education
The Canadian Kwantlen Polytechnic University (KPU) has announced that it will launch Canada’s first bachelor’s degree in Traditional Chinese Medicine (TCM). Greenlit by the B.C. government to fill what it calls rising demand in the labour market, the new program marks a major step in Canadian recognition of TCM. However, skeptics of TCM and other so-called alternative medicine (SCAM) remain wary of movement in this direction.
TCM is regulated in British Columbia, Alberta, Quebec, Ontario and Newfoundland and Labrador, with more than 7,000 licensed practitioners working in these provinces.
John Yang has worked for nearly a decade toward KPU’s bachelor’s degree, which will welcome its inaugural cohort starting September 2025. As chair of KPU’s TCM program, he hopes the new offering will boost its acceptance and encourage more integration with the Canadian health-care system. “The degree program can let the public [feel] more confident that we can train highly qualified TCM practitioners. Then there will be more mainstream public acceptance,” he said. “Currently we are not there yet, but I hope in the future there’s an integrated model.”
The degree will add topic areas like herbology and more advanced TCM approaches to the current diploma’s acupuncture-focused study, as well as courses in health sciences, arts and humanities, ethics and working with conventional health practitioners, says Sharmen Lee, dean of the B.C. school’s faculty of health. “You’re getting a much broader, deeper education that allows you to develop additional competencies, such as being able to critically think, to evaluate and participate in research, and all of those other things that a university-based education can provide.” Lee believes future graduates will be able to work alongside with biomedical professionals, with some becoming researchers as well — able to pursue post-grad studies abroad. “They start to understand the fundamentals of conducting research, of reviewing published studies and then … to critically analyze what that means so that they can apply that to their practice,” Lee said. “It’s going to help to elevate the practice of traditional Chinese medicine … in our province.”
With the World Health Organization (WHO) encouraging governments toward integrating traditional and complementary medicine into their health-care systems, there’s a need for researchers to develop strong evidence to guide policy-makers, says Nadine Ijaz, an assistant professor at Carleton University in Ottawa and president of the International Society for Traditional, Complementary and Integrative Medicine Research. “Most Canadians at some point in their lifetime are using some form of what we call traditional and complementary medicine: that might be acupuncture, chiropractic, massage therapy, vitamins, yoga … people who are participating in Indigenous healing ceremonies within their own communities,” she said. “How are governments to make good determinations about what to include? What is rigorous? What is safe? What is effective and what is cost effective, in addition to what is culturally appropriate?”
More research and scientific inquiry is a good thing, but it depends on the type of research, says Jonathan Jarry, a science communicator for the McGill Office of Science and Society and co-host of the health and medicine podcast Body of Evidence. Jarry said many studies on SCAM are low quality: too few participants, too short in duration, lacking follow-up or a proper control group. It’s an issue that plagues research on conventional therapies too, he acknowledged. “I’m all for doing research on things that are plausible enough that they could realistically have a benefit, but then you have to also do very good, rigorous studies. Otherwise you’re just creating noise in the research literature.”
Ijaz and a group of colleagues around the globe are working toward determining strong research parameters without forcing alternative approaches “into a box where they don’t fit.” For instance, a randomized controlled trial is the gold standard of research in biomedicine and excellent for studying pharmaceutical drugs and their effects, because participants in the control group get a placebo, perhaps a sugar pill, that means they can’t tell if they’re being treated with medication or not. But it doesn’t work for studying acupuncture treatment, chiropractic or even psychotherapy, Ijaz pointed out. “If you’re getting an acupuncture treatment, you usually know that you’re getting a treatment…. It’s a little bit challenging to develop a placebo control for for those approaches,” said Ijaz. “When we apply that particular gold standard to researching all therapeutic approaches … it sort of privileges the issue in favour of pharmaceutical drugs immediately.”
“A randomized controlled trial is the gold standard of research in biomedicine and excellent for studying pharmaceutical drugs … but it doesn’t work for studying acupuncture treatment, chiropractic or even psychotherapy.” When I hear nonsensical drivel like this, I know what to think of a university course led or influenced by people who believe this stuff. They should themselves go on a course of research methodology for beginners rather that try brainwashing naive students into believing falsehoods.
The German ‘TAZ’ recently reported about an interesting homeopathic research project. Here I have translated a few excerpts for you:
The title of the research project at the University of Oldenburg is unspectacular: ‘Microbiological investigation of the maturation process of mother tinctures’. However, the sponsor and the word ‘mother tincture’ make you wonder. The project, which ran from 2016 to 2023, investigated the microbiome of various medicinal plants that are used to produce ‘mother tinctures’. These are the undiluted starting materials for homeopathic remedies. The project was financed and largely controlled by the homeopathy company Wala … According to the German Medical Association, homeopathy is generally incompatible with rational medicine and medical ethics. So why is a state university researching ‘mother tinctures’?
The person responsible is marine biologist Meinhard Simon … a member of the university’s Commission for Good Scientific Practice since 2020 and is therefore responsible for ensuring compliance with scientific standards. Prior to that, he was Chairman of the Ethics Committee for ten years. Meinhard Simon describes questions about ethical aspects of the collaboration with Wala as ‘pointless’. When asked, he explained that current studies do indeed prove the effectiveness of homeopathy. Publications and press articles stating otherwise are ‘one-sided’ and ‘tendentious’.
For years, he has used his position to give homeopathy a scientific veneer. He has co-authored several studies on the subject, supported by homeopathic companies and lobby groups. If he and his colleagues are unable to prove an effect despite funding from the homeopathy industry, they simply blame the study design for the failure, as in a 2011 study, and remain in line with the funders, despite their own data. Simon and colleagues assume ‘force-like (immaterial) resonance effects’ of homeopathy. In other words: magic.
In the past, Wala has funded a lobbyist who has publicly denounced scientists and journalists who have criticised homeopathy and warned of its risks. Among them was Edzard Ernst who said of the university’s collaboration with Wala: ‘I take a rather critical view, especially when it’s a company whose advertising misleads customers.’
‘As a basic researcher in microbiology, I believe that cooperation projects with a company like Wala are not only justifiable in terms of medical ethics, but also important and in keeping with the times,’ explains Simon. He himself is a member of a lobby group for alternative medicine, which is part of the Wala-affiliated ‘Foundation for Integrative Medicine & Pharmacy’. Among other things, it campaigns for the treatment of cancer with mistletoe.
When asked, the University of Oldenburg explained that it saw no reason to judge Simon’s research as negative and referred to his good reputation. It does not answer questions about Wala’s dubious methods or how Simon’s relaxed relationship with science can be reconciled with his role as a guardian of scientific rigour and ethics.
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Prof Simon’s papers on homeopathy include the following:
Development of a test system for homeopathic preparations using impaired duckweed (Lemna gibba L.).
Effects of potentised substances on growth rate of the water plant Lemna gibba L.
Duckweed (Lemna gibba L.) as a test organism for homeopathic potencies.
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All of this seems to beg the following question: should Simon be adnitted to my ALTERNATIVE MEDICINE HALL OF FAME?
I think the answe is a clear YES!
So, welcome, Prof. Meinhard Simon, you are in excellent company:
- Richard C. Niemtzow (acupuncture)
- Helmut Kiene (anthroposophical medicine)
- Helge Franke (osteopathy, Germany)
- Tery Oleson (acupressure , US)
- Jorge Vas (acupuncture, Spain)
- Wane Jonas (homeopathy, US)
- Harald Walach (various SCAMs, Germany)
- Andreas Michalsen ( various SCAMs, Germany)
- Jennifer Jacobs (homeopath, US)
- Jenise Pellow (homeopath, South Africa)
- Adrian White (acupuncturist, UK)
- Michael Frass (homeopath, Austria)
- Jens Behnke (research officer, Germany)
- John Weeks (editor of JCAM, US)
- Deepak Chopra (entrepreneur, US)
- Cheryl Hawk (chiropractor, US)
- David Peters (osteopathy, homeopathy, UK)
- Nicola Robinson (TCM, UK)
- Peter Fisher (homeopathy, UK)
- Simon Mills (herbal medicine, UK)
- Gustav Dobos (various SCAMs, Germany)
- Claudia Witt (homeopathy, Germany/Switzerland)
- George Lewith (acupuncture, UK)
- John Licciardone (osteopathy, US)
Some people seem to be impressed by the amount of publications that is currently being published on so-called alternative medicine (SCAM). Last year, for example, Mediline listed around 1 500 articles on the subject.
Is that really impressive?
No!
- Firstly, compared to other subjects, the number is small. If you look in Medline for ‘pharmacological treatments’, for instance, the number is 10 times larger.
- Scecondly, and more importantly, most of the SCAM articles are complete rubbish.
Let me give you just one example of a paper I came across the other day. It is typical in that there are hundreds of very similar articles every week. Its title is “Assessing Perceived Healthcare Access and Attitudes Towards Complementary and Alternative Medicine Amongst Parents in Cebu City”
(Cebu City is in the Philippines.)
Let’s for a moment assume that the information in the paper is of interest to a wider audience. In this case, such information should also be interestiong form the hundreds of other cities in the region. And if that is so, why focus on the Philippines? There are hundreds of thousands of cities around the world that would matter at least as much as Cebu City.
And why survey just parents? Why not childless adults, or children, or older people?
And why just healthy individuals? Surely, this information would be even more relevant, if it related to ill people!
As there are thousands of different illnesses, we would need thousands of different papers reporting the relevant information.
I am sure you see where I am going. If the hundreds of papers like Assessing Perceived Healthcare Access and Attitudes Towards Complementary and Alternative Medicine Amongst Parents in Cebu City are interesting to sufficient amounts of people to merit publication, we need millions of similar papers to cover the subject properly. What is more, as the situation about perceived healthcare access changes rapidly depending on a whole host of factors, we really would require yearly updates. That would mean millions of papers each year for the sole reason of monitoring the perceived healthcare access of various group of people in various locations. This means we need millions of researchers spending millions of hours and millions of dollars conducting millions of surveys.
Alternatively, we could take a step back and ask whether my above-made assumption (that the named paper is interesting) was correct. It does not require much contemplation to conclude it was, in fact, incorrect: the paper is neither interesting nor relevant to anybody.
And, once you look at the myriad of useless papers that are being published in SCAM, you arrive at the conclusion that the effort and funds needed for conducting these nonsensical pseudoscientific studies must urgently be re-directed towards answering some of the many more meaningful research questions. To me, this is nothing less than an ethical imperative.
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END OF RANT
Chemotherapy-induced nausea and vomiting (CINV) is a common adverse event in cancer patients and can negatively affect their quality of life (QoL). This randomized phase II cross-over trial aimed to evaluate the clinical efficacy of an electric massage chair (EMC) for the treatment of CINV. It was conducted on solid cancer patients who received moderate (MEC) to high emetogenic chemotherapy (HEC). The participants were randomly assigned to receive their first chemotherapy either on a standard bed (Group A) or in an EMC (Group B) during the infusion. The patients were then crossed over to the next cycle. CINV and QoL questionnaires were collected from the participants.
A total of 59 patients completed the trial protocol and were included in the analysis, with 29 and 30 patients in Groups A and B, respectively. The mean INVR (Index of Nausea, Vomiting, and Retching) score in the 2nd day of the first cycle was higher in Group B (3.63 ± 5.35) than Group A (2.76 ± 4.78), but the difference was not statistically significant (p = 0.5367). The complete response rate showed little difference between the groups. Among the high-emetic risk subgroups, patients who received HEC (p = 0.04595), younger patients (p = 0.0108), and non-colorectal cancer patients (p = 0.0495) presented significantly lower CINV scores when EMC was applied.
The authors concluded that there was no significant difference in INVR scores between standard care and EMC. Applying EMC at the first chemotherapy infusion may help preserve QoL and reduce CINV in high-risk patients.
Receiving chemotherapy for the first time is a very frightening event. In my view, everything should be done by the care team to make it less scary and as agreeable as possible. Patients might chose whether they prefere to lie down or sit, whether they have their own room or are treated in the company of others, with or without music, etc., etc. If an EMC is available, they should be able to try it and decide whether it suits them or not. If it does, I would not care a hoot whether EMC is a proven intervention or not, wether it is placebo or not, etc.
The main thing here is to make patients comfortable – and that, in my view, hardly needs a clinical trial.
You might remember that I recently reported of TWO studies sponsored by the ‘Carstens Stiftung’ and wonder whether the second is any better that the first. Here is its published outline: Multimodal online programme and biosignal analysis:
Here, too, the basic principles of a plant-based wholefood diet, Kneipp hydrotherapy, naturopathic self-help strategies and elements of holistic therapy and mind-body medicine are taught – but online. ‘The study represents a prototype for the optimal use of modern digital tools in naturopathic care situations and could serve as a best-practice model for online therapy approaches,’ says Dr Michael Jeitler, Deputy Research Coordinator at the Charité University Outpatient Clinic for Naturopathy at Immanuel Hospital Berlin. There is an urgent need for this, as it is known that only one sixth of the population in Germany is reached with appropriate lifestyle interventions taught in a practical manner.
The hypothesis: The physical resilience of patients with post-COVID syndrome improves more with a combination of naturopathic therapy in an online setting and routine care than with routine care alone. A total of 120 subjects will be included in the two-arm randomised controlled trial.
Group 1 will receive online training lasting 120 minutes once a week over a period of 2 months. In addition, there will be a recommendation to consolidate what has been learnt in daily 30-minute exercises at home. An online diary will also be kept. The observation period per patient is 12 months.
Group 2 will initially be placed on a waiting list.
A highlight of the project is a physiological sub-study focusing on the establishment and validation of a biosignal characterisation of post-COVID syndrome and in particular the prominent symptoms of fatigue. To this end, heart rate, blood pressure, respiratory rate, pulse, electrodermal activity and brain activity are measured simultaneously in patients with fatigue. ‘This approach should make it possible to objectively quantify the clinical symptom changes of fatigue, which have been difficult to objectify up to now,’ says Jeitler. ‘We hope to gain a better understanding of fatigue itself and its role in post-COVID syndrome. Ideally, this will improve diagnosis in the future.’
There will also be an embedded qualitative sub-study. After two months, both some of the test subjects and the GPs treating them will be interviewed individually about their perceptions and experiences in order to better adapt the naturopathic interventions to the needs and requirements of the patients in the long term.
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What is in my view particularly noteworthy is the fact that both studies pretend (like proper science) to test a hypothesis. This is, of course, not true. A true test of a hypothesis would be open to either its confirmation or its rejection. However, with the present study we have a situation where only a confirmation is on the cards. This discloses one thing very clearly: we are dealing here not with proper science, but with proper pseudoscience.
This study follows (just as the first trial) a ‘A+B versus B’ design and thus has the same major flaws as the first trial sponsored by the ‘Carstens Stiftung’. The reason for using this study design seems all too obvious: it will always generate a positive outcome. There is, of course, a prize: the study is unable to show that the intervention has any effects other than placebo. The Carstens Stiftung is happy to pay this price; their main interest seems to be not to answer meaningful research questions but to generate findings that lend themselves to promoting so-called alternative medicine (SCAM).
The Carl and Veronica Carstens Foundation is providing EUR 600,000 for 2 research projects to identify effective so-called alternative medicine (SCAM) therapies for post-COVID syndrome. The one that I will focus on here is headed by a member of my ALTERNATIVE MEDICINE HALL OF FAME, Prof Dr Gustav Dobos, Essen University Hospital.
The project is entitled: Multimodal group programme based on Kneipp
It is being described as follows:
A team of researchers led by Prof Gustav Dobos and Dr Heidemarie Haller, in cooperation with Prof Mark Stettner and Prof Christoph Kleinschnitz from the Department of Neurology at Essen University Hospital, will conduct a single-blind, randomised controlled study with two arms. A total of 86 subjects with post-COVID syndrome will be included and randomly divided into two groups.
Group 1 will undergo a 10-week group programme based on the Kneipp therapy pillars. The subjects will meet once a week, so there will be two sessions for each Kneipp pillar. These will include an educational and a practical part with the aim of developing their own strategies for coping with illness and actively integrating these into their everyday lives.
- Plant-based wholefoods and medicinal teas will be used to strengthen convalescence.
- Mindful exercise sessions in nature should help to utilise the effect of daylight and vitamin D on the immune system.
- In the area of hydrotherapy, water treatments, dry brushing, wraps and compresses will be used.
- There will be medical advice on herbal medicine options for individual symptoms such as sleep disorders, digestive problems, pain, coughs, anxiety or circles of thought.
The aim is to facilitate a balance of lifestyle in professional, family and social areas by means of organisational therapy. Relaxation and meditation techniques, for example, are taught for this purpose. In order to consolidate what they have learnt, participants in group 1 also receive a self-help book and homework.
Group 2 is the control group and is initially placed on a waiting list. In both groups, standard therapy is (additionally) permitted at any time. A symptom and therapy diary will also be kept in both groups.
The primary aim is to test whether the group programme as an add-on to standard therapy can improve self-help skills and alleviate the burden of post-COVID symptoms more than standard therapy alone. Parameters of quality of life, cardiovascular and pulmonary performance and the so-called flourishing of the test subjects as motivated personalities are also recorded at 4 points in time before, during and up to 16 weeks after the end of the intervention phase.
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And why do I call this study ‘nonsensical’?
Mainly because the results of the trial are known before even the first patient was recruited!
How come?
Because, as we have previously discussed here at nauseam, A+B will always be more than B alone. Kneipp therapy plus usual care will have more effects than usual care alone, even if Kneipp therapy generates nothing but placebo effects. This is particularly true, of course, for subjective outcome measures.
So, the conclusion of the trial, once it is published, will state something like this:
Our study has shown that the multimodal group programme based on Kneipp is effective in reducing the symptoms of post-COVID.
And what is wrong with that?
Plenty!
It means that money and effort will be wasted, that science will be undermined, and that we will be potentially misled about the effectiveness of mixed bag of treatments called ‘Kneipp therapy’. Perhaps it is effective (beyond placebo), but perhaps it’s not – this study will not tell us either way.
Uterine fibroids are a common gynaecological condition often impacting quality of life. While conventional treatment options exist, there is growing interest in so-called alternative Medicine (SCAM) such as homeopathy. The objective of this review paper was to assess the effectiveness of homeopathic medicines in treating uterine fibroids through the analysis of recent clinical trials and observational studies, aiming to provide insights into the potential role of homeopathy as a SCAM for uterine fibroids.
A thorough search of databases such as PubMed, Google Scholar, Scopus, and pertinent medical journals was undertaken to locate recent studies on the efficacy of homeopathic medicines for uterine fibroids. Only studies meeting predefined inclusion criteria, including randomized controlled trials, prospective observational studies, and systematic reviews, were included in the review process.
Recent studies investigating the efficacy of homeopathic medicines in treating uterine fibroids consistently demonstrated positive outcomes, including symptom alleviation, reduction in fibroid size, and improved quality of life. Various remedies showed effectiveness across various potencies. Symptom severity scales, including the Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), and Verbal Multidimensional Scoring System (VMSS), were utilized to assess pelvic pain, menstrual bleeding, and discomfort. Quality of life measures like the WHOQOL-BREF scale provided insights into overall well-being.
The authors concluded that the collective findings from these studies provide robust evidence supporting the efficacy and safety of homeopathic medicines in the management of uterine fibroids. By employing individualized treatment approaches tailored to patient-specific symptoms and characteristics, homeopathy offers a holistic and personalized approach to addressing fibroids and improving the quality of life for affected individuals. Overall, these studies provide robust evidence supporting the efficacy and safety of homeopathic medicines in treating uterine fibroids.
This is a very odd paper:
- The authors call it a “comprehensive review”, a term that is next to meaningless.
- It certainly is not a systematic review.
- The reason for merely including “recent studies” is unclear; it also makes a mockery of the attribute “comprehensive”.
- The reason for including observational studies, however, seems to be very clear: it is an age-old trick to generate a false-positive result.
- There was no assessment of the quality of the primary studies.
- In total, there were just 6 primary studies none of which was anywhere near to being rigorous.
- The authors never even investigated the safety of homeopathic remedies, yet they draw firm conclusions about it.
My conclusion is that this “comprehensive review” is comprehensive example of how to comprehensively mislead with comprehensively dishonest research. And why would anyone set out to do such a thing? Perhaps the authors’ affiliation provide some hints:
- Department of Homoeopathic Pharmacy,
- Homoeopathic Medical College & Research Centre.
I sometimes like to browse through old articles of mine and amaze myself. It is now 15 years ago that I published this paper:
Since 1994 chiropractic has been regulated by statute in the UK. Despite this air of respectability, a range of important problems continue to bedevil this profession. Professional organizations of chiropractic and their members make numerous claims which are not supported by sound evidence. Many chiropractors adhere to concepts which fly in the face of science and most seem to regularly violate important principles of ethical behaviour. The advice chiropractors give to their clients is often dangerously misleading. If chiropractic in the UK is to grow into an established health care profession, the General Chiropractic Council and its members should comply with the accepted standards of today’s health care.
This begs the question: HAVE THINGS IMPROVED AT ALL?
- Have professional organizations of chiropractic stopped making claims which are not supported by sound evidence?
- Have their members stopped making claims which are not supported by sound evidence?
- Do chiropractors no longer adhere to concepts which fly in the face of science?
- Have they ceased violating important principles of ethical behaviour?
- Is the advice chiropractors give to their clients no longer dangerously misleading?
Here are my answers to these questions:
- No.
- No.
- No.
- No.
- No.
Yes, there are moments when I surprise myself. And there are also those when I ask whether any of my work has ever had any effect. And then, after some reflection, I discover that my job is not nearly as bad as some others.
This paper employs a governmentality framework to explore resistance by sceptics to homeopathy’s partial settlement in the public health systems of England and France, resulting in its defunding in both countries in 2018 and 2021, respectively. While partly dependent upon long-standing problematisations – namely, that homeopathy’s ability to heal is unproven, its mechanisms implausible, and its consequences for patients potentially dangerous – the defunding of homeopathy was also driven by the conduct of sceptics towards so-called alternative medicine (SCAM), who undermined homeopathy’s position in strikingly different ways in both contexts. This difference, we suggest, is a consequence of the diverging regulatory arrangements surrounding homeopathy (and SCAMs more generally) in England and France—and the ambivalent effects of SCAM’s regulation. If law and regulation have been a key component of SCAM’s integration and (partial) acceptance over the past four decades, the fortunes of homeopathy in England and France highlight their unpredictability as techniques of governmentality: just as the formal regulatory systems in England and France have helped to normalise homeopathy in different ways, they have also incited and galvanised opposition, providing specific anchor-points for resistance by SCAM sceptics.
The authors state that they approach the sceptics’ actions as a form of resistance to the normalising power of governmentality—a resistance that is also shaped by the possibilities and spaces offered by legal orderings. From a Foucauldian perspective, resistance is immanent to relations of power: the two presuppose one another. If regimes of governmentality have increasingly let SCAMs ‘in’ as a means of normalising them, then this paper attends to some of the resistances the modes of SCAM’s regulation have incited and shaped, and how resistance to SCAM has taken different forms in different regulatory contexts. At times, resistance has emanated from some SCAM healers themselves, who regard their practice as inimical to the standardisation and bureaucratisation required by formal regulation. In the case of homeopathy, much resistance has come from those outside of the SCAM professions. Such resistance seemingly rejects per se the notion that ‘good’ homeopathy (or SCAMs more generally) can be distinguished from ‘bad’—and, hence, the idea that state institutions should grant any form of legitimacy to such practices. By grounding our analysis in a governmentality perspective, we invite a closer consideration of the means by which homeopathy’s regulation (and its conditional acceptance by formal institutions)—a core component of its normalisation—has incited irritations, aggravations and resistances which have paradoxically helped to challenge its place in the national healthcare systems of England and France.
The authors further explain that SCAM sceptics’ initial resistance to homeopathy began to emerge in a coordinated fashion in the mid 2000s, and can best be described as a cumulative build-up of dispersed sceptic activism and campaigning on the part of a loose coalition of prominent non-state, non-official individuals, often, but not always, from outside the medical profession itself. It included high profile scientists and academics such as Edzard Ernst and David Colquhoun, and sceptic campaigning groups, such as Sense About Science (SAS), which was founded in 2002. In other words, the multifaceted nature of their campaigning and the dispersal of their targets appeared to be a reaction to the diffuse, decentred provision and regulation of homeopathy in England and the involvement of a broad range of actors ‘beyond the state’.
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I find this version of events interesting (I encourage you to read the full text of the paper) and somewhat amusing, as I hardly recognise it. The way I experienced and recall this story is roughly as follows:
- In the 1970/80s EBM had become the generally accepted norm and logic in healthcare. It had begun to generate significant, tangible advantages for the fate of suffering patients.
- Thus many areas of medicine came under scrutiny and those that were non-compliant with EBM were rightly criticised.
- From the early 1990s, I and others started to apply the principles of EBM to homeopathy (and other SCAMs).
- This soon made it obvious that homeopathy was lacking convincing evidence of efficacy.
- Now, it was merely a question of time that the regulators had to act accordingly.
- England and France happened to do this first, but, in my view, it is virtually inevitable that other countries will follow – not because of any organised activism but because ethical medicine must always follow the evidence and cannot tolerate quackery.
I disagree with the authors of the above paper; there was no coordinated resistance, cumulative build-up, activism, coalition of individuals, multifacetet campaigning to speak of. The actions that occurred were merely the inevitable consequence of the scientific evidence that emerged from the 1990s onwards. In other words, the principles of EBM were simply taking their course. The defunding is thus not unique to homeopathy but has happened (and will continue to happen) in many other areas of healthcare that do not demonstrably generate more good than harm.
The authors of the above article mention my name repeatedly and seem to imply that I assumed the role of a key activist. Interestingly, they do not cite a single of my papers, presumably because none of them can demonstrate the points they are trying to make. The truth is that, until my retirement from academia in 2012/13, my role was merely that of a researcher. The activism that did happen consisted mostly of diverse and unfunded actions of rationalists who felt that homeopathy was making a mockery of EBM.
Looking back, I am still surprised that these actions were achieved almost entirely by altruistic amateurs. I even feel a little ashamed that the vast majority of doctors seemed to care so little (and were put to shame by the amateurs) about upolding the values of EBM, the best interest of patients and the importance of medical ethics.
This prospective, community-based, active surveillance study aimed to report the incidence of moderate, severe, and serious adverse events (AEs) after chiropractic (n = 100) / physiotherapist (n = 50) visit in offices throughout North America between October-2015 and December-2017.
Three content-validated questionnaires were used to collect AE information: two completed by the patient (pre-treatment [T0] and 2-7 days post-treatment [T2]) and one completed by the provider immediately post-treatment [T1]. Any new or worsened symptom was considered an AE and further classified as mild, moderate, severe or serious.
From the 42 participating providers (31 chiropractors; 11 physiotherapists), 3819 patient visits had complete T0 and T1 assessments. The patients were on average 50±18 years of age and 62.5% females. Neck/back pain was the most common presenting condition (70.0%) with 24.3% of patients reporting no condition/preventative care.
From the patients visits with a complete T2 assessment (n = 2136 patient visits, 55.9%), 21.3% reported an AE, of which:
- 7.9% were mild,
- 6.2% moderate,
- 3.7% severe,
- 1.5% serious,
- 2.0% had missing severity rating.
The most common symptoms reported with moderate or higher severity were:
- discomfort/pain,
- stiffness,
- difficulty walking,
- headache.
The authors concluded that this study provides valuable information for patients and providers regarding incidence and severity of AEs following patient visits in multiple community-based professions. These findings can be used to inform patients of what AEs may occur and future research opportunities can focus on mitigating common AEs.
They also note that:
- The incidence of AEs reported in their study was lower than the 30%-50% reported in a recent scoping review of 250 observational and experimental studies of manual treatments of the spine.
- A similar prospective clinic-based survey collected data from 4712 encounters from Norwegian chiropractors found that 55% of these encounters had an AE.
- A clinical trial of chiropractic care for patients with neck pain found that 30% reported an AE.
- The Scandinavian College of Naprapathic Manual Medicine collected AE information from 767 patients and found that 51% of those who had at least 3 SMT treatments reported an AE.
The authors did not mention our systematic review:
The aim of this systematic review was to summarize the evidence about the risks of spinal manipulation. Articles were located through searching three electronic databases (MEDLINE, EMBASE, Cochrane Library), contacting experts (n =9), scanning reference lists of relevant articles, and searching departmental files. Reports in any language containing data relating to risks associated with spinal manipulation were included, irrespective of the profession of the therapist. Where available, systematic reviews were used as the basis of this article. All papers were evaluated independently by the authors. Data from prospective studies suggest that minor, transient adverse events occur in approximately half of all patients receiving spinal manipulation. The most common serious adverse events are vertebrobasilar accidents, disk herniation, and cauda equina syndrome. Estimates of the incidence of serious complications range from 1 per 2 million manipulations to 1 per 400,000. Given the popularity of spinal manipulation, its safety requires rigorous investigation.
Whatever the true rate of AEs turns out to be, one thing is very clear: it is unacceptably high, particularly if we consider that the benefits of spinal manipulations are doubtful and at best small.
