newspapers in July 2022 claiming that ayurvedic products could cure chronic conditions like diabetes, high blood pressure, heart diseases and autoimmune conditions. The Indian Medical Association’s petition alleged that such claims were in violation of India’s Drugs and Magic Remedies (Objectionable Advertisements) Act.

…The company’s public face – yoga guru Baba Ramdev – is a vocal supporter of India’s ruling party, the BJP, and Prime Minister Narendra Modi. Modi even inaugurated Patanjali’s ayurvedic research facility in 2017… Some scientists have accused their government of promoting these alternative medicines at the expense of modern medicine, partly as a way to glorify India’s culture and history. “One of the political ideas of this government is to glorify the Hindu tradition,” says Dhrubajyoti Mukherjee, president of the Breakthrough Science Society, an organization that promotes scientific thinking. “But in the name of our glorious past, the government is propagating obscure, unscientific ideas.”

… A few months after the outbreak of the COVID-19 pandemic in 2020, India’s health minister at the time, Harsh Vardhan participated in the company’s launch of pills, where Ramdev, the yoga guru, claimed the pills showed “100 percent favorable results” during clinical trials on patients. Despite experts flagging the lack of evidence, the company said it sold 2.5 million kits in six months, consisting of the tablets to ward off COVID-19 and bottled oils that would allegedly boost immunity. And the company is making an enormous amount of money: Its income was over $1.3 billion in the financial year 2021-22, with profits of $74 million before taxes.

Addressing the overall impact of misinformation about ayurvedic treatments, Dr. Jayesh Lele, vice president of the Indian Medical Association, says “Our worry is people are being misguided. We have got people who’ve left our treatment saying their kidneys will be able to function properly [using ayurvedic medicines] and ended up with renal failure. The same happened with patients suffering from hepatitis, who’ve got the wrong medicine and ended up with further problems. And if you say every day that modern medicine is bad, that is not acceptable.”

_______________

The sad thing, in my view, is that (as discussed previously) ayurvedic medicine has not just taken India for a ride:

And perhaps even more disappointing is the notion that, while in India they take action in order to prevent harm, I can see no such developments in the UK.

The origin of coronavirus 2 (SARS-CoV-2) has been the subject of intense speculation and several conspiracy theories, not least amongst the enthusiasts of so-called alternative medicine. Now Australian scientists have attempted to identify the origin of the coronavirus 2 (SARS-CoV-2). As this is undoubtedly a most sensitive subject, let me show you the unadulterated abstract of their paper:

The origin of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is contentious. Most studies have focused on a zoonotic origin, but definitive evidence such as an intermediary animal host is lacking. We used an established risk analysis tool for differentiating natural and unnatural epidemics, the modified Grunow–Finke assessment tool (mGFT) to study the origin of SARS-COV-2. The mGFT scores 11 criteria to provide a likelihood of natural or unnatural origin. Using published literature and publicly available sources of information, we applied the mGFT to the origin of SARS-CoV-2. The mGFT scored 41/60 points (68%), with high inter-rater reliability (100%), indicating a greater likelihood of an unnatural than natural origin of SARS-CoV-2. This risk assessment cannot prove the origin of SARS-CoV-2 but shows that the possibility of a laboratory origin cannot be easily dismissed.

The somewhat clumsy wording harbours explosive potential. It is more likely that the pandemic was started by a laboratory accident than by a zoonosis. In this case, it would be man-made rather than natural. The authors of the paper do, however, caution that their analysis does not prove the origin of the coronavirus. They merely speak of likelihoods. Moreover, it seems important to stress that there is no scientific evidence that Sars-CoV-2 was deliberately developed as a biological warfare agent.

Will this paper put an end to speculation and conspiracy?

I doubt it!

 

 

 

The Amercian Medical Association (AMA) recently published a lengthy article on naturopathy in the US. Here are some excerpts:

There are three types of health professionals who offer naturopathic treatment:

  • Naturopathic doctors. These nonphysicians graduate from a four-year, professional-level program at an accredited naturopathic medical school, earning either the doctor of naturopathy (ND) degree or the doctor of naturopathic medicine (NMD) degree.
  • Traditional naturopaths, who have obtained education through some combination of a mentorship program with another professional or at an alternative clinic, distance-learning program or classroom schooling on natural health, or other holistic studies.
  • Other health professionals such as chiropractors, massage therapists, dentists, nurses, nutritionists, or physicians who practice under a professional license but include some naturopathic methods in their practice and who may have studied on their own or taken courses on naturopathic methods.

At least 24 states and the District of Columbia regulate the practice of naturopathy. In order to be licensed, naturopaths in these states must earn an ND or NMD from an accredited naturopathic program and pass the Naturopathic Physicians Licensing Exam. Three states—Florida, South Carolina and Tennessee—prohibit the practice of naturopathy. In states that neither license nor prohibit the practice of naturopathy, traditional naturopaths and NDs alike may practice without being subject to state regulation.

Postgraduate training is neither common nor required of graduates of naturopathic schools, except in Utah … less than 10% of naturopaths participate in an approved residency, and such residencies last only a year and lack a high degree of standardization.

… naturopaths are required to get at least 1,200 hours of direct patient contact, physicians get 12,000–16,000 hours of clinical training…

ND programs emphasize naturopathic principes—for example, the healing power of nature—and naturopathic therapeutics such as botanical medicine, homeopoathy and hydrotherapy. Coursework in naturopathic therapeutics is combined with, and taught alongside, coursework in sciences. But there are no specifications around the number of hours required in each area … naturopathic students may lack exposure to key clinical scenarios in the course of their training … naturopathic students’ clinical experience is typically gained through outpatient health care clinics, as naturopathic medical schools typically do not have significant hospital affiliation. This means there is no guarantee that a naturopathic student completing a clinical rotation will see patients who are actually sick or hospitalized, and they may not be exposed to infants, children, adolescents or the elderly. It has been said that naturopaths tend to treat the “worried well.”

… Naturopaths claim they are trained as primary care providers and, as such, are educated and trained to diagnose, manage and treat many conditions, including bloodstream infections, heart disease and autoimmune disorders. Yet their education and training falls several years and thousands of hours short of what physicians get.

…The AMA believes it is the responsibility of policymakers to ensure that naturopaths’ claims that they can treat a broad range of conditions are backed by facts—facts that include the specific education and training necessary to ensure patient safety.

________________

The AMA is clearly cautious here. A less polite statement might simply stress that naturopaths are taught a lot of nonsense which they later tend to administer to their unsuspecting patients. On this blog, we have repeatedly discussed the danger naturopaths present to public health in the US and elsewhere, e.g.:

Claims that naturopaths are a viable alternative to evidence-based medicine are wrong, irresponsible and dangerous. Regulators must be reminded that they have the duty to protect the public from charlatans and should therefore ensure that no false therapeutic or diagnostic claims can be made by naturopaths.

Please allow me to write a post today that has nothing at all to do with so-called alternative medicine, not even with medicine.

Yesterday, 13 March, was my mother’s birthday. She was born in 1911 and died in 1989. I often think of her and the remarkable life she had, particularly, of course, on 13 March.

Going through my X-feed yesterday, I saw this post from the Auschwitz Memorial:

13 March 1911 | A Pole, Józef Kowalski, was born in Siedliska. A Catholic priest, Salesian. In Auschwitz from 26 June 1941. No. 17350 On 4 July 1942 he was drowned in a barrel of fecal matter in the Penal Company, where he was placed for refusing to trample a rosary.

Image

Image

I am not a religious person but I was struck: this man was born on the same day as my mother and lived not far from where she did. He was brutally killed, while she, not far away, was peacefully trying to buid a future with my father,
I simply had to find out more about him. This turned out to be easy because there is plenty of information, even a Wiki page on him. Here is a short summary of his life:

Józef Kowalski was born in Siedliska on 13 March 1911 to Wojciech and Zofia Borowiec, the seventh of their nine children. He was ordained a priest on 29 May 1938 as member of the Salesian Religious Society. During the German occupation of Poland, the Salesians continued their educational work. The Gestapo arrested Kowalski on 23 May 1941, along with eleven other Salesians. They were taken to Montelupich Prison and tortured.

Kowalski was sent to Auschwitz on 26 June 1941. There, he ministered to his fellow prisoners usually in secret, but at least once in front of everyone at the moment of mass execution. He was ordered by Blockführer Gerhard Palitzsch to trample upon his rosary but refused. Palitzsch was one of the most brutal of all the SS officers of the camps (he later vanished from the records, possibly killed in action). As punishment, he was assigned to a penal company. In his last letter to his parents, Józef wrote:

Do not worry about me; I am in God’s hands. I want to assure you that I feel His help at every step. Despite the present situation, I am happy and completely at peace.

On 3 July 1942 he was mocked and severely beaten by the guards for being a priest. The same night, they pulled him out of his barracks, gravely beat him again and killed him. Kowalski’s body was found the next day and burned with others. He was 31 years of age.

Pope John Paul II who had known Kowalski personally beatified Kowalski on 13 June 1999.

____________________________

Please forgive me if you find this post irrelevant or inappropriate.

 

Dry needling is a therapy that is akin to acupuncture and trigger point therapy. It is claimed to be safe – but is this true?

Researchers from Ghent presented a series of 4 women aged 28 to 35 who were seen at the emergency department (ED) with post-dry needling pneumothorax between September 2022 and December 2023. None of the patients had any relevant medical history. All had been treated for a painful left shoulder, trapezius muscle or neck region in outpatient physiotherapist practices. At least three different physiotherapists were involved.

One patient presented to the ER on the same day as the dry needling procedure, the others presented the day after. All mentioned thoracic pain and dyspnoea. Clinical examination in all of these patients was unremarkable, as were their vital signs. Diagnosis was confirmed with ultrasound (US) and chest X-ray (CXR) in all patients. The latter exam showed left-sided apical pleural detachment with a median of 3.65 cm in expiration.

Two patients were managed conservatively. One patient (initial pneumothorax 2.5 cm) was discharged. The US two days later displayed a normally expanded lung. One patient with an initial apical size of 2.8 cm was admitted with 2 litres of oxygen through a nasal canula and discharged from the hospital the next day after US had shown no increase in size. Her control CXR 4 days later showed only minimal pleural detachment measuring 6 mm. The two other patients were treated with US guided needle aspiration. One patient with detachment initially being 4.5 cm showed decreased size of the pneumothorax immediately after aspiration. She was admitted to the respiratory medicine ward and discharged the next day. Control US and CXR after 1 week showed no more signs of pneumothorax. In the other patient, with detachment initially being 5.5 cm, needle aspiration resulted in complete deployment on US immediately after the procedure, but control CXR showed a totally collapsed lung 3 hours later. A small bore chest drain was placed but persistent air leakage was seen. Several trials of clamping the drain resulted in recurrent collapsing of the lung. After CT-scan had shown no structural deformities of the lung, suction was gradually reduced and the drain was successfully removed on the sixth day after placement. The patient was then discharged home. Control CXR 3 weeks later was normal.

The authors concluded that post-dry needling pneumothorax is, contrary to numbers cited in literature, not extremely rare. With rising popularity of the technique we expect complications to occur more often. Patients and referring doctors should be aware of this. In their informed consent practitioners should mention pneumothorax as a considerable risk of dry needling procedures in the neck, shoulder or chest region. 

The crucial question, in my view, is this: do the risks of dry-needling out weigh the risks of this form of therapy? Let’s have a look at some of the recent evidence that we discussed on this blog:

The evidence is clearly mixed and unconvincing. I am not sure whether it is strong enough to afford a positive risk/benefit balance. In other words: dry needling is a therapy that might best be avoided.

According to its authors, this study‘s objective was to demonstrate that acupuncture is beneficial for decreasing the risk of ischaemic stroke in patients with rheumatoid arthritis (RA).

The investigation was designed as a propensity score-matched cohort nationwide population-based study. Patients with RA diagnosed between 1 January 1997 and 31 December 2010, through the National Health Insurance Research Database in Taiwan. Patients who were administered acupuncture therapy from the initial date of RA diagnosis to 31 December 2010 were included in the acupuncture cohort. Patients who did not receive acupuncture treatment during the same time interval constituted the no-acupuncture cohort. A Cox regression model was used to adjust for age, sex, comorbidities, and types of drugs used. The researchers compared the subhazard ratios (SHRs) of ischaemic stroke between these two cohorts through competing-risks regression models.

After 1:1 propensity score matching, a total of 23 226 patients with newly diagnosed RA were equally subgrouped into acupuncture cohort or no-acupuncture cohort according to their use of acupuncture. The basic characteristics of these patients were similar. A lower cumulative incidence of ischaemic stroke was found in the acupuncture cohort (log-rank test, p<0.001; immortal time (period from initial diagnosis of RA to index date) 1065 days; mean number of acupuncture visits 9.83. In the end, 341 patients in the acupuncture cohort (5.95 per 1000 person-years) and 605 patients in the no-acupuncture cohort (12.4 per 1000 person-years) experienced ischaemic stroke (adjusted SHR 0.57, 95% CI 0.50 to 0.65). The advantage of lowering ischaemic stroke incidence through acupuncture therapy in RA patients was independent of sex, age, types of drugs used, and comorbidities.

The authors concluded that this study showed the beneficial effect of acupuncture in reducing the incidence of ischaemic stroke in patients with RA.

It seems obvious that the editors of ‘BMJ Open’, the peer reviewers of the study and the authors are unaware of the fact that the objective of such an investigeation is not to to demonstrate that acupuncture is beneficial but to test whether acupuncture is beneficial. Starting a study with the intention to to show that my pet therapy works is akin to saying: “I am intending to mislead you about the value of my intervention”.

One needs therefore not be surprised that the authors of the present study draw very definitive conclusions, such as “acupuncture therapy is beneficial for ischaemic stroke prevention”. But every 1st year medical or science student should know that correlation is not the same as causation. What the study does, in fact, show is an association between acupuncture and stroke. This association might be due to dozens of factors that the ‘propensity score matching’ could not control. To conclude that the results prove a cause effect relationship is naive bordering on scientific misconduct. I find it most disappointing that such a paper can pass all the hurdles to get published in what pretends to be a respectable journal.

Personally, I intend to use this study as a good example for drawing the wrong conclusions on seemingly rigorous research.

 

 

Subscribe via email

Enter your email address to receive notifications of new blog posts by email.

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories