experience
As we have often discussed on this blog, chiropractic spinal manipulations can lead to several complications and can result in vascular injury, including traumatic dissection of the vertebral arteries with often dire consequences – see, for instance, here:
- Chiropractor caused a Vertebral Artery Dissection from a completely unnecessary neck adjustment
- Associations between cervical artery dissection and spinal manipulation
- Chiropractic spinal manipulation is a risk factor for cranio-cervical artery dissection
- Double-sided vertebral artery dissection in a 33-year-old man. The chiropractor is not guilty?
- Vertebral artery dissection in a pregnant woman after cervical spine manipulation
- Chiropractic manipulations are a risk factor for vertebral artery dissections
- Cervical artery dissection and stroke related to chiropractic manipulation
- Vertebral artery dissection after chiropractic manipulation: yet another case
- Pseudoaneurysm of Neck External Carotid Artery Related to Chiropractic Manipulation
- Cervical Arterial Dissections and Association With Cervical Manipulative Therapy
- Chiropractic adjustments are causing more and more strokes in younger adults
- Another case of stroke due to chiropractic
- More about the dangers of chiropractic
- The incidence of severe adverse events after chiropractic spinal manipulative therapy
- Catastrophic injuries after chiropractic treatment
- “As soon as the chiropractor manipulated my neck, everything went black”
This recent paper is a most unusual addition to the list. It is a case report of a 43-year-old woman who was admitted to the emergency department after performing a self-chiropractic spinal manipulation. She experienced headache and vomiting and was unresponsive with severe hypertension at the time of hospital admission. Clinical computerized tomography angiography showed narrowing of the right vertebral artery but was inconclusive for dissection or thrombosis.
The patient died a short while later. At autopsy, subacute dissection of the right vertebral artery was identified along with cerebral edema and herniation. A small peripheral pulmonary thromboembolism in the right lung was also seen. Neuropathology consultation confirmed the presence of diffuse cerebral edema and acute hypoxic-ischemic changes, with multifocal acute subarachnoid and intraparenchymal hemorrhage of the brain and spinal cord.
The authors concluded that this case presents a unique circumstance of a fatal vertebral artery dissection after self-chiropractic manipulation that, to the best of our knowledge, has not been previously described in the medical literature.
We have often asked whether the General Chiropractic Council (GCC) is fit for purpose. A recent case bought before the Professional Conduct Committee (PCC) of the GCC provides further food for thought.
The male chiropractor in question admitted to the PCC that:
- he had requested the younger female patient remove her clothing to her underwear for the purposes of examination;
- he then treated the area near her vagina and groin with a vibrating tool;
- that he also treated the area around her breasts.
After the appointment, which the patient had originally booked for a problem with her neck, the patient reflected on the treatment and eventually complained about the chiropractor to the GCC. The PCC considered the case and did not find unprofessional conduct in the actions and conduct of the chiropractor. His the diagnosis and treatment were both found to be clinically justified.
According to the GCC, the lesson from this case is that the complaint to the GCC may have been avoided if the chiropractor had been more alert to the need to ensure he communicated effectively so that the patient was clear as to why the intimate areas were being treated and, on that basis, given informed consent. Patients often feel vulnerable before, during and after treatment; and this effect is magnified when the patient is unclothed, new to chiropractic treatment or the work of a particular chiropractor, or they are being treated in an intimate area. Chiropractors can reduce this feeling of vulnerability by offering a chaperone and gown (and recording a note of the patient’s response) as well as taking the time to ensure you have fully explained the procedure to them and obtained informed consent. Standard D4 of the GCC Code states registrants must “Consider the need, during assessments and care, for another person to be present to act as a chaperone; particularly if the assessment or care might be considered intimate or where the patient is a child or a vulnerable adult.”
Excuse me?
I find this unbelievably gross and grossly unbelievable!
It begs, I think, the following questions:
- What condition requires treatment with a ‘vibrating tool’ near the vagina (I assume they mean vulva)?
- What condition requires treatment with a ‘vibrating tool’ around the breasts?
- Is there any reliable evidence?
- Was informed consent obtained?
- What precisely did it entail?
About 15 years ago, I was an expert witness in a very similar UK case. The defendant was sent to prison for two years. The GCC is really not fit for purpose. It seems to consistently defend chiropractors rather than do its duty and defend their patients.
My advice to the above-mentioned patient is not to bother with the evidently useless GCC but to initiale criminal proceedings.
Yestderday, it was announced that King Charles has cancer. He had been in hospital for surgery for his enlarged prostate. Initially, the news was positive, as it was confirmed not to be prostate cancer. However, during the investigations, a cancer was discovered that apparently is unrelated to the prostate. Since the announcement, many journalists and other people have written to me asking what I think about it and what treatment Charles is likely to receive. I therefore decided to write a short post about the matter.
As a physician and human being I am very sorry whenever I hear that anyone has fallen ill, particularly if the condition is serious and potentially life-threatening. That this includes Charles goes without saying. Equally it is self-evident that I wish that all goes well for him, that the treatment he reportedly has already started is not too arduous, that he keeps in good spirit, that he has empathetic support from all his family and recovers quickly and fully.
Charles will, I am sure, have the best treatment anyone could wish for. Will he use so-called alternative medicine (SCAM), for example, the Gerson therapy, one of the SCAMs he once promoted as a cure of cancer? Of course not! He will receive the most effective, evidence-based care that is currently available. Will he thus not try any SCAM at all? I am confident that he will use SCAM wisely, namely not as a cure but as a supportive measure. In my book on this very subject, I go through all the relevant evidence and conclude that, while SCAM is most certainly not a cancer cure, it can have a place in supportive cancer care. Depending on the symptoms that develop during and after the conventional treatments, certain SCAMs can, according to fairly sound evidence, be helpful in improving wellness and quality of life.
Going through a battle against cancer is often a most humbling experience. Therefore, I am hopeful that, as he recovers from his ordeal, Charles will see that modern medicine – he once described it as being out of balance like the leaning tower of Pisa – is not just effective, empathetic and caring but also not nearly as unbalanced and unholistic as he often proclaimed it to be. In that sense, the experience might reform our king, and – who knows? – he might, after all, turn out to be not the self-proclaimed enemy but a true friend of the Enlightenment.
Supportive care is often assumed to be beneficial in managing the anxiety symptoms common in patients in sterile hematology unit. The authors of this study hypothesize that personal massage can help the patient, particularly in this isolated setting where physical contact is extremely limited.
The main objective of this study therefore was to show that anxiety could be reduced after a touch-massage performed by a nurse trained in this therapy.
A single-center, randomized, unblinded controlled study in the sterile hematology unit of a French university hospital, validated by an ethics committee. The patients, aged between 18 and 65 years old, and suffering from a serious and progressive hematological pathology, were hospitalized in sterile hematology unit for a minimum of three weeks. They were randomized into either a group receiving 15-minute touch-massage sessions or a control group receiving an equivalent amount of quiet time once a week for three weeks.
In the treated group, anxiety was assessed before and after each touch-massage session, using the State-Trait Anxiety Inventory questionnaire with subscale state (STAI-State). In the control group, anxiety was assessed before and after a 15-minute quiet period. For each patient, the difference in the STAI-State score before and after each session (or period) was calculated, the primary endpoint was based on the average of these three differences. Each patient completed the Rosenberg Self-Esteem Questionnaire before the first session and after the last session.
Sixty-two patients were randomized. Touch-massage significantly decreased patient anxiety: a mean decrease in STAI-State scale score of 10.6 [7.65-13.54] was obtained for the massage group (p ≤ 0.001) compared with the control group. The improvement in self-esteem score was not significant.
The authors concluded that this study provides convincing evidence for integrating touch-massage in the treatment of patients in sterile hematology unit.
I find this conclusion almost touching (pun intended). The wishful thinking of the amateur researchers is almost palpable.
Yes, I mean AMATEUR, despite the fact that, embarrassingly, the authors are affiliated with prestigeous institutions:
- 1Nantes Université, CHU Nantes, Service Interdisciplinaire Douleur, Soins Palliatifs et de Support, Médecine intégrative, UIC 22, Nantes, F-44000, France.
- 2Université Paris Est, EA4391 Therapeutic and Nervous Excitability, Creteil, F-93000, France.
- 3Nantes Université, CHU Nantes, Hematology Department, Nantes, F-44000, France.
- 4Nantes Université, CHU Nantes, CRCI2NA – INSERM UMR1307, CNRS UMR 6075, Equipe 12, Nantes, F-44000, France.
- 5Institut Curie, Paris, France.
- 6Université Paris Versailles Saint-Quentin, Versailles, France.
- 7Nantes Université, CHU Nantes, Direction de la Recherche et l’Innovation, Coordination Générale des Soins, Nantes, F-44000, France.
- 8Methodology and Biostatistics Unit, DRCI CHU Nantes CHD Vendée, La Roche Sur Yon, F-85000, France.
- 9Nantes Université, CHU Nantes, Service Interdisciplinaire Douleur, Soins Palliatifs et de Support, Médecine intégrative, UIC 22, Nantes, F-44000, France. [email protected].
So, why do I feel that they must be amateurs?
- Because, if they were not amateurs, they would know that a clinical trial should not aim to show something, but to test something.
- Also, if they were not amateurs, they would know that perhaps the touch-massage itself had nothing to do with the outcome, but that the attention, sympathy and empathy of a therapist or a placebo effect can generate the observed effect.
- Lastly, if they were not amateurs, they would not speak of convincing evidence based on a single, small, and flawed study.
After the nationwide huha created by the BBC’s promotion of auriculotherapy and AcuSeeds, it comes as a surprise to learn that, in Kent (UK), the NHS seems to advocate and provide this form of quackery. Here is the text of the patient leaflet:
Kent Community Health, NHS Foundation Trust
Auriculotherapy
This section provides information to patients who might benefit from auriculotherapy, to complement their acupuncture treatment, as part of their chronic pain management plan.
What is auriculotherapy?
In traditional Chinese medicine, the ear is seen as a microsystem representing the entire body. Auricular acupuncture focuses on ear points that may help a wide variety of conditions including pain. Acupuncture points on the ear are stimulated with fine needles or with earseeds and massage (acupressure).
How does it work?
Recent research has shown that auriculotherapy stimulates the release of natural endorphins, the body’s own feel good chemicals, which may help some patients as part of their chronic pain management plan.
What are earseeds?
Earseeds are traditionally small seeds from the Vaccaria plant, but they can also be made from different types of metal or ceramic. Vaccaria earseeds are held in place over auricular points by a small piece of adhesive tape, or plaster. Applying these small and barely noticeable earseeds between acupuncture treatments allows for patient massage of the auricular points. Earseeds may be left in place for up to a week.
Who can use earseeds?
Earseeds are sometimes used by our Chronic Pain Service to prolong the effects of standard acupuncture treatments and may help some patients to self manage their chronic pain.
How can I get the most out my treatment with earseeds?
It is recommended that the earseeds are massaged two to three times a day or when symptoms occur by applying gentle pressure to the earseeds and massaging in small circles.
Will using earseeds cure my chronic pain?
As with any treatment, earseeds are not a cure but they can reduce pain levels for some patients as part of their chronic pain management programme.
________________________
What the authors of the leaflet forgot to tell the reader is this:
- Auriculotherapy is based on ideas that fly in the face of science.
- The evidence that auriculotherapy works is flimsy, to say the least.
- The evidence earseeds work is even worse.
- To arrive at a positive recommendation, the NHS had to heavily indulge in the pseudo-scientific art of cherry-picking.
- The positive experience that some patients report is due to a placebo response.
- For whichever condition auriculotherapy is used, there are treatments that are much more adequate.
- Advocating auriculotherapy is therefore not in the best interest of the patient.
- Arguably, it is unethical.
- Definitely, it is not what the NHS should be doing.
I had the rare pleasure to give an interview for the ‘Frankfurter Allgemeine’. As it was, of course, in German, I took the liberty to translate it for my non-German speaking readers:
You have researched so-called alternative medicine over several decades, including homeopathy. What is your conclusion?
We are talking about far more than 400 methods – to draw one conclusion about all of them
is completely impossible. Except perhaps for this one: if something sounds too good to be true, it probably is.
Does this apply to homeopathy?
Highly diluted homeopathic remedies are popular because they have no side-effects. But there is also no effect. They are touted as a panacea. This is certainly not the case, on the contrary, they are
ineffective. And any therapy that is ineffective and promoted as a panacea is also dangerous.
How do you explain the fact that so many people swear by homeopathy?
There are several reasons for this. In Germany, homeopathy has an unbroken tradition, it was, for instance, promoted by the Nazis and later in the Federal Republic of Germany. It has a reputation for being gentle and effective. It might be gentle, but it is certainly not effective. It is also supported by lobby groups such as the manufacturers. And most people who use it don’t even understand what it actually is.
In any case, the placebo effect helps. What’s so bad about that??
Nothing at all, on the contrary: it is to be advocated. When we talk about placebo effects, we subsume many things under this umbrella that do not actually belong to it, such as the extensive, empathetic conversation that homeopaths often have with their patients. Besides, a common cold goes away whether you treat it or not. If you then use homeopathy, you can easily get the impression that it worked. Every good, empathetic doctor tries to maximize the placebo effect. To put it bluntly: you don’t need a placebo to generate a placebo effect. Patients also benefit from it when I give an effective remedy with empathy. In addition they benefit from the specific effect of my therapy, which should make up the lion’s share of the therapeutic response. If I withhold the most important thing I mistreat my patient.
But there are diseases for which there are no good remedies.
I often hear that argument. But there is practically always something we can do that at least
improves symptoms. Otherwise you should also say that instead of lying and recommending homeopathy – and thinking that, although there is nothing in it and it doesn’t work, but the patient, being an idiot, should take it nevertheless. It is unethical to use placebos as much as it is to use homeopathy.
Neurophysiologically, the placebo effect is becoming better and better understood.
The Italian neuroscientist Fabrizio Benedetti in particular has done very good work. But he also warns that this does not justify the use of homeopathy, for example.
Are there any studies on whether the placebo effect of homeopathy with its esoteric superstructure is greater than that giving just a piece of sugar?
There are analyses of what makes a particularly effective placebo. From this, we can learn that effective therapies in evidence-based medicine must be applied with empathy and sufficient time in order to maximize the ever-present placebo effect. So-called alternative medicine often does this quite well, and we can learn something from it. But the reason is that it often has nothing else. Homeopaths are a serious danger because they see homeopathy as a panacea. If someone has homeopathically treated their cold “successfully” for years and then gets cancer, they might think of turning to homeopathy for their cancer. It sounds crazy, but many homeopaths do offer cancer treatments on the internet, for instance. That sends shivers down my spine.
How should doctors and pharmacists react to the demand for homeopathic remedies?
Pharmacists are not primarily salespeople, they are a medical profession – they have to adhere to ethical guidelines. In this respect, evidence-based information of their clients/patients is very important.
Thomas Benkert, President of the German Federal Chamber of Pharmacists, has stated that he would not be able to stop giving advice if he always had to explain the lack of proof of efficacy.
He should perhaps read up on what his ethical duty to patients is.
What if doctors or pharmacists themselves believe in the effect?
Belief should not play a role, but evidence should.
Are you pleased with Lauterbach’s plan to no longer reimburse homeopathy?
I think it’s a shame that he justifies it by saying it’s ineffective. That is true. But the justification should be that it’s esoteric nonsense and therefore ineffective – and dangerous.
In the end, the Bundestag will decide.
I think Lauterbach has a good chance because things have started to move. Medical associations in Germany have spoken out against the additional designation of homeopathy, for example, and overall the wind has changed considerably.
What is it like in the UK, where you live?
The UK healthcare system, NHS, said goodbye to reimbursement of homeopathy about five years ago, even before France. The pharmacists’ association has distanced itself very clearly from homeopathy. However, most pharmacists still sell the remedies and many continue to support them.
You have also had disputes with the current head of state, King Charles. How did that come about?
A few years ago, he commissioned a paper claiming that so-called alternative medicine could save the British health service a lot of money. I protested against this – Charles accused me of leaking it to The Times before it was published. My university launched an investigation, which eventually found me innocent, but it led to the demise of my department. That caused me to retire two years early.
So Charles managed to close down the only research unit in the world that conducted critical and systematic research into so-called alternative medicine. Most researchers in this field only want to confirm their own prejudices and not disprove hypotheses. This is a serious misunderstanding of how science works. If someone reports only positive results for their favorite therapy in all conditions, something is wrong.
Some people say that homeopathy should not be researched because nothing positive can come out of it anyway.
There are certainly some SCAMs that are so nonsensical that they should not be researched, as is currently the case with homeopathy. I put it this way because I have researched homeopathy myself and, from my point of view, the situation was not so crystal clear 30 years ago.
Would you say that you have approached the matter with a sufficiently open mind?
No one can be completely unbiased. That’s why it’s important to do science properly, then you minimize bias as much as possible. When I took up my position at Exeter in 1993, I was perhaps somewhat biased towards homeopathy in a positive sense, because I had learned and used it myself, as well as other alternative medicine methods. The fact that the results then turned out to be negative in the vast majority of cases initially depressed me. But I have to live with that.
Every researcher prefers positive results, also because they are easier to publish. It was clear to me that, if I had succeeded in proving homeopathy right, I wouldn’t get one Nobel Prize, but two. Who wouldn’t want that?
(The interview was conducted by Hinnerk Feldwisch-Drentrup.)
On this blog, I have often been highly critical of integrative (or integrated) medicine (IM) – see, for instance:
- Integrative medicine: a satirical perspective
- A slightly different perspective on ‘INTEGRATIVE MEDICINE’
- Memorandum ‘INTEGRATIVE MEDICINE’
- Prince Charles’ opening speech at the ‘biggest ever’, ‘history-making’ integrative medicine conference
- The European Parliament’s Pathetic Attempt to Dabble in Integrative Medicine
- Integrative Medicine or Infiltrative Pseudoscience?
- Integrative Medicine: here is my slightly altered and much improved version
- More uncomfortable thoughts on ‘integrative medicine’
- The reality of ‘integrative medicine’ consists of little more than re-discoveries from conventional medicine, platitudes and outright nonsense
Recently, I began to realize that my previously critical stance has been largely due to the fact that 1) a plethora of definitions of IM exist causing endless confusion, 2) most, if not all, of the definitions of IM are vague and insufficient. At the same time, IM is making more and more inroads which makes it imprudent to ignore it.
I therefore decided it is time to change my view on IM and think more constructively. The first step on this new journey is to define IM in such a way that all interested parties can come on board. So, please allow me to present to you a definition of IM that is constructive and in the interest of progress:
IM is defined as the form of healthcare that employs the best available research to clinical care integrating evidence on all types of interventions with clinical expertise and patient values. By best available research, I mean clinically relevant (i.e., patient oriented) research that:
- establishes the efficacy and safety of all types of therapeutic, rehabilitative, or preventive healthcare strategies and
- seeks to understand the patient experience.
Healthcare practitioners who are dedicated to IM use their clinical skills and prior experience to identify each patient’s unique clinical situation, applying the evidence tailored to the individual’s risks versus benefits of potential interventions. Ultimately, the goal of IM is to support the patient by contextualising the evidence with their preferences, concerns, and expectations. This results in a process of shared decision making, in which the patient’s values, circumstances, and setting dictate the best care.
If applied appropriately, IM has the potential to be a great equaliser – striving for equitable care for patients in disparate parts of the world. Furthermore, IM can play a role in policy making; politicians are increasingly speaking to their use of research evidence to inform their decision making as a declaration of legitimacy. IM reflects the work of countless people who have improved the process of generating clinical evidence over several decades, and that it continues to evolve.
Developing the skills to practise IM requires access to evidence, opportunities to practise, and time. IM proponents strive to find novel ways to integrate evidence into personal holistic health in the best interest of our patients.
_________________________
I feel confident that this could create a basis for a fresh start in the dabate about the merits of IM. I for one am all for it!
In case some of my readers thought that the wording of my definition sounded somewhat familiar, I should perhaps tell you that it is my adaptation of the definition of evidence-based medicine (EBM) as published in ‘BMJ Best Practice‘.
What does that mean?
The points I am trying to make are the ones that I have tried to get across many times before:
- IM is a flawed, unethical, superflous and counter-productive concept.
- It is flawed because it is aimed at smuggling unproven or disproven treatments into routine care which can only render healthcare less safe and less effective.
- It is unethical because it cannot provide the best possible healthcare and thus is not in the best interest of patients.
- It is superflous because the aspects of IM that might seem valuable to proponents of so-called alternative medicine (SCAM) are already part of EBM.
- It is counter-productive because it distracts from the laudable efforts of EBM.
The risks of chiropractic spinal manipulations (CSMs) feature regularly on my blog, not least because most chiropractors are in denial of this important issue and insist that chiropractic spinal manipulations are safe!!!. I therefore thought it might be a good idea to try and summarize the arguments they often put forward in promoting their dangerously fallacious and quasi-religious belief that CSMs are safe:
- There is not evidence to suggest that CSMs do harm. Such a statement is based on wishful thinking and ignorance motivated by the need of making a living. The evidence shows a different picture.
- There are hundreds of clinical trials that demonstrate the safety of CSMs. This argument is utterly unconvincing for at least two reasons: firstly clinical trials are far too small for identifying rare (but serious) complications; secondly, we know that clinical trials of CSM very often fail to report adverse events.
- Case reports of adverse effects are mere anecdotes and thus not reliable evidence. As there is no post-marketing surveillance system of adverse events after CSMs, case reports are, in fact, the most important and informative source of information we currently have on this subject.
- Case reports of harm by CSMs are invariably incomplete and of poor quality. Case reports are usually published by doctors who often have to rely on incomplete information. It would be up to chiropractors to publish case reports with the full details; yet chiropractors hardly ever do this.
- Case reports cannot establish cause and effect. True, but they do provide important signals which then should be investigated further. It would be up to chiropractors to do this; sadly, this is not what is happening.
- Adverse effects such as arterial dissections or strokes occur spontaneaously. True, but many have an identifiable cause, and it is our duty to find it.
- The forces applied during CSM are small and cannot cause an injury. This might be true under ideal conditions, but in clinical practice the conditions are often not ideal.
- If an arterial dissection occurs nevertheless, it is because there was a pre-existing injury. This argument is largely based on wishful thinking. Even if it were true, it would be foolish to aggravate a pre-existing injury by CSMs.
- Injuries happen only if the contra-indications of CSMs are ignored. This obviously begs the question: what are the contra-indications and how well established are they? The answer is that they are largely based on guess-work and not on systematic research. Thus chiropractors are able to claim that, once an adverse effects has occurred, the incident was due to a disregard of contra-indication and not due to the inherent risks of CSM.
- Only poorly trained chiropractors cause harm. This is evidently untrue, yet the argument provides yet another welcome escape route for those defending CSMs: if something went wrong, it must have been due to the practitioner and not the intervention!
- Chiropractors are an easy target. In my fairly extensive experience in this field, the opposite is true. Chiropractors tend to have multiple excuses and escape routes. As a consequence, they are difficult to pin down.
- Other causes, e.g. car accidents, are much more common causes of vascular injuries. Even if this were true, it does certainly not mean that CSM can be ruled out as the cause of serious harm.
- Patients who experience harm had pre-existing issues. Again, this notion is mostly based on wishful thinking and not based on sound evidence. Yet, it clearly is another popular escape route for chiropractors. And again, it is irresponsible to administer CSM if there is the possibility that pre-existing issues are present.
- The alleged harms of CSMs are merely an obsession for people who don’t really understand chiropractic. That is an old trick of someone trying to defend the indefensible. Chiropractors like to pompously claim that opponents are ignorant and only chiropractors understand the subject area. They use arrogance in an attempt to intimidate or scilence experts who disagree with them.
- Chiropractors do so much more than just CSN. True. They have ‘borrowed’ many modalities from physiotherapy and, by pointing that out, they aim at distracting from the dangers of CSMs. Yet, it is also true that practically every patient who consults a chiropractor will receive a CSM.
- Doctors are just jealous of the success of chiropractors. This fallacy is used when chiropractors run out of proper arguments. Rather than addressing the problem, they try to distract from it by claiming the opponent has ulterior motives.
- Medical treatments cause much more harm than CSM. Chiropractors are keen to mislead us into believing that NSAIDs, for instance, are much more dangerous than CSMs. The notion is largely based on one lousy article and thus not convincing. Even if it were true, it would obviously be no reason to ignore the risks of CSNs.
I am sure my list is far from complete. If you can think of further (pseudo-) arguments, please use the comments section below to let us know.
Jean-Maurice Latsague (85 years old) has a track record of sexual assaults. Recently, he stood trial before the Sarthe Assize Court from 13 to 15 December for rapes committed during healing sessions. He has worked as an energy healer for many years, and it was in this capacity that he came into conflict with the law nearly 30 years ago.
- In 1994, he was sentenced to 10 years’ imprisonment for the rape and indecent assault of minors that he had committed in the Dordogne.
- In February 2023, he settled in Sarthe after his release from prison and was again convicted for sexual assaults.
- Now we’re talking about crimes again, with an accusation of rape against two women.
During the first few hours of the current trial, Jean-Maurice Latsague listened to the proceedings, bent over on his cane. He explained that he had asked his patients to strip naked because “healing energy doesn’t pass through tissue”.
The healing sessions seemed to always follow the same routine:
- They begin with discussions.
- This is followed by prayers.
- Subsequently, Jean-Maurice Latsague asks his victims to strip naked.
- Then he administeres massages with oil.
- Finally, he rapes his victim.
On the second day of the proceedings, one of the victims chose to bring a civil action. She is one of three other women attacked by Jean-Maurice Latsague (apart from a mother and daughter who gave evidence before), but who had not lodged a complaint at the time of the investigation.
New testimony sheds light on the healer’s practices, in a much more sordid and perverse way. “He would masturbate in front of me to stimulate ovulation,” said a victim who took the witness stand and was undergoing treatment for infertility.
At the end of a three-day trial, the Sarthe Assize Court found Jean-Maurice Latsague guilty of repeated rape and sexual assault committed by a person abusing the authority conferred by his position.
He was sentenced to twenty years’ imprisonment.
Sources:
Un magnétiseur accusé de plusieurs viols devant les Assises de la Sarthe (francetvinfo.fr)
À 85 ans, le magnétiseur condamné à vingt ans de réclusion criminelle pour viols (ouest-france.fr)
As promised, here is my translation of the article published yesterday in ‘Le Figaro’ arguing in favour of integrating so-called alternative medicine (SCAM) into the French healthcare system [the numbers in square brackets were inserted by me and refer to my comments listed at the bottom].
So-called unconventional healthcare practices (osteopathy, naturopathy, acupuncture, homeopathy and hypnosis, according to the Ministry of Health) are a cause for concern for the health authorities and Miviludes, which in June 2023 set up a committee to support the supervision of unconventional healthcare practices, with the task of informing consumers, patients and professionals about their benefits and risks, both in the community and in hospitals. At the time, various reports, surveys and press articles highlighted the risks associated with NHPs, without pointing to their potential benefits [1] in many indications, provided they are properly supervised. There was panic about the “booming” use of these practices, the “explosion” of aberrations, and the “boost effect” of the pandemic [2].
But what are the real figures? Apart from osteopathy, we lack reliable data in France to confirm a sharp increase in the use of these practices [3]. In Switzerland, where it has been decided to integrate them into university hospitals and to regulate the status of practitioners who are not health professionals, the use of NHPs has increased very slightly [4]. With regard to health-related sectarian aberrations, referrals to Miviludes have been stable since 2017 (around 1,000 per year), but it should be pointed out that they are a poor indicator of the “risk” associated with NHPs (unlike reports). The obvious contrast between the figures and the press reports raises questions [5]. Are we witnessing a drift in communication about the risks of ‘alternative’ therapies? [6] Is this distortion of reality [7] necessary in order to justify altering the informed information and freedom of therapeutic choice of patients, which are ethical and democratic imperatives [8]?
It is the inappropriate use of certain NHPs that constitutes a risk, more than the NHPs themselves! [9] Patients who hope to cure their cancer with acupuncture alone and refuse anti-cancer treatments are clearly using it in a dangerous alternative way [10]. However, acupuncture used to relieve nausea caused by chemotherapy, as a complement to the latter, is recommended by the French Association for Supportive Care [11]. The press is full of the dangers of alternative uses, but they are rare: less than 5% of patients treated for cancer according to a European study [12]. This is still too many. Supervision would reduce this risk even further [13].
Talking about risky use is therefore more relevant than listing “illusory therapies”, vaguely defined as “not scientifically validated” and which are by their very nature “risky” [14]. What’s more, it suggests that conventional treatments are always validated and risk-free [15]. But this is not true! In France, iatrogenic drug use is estimated to cause over 200,000 hospital admissions and 10,000 deaths a year [16]. Yes, some self-medication with phytotherapy or aromatherapy does carry risks… just like any self-medication with conventional medicines [17]. Yes, acupuncture can cause deep organ damage, but these accidents occur in fewer than 5 out of every 100,000 patients [18]. Yes, cervical manipulations by osteopaths can cause serious or even fatal injuries, but these exceptional situations are caused by practitioners who do not comply with the decree governing their practice.[19] Yes, patients can be swindled by charlatans, but there are also therapeutic and financial abuses in conventional medicine, such as those reported in dental and ophthalmology centres. [20]
Are patients really that naive? No. 56% are aware that “natural” remedies can have harmful side-effects, and 70% know that there is a risk of sectarian aberrations or of patients being taken in by a sect [21]. In view of the strong demand from patients, we believe that guaranteeing safe access to certain NHPs is an integral part of their supervision, based on regulation of the training and status of practitioners who are not health professionals, transparent communication, appropriate research, the development of hospital services and outpatient networks of so-called “integrative” medicine combining conventional practices and NHPs, structured care pathways with qualified professionals, precise indications and a safe context for treatment.[22] This pragmatic approach to reducing risky drug use [17] has demonstrated its effectiveness in addictionology [23]. It should inspire decision-makers in the use of NHPs”.
- Reports about things going wrong usually do not include benefits. For instance, for a report about rail strikes it would be silly to include a paragraph on the benefits of rail transport. Moreover, it is possible that the benefits were not well documented or even non-existent.
- No, there was no panic but some well-deserved criticism and concern.
- Would it not be the task of practitioners to provide reliable data of their growth or decline?
- The situation in Switzerland is often depicted by enthusiasts as speaking in favour of SCAM; however, the reality is very different.
- Even if reports were exaggerated, the fact is that the SCAM community does as good as nothing to prevent abuse.
- For decades, these therapies were depicted as gentle and harmless (medicines douces!). As they can cause harm, it is high time that there is a shift in reporting and consumers are informed responsibly.
- What seems a ‘distortion of reality’ to enthusiasts might merely be a shift to responsible reporting akin to that in conventional medicine where emerging risks are taken seriously.
- Are you saying that informing consumers about risks is not an ethical imperative? I’d argue it is an imperative that outweighs all others.
- What if both the inappropriate and the appropriate use involve risks?
- Sadly, there are practitioners who advocate this type of usage.
- The recommendation might be outdated; current evidence is far less certain that this treatment might be effective (“the certainty of evidence was generally low or very low“)
- The dangers depend on a range of factors, not least the nature of the therapy; in case of spinal manipulation, for instance, about 50% of all patients suffer adverse effects which can be severe, even fatal.
- Do you have any evidence showing that supervision would reduce this risk, or is this statement based on wishful thinking?
- As my previous comments demonstrate, this statement is erroneous.
- No, it does not.
- Even if this figure is correct, we need to look at the risk/benefit balance. How many lives were saved by conventional medicine?
- Again: please look at the risk/benefit balance.
- How can you be confident about these figures in the absence of any post-marketing surveillance system? The answer is, you cannot!
- No, they occur even with well-trained practitioners who comply with all the rules and regulations that exist – spoiler: there hardly are any rules and regulations!
- Correct! But this is a fallacious argument that has nothing to do with SCAM. Please read up about the ‘tu quoque’ and the strawman’ fallacies.
- If true, that is good news. Yet, it is impossible to deny that thousands of websites try to convince the consumer that SCAM is gentle and safe.
- Strong demand is not a substitute for reliable evidence. In any case, you stated above that demand is not increasing, didn’t you?
- Effectiveness in addictionology? Do you have any evidence for this or is that statement also based on wishful thinking?
My conclusion after analysing this article in detail is that it is poorly argued, based on misunderstandings, errors, and wishful thinking. It cannot possibly convince rational thinkers that SCAM should be integrated into conventional healthcare.
PS
The list of signatories can be found in the original paper.
