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

experience

1 2 3 21

This review was aimed at quantifying the proportion attributable to contextual effects of physical therapy interventions for musculoskeletal pain. Randomized placebo-controlled trials evaluating the effect of physical therapy interventions on musculoskeletal pain.

Risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials (ROB 2.0). The proportion of physical therapy interventions effect that is explained by contextual effects was calculated, and a quantitative summary of the data from the studies was conducted using the random-effects inverse-variance model (Hartung-Knapp-Sidik-Jonkman method).

Sixty-eight studies were included in the systematic review (total number of participants: n=5,238), and 54 placebo-controlled trials informed our meta-analysis (participants: n=3,793). Physical therapy interventions included:

  • soft tissue techniques,
  • mobilization,
  • manipulation,
  • taping,
  • exercise therapy,
  • dry needling.

Placebo interventions included manual, non-manual interventions, or both.

The results show the following:

  • The type of treatment with the largest proportion not attributable to the specific effects (PCE) for pain intensity assessed immediately after the intervention was mobilization, which represented 87% of the overall treatment effect (PCE = 0.87, 95% CI: 0.54, 1.19).
  • For soft tissue techniques, the PCE was 81% of the overall treatment effect (PCE = 0.81, 95% CI: 0.64, 0.97).
  • For dry needling, the PCE was 75% (PCE = 0.75, 95% CI: 0.36, 1.15).
  • For manipulation techniques the PCE was 74% (PCE = 0.74, 95% CI: 0.33, 1.14).
  • For taping the PCE was 69% of the overall treatment effect (PCE = 0.69, 95% CI: 0.48, 0.89).
  • The smallest proportion not attributable to the specific intervention itself for pain intensity was exercise therapy accounting for 46% of the overall treatment effect (PCE = 0.46, 95% CI: 0.41, 0.52).

The authors concluded that the outcomes of physical therapy interventions for musculoskeletal pain were significantly influenced by contextual effects. Boosting contextual effects consciously to enhance therapeutic outcomes represents an ethical opportunity that could benefit patients.

This sounds as though most of the treatments in question rely mainly on placebo effects. But what about conventional therapies? The authors point out that the PCEs of general medicine and surgery in pain-related conditions are also large. In particular, the overall proportion not attributable to the specific effects of general medicine interventions is high (PCE = 65%), with higher values observed in semi-objective and objective outcomes (PCE = 78 and 94%, respectively) than in subjective outcomes (PCE = 50%).

What does that mean for healthcare routine?

As placebo and other context effects are unreliable, usually short-lived, and not normally affecting the cause of the problem (but merely the symptoms), I would say that those treatments with a very high PCE are of limited value, paticularly if they are also expensive or burdened with risks. Of the treatments studied here, I would – based on the current analysis – avoid the following therapies for pain management:

  • mobilization,
  • soft tissue techniques,
  • dry needling,
  • manipulation,
  • taping.

By and large, these are also the conclusions drawn from various other strands of evidence that we have repeatedly discussed in previous posts.

Of all the many forms of so-called alternative medicine (SCAM), Reiki is perhaps the one that has the least plausibility. It assumes that a Reiki healer can send healing energy into the body of a patient which, in turn, stimulates the self-healing ability of the body and thus cures illness. Neither the source of the energy, its nature, or its effects have ever been convincingly demonstrated. These facts, however, do not stop enthusiasts to conduct clinical trials of Reiki.

The aim of this randomised clinical trial was to investigate the effect of the application of Reiki on fatigue and sleep quality in people with MS. A total of 60 people (control group = 30, intervention group = 30) participated in this study. Personal Information Form, Piper Fatigue Scale (PFS) and Pittsburg Sleep Quality Index (PSQI) were used as endpoints.

It was found that the PFS and PSQI total and subcomponent scores of the intervention group decreased after Reiki compared to the control group and this was statistically significant (p<0.05). The study showed that Reiki was significantly effective in improving fatigue and sleep quality in people with MS.

The authors concluded that, as Reiki is a simple, inexpensive and accessible method, it was suggested that its use in the management of MS should be encouraged and maintained in nursing practice.

In the introduction, the authors state this:

Reiki is a non-invasive, low-cost, easy-to-apply practice with no side effects and no negative effects on the existing treatment, and prevents acute and chronic conditions. It is frequently preferred in rehabilitation centres, emergency care units, nursing homes, elderly care centres, paediatrics, psychiatry, obstetrics and gynaecology clinics. Reiki can be applied by trained practitioners such as health professionals who have received first level reiki training in hospitals and clinics, caregivers or patients themselves. Reiki can be administered from with the patient or remotely when the patient and practitioner are in separate locations. Both types of Reiki are based on the premise of a universal source of healing energy that the Reiki practitioner can channel through intention.

For me, this begs the questions:

  • If all of this were true, why do we need a study?
  • If anyone believes such BS, are they the ideal people to conduct a study of Reiki?

Anyway, we should ask why this study generated a positive result. The most plausible explanation is that, as the study was not blind, the Reiki healers managed to maximise patient expectation. This, in turn, has generated a placebo respose which affected the subjective outcome measures. In other words, Reiki has no specific effect but patients tend to improve because of non-specific effects.

We have recently heard much about spinal manipulations for kids. It might therefore be relevant to learn about an international taskforce of clinician-scientists formed by specialty groups of World Physiotherapy – International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) & International Organisation of Physiotherapists in Paediatrics (IOPTP) – to develop evidence-based practice position statements directing physiotherapists clinical reasoning for the safe and effective use of spinal manipulation and mobilisation for paediatric populations (<18 years) with varied musculoskeletal or non-musculoskeletal conditions.

A three-stage guideline process using validated methodology was completed: 1. Literature review stage (one scoping review, two reviews exploring psychometric properties); 2. Delphi stage (one 3-Round expert Delphi survey); and 3. Refinement stage (evidence-to-decision summative analysis, position statement development, evidence gap map analyses, and multilayer review processes).

Evidence-based practice position statements were developed to guide the appropriate use of spinal manipulation and mobilisation for paediatric populations. All were predicated on clinicians using biopsychosocial clinical reasoning to determine when the intervention is appropriate.

1. It is not recommended to perform:

• Spinal manipulation and mobilisation on infants.

• Cervical and lumbar spine manipulation on children.

•Spinal manipulation and mobilisation on infants, children, and adolescents for non-musculoskeletal paediatric conditions including asthma, attention deficit hyperactivity disorder, autism spectrum disorder, breastfeeding difficulties, cerebral palsy, infantile colic, nocturnal enuresis, and otitis media.

2. It may be appropriate to treat musculoskeletal conditions including spinal mobility impairments associated with neck-back pain and neck pain with headache utilising:

• Spinal mobilisation and manipulation on adolescents;

• Spinal mobilisation on children; or

• Thoracic manipulation on children for neck-back pain only.

3. No high certainty evidence to recommend these interventions was available.

Reports of mild to severe harms exist; however, risk rates could not be determined.

It was concluded that specific directives to guide physiotherapists’ clinical reasoning on the appropriate use of spinal manipulation or mobilisation were identified. Future research should focus on trials for priority conditions (neck-back pain) in children and adolescents, psychometric properties of key outcome measures, knowledge translation, and harms.

Whether one agrees with these directions or not (and I am not sure I fully do), I have always thought that people who, despite the largely lacking or flimsy evidence for spinal manipulations, insist on having manual therapy should consult a physiotherapist, rather than a chiropractor or osteopath.

Why?

Because, in my experience, physiotherapist:

  • display less cult-dependent behaviours,
  • do not follow the gospel of charlatans, like Palmer and Still,
  • do not believe in the fiction of subluxation,
  • are not so money-minded,
  • less prone to use un- or disproven methods, like applied kinesiology, homeopathy, cranial osteopathy, etc.,
  • unlikely to try to sell you useless dietary supplements,
  • tend to judge better their limits of professional competence,
  • are far less likely to try to persuade you of BS related to anti-vax, anti-drug, anti-science, anti-EBM, etc.

In response to criticism voiced against Australian chiropractors’ decision to re-commence manipulating children, the Australian Chiropractors Association (ACA) president, David Cahill, welcomed the updated statement on paediatric care by the Chiropractic Board of Australia. “The statement serves to reinforce the confidence the Australian public has in chiropractic care provided by registered ACA member chiropractors,” said Cahill.

The Safer Care Victoria Review has shown chiropractic care for children to be extremely safe. Of the 29,599 online submissions received from across Australia (the largest survey of its kind), there were no reports of harm to a child receiving chiropractic healthcare. Of those submissions, 21,824 responses were from parents who had accessed chiropractic healthcare for their children, and there was not a single report of significant harm in these submissions. “In a particularly strong endorsement, 99.6% of those parental submissions affirmed that chiropractic healthcare benefitted their child highlighting the exemplary safety record of chiropractic healthcare,” Cahill said.

ACA member chiropractors are healthcare professionals who effectively treat a wide range of musculoskeletal disorders. Chiropractors are 5-year university degree educated healthcare professionals, equipped with expertise enabling them to tailor the appropriate care for people of all ages including children. Established in 1938, the Australian Chiropractors Association (ACA) is the peak body representing chiropractors. The ACA promotes the importance of maintaining spinal health to improve musculoskeletal health through non-invasive, drug-free spinal health and lifestyle advice to help Australians of all ages lead and maintain healthy lives.

_________________________

Mr Cahill and the Australian Chiropractors Association have thus demonstrated that they fail to understand how one needs to establish the benefits and harms of a therapy. That chiropractic spinal manipulations are “extremely safe” cannot be established by an online survey which might or might not have been manipulated by the chiropractors who have an interest in not loosing the lucrative option of treating children. It cannot even establish “the confidence the Australian public has in chiropractic care”.

Mr Cahill and the Australian Chiropractors Association should know that chiropractic spinal manipulation – just like any other intervention – must be evaluated according to accepted principles of risk-benefit analyses. No proven benefit and a possibility of harm mean that the risk-benefit balance fails to be positive. And this means that it is irresponsible to use chiropractic spinal manipulations.

Mr Cahill and the Australian Chiropractors Association, however, seem to not know even the essentials of ethical healthcare. The obvious conclusion, therefore, is to send the lot of them back to school.

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?

 

We have discussed the LIGHTNING PROCESS before:

Now, the BBC reports that it is promoted as a treatment of Long-COVID. Oonagh Cousins was offered a free place on a course run by the Lightning Process, which teaches people they can rewire their brains to stop or improve long Covid symptoms quickly. Ms Cousins, who contracted Covid in March 2020, said it “exploits” people.

Ms Cousins had reached a career goal many athletes can only dream of – being selected for the Olympics – when she developed long Covid. By the time the cancelled 2020 Olympic Games in Tokyo were rescheduled for 2021, Ms Cousins was too ill to take part. When she went public with her struggles, she was approached by the Lightning Process. It offered her a free place on a three-day course, which usually costs around £1,000.

“They were trying to suggest that I could think my way out of the symptoms, basically. And I disputed that entirely,” the former rower said. “I had a very clearly physical illness. And I felt that they were blaming my negative thought processes for why I was ill.” She added: “They tried to point out that I had depression or anxiety. And I said ‘I’m not, I’m just very sick’.

In secret recordings by the BBC, coaches can be heard telling patients that almost anyone can recover from long Covid by changing their thoughts, language and actions. Over three days on Zoom, the course taught the ritual that forms the basis of the programme. Every time you experience a symptom or negative thought, you say the word “stop”, make a choice to avoid these symptoms and then do a positive visualisation of a time you felt well. You do this while walking around a piece of paper printed with symbols – a ritual the BBC was told to do as many as 50 times a day.

In some cases the Lightning Process has encouraged participants to increase their activity levels without medical supervision, against official advice – which could make some more unwell, according to NHS guidelines. Lightning Process founder, Dr Phil Parker, who’s not a medical doctor but has a PhD in psychology of health, told us his course was “not a mindset or positive thinking approach,” but one that uses “the brain to influence physiological changes”, backed by peer-reviewed evidence. The coach on the course the BBC attended said “thoughts about your symptoms, your worry about whether it’s ever going to go – that’s what keeps the neurology going. Being in those kind of thoughts is what’s maintaining your symptoms. They’re not caused by a physical thing any more.”

___________________

As I pointed out previously, The Lightning Process  (LP) is a therapy based on ideas from osteopathy, life coaching, and neuro-linguistic programming. LP is claimed to work by teaching people to use their brains to “stimulate health-promoting neural pathways”.

LP teaches individuals to recognize when they are stimulating or triggering unhelpful physiological responses and to avoid these, using a set of standardized questions, new language patterns, and physical movements with the aim of improving a more appropriate response to situations.

Proponents of the ‘LP’ in Norway claim that 90% of all ME patients get better after trying it. However, such claims seem to be more than questionable.

  • In the Norwegian ME association’s user survey from 2012 with 1,096 participants, 164 ME patients stated that they had tried LP. 21% of these patients experienced improvement or great improvement and 48% got worse or much worse.
  • In Norway’s National Research Center in Complementary and Alternative Medicine, NAFKAM’s survey from 2015 amongst 76 patients 8 had a positive effect and 5 got worse or much worse.
  • A survey by the Norwegian research foundation, published in the journal Psykologisk, with 660 participants, showed that 62 patients had tried LP, and 5 were very or fairly satisfied with the results.

Such figures reflect the natural history of the condition and are no evidence that the LP works.

Is there any evidence supporting the LP specifically for long COVID?

My Medline search retrieved just one single paper. Here is the abstract:

As a result of the COVID-19 pandemic, Long COVID (LC) is now prevalent in many countries. Little evidence exists regarding how this chronic condition should be treated, but guidelines suggest for most people it can be managed symptomatically in primary care. The Lightning Process is a trademarked positive psychology focused self-management programme which has shown to be effective in reducing fatigue and accompanying symptoms in other chronic conditions including Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. Here we outline its novel application to two patients with LC who both reported improvements in fatigue and a range of physical and emotional symptoms post-treatment and at 3 months follow-up.

Well, that surely convinced everyone! Except me and, of course, anyone else who can think critically.

So, I look further and find this on the company’s website:

Do you know how it feels to…

  • …be exhausted and tired no matter how much rest you get?
  • …be stuck with re-occurring pain, health symptoms and issues?
  • …get so stressed by almost everything?
  • …feel low and upset much of the time?
  • …want a better life and health but just can’t find anything that works?

If any, or all, of these sound familiar then the Lightning Process, designed by Phil Parker, PhD, could be the answer that you’re looking for.  There are lots of ways you can find out more about the suitability of the Lightning Process for you, have a look through below…

___________________________

Let me try to summarise:

  • The LP is promoted as a cure for long-Covid.
  • There is no evidence that LP is effective for it.
  • The claim is that it has been shown to work for ME.
  • There is no evidence that LP is effective for it.
  • A 3-day course costs £1 000.
  • Their website claims it is good for practically everyone.

Does anyone think that LP or its promoters are remotely serious?

I am glad to hear that the Vatican is issueing  new guidelines on supernatural phenomena. The document, compiled by the Vatican’s Dicastery for the Doctrine of the Faith, will lay out rules to assess the truthfulness of supernatural claims. Reports of such phenomena are said to have soared in recent years in an era of social media – sometimes spread through disinformation and rumour. The guidelines are likely to tighten criteria for the screening, analysis, and possible rejection of cases.

Apparitions have been reported across the centuries. Those recognised by the Church have prompted pilgrims, and popes, to visit spots where they are said to have taken place. Millions flock to Lourdes in France, for example, or Fatima in Portugal, where the Virgin Mary is alleged to have appeared to children, promising a miracle – after which crowds are said to have witnessed the sun zig-zagging through the sky. The visitation was officially recognised by the Church in 1930.

But other reports are found by church officials to be baloney. In 2016, an Italian woman began claiming regular apparitions of Jesus and Mary in a small town north of Rome after she brought back a statue from Medjugorje in Bosnia, where the Virgin Mary is also said to have appeared. Crowds prayed before the statue and received messages including warnings against same-sex marriage and abortion. It took eight years for the local bishop to debunk the story.

_________________________

 

Perhaps the Vatican should also have a look at faith healing*, the attempt to bring about healing through divine intervention. The Bible and other religious texts provide numerous examples of divine healing, and believers see this as a proof that faith healing is possible. There are also numerous reports of people suffering from severe diseases, including cancer and AIDS, who were allegedly healed by divine intervention.

Faith healing has no basis in science, is biologically not plausible. Some methodologically flawed studies have suggested positive effects, however, this is not confirmed by sound clinical trials. Several plausible explanations exist for the cases that have allegedly been healed by divine intervention, for instance, spontaneous remission or placebo response. Another explanation is fraud. For instance, the famous German faith healer, Peter Popoff, was exposed in 1986 for using an earpiece to receive radio messages from his wife giving him the home addresses and ailments of audience members which he purported had come from God during his faith healing rallies.

Faith healing may per se be safe, but it can nevertheless do untold indirect harm, and even fatalities are on record: “Faith healing, when added as an adjuvant or alternative aid to medical science, will not necessarily be confined to mere arguments and debates but may also give rise to series of complications, medical emergencies and even result in death.”

Alternatively, the Vatican might look at the healing potential of pilgrimages*, journeys to places considered to be sacred. The pilgrims often do this in the hope to be cured of a disease. The purpose of Christian pilgrimage was summarized by Pope Benedict XVI as follows:

To go on pilgrimage is not simply to visit a place to admire its treasures of nature, art or history. To go on pilgrimage really means to step out of ourselves in order to encounter God where he has revealed himself, where his grace has shone with particular splendour and produced rich fruits of conversion and holiness among those who believe.

There are only few scientific studies of pilgrimages. The purpose of this qualitative research was to explore whether pilgrims visiting Lourdes, France had transcendent experiences. The authors concluded that visiting Lourdes can have a powerful effect on a pilgrim and may include an “out of the ordinary” transcendent experience, involving a sense of relationship with the divine, or experiences of something otherworldly and intangible. There is a growing focus on Lourdes as a place with therapeutic benefits rather that cures: our analysis suggests that transcendent experiences can be central to this therapeutic effect. Such experiences can result in powerful emotional responses, which themselves may contribute to long term well-being. Our participants described a range of transcendent experiences, from the prosaic and mildly pleasant, to intense experiences that affected pilgrims’ lives. The place itself is crucially important, above all the Grotto, as a space where pilgrims perceive that the divine can break through into normal life, enabling closer connections with the divine, with nature and with the self.

Other researchers tested the effects of tap water labelled as Lourdes water versus tap water labelled as tap water found that placebos in the context of religious beliefs and practices can change the experience of emotional salience and cognitive control which is accompanied by connectivity changes in the associated brain networks. They concluded that this type of placebo can enhance emotional-somatic well-being, and can lead to changes in cognitive control/emotional salience networks of the brain.

The risks involved in pilgrimages is their often considerable costs. It is true, as the text above points out that “millions flock to Lourdes in France”. In other words, pilgrimiges are an important source of income, not least for the catholoc church.

A more important risk can be that they are used as an alternative to effective treatments. This, as we all know, can be fatal. As there is no good evidence that pilgrimiges cure diseases, their risk/benefit balance as a treatment of disease cannot be positive.

So, will the new rules of the Vatican curtail the risks on supernatural healing practises? I would not hold my breath!

_________________

* for references see my book from where this text has been borrowed and modified.

I have attended numerous ‘Skeptics in the Pub’ (SITP) meetings, either as a member of the audience or as a lecturer. They can be splendid occasions to learn, be entertained, to discuss, and to socialise in a relaxed atmosphere.

The usual format of a SITP meeting includes an invited speaker (often a renouned expert with an international reputation) who gives a talk on a specific topic, followed by a break where people can re-fill their glasses, followed by a long question-and-answer session. Meetings are usually scheduled on a monthly basis. The SITP movement started in 1999 in London. The concept soon spread, and now there are SITP meetings in many countries across the world.

The organisers of the meetings are local enthusiasts who run them on a shoestring. Each attendee pays a small entrance fee or gives a donation. Speakers usually get their expenses paid. As the meetings take place in pubs, there is no expense for room hire.

As I already stated, the concept of SITP is great, no question.

Unfortunately, however, there is also a ‘BUT’.

I have been to SITP meetings that were run perfectly – but I have experienced also the exact opposite, both as a lecturer as well as a attendee. For instance:

  • I have attended meetings where the room was too small and stuffy.
  • I have sat on chairs that seemed like medevial torture instruments.
  • I have suffered through lectures where the technical equipment did not work properly.
  • I have been at meetings that were attended by embarrassingly few people.
  • I have, as an invited speaker, been told retrospectively that my (very modest) expenses could not be paid.

Here is my plea to the organisers of SITP worldwide:

I know you volunteer for this job with enthusiasm and dedication. But PLEASE, do it also with competence. Your speakers are as dedicated as you; often they are top experts. They have a right to be met not just with kindness but also with competence.

So, please advertise each SITP meeting as best as you can; for example, go to your local papers, radio, social media etc. Do not humiliate your speakers by having them lecture in front of a half empty room. Make sure that your technical equipment works and test it thoroughly before your speaker arrives. Do not use locations that are unsuited for such events because they are too small, uncomfortable or poorly ventilated. If you are unable to organise meetings that are good in every respect, it might be better to not run any at all.

Yes, SITP is a great idea in theory. But even a great idea can be destroyed by deficient practice.

 

 

Conspiracy theories, as often discussed here, plague the realm of so-called alternative medicine (SCAM), e.g.:

In fact, I did recently suggest that so-called alternative medicine is a conspiracy theory in disguise. Previous research has found that individuals who struggle with emotion regulation are more prone to believing in conspiracy theories. Emotional granularity – the ability to differentiate between nuanced emotional states – is a key component of effective emotion regulation, yet its relationship with conspiracy beliefs has not been explored thoroughly.

Psychologists from the Uni Graz in Austria conducted an experience-sampling study (165 participants, mean age = 26.3 years) including measures of emotion regulation and differentiation. The study started with an online survey that assessed participants’ sociodemographic (age, sex, and education) and trait measures. Following this, participants were asked to install an in-house developed app on their smartphones to obtain the emotional granularity specificity index. The app displayed two notifications each day for over a week (14 max.). Notifications were randomly displayed between 08:00 am and 10:00 pm with a minimum of at least 5 h between two notifications. Participants, on average, answered 57% of the notifications.

The findings revealed that individuals who endorse conspiracy theories engage in repetitive thinking about the causes and consequences of events and exhibit a reduced ability to distinguish between negative emotions. This effect, however, was observed only in the performance-based measure of emotion differentiation, not in the self-report measures.

The authors conclused that this suggests that enhancing emotional granularity may help individuals in regulating their emotions more effectively, thereby reducing their vulnerability to adopt conspiracy beliefs.

To reduce belief in conspiracy theories, one might, according to the authors, consider a training program to enhance emotion regulation and differentiation. A combination of cognitive control training on emotion regulation, which has been shown to reduce overthinking, as well as reflecting on and diversifying emotional experiences, could provide simple tools for assessing and regulating emotional experiences. This, in turn, may lead to decreased endorsement of conspiracy theories in the long run.

Perhaps we should recommend this to the chaps who recularly comment on this blog bursting with conspiracy theories?

In the realm of so-called alternative medicine (SCAM), dental amalgam is a big topic. Therefore, we have discussed it several times before, e.g.:

This study evaluated the changes of health complaints after removal of amalgam restorations in patients with health complaints attributed to dental amalgam fillings.

Patients with medically unexplained physical symptoms (MUPS) attributed to dental amalgam (Amalgam cohort) had all their amalgam fillings removed. The participants indicated an intensity of 11 local and 12 general health complaints on numeric rating scales before the treatment and at follow-up after 1 and 5 years.

The comparison groups comprising

  1. a group of healthy individuals
  2. a group of patients with MUPS without symptom attribution to dental amalgam

did not have their amalgam restorations removed.

In the Amalgam cohort, mean symptom intensity was lower for all 23 health complaints at follow-up at 1 year compared to baseline. Statistically significant changes were observed for specific health complaints with effect sizes between 0.36 and 0.68. At the 5-year follow-up, the intensity of symptoms remained consistently lower compared to before the amalgam removal. In the comparison groups, no significant changes of intensity of symptoms of health complaints were observed.

The authors concluded that, after removal of all amalgam restorations, both local and general health complaints were reduced. Since blinding of the treatment was not possible, specific and non-specific treatment effects cannot be separated.

This is an interesting study with a particularly long follow-up. Unfortunately, due to the study’s design, its results tell us very little about causality. The results are perfectly consistent with two entirely different explanations:

  1. Amalgam was the cause of MUPS and therefore removal of amalgam cured the problem permanently.
  2. Amalgam was not the cause of MUPS but the knowledge that the evil substance had finally been removed sufficed for MUPS to disappear.

It is to the credit of the authors that they consider both options.

A word of caution: amalgam removal can lead to a spike in Hg levels in the body!

1 2 3 21
Subscribe via email

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

Recent Comments

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

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

Archives
Categories