education
In response to yesterday’s post, I received a lengthy comment from ‘Stan’. Several readers have already commented on it. Therefore, I can make my arguments short. In this post, will repeat Stan’s points each followed by my comments (in bold). Here we go:
Seven Reasons Homœopathy is Not Placebo Effect
Sorry, Stan, but your heading is not proper English; I have therefore changed it for the title of this post.
1. Homeopathic remedies work on babies, animals, plants and people in a coma. Biodynamic farmers use homeopathic remedies to repel pests and treat plant diseases. Some organic ranchers rely on homeopathic remedies to treat their herds. Some “placebo by proxy” effect has been shown for children but its doubtful that it could be shown for a herd of cattle or crops in a field. Farmers can’t rely on wishful thinking to stay in business.
As discussed ad nauseam on this blog, homeopathic remedies do not work on babies or animals better than placebos. I don’t know of any studies with “people in a coma” (if you do, Stan, please let me know). The fact that ranchers rely on homeopathy is hilarious but does not prove anything.
2. The correct curative remedy will initially cause a worsening of the condition being cured if it is given in too strong (i.e. too dilute) a dose. A placebo might only cause a temporary improvement of the condition being treated; certainly not an aggravation.
The ‘homeopathic aggravation’ is a myth created by homeopaths. It disappears if we try to systematically research it; see here, for instance.
3. One can do a “proving” of an unknown homeopathic remedy by taking it repeatedly over several days and it will temporarily cause symptoms that one has never experienced previously – symptoms it will cure in a sick person. This is a repeatable scientific experiment used to determine the scope of a new remedy, or confirm the effects of an already proven remedy. A placebo might possibly have an effect if the individual taking it has been “prepared” by being told what they are taking but it likely wouldnt match previously recorded symptoms in the literature.
Homeopathic provings are rubbish and not reproducible when done rigorously; see here.
4. One can treat simple acute (self-limiting) conditions (e.g. minor burns, minor injuries, insect bites, etc.) and see unusually rapid cures with homeopathic remedies. A placebo might only cause a temporary improvement of the condition being treated while taken. Placebos have been found mostly effective in conditions with a strong psychological component like pain.
You mean like using Arnica for cuts and bruises? Sadly, it does not work.
5. One can get homeopathic treatment for long term chronic (non self-limiting) conditions and see a deep lasting cure, as has been documented clinically for a couple centuries. A placebo might only cause a temporary partial improvement of the condition being treated while the placebo is being taken.
You mean like asthma, eczema, or insomnia?
6. There is over 200 years worth of extensive documentation from around the world, of the clinical successes of homeopathy for both acute and chronic conditions of all types. As Dr Hahn has said you have throw out 90% of the evidence to conclude that homeopathy doesnt work. The Sheng et al meta-analysis in 2005 Lancet that was supposedly the death knell of homeopathy used only 8 studies, excluding hundreds of others. Unsurprisingly homeopathy was found wanting. So-called Skeptics see what they want to see in the science. There is relatively little documentation of placebo usage. A few recent studies have been done showing the limited temporary benefits of placebos.
What Hahn wrote is understandably liked by homeopaths but it nevertheless is BS. If you don’t trust me, please rely on independent bodies from across the world.
7. Homeopathic remedies have been shown to have a very weak electromagnetic signature and contain some nano-particles. Some believe this explains their mechanism. An exciting new potential field of research is the subtle cell signalling that has been found to direct the development of stem cells. Scientists have created double-headed planeria worms and this trait has been found to be inherited by their offspring without any change in the genes or epigenetics. Until now we had no idea how a single fertilized ovum could evolve into a complex creature that is bilateral and has multiple cell types. It is possible that the very subtle electromagnetic signature or some other unknown effect of homeopathic remedies is effecting this subtle cell signalling.
The homeopathic nano-myth is nonsense. And so is the rest of your assumptions.
Every conventional drug has “side effects” that match the symptoms for which it is indicated! Aspirin can cause headaches and fever, ritalin can cause hyperactive effects, radiation can cause cancer. Conventional doctors are just practicing bad homeopathy. They are prescribing Partially similar medicines. If their drugs were homeopathic (i.e. similar) to the patients symptoms on all levels they would be curative. Radiation sometimes does cure cancer instead of just suppressing it per usual.
Even if this were true, what would it prove? Certainly not that homeopathy works!
Dr Hahneman did forbid mixing homeopathy and conventional medicine. In his day doctors commonly used extensive blood letting and extreme doses of mercury. Its not Quite as bad now.
You evidently did not read Hahnemann’s writings.
Just because we dont know how extremely dilute homeopathic remedies work, doesn’t discount that they Do work. Homeopathy seems to fly in the face of Known science. In no way is it irrational or unscientific. There are lots of phenomena in the universe that cant be explained yet, like dark energy and dark matter effects and even consciousness!
Not knowing how a treatment works has not stopped science to test whether it works (e.g. Aspirin). In the case of homeopathy, the results of these endeavors were not positive.
The assumption that the moon is made of cheese also flies in the face of science; do you perhaps think that this makes it true?
The actions of homeopathy can and have been well-explained: they are due to placebo effects.
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Stan, thank you for this entertaining exercise. But, next time, please remember to supply evidence for your statements.
After all these years, I am still fascinated by what proponents of homeopathy try to tell others about their trade. Recently I found a long article in this vein. It is aimed at an audience of HEILPRAKTIKER and their patients. It should therefore be responsible, thorough, and evidence-based (yes, I am an optimist).
“With this article”, the authors state, “we aim to provide a comprehensive overview of homeopathy and help people make informed decisions about their health. Whether you already have experience with homeopathy or simply want to inform yourself, we hope that this article will provide you with valuable insights and information” (my translation).
Here I present to you just the relatively short section dedicated to the ‘pros and cons’ of homeopathy. Here we go:
Advantages of homeopathy:
- Holistic approach: homeopathy considers the human being as a whole and takes into account both physical and emotional aspects. It aims to support individual balance and the body’s self-healing powers.
- Gentle and non-invasive treatment: Homeopathic remedies are usually taken as globules, drops, or tablets and are therefore easy and convenient to use. They rarely cause side effects and are generally well tolerated.
- Individualized treatment: In homeopathy, each patient is considered unique and treatment is based on individual symptoms and characteristics. There is no “one-size-fits-all” solution, but a personalized approach.
- Support for chronic diseases: Homeopathy can be an alternative or complementary treatment for chronic conditions where conventional medicines offer limited relief. It can help improve quality of life and promote overall well-being.
Limitations of homeopathy:
- Placebo effect: Much of the effect of homeopathy is attributed to the placebo effect. It is argued that the improvements patients experience occur because of belief in the efficacy of the remedies and positive expectations, rather than due to a specific effect of the diluted substances.
- Lack of scientific evidence: The scientific evidence for the efficacy of homeopathy is limited and controversial. Many studies have failed to demonstrate benefits beyond the placebo effect. There is a lack of well-conducted randomized controlled trials that clearly show the effectiveness of homeopathy.
- Delay or rejection of conventional treatments: In some cases, the choice of homeopathy as the sole method of treatment may lead to delays in the diagnosis and timely treatment of serious or acute illnesses. It is important that serious illnesses are examined by a doctor and treated appropriately.
- Difficulties in standardization: Homeopathy involves a variety of remedies used in different potencies and dilutions. This makes standardization and the conduct of reproducible studies difficult. There are also controversial debates about whether the dilutions go beyond the extent to which molecules of the original substance are still present.
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I am sure that you have heard the BS about the alleged advantages of homeopathy often enough. Therefore, I will here not bother to comment on them again. More interesting, in my view, are the limitations of homeopathy, as seen by its proponents. Please allow me, therefore, to discuss them briefly.
- The authors state that “it is argued that the improvements patients experience occur because of belief in the efficacy of the remedies and positive expectations”. This sounds as though this is a mere aberrant opinion or at least an ongoing debate amongst scientists. In fact, it is the scientific consensus supported by tons of evidence.
- This is the same point expressed differently.
- The admission that “the choice of homeopathy as the sole method of treatment may lead to delays in the diagnosis and timely treatment” is yet another way of stating that homeopathy is not effective. What is, however, not expressed clearly enough, in my view, is the fact that homeopathic treatment usually amounts to medical neglect which is unethical and can cause serious harm, in extreme cases even death.
- It is not true that the range of potencies renders “the conduct of reproducible studies difficult”. There are plenty of examples to demonstrate this, for instance, this study. “There are also controversial debates about whether the dilutions go beyond the extent to which molecules of the original substance are still present.” Yes, I did translate this correctly. I am sorry to say that this sentence does make no sense in German or in English.
What I find particularly interesting is that the authors do not mention disadvantages that non-homeopaths would rate as quite important, e.g.:
- The assumptions of homeopathy fly in the face of science.
- Hahnemann strictly forbade homeopathy to be combined with ‘allopathy’ (yet proponents now claim this option to be an advantage).
- Treating a patient with homeopathy violates even the most basic rules of medical ethics.
- Homeopaths have no choice but to lie to their patients on a daily basis.
- Many homeopaths have the nasty habit of advising their patients against using effective treatments, e.g. vaccinations.
- Homeopathy undermines rational thinking in a general way.
In summary, the authors’ “aim to provide a comprehensive overview of homeopathy and help people make informed decisions about their health” has not been reached.
The well-known Dr. Chris van Tulleken recently joined forces with Professor Michael Heinrich and Dr. Anthony Booker from the University College London School of Pharmacy to test a range of herbal products on sale in the UK. They bought over 70 herbal products from various high street stores and internet retailers. Some of the products were ‘THR’ (traditional herbal registration) herbal medicines, and some were marketed as food supplements. They then analyzed their chemistry to see whether each one really contained what the label says. The three popular herbal remedies we tested were:-
- Milk thistle (Silybum marianum),
- Ginkgo (Ginkgo biloba),
- Evening primrose (Oenothera).
The team at UCL used two different methods of analysis to verify the identity of these herbal products and extracts. High-performance thin-layer chromatography (HPTLC) is a sophisticated technique for the analysis of herbal products and is one of the most commonly used methods in the industry. HPTLC analysis creates a chemical fingerprint of the product which the researchers can then compare to an accepted reference standard for the herb. They look for a broad spectrum of ‘marker compounds’ these are the pharmacologically active and/or chemical constituents within a plant that can be used to verify its potency or identity. For complex samples or where additional confirmation is required, researchers often turn to ¹H nuclear magnetic resonance spectroscopy (¹H-NMR) which allows individual samples to be compared in detail against other samples or to the whole group.
In every THR product tested, the product contained what was claimed on the label. However, the food supplements showed a wide range of quality.
- Of the food supplement products labeled as Ginkgo, 8 out of 30 (27%) contained little or no ginkgo extract.
- 36% of the food supplement milk thistle products contained no detectable milk thistle. Although this is quite a small sample size it is still a startling result. Furthermore, in one case of milk thistle, unidentified adulterants suspected to be synthetic compounds were present in place of milk thistle.
- All of the evening primrose food products we tested did contain what the packet claimed.
The researchers concluded that their investigation shows that a regulatory system for herbal products, like the THR scheme, ensures that people have access to safe herbal medicine products. So, if you are considering buying herbal products then do look out for the THR mark– otherwise, you might not just be wasting your money, you might be consuming other, potentially dangerous, ingredients.
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This is an interesting investigation. The researchers should be commended for it! However, I disagree with some of their conclusions. Here is why:
- The investigation merely tested the quality of the products and NOT THEIR SAFETY! To claim that the THR ensures access to safe herbal medicines is incorrect. A product might be of adequate quality but can still be unsafe. The THR only implies safety because the herbal has been used for years without problems being noted. This is not the same as ensuring that it is safe. A direct test of safety is usually not available.
- The recommendation to buy a product with a THR mark is also somewhat misleading. It implies that these products are effective. I fail to see convincing evidence that either MILK THISTLE, GINKGO, or EVENING PRIMROSE are effective for any disease or condition. Thus the responsible recommendation should, in my view, be to NOT buy them regardless of whether they are of good quality or not.
Richard Rasker has been one of our most loyal commentators with hundreds of sensible contributions to his credit. And now he has published a book! “This book”, he writes in his introduction, “is perhaps best described as a kind of travel guide for exploring different worlds, some of which are probably familiar, while others may be completely alien to you. Some of those worlds only exist in the minds of people, while others are very real indeed, yet often go unnoticed or have unexpected things to offer. This journey is also my personal exploration, during which I try to look through the eyes of the inhabitants of worlds that are wildly different from my own, to try and understand why those people believe certain things, and why I myself believe different things.”
Richard is not a medic, he is a man who understands science and empathizes with the many people who try to make sense of the often confusing concepts of healthcare. In his book, he takes the reader by the hand and carefully guides him or her through some of the issues that are of concern to so many of us. The journey takes us to so-called alternative medicine (SCAM) and beyond. At its end, the reader is wiser, more knowledgeable, and has learned the art of critical thinking.
Most chapters start with a story or anecdote that enables the reader to identify with the subject at hand. This serves the purpose of focusing the reader’s mind on the issue at hand which is then explained in full detail. The fact that Richard is not a medic turns out to be a strength of this book. Richard is not even tempted (as medics invariably are) to use jargon or to assume that the reader has prior knowledge of the subject. Instead, he starts from first principles and makes it impossible to get lost on the journey. What may seem complicated and confusing thus becomes clear and straightforward; what might have appeared to be dry and off-putting thus becomes lively and fascinating.
The range of topics that this book tackles is vast. It covers much of SCAM, of course. But it also includes topics that are way beyond SCAM, such as radiation and vaccination. In essence, the book deals with most things that people concerned about their health tend to worry about. Because Richard is a gifted writer who can render things simple without making them unduly simplistic, the book is a joy to read.
In my view, this book is a MUST-READ for anyone who wants to find his/her way safely through the maze of seemingly complex problems in healthcare.
‘Spagyric’ is a so-called alternative medicine (SCAM) based on the alchemy of Paracelsus (1493-1541). Paracelsus borrowed the term from “separate” (spao) and “combine” (ageiro) to indicate that spagyric preparations are based on the “separation”, “extraction” and “recombination” of the active ingredients of a substance. Plant, mineral as well as animal source materials are used.
The production of spagyric remedies is based on a complex process of maceration and fermentation of a plant extract in alcohol. It takes place in dark, thick-walled glass flasks that are hermetically sealed and kept at a controlled temperature of 37 °C for 28 days. The tincture thus obtained is then decanted and the drug residue is removed from the solution, completely dried, and burned to ash to recover the inorganic components of the plant material. The ash is subsequently dissolved in the alcoholic solution of maceration, and the finished spagyric preparation is left for 12 days before use.
Spagyric is not the most popular of all SCAMs but it certainly does have a significant following. One enthusiast claims that “spagyric essences work on a vibrational level in their action upon the emotional/mind and physical spheres and can be employed in numerous situations. Most people seek help to relieve physical symptoms. Even so, it is often necessary to address the emotional and psychological aspects which may predispose the illness or imbalance. In an era where many people are experiencing life-changing events, the ability to transition smoothly is essential for well-being and vitality. Guidance and help are required to maintain homeostasis. These medicines can help the patient to understand the root cause of their illness and learn to regain control of their lives. Some medicine systems appear to be less effective than in previous times. It has been suggested that the energetic frequency of both the earth and human organism are changing. Therefore these systems may no longer be a vibrational match for the changing frequencies. Spagyric Medicine is designed to ‘tune in with’ these current frequencies. Research suggests that the Spagyric essences may instigate improved health by energetically influencing DNA.”
After reading such weird statements, I ask myself, is there any evidence that spagyric remedies work? In my search for robust studies, I was unsuccessful. There does not seem to be a single controlled study on the subject. However, there are fragmentary reports of a study initiated and conducted by a now largely unknown healer named Karl Hann von Weyhern.
Von Weyhern (1882 – 1954) had taken a few semesters of pharmacy and medicine in Freiburg but remained without a degree. In 1930, he became a member of the NSDAP (Hitler’s Nazi party) and in 1940 he joined the SS. Around 1935, he settled in Munich as a non-medical practitioner (Heilpraktiker), and Heinrich Himmler who has a soft spot for SCAM enlisted as one of his patients. By then von Weyhern had by then made a steep career in the Nazi hierarchy, and he managed to convince Himmler that his spagyric remedies could cure tuberculosis, which was still rampant at the time. They decided to carry out experiments in this regard in the Dachau concentration camp.
Thus, von Weyhern was allowed to test spagyric remedies on forcibly recruited concentration camp prisoners. These experiments lasted for about one year and included around 150 patients who, according to von Weyhern’s iridology diagnosis, suffered from tuberculosis. Half of them were treated with spagyric remedies and the others with conventional treatments. At the end of the experiment, 27 persons were reportedly released into everyday concentration camp life as ‘fit for work’. How many of the 150 prisoners lost their lives due to these experiments is not known. Von Weyhern never filed a final report. It is to be feared that the death toll was considerable. [1]
After the war, von Weyhern denied belonging to the SS, claimed that he had ‘sacrificed himself’ for his patients in the concentration camp, merely had to pay a fine, and was ‘denazified’ in 1948. Subsequently, he resumed his work as a ‘Heilpraktiker’ in Olching, a village near Dachau. [1]
Of course, these infamous experiments cannot be blamed on spagyric medicine. Yet, I feel they are nevertheless important, not least because they seem to reveal the only thing remotely resembling something like evidence.
[1] Die Ärzte der Nazi-Führer: Karrieren und Netzwerke : Mathias Schmidt (Hg.), Dominik Groß (Hg.), Jens Westemeier (Hg.): Amazon.de: BooksA ‘manifesto’ is not something that I come across often in my area of research, i.e. so-called alternative medicine (SCAM). This one is in German, I, therefore, translated it for you:
Manifesto for healthy medicine
With the Manifesto for healthy medicine, we, the citizens and patients alliance weil’s hilft! (‘BECAUSE IT HELPS’) demand a fundamental change in our healthcare system, towards a diverse medicine that focuses on people and health. Be part of it! Sign the manifesto and become part of the movement.
It’s of paramount importance, the Manifesto for healthy medicine. About the way we live. It’s about our health. It’s about you and it’s about me.
We want our healthcare system to actually focus on health.
We want a medicine that doesn’t ask what’s missing, but what is possible.
We want a medicine that cares about people, that takes care, gets to the bottom of things, and uses innovative technologies to do so.
We want more bio, so that the chemistry is right, and we want naturopathic procedures and naturally effective medicines to be recognized, promoted, and researched further.
We want research that creates knowledge because, in addition to studies, it also takes into account the experience of physicians and the needs of patients.
We want carers and doctors to be able to work in a way that is good for their patients and for themselves.
We want people from all healthcare professions to work together as equals.
We want a medicine that creates awareness for a good and healthy life because climate protection also begins in one’s own body.
We want an integrative medicine that puts people at the center and self-evidently combines conventional and natural healing methods.
And we want this medicine to be accessible and affordable for everyone.
We fight for a healthy medicine of the future.
Be part of it!
(sorry, if some of it might sound badly translated but the German original is in parts pure gibberish)
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Who writes such tosh composed of every thinkable platitude and then pompously calls it a MANIFESTO?
BECAUSE IT HELPS! (weil’s hilft!) is a citizens’ movement that demands a change in the health care system – towards the needs and preferences of patients, towards a holistic view of people, and a focus on health instead of disease. The sensible combination of natural medicine and conventional medicine, an integrative medicine, makes an indispensable contribution to this. This is because it relies fully on the patients and involves them as active partners in the treatment. Modern medicine of the future, therefore, needs the equal cooperation of natural medicine and conventional medicine – in the everyday life of physicians and patients, in the reimbursement by the health insurance companies as well as in research and teaching.
On the information platform www.weils-hilft.de weil’s hilft! informs about current developments in integrative medicine, provides background information, and publishes a podcast once a month. The movement is also active on social media at www.facebook.com/weilshilft and www.instagram.com/weilshilft.
weil’s hilft! is supported by the health and patient organizations GESUNDHEIT AKTIV, KNEIPP-BUND, and NATUR UND MEDIZIN. Together, the alliance represents the interests of more than 220,000 people.
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One could easily disclose the funny side of this, the utter stupidity of the arguments, the platitudes, fallacies, misunderstandings, ignorance, etc. Yes, that would hardly be difficult. But it would ignore how worrying this and similar movements are. They systematically misinform consumers with the sole aim of persuading them that the integration of unproven or disproven treatments into medical routine is in their interest. Yet, if we only scratch the surface of their arguments, we realize that it is exclusively in the interest of those who profit from this type of misinformation.
Exceptionally, this post is unrelated to so-called alternative medicine (SCAM). It addresses a new and worrisome development in UK healthcare. The UK has fewer doctors per population than most other developed countries. This shortage has now reached a level where it puts patients in danger. Recently, the government has unveiled a new NHS plan aimed to fix the problem.
The apprenticeship scheme could allow one in 10 doctors to start work without a traditional medical degree, straight after their A-levels. A third of nurses are also expected to be trained under the “radical new approach”. It is the centerpiece of a long-delayed NHS workforce strategy, following warnings that staff shortages in England could reach half a million without action to find new ways to train and recruit health workers. Amanda Pritchard, the head of NHS England, said: “This radical new approach could see tens of thousands of school-leavers becoming doctors and nurses or other key healthcare roles, after being trained on the job over the next 25 years.” She added that the plan offered a “once-in-a-generation opportunity to put the NHS on a sustainable footing”.
The “medical doctor degree apprenticeship” involves the same training and standards as traditional education routes, including a medical degree and all the requirements of the General Medical Council. Candidates will be expected to have similar A-levels as those for medical school, with qualifications in sciences, as well as options for graduates with non-medical degrees. The key difference behind such models is that apprentice medics would be available on the wards almost immediately, working under supervision, while being paid.
The medical degree apprenticeship is due to launch this autumn.
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I am impressed!
Sadly, not in a positive way.
In fact, I cannot remember having ever heard of a more stupid idea for dealing with doctor shortages.
As incompetent amateurs, do the Tories really think that a similar level of incompetence might work also in healthcare?
Such shortages have happened before.
They are regrettable and need swift and firm action.
The only countermeasure that works is to train more doctors.
REAL DOCTORS!
The German Heilpraktiker (HP), a non-medically trained practitioner of so-called alternative medicine (SCAM), has repeatedly been the subject of my posts. In a nutshell: the profession was created by the Nazis and was originally destined to disappear within one generation. But this did not happen, and today there are ~100 000 HPs who are allowed to treat almost any condition without mandatory training or experience. Many HP schools exist but you can also become an HP without formal training.
Now a report has been published by undercover journalists investigating these HP schools in Germany. Here I have summarized a few crucial passages for you (if you read German, I strongly recommend reading the original article):
There are more than 150 HP schools in Germany. On average, training costs several thousand euros. There is no uniform and state regulation for the training. The curricula are mostly created by the schools themselves.
In addition to medical and psychological content, the schools often offer seminars that are not based on scientific knowledge. The curricula sometimes include courses such as astrology, homeopathy, or so-called quantum healing. HP organizations give indeed training guidelines. However, these are not met by about 83% of the schools.
The students were isolated at the HP school from their environment and urged to break off contact with their families. “Without us you are nothing. That came so often and I then, unfortunately, believed in it, because I was alone. If I had had no one else from school, then I would really have been completely alone,” explains a former student in an interview. “During that time, I also thought for the first time: Are we in some kind of cult here?
The school’s principal rejects the cult accusation: “We have been confronted with the allegation that we are a cult for some time and have always dealt with it very openly because we are not a cult. The principal also denies other accusations made by former students, saying that the allegations of suggestion, coercion, compulsion, or sweeping statements are simply false. He said he would be happy to face them “in a personal conversation outside the public eye to answer their questions.”
In order to get to the bottom of the treatment methods, the reporter also had herself treated by the principal of the school in an undercover self-experiment. In the first session, she determined that the reporter’s sciatica had been passed on to her by her mother, which is why she should sever her ties with her. In the second session, she recommended that she no longer visit her cancer-stricken grandfather. When the principal learned that the ill grandpa was of the zodiac sign Cancer, she concluded, “Cancer gets cancer.” The cancer, she said, was due to the fact that he had done nothing for his soul. And further, the patient runs the risk of adopting the grandfather’s cancer symptoms when she visits him.
The Hamburg health authority, which is listed as a “supervisory authority” on the school’s homepage, explains in response to an inquiry that no official supervision exists for HP schools. To obtain permission for opening a school, no training is necessary. Neither possible training courses nor institutions offering such training courses are regulated by the state.
The journalist also asked the Federal Health Ministry whether it sees the need for action and legal control. The Ministry’s response was evasive: “If necessary,” the HP law should be reformed in the future.
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This is shocking news for many Germans who believe that HPs are well-trained healthcare professionals. However, those who have read my recently published book cannot be surprised. Poor training is only one of a myriad of deficits of HPs. It is time that the government realizes that the current is unacceptable and endangers public health. It is time, in other words, that the government does something about the HP profession.
How often do we hear that chiropractic is safe because numerous trials reported no adverse events? This systematic review tested whether there has been a change in the reporting of adverse events associated with spinal manipulation in randomized clinical trials (RCTs) since 2016.
Databases were searched from March 2016 to May 2022: MEDLINE (Ovid), Embase, CINAHL, ICL, PEDro, and Cochrane Library. Domains of interest (pertaining to adverse events) included: completeness and location of reporting; nomenclature and description; spinal location and practitioner delivering manipulation; methodological quality of the studies and details of the publishing journal. Frequencies and proportions of studies reporting on each of these domains were calculated. Univariable and multivariable logistic regression models were fitted to examine the effect of potential predictors on the likelihood of studies reporting on adverse events.
5399 records were identified by the electronic searches, of which 154 (2.9%) were included in the analysis. Of these, 94 (61.0%) reported adverse events with only 23.4% providing an explicit description of what constituted an adverse event. Reporting of adverse events in the abstract has increased (n=29, 30.9%) while reporting in the results section has decreased (n=83, 88.3%) over the past 6 years. Spinal manipulation was delivered to 7518 participants in the included studies. No serious adverse events were reported in any of these studies.
The authors concluded as follows: while the current level of reporting of adverse events associated with spinal manipulation in RCTs has increased since our 2016 publication on the same topic, the level remains low and inconsistent with established standards. As such, it is imperative for authors, journal editors and administrators of clinical trial registries to ensure there is more balanced reporting of both benefits and harms in RCTs involving spinal manipulation.
This article is clearly relevant to our discussions about adverse events after spinal manipulation. However, I find it far too uncritical. This might be due to the affiliations of some of the authors:
- Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist and University of Zurich, Zurich, Switzerland.
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
Interestingly, the authors stated that they have no conflict of interest. Also interesting is the fact that they do not cite our paper from 2012. I, therefore, take the liberty of doing it:
Objective: To systematically review the reporting of adverse effects in clinical trials of chiropractic manipulation.
Data sources: Six databases were searched from 2000 to July 2011. Randomised clinical trials (RCTs) were considered, if they tested chiropractic manipulations against any control intervention in human patients suffering from any type of clinical condition. The selection of studies, data extraction, and validation were performed independently by two reviewers.
Results: Sixty RCTs had been published. Twenty-nine RCTs did not mention adverse effects at all. Sixteen RCTs reported that no adverse effects had occurred. Complete information on incidence, severity, duration, frequency and method of reporting of adverse effects was included in only one RCT. Conflicts of interests were not mentioned by the majority of authors.
Conclusions: Adverse effects are poorly reported in recent RCTs of chiropractic manipulations.
In percentage terms the results are similar. What is very different is that the authors of the new paper merely lament that the level remains low and inconsistent with established standards, while we make it clear in the abstract that adverse effect reporting is poor and in the paper identify this deficit as a violation against research ethics and thus as a form of scientific misconduct.
In view of all this, let me re-phrase the last sentence of the authors’ conclusion:
it is imperative for authors, journal editors, and administrators of clinical trial registries to ensure that researchers adhere to accepted ethical standards and that scientific misconduct no longer gets published.
Following the death from cancer of a 14-year-old Carinthian girl, the Klagenfurt public prosecutor’s office has launched an investigation against the girl’s parents. In February this year, the 14-year-old was taken to a hospital in Graz, Austria, where she died a few days later from cancer. The hospital filed charges because the tumor had been treated incorrectly with so-called alternative medicine (SCAM).
Investigations are underway on suspicion of torturing or neglecting underage, younger, or defenseless persons. Currently, the accused and witnesses are being questioned. The parents’ lawyer, Alexander Todor-Kostic, stated that the accusations were without any basis and claimed that the 14-year-old girl had decided of her own free will against being treated with chemotherapy and surgery. The parents respected this, allowed her alternative treatment methods, and acted in accordance with the applicable legal situation.
The girl had developed cancer the previous year that was not detected. Instead of seeing conventional oncologists for a reliable diagnosis and effective treatments, the parents consulted private doctors. Instead of chemotherapy, radiation, and surgery, the girl had deliberately chosen “alternative treatments” herself, the lawyer stressed.
Even though the case has been reported in several Austrian papers, I did not succeed in finding further details about it. In particular, it is unclear what type of cancer the girl had been suffering from and what type of SCAMs she received.
The Austrian skeptic Christian Kreil commented: “Sugar pills in the pharmacies, homeopathic advanced training for doctors, a proliferation of energetics offering every conceivable bullshit … the dead girl is the logical result of this esoteric foolishness covered by politics and chambers.”
I am afraid that he might have a point here: as we have discussed repeatedly on this blog, Austria is currently particularly prone to misinformation about SCAM. Here are a few examples of previous blog posts on this subject:
- Austrian osteopaths seem to violate legal, ethical and moral rules and conventions
- An open letter to the President of the Austrian Medical Association aims to stop medical quackery
- Has the ‘Vienna Medical Association’ taken leave of its senses?
- When politicians become snake-oil salesmen
- Michael Frass’ research into homeopathy for cancer: “numerous breaches of scientific integrity”
- A well-known opponent of vaccination has died of COVID after self-treatment with MMS
- The case of a boy tortured to death with homeopathy
- A truly perplexing homeopath – is it time for an official investigation?
Misinformation about SCAM can be lethal. This is one of the reasons why responsible information is so very important.
