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

education

Conspiracy theories have become a frequent theme on this blog, e.g.:

 

In fact, I have previously postulated that so-called alternative medicine (SCAM) can be understood as a conspiracy theory.

A new paper asked a relevant question: who believes in conspiracy theories? Conspiracy theories are ubiquitous and can have negative consequences. Thus, there is an increasing need for evidence-based recommendations with respect to interventions and prevention measures. Present Bayesian three-level meta-analysis includes a synthesis of the extant literature with respect to 12 personality correlates and their relationship with conspiracy beliefs. On average, people who believe in pseudoscience, suffer from paranoia or schizotypy, are narcissistic or religious/spiritual and have relatively low cognitive ability, are more likely to believe in conspiracy theories. Heterogeneity was partially explained by the examined moderators and no strong evidence for publication bias was found. Implications for developing tailored interventions are discussed in the article.

Conspiracy is a “secret plot by two or more powerful actors … Conspiracies typically attempt to usurp political or economic power, violate rights, infringe upon established agreements, withhold vital secrets, or alter bedrock institutions”. Conspiracy theories are used to describe and explain purported conspiracies.

People who believe in conspiracy theories are, according to this meta-analysis, more likely than other people to hold pseudoscientific beliefs, exhibit paranoid ideation, suffer from schizotypy, be narcissistic, be religious/spiritual and have lower cognitive ability.

Reading the comments sections of my blog, I agree with this conclusion.

It has been reported that HomeoCare Laboratories Inc. is recalling two batches of Homeopathic StellaLife Oral Care Products citing microbial contamination. The recall involves Homeopathic Stella Life Vega Oral Care Spray Unflavored and Advanced Formula Peppermint Oral Care Rinse manufactured in 2024, which are marketed to promote oral health, hydrate oral cavities and support healthy gums. The recall is to be performed at the consumer level.

StellaLife VEGA Oral Care, Spray Unflavored comes with NDC 69685-121-01, lot no. 2552 and expiration date of 02-2026. StellaLife Advanced Formula Peppermint VEGA Oral Care Rinse comes with NDC 69685-143-16, lot no. 2550, and expiration date of 02- 2026.

The affected products were manufactured at HomeoCare Laboratories, shipped nationwide, and distributed through various dental practices. As per the FDA, higher than acceptable levels of TAMC was found in the Advanced Formula Peppermint Vega Oral Care Rinse, while Bacillus sp was found in the StellaLife Vega Oral Spray, Unflavored. Bacillus is a common species found in the environment and are generally non-pathogenic, while patients with oral disease, undergoing dental surgical procedures or with compromised immune systems hold potential risks. In the immunocompromised population, the impacted product may cause severe or life-threatening adverse events due to the introduction of bacteria to the disrupted oral mucosa, possibly leading to bacteremia and sepsis. However, the manufacturer of homeopathic products has not received any reports of adverse events related to these two recalled products so far.

Dental practices and consumers, who have the recalled products, are urged to return the impacted products to HomeoCare Laboratories or to the place of purchase or discard them. The company said it is implementing enhanced quality control measures to prevent recurrence.

On the manufacturer’s website, we find the following:

Homeopathy is a safe, gentle, and natural system of healing that works with your body to relieve symptoms, restore itself, and improve your overall health. It is safe to use and has none of the side effects of many traditional medications, because it is made from the natural substances and is FDA regulated. Homeopathic medicines – known as “remedies” – are made from natural sources (e.g., plants, minerals), and are environmentally friendly and cruelty free.

Homeopathic remedies when used as directed, are completely safe for everyone. They are given in such small doses that they don’t cause side effects.* Homeopathy is not a general or “umbrella” term that describes a variety of different natural therapies. Although homeopathic remedies are derived from natural substances, homeopathy should not be confused with herbal medicine, Chinese medicine, or other types of natural medicines. It is its own, unique therapeutic system.

The FDA’s present policy does not require homeopathic medicines to go through the FDA approval process.  The homeopathic ingredients monographed in the Homeopathic Pharmacopoeia of the United States have been reviewed for homeopathic efficacy, toxicology, adverse effects and clinical use. The historical safety record with the use of homeopathic drugs, some for close to 200 years. The FDA drug monitoring process does not reveal any significant instances of problems with homeopathic drug products, thus establishing a positive safety profile.

Homeopathy’s Basic Principle: The Law of Similars It is accepted knowledge that every plant, mineral, and chemical can cause in overdose its own unique set of physical, emotional, and mental symptoms. It also is readily acknowledged that individuals, when ill, have their own idiosyncratic physical, emotional, and mental symptom patterns, even when people have the same disease. Homeopathic medicine is a natural pharmaceutical science in which a practitioner seeks to find a substance which would cause in overdose similar symptoms to those a sick person is experiencing. When the match is made, that substance then is given in very small, safe doses, often with dramatic effects.

Homeopaths define the underlying principle for this matching process as the “law of similars.” The “law” is not unknown to conventional medicine. Immunizations are based on the principle of similars. No less a person as Dr. Emil Adolph Von Behring, the “father of immunology,” directly pointed to the origins of immunizations when he asserted, “By what technical term could we more appropriately speak of this influence than by Hahnemann’s word “homeopathy.”

Homeopathy is a natural form of medicine used by over 200 million people worldwide.  The holistic nature of homeopathy means each person is treated as a unique individual and their body, mind, spirit and emotions are all considered in the management and prevention of disease. Taking all these factors into account a homeopath will select the most appropriate medicine based on the individual’s specific symptoms and personal level of health to stimulate their own healing ability.

Homeopathic medicines are safe to use as they rarely cause side-effects. This means when used appropriately under the guidance of a qualified homeopath they can be taken by people of all ages*.

* Claims based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated. Individual results may vary.

__________________________

I feel like congratulating the manufacturer: not only have they managed to produce normally harmless products in such a way that they are dangerous, but also they are promoting a plethora of untruth and misleading statements about homeopathy. A most remarkable effort!

 

The over-use of X-ray diagnostics by chiropractors has been the topic of previous posts, e.g.:

The authors of this review state that many clinicians use radiological imaging in efforts to locate and diagnose the cause of their patient’s pain, relying on X-rays as a leading tool in clinical evaluation. This is fundamentally flawed because an X-ray represents a “snapshot” of the structural appearance of the spine and gives no indication of the current function of the spine. The health and well-being of any system, including the spinal motion segments, depend on the inter-relationship between structure and function. Pain, tissue damage, and injury are not always directly correlated. Due to such a high incidence of abnormalities found in asymptomatic patients, the diagnostic validity of X-rays can be questioned, especially when used in isolation of history and/or proper clinical assessment. The utility of routine X-rays is, therefore, questionable. One may posit that their application promotes overdiagnosis, and unvalidated treatment of X-ray findings (such as changes in postural curvature), which may mislead patients into believing these changes are directly responsible for their pain. A substantial amount of research has shown that there is no association between pain and reversed cervical curves. Accuracy can also be questioned, as X-ray measurements can vary based on the patient’s standing position, which research shows is influenced by an overwhelming number of factors, such as patient positioning, patient physical and morphological changes over time, doctor interreliability, stress, pain, the patient’s previous night’s sleep or physical activity, hydration, and/or emotional state. Furthermore, research has concluded that strong evidence links various potential harms with routine, repeated X-rays, such as altered treatment procedures, overdiagnosis, radiation exposure, and unnecessary costs. Over the past two decades, medical boards and health associations worldwide have made a substantial effort to communicate better “when” imaging is required, with most education around reducing radiographic imaging. In this review, we describe concerns relating to the high-frequency, routine use of spinal X-rays in the primary care setting for spine-related pain in the absence of red-flag clinical signs.

Many chiropractors over-use X-rays (not least because it is a significant source of income) and claim to be able diagnose subluxations with X-ray diagnostics. The authors of the review state are unimpressed by this habit:

Spinal X-rays can lead to the detection of radiographic findings that can be used as an overdiagnosis for the patient, even though they may be asymptomatic. These include spinal anomalies, osteophytes, reduced disc heights, low-grade spondylolisthesis, transitional segments, and spina bifida occulta. The chiropractor can use all radiographic findings as “scare tactics” or “fear-mongering” to retain a patient under a specific frequency of care, thus creating unnecessary concern for the patient. Multiple studies have concluded that radiographic findings do not always correlate with a patient’s symptomatology. Brinjikji et al. (2015) concluded that disc degeneration was present in asymptomatic individuals, ranging from 37% in 20 year olds to 96% in 80 year olds.

Many chiropractors use “phases of degeneration” as a method of communication in order for patients to adhere to excessive treatment plans. It is unnecessary and unethical to scare patients to obtain compliance with chiropractic care. These “scare tactics” can negatively influence patients’ behavior, especially those who already experience reduced levels of self-efficacy. This unnecessary use of communication can cause negative thoughts, leading to fear of avoidance of physical activity and management advice as there is a concern for further damage. In addition, the likelihood that a patient will experience chronic pain may arise due to the belief that they won’t get better until the radiographic findings are resolved.

Vertebral subluxation is a term and condition created by chiropractors that refers to misalignment of the vertebra, a bone out of place, causing pressure on the spinal nerve and interference with mental impulses. Subluxation is a legitimate medical condition; however, this completely differs from the condition used by chiropractors. Over the years, there have been numerous definitions and takes on what “vertebral subluxation” is – even though the term and concept date back to 1902, it is still commonly used in the chiropractic community. It has been described that the misalignment of the vertebra causes occlusion of where the spinal nerve travels, thus causing nerve pressure and disrupting the “mental impulse,” which is part “intelligence,” a synonym for “spirit” and part of the “mental realm,” and part neural impulse; which is part of the physical realm. Many chiropractors believe that when bones press on nerves, the corresponding organ on the other end of the nerve will suffer disease. At this point, it appears more like religion; however, it is crucial that we include this as many clinicians use this “condition” as grounds to order unnecessary radiographic imaging. Extensive medical research has shown that bones do not slip out of place, squishing nerves causing various and different pathologies – and there is certainly no way to scientifically prove the interference of a “spirit” or life force. Nonetheless, none of this is grounds for ordering an X-ray and does not qualify as any type of “red flag,” raising concern about how and when chiropractors are using radiographic imaging.

The authors conclude that the importance of medical imaging cannot be overstated. Medical professionals, on the other hand, must adhere to ethical and responsible standards. These guidelines may be ambiguous in some situations, professions, and countries, resulting in many gray areas of practice. As discussed in this review, the ongoing justification many use to justify the excessive, repetitive, and ongoing use of X-rays for reasons that research does not support is highly concerning. This article highlights potential unvalidated practices within the chiropractic field relating to poor utility imaging.

 

Astrology is a subject that regularly crops up in the realm of so-called alternative medicine (SCAM). Thus we have dealt with it on several occasions, e.g.:

Many SCAM proponents evidently believe that astrology works.

The question is, does astrology have any value at all in healthcare?

Several recent papers go some way in answering it.

The first paper evaluated the existing research base on correlates of belief in astrology and fortune-telling. the researchers conducted a scoping review to synthesize the available literature base on belief in astrology and to review the evidence for “fortune-telling addiction” using Arksey and O’Malley’s methodological framework. Databases of PubMed, ProQuest, EBSCO, and SCOPUS were searched for relevant studies published in peer-reviewed journals.

The search findings revealed the association of belief in astrology with cognitive, personality, and psychological factors such as thinking style, self-concept verification, and stress. Case studies on “fortune-telling addiction” have conceptualized it as a possible behavioral addiction and have reported symptoms such as distress, cravings, and salience.

The second study examined the relationship between Western zodiac signs and subjective well-being in a nationally representative American sample from the General Social Survey (N = 12,791). Well-being was measured across eight components:

  • general unhappiness,
  • depressive symptoms,
  • psychological distress,
  • work dissatisfaction,
  • financial dissatisfaction,
  • perceived dullness of one’s life,
  • self-rated health,
  • unhappiness with marriage.

Parametric and nonparametric analyses consistently revealed no robust associations between zodiac signs and any of the well-being variables, regardless of whether demographic factors were controlled for. The effect sizes were negligible, accounting for 0.3% or less of the variance in well-being, demonstrating that zodiac signs lack predictive power for well-being outcomes. An additional analysis revealed that astrological signs were no more predictive of than random numbers. Thus, a randomly generated number between 1 and 12 is statistically as predictive of one’s well-being as one’s zodiac sign.

The authors concluded that these findings challenge popular astrological claims about the influence of zodiac signs on well-being and quality of life.

The third paper reports a retrospective, single-center cohort study of 2545 adult patients with confirmed COVID-19 infection presenting to the emergency room over a 14-month period (September 2020 to November 2021). COVID-19 infectivity was determined based on polymerase chain reaction (PCR) testing. Western and Chinese Zodiac signs were designated using date of birth. Both Zodiac signs were evaluated for risk of infection and death.

Mortality rates across the zodiac and astrology signs showed no statistical difference using the 12-sample test for equality of proportions. Coincidentally, the mean age for the deceased was 74.5 years, and it was 53.9 years for those alive, resulting in a difference of 20.6 years. A two-sample t-test confirms that the observed difference of 20.6 years of age between the two groups is statistically significant with a p-value <0.05. The coefficient of the predictor age is statistically significant. The odds ratio estimate of age is 1.06, with the corresponding 95% confidence interval (CI) being (1.048, 1.073). This means that the odds of dying increase by 6% for every additional year.

The authors concluded that there was no statistical significance between Western and Chinese Zodiac signs and mortality or infections. 

So, does astrology have any value in healthcare?

The answer is as simple as it is unsurprising:

No!

This systematic review and meta-analysis investigated the impact of quality of life (QoL) on mortality risk in patients with esophageal cancer.

A literature search was conducted using the CINAHL, PubMed/MEDLINE, and Scopus databases for articles published from inception to December 2022. Observational studies that examined the association between QoL and mortality risk in patients with esophageal cancer were included. Subgroup analyses were performed for time points of QoL assessment and for types of treatment.

Seven studies were included in the final analysis.

  • Overall, global QoL was significantly associated with mortality risk (hazard ratio 1.02, 95% confidence interval 1.01–1.04; p < 0.00004).
  • Among the QoL subscales of QoL, physical, emotional, role, cognitive, and social QoL were significantly associated with mortality risk.
  • A subgroup analysis by timepoints of QoL assessment demonstrated that pre- and posttreatment global and physical, pretreatment role, and posttreatment cognitive QoL were significantly associated with mortality risk.
  • Moreover, another subgroup analysis by types of treatment demonstrated that the role QoL in patients with surgery, and the global, physical, role, and social QoL in those with other treatments were significantly associated with mortality risk.

The authors concluded that these findings indicate that the assessment of QoL in patients with esophageal cancer before and after treatment not only provides information on patients’ condition at the time of treatment but may also serve as an outcome for predicting life expectancy. Therefore, it is important to conduct regular QoL assessments and take a proactive approach to improve QoL based on the results of these assessments.

Am I missing something here?

Isn’t this rather obvious?

The way this paper is written, some practitioners of so-called alternative medicine (SCAM) might feel that, by improving QoL (for instance, by some fancy aromatherapy, reflexology, etc.), they can significantly better the cancer prognosis.

Patients with a poor prognosis are more seriously ill and therefore have a lowe QoL. Assessing QoL might be a useful marker, but would it not be better to ask why the QoL is in some patients less than in others?

For some time I have had the impression that research into SCAM is on its knees. Specifically, I seemed to notice that less and less of it is getting published in the best journals of conventional medicine. So, today I decided to put my impression to the test.

I went on Medline and serached for ‘COMPLEMENTARY ALTERNATIVE THERAPY + NEJM or Ann Int Med or Lancet or JAMA. This gave me the number of papers each of these four top medical journals published during the last decades. These figures alone seemed to indicate that I was on to something. To get a more reliable overall pivture, I added them up to get the total number of SCAM articles per year published in all four jurnals. As these figures indicated a lot of noise, I grouped them into periods of 4 years.

Here are the results:

  • Number of papers in the four journals published between 1999 and 2002 =115
  • Number of papers in the four journals published between 2003 and 2006 = 44
  • Number of papers in the four journals published between 2007 and 2010 = 20
  • Number of papers in the four journals published between 2011 and 2014 = 23
  • Number of papers in the four journals published between 2015 and 2018 = 38
  • Number of papers in the four journals published between 2019 and 2022 = 36

These figures confirm my suspicion: top medical journals publish far less SCAM articles than they once used to. But how do we interpret this finding?

The way I see it, there are several possible explanations:

  1. The editors are becoming increasingly anti-SCAM.
  2. Less and less SCAM research is of high enough quality to merit publication in a top journal.
  3. Numerous SCAM journals have sprung up which absorb most of the SCAM research but which are largely ignored by the broader medical community.

Personally, I think all of these explanations apply. They are the expression of a phenomenon that I discussed often before: over the years, SCAM has managed to discredit and isolate itself. Thus, it is no longer taken seriously and in danger of becoming a bizarre cult.

I fear that serious healthcare professionals get increasingly irritated by:

  • the embarrassing unreliability of much of SCAM research (as discussed so many times on this blog);
  • the fact that some research group manage to publish nothing but positive results (see my ‘ALTERNATIVE MEDICINE HALL OF FAME);
  • the news that a substantial proportion of SCAM research seems fabricated (see, for instance, here);
  • the fact that too much of SCAM research is of dismal quality (as disclosed regularly on this blog);
  • the fact that many SCAM proponents are unable of (self)critical thinking (as demonstrated regualrly by the comments left on this blog).

If I am correct, this would mean that, in the long-term, one of the biggest enemy of SCAM are the SCAM researchers who, instead of testing hypotheses, abuse science by trying to confirm their hypotheses. As Bert Brecht said: the opposite of good is not evil, but good intentions.

Although the vaccine has many individual and social benefits, ‘Vaccine Hesitancy’ has led to an increase in the number of vaccine-preventable diseases.

The aim of this study is to determine the effect of ideas that cause vaccine hesitancy to comply with traditional medicine practices and drugs and to determine the ratio of parents’ preference for so-called alternative medicine (SCAM).

This study was performed on the parents who refused vaccination in their children under the age of 8 between the years 2017-2022. Parents of the vaccinated children who were matched for age and gender were determined as the control group. Demographic characteristics of families, education levels, compliance ratios for well-child follow-up and pregnancy follow-up, preference ratios for traditional medicine and/or SCAM applications were compared.

A total of 123 families, 61 of whom were vaccine refusal and 62 of the control group, were included in the study. It was determined that the ratio of parents who refuse vaccination have increased in the last five years. The education level was found to be higher in the SCAM group (p=0.019). The most common reasons for vaccine refusal were distrust of the vaccine content (72.1%) and noncompliance with religious beliefs (49.1%). It was also found that the ratios of prophylactic vitamin use and tetanus vaccination of mothers during pregnancy were lower in the SCAM group. While the rate of compliance with vitamin D and iron prophylaxis for infants was lower in the vaccine refusal group, the ratio of preference for SCAM was higher.

The authors conclused that vaccine hesitancy is a complex issue that affects public health, in which many individual, religious, political and sociological factors play a role. As with recent studies, this research shows that the most important reason for vaccine rejection is “lack of trust”. The higher education level in the vaccine refusal group may also be a sign of this distrust. Not only the rejection of the vaccine, but also the lack of use of vitamin drugs seems to be related to lack of trust. This may also cause SCAM methods to be preferred more. These results show that providing trust in vaccination is the biggest step in the fight against vaccine hesitancy.

We have discussed the link between SCAM and vaccination hesitancy many times before, e.g.:

This new study seems to imply that the common denominator of both SCAM use and vaccination hesitancy is distrust, distrust in vaccinations and distrust in conventional medicine. That makes sense at first glance but not when you think about it for only a minute.

I can see why people distrust conventional medicine (to some extend, I do it myself). But why should distrust motivate some people to put their trust into SCAM which is even less trustworthy than conventional medicine. The rational thing for a distrusting person would be to critically assess the evidence and go where the evidence leads him/her. This path cannot possibly lead to SCAM but would lead to the best available evidence-based therapies.

If we consider this carefully, we arrive at the conclusion that not distrust but a degree of irrationality is more likely be the common denominator between SCAM use and vaccination hesitancy.

What do you think?

Yes, I have done it again: another book!

Bizarre Medical Ideas: … and the Strange Men Who Invented Them

In order to let you know what it is all about, allow me to post the intoduction here:

Medicine has always relied on extraordinary innovators. Without them, progress would hardly have been possible, and we might still believe in the four humours and be treated with blood letting, mercury potions, or purging. The history of medicine is therefore to a large extent the history of its pioneers. This book is about some of them. It focusses on the mavericks who separated themselves from the mainstream and invented alternative medicine, healthcare that remained outside conventional medicine.

Few people would deny that differences of opinion are necessary for progress. This is true for healthcare as it is for any other field. Divergent views and legitimate debate have always been important drivers of innovation. Yet, some opinions have been so thoroughly repudiated by evidence as to be considered demonstrably wrong and harmful.

The realm of alternative medicine is full of such opinions. They are personified by men who created therapies based on wishful thinking, fallacious assumptions, and pseudoscience. Many of the alternative modalities – therapies or diagnostic methods – that are today so surprisingly popular have been originated by one single person. This book is about these men. It is an investigation into their lives, ideas, pseudoscience, and achievements and an attempt to find out what motivated each of these individuals to create treatments that are out of line with the known facts.

The book is divided into two parts. The first section sets the scene by establishing what true discoveries in medicine might look like. It offers short biographical sketches of my personal choice of some of my ‘medical icons’. In addition, it provides the necessary background about the field of alternative medicine. The second section is dedicated to the often strange men who invented these bizarre alternative treatments and diagnostic methods. In this section, we discuss in some detail the life and work of these individuals. Moreover, we critically evaluate the evidence for and against each of these modalities. An finally, we attempt to draw some conclusions about the strange men who invented bizarre alternative methods.

Having studied alternative medicine for more than three decades and having published more scientific papers on this subject than anyone else, the individuals behind the extraordinary modalities have intrigued me for many years. By describing these eccentric men, their assumptions, motivations, delusions, and failures, I hope to offer both entertainment as well as information. Furthermore, I aim at promoting my readers’ ability to tell science from pseudoscience and at stimulating their capacity of critical thinking.

Phantom pain (pain felt in an amputated limb) affects the lives of individuals in many ways and can negatively affect the well-being of individuals. Distant Reiki is sometimes used in the management of these problems. But does it work?

This study was conducted to examine the effect of distant Reiki applied to individuals  suffering from phantom pain on:

1) pain level,

2) holistic well-being.

This study was designed as a single group pre-test/post-test comparison. The research was conducted between September 2022 and April 2023 and included 25 individuals with extremity amputations. Distant Reiki was performed for 20 minutes every day for 10 days. Data were collected at the beginning of the study and at the end of the 10th day. The measurements included an Introductory Information Form, the Visual Analog Scale for Pain, and Holistic Well-Being Scale (HWBS).

The results show that there was a significant difference between pre-test and post-test pain levels of the participants (p < .05) and HWBS subscale scores (p < .05). Accordingly, it was determined that after 20-minute distant Reiki sessions for 10 consecutive days, the pain levels of the individuals were significantly reduced and their holistic well-being improved.

The authors concluded that distant Reiki has been found to be easy to administer, inexpensive, non-pharmacological, and appropriate for independent nursing practice to be effective in reducing phantom pain levels and increasing holistic well-being in people with limb amputation.

Yes, I agree that Reiki might have been easy to administer.

I also agree that it is inexpensive and non-pharmacological.

I disagree, however that it is an appropriate therapy for an independent nursing practice.

And I disagree even more that this study shows or even suggests that Reiki is effective.

Why?

You probably kow the reason: this study had no control group. The observed outcomes can have several explanations that are unrelated to Reiki. For instance, the 200 minutes of attention, empathy and encouragement are likely to have generated an impact.

My conclusion: it is high time that researchers, peer-reviewers, editors, etc. stop trying to mislead the public with offensively poor-quality research and false conclusions. Reiki is an utterly implausible therapy for which no sound evidence exist.

Terry Power had been registered as a chiropractor since 1988, and as a Chinese medicine practitioner since 2012. In 2020, two female patients (Patient A and Patient B), made separate and unrelated complaints about Power to NSW Police and subsequently to the Health Care Complaints Commission.

Patient A alleged that, during a consultation in May 2020, Power kneaded and squeezed her right breast. Patient B alleged that during a consultation on 14 July 2020, Dr Power inserted two fingers into her vagina. On 27 August 2020, in proceedings conducted under Health Practitioner Regulation National Law (NSW), the Chiropractic and Chinese Medical Council of New South Wales imposed several conditions on Power’s registration including that he must not consult or treat female clients. Subsequently, Power did not practised as a chiropractor, or a Chinese medicine practitioner, since those conditions were imposed.

Power admits inserting his fingers into Patient B’s vagina but denies that he did not do so without “proper and sufficient clinical indications” as alleged by the Commission. In addition, Power denies kneading and squeezing Patient A’s right breast.

In January 2023, following investigation of complaints referred by the Council, the Commission lodged a complaint about Power with the New South Wales Civil and Administrative Tribunal (NCAT). With the leave of the Tribunal, the Commission amended that complaint. In May 2024, NCAT found Power to be guilty of professional misconduct. NCAT will determine the appropriate disciplinary orders at a future hearing.

The statements of Patient B are harrowing:

After being escorted to a treatment room and changing into a hospital gown, Patient B said to Power “I am in a lot of pain due to my chronic pain”. Power then put his hand on Patient B’s pubic bone, which was “right on the pain”, “my legs gave out and I collapsed down. I was in pain” … Power lifted her up to crack her back, a procedure he had undertaken before and with which she was comfortable. Power then instructed her to lie down on her side on the treatment table and began to manipulate her hips. He said that her right hip was “out of place” and then cracked her neck. She was still in pain. Power then said, “you can say no, but how do you feel about an internal?”, to which she replied “if it is going to help then yes”. While standing to her side, Power put on white latex gloves and then inserted two gloved fingers into her vagina. This caused some pain and discomfort. Patient B could feel Power’s fingers pressing on parts of her body inside her vagina, “it hurt like hell and I wanted to scream”. After a minute Power pulled out his fingers. Patient B then asked, “what did you find?”, Power responded by walking over to a skeleton in the treatment room and showing her what he had done. He talked about the muscles and said, “I felt where your ovary was missing. The muscles are really tight around where the ovary was and your uterus”. Power then administered acupuncture above and below her breasts. The entire consultation lasted about an hour. At the end Power said words to the effect “we will see you next time”.

Patient B got dressed and walked out without making another appointment … On 29 July 2020 … when she told the GP “what happened with the chiropractor”, Patient B “broke down in tears and was an emotional wreck”. On return to her grandmother’s house, Patient B collapsed into her mother’s arms and rang the Commission and the Health Board, who instructed her to “make a police report and contact the Health Professional Council”. In conclusion Patient B said: “When I saw Terry Power on the 14th of July 2020, I trusted his professional opinions. When he asked me to consent to him doing an internal on me, I thought at the time this was a normal procedure and l trusted him. My pain is at a stage that I would do anything to have it relieved. At no time during the procedure was another person with Terry.”

__________________________

Was patient B’s right hip was “out of place”?

No.

Is there any justification for a chiropractor to insert two fingers into a patient’s vagina?

No.

Does the question: “you can say no, but how do you feel about an internal?” amount to anything like informed consent?

No.

Is the description “he muscles are really tight around where the ovary was and your uterus” credible?

No.

But this is merely a case report of a chiropractor whom others might classify as a ‘rotten apple’ within their profession. I would, however, point out that such cases are not as rare as we might hope.

A retrospective review of data from the California Board of Chiropractic Examiners, for instance, was aimed at determining categories of offense, experience, and gender of disciplined doctors of chiropractic (DC) in California and compare them with disciplined medical physicians. 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. 

And what’s the explanation?

Could it be that chiropractors have no or too little education and training in medical ethics?

 

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