Misinformation by chiropractors is unfortunately nothing new and has been discussed ad nauseam on this blog. It is tempting to ask whether chiropractors have lost (or more likely never had) the ability to ditinguish real information from misinformation or substantiated from unsubstantiated claims. During the pandemic, the phenomenon of chiropractic misinformation has become even more embarrassingly obvious, as this new article highlights.
Chiropractors made statements on social media claiming that chiropractic treatment can prevent or impact COVID-19. The rationale for these claims is that spinal manipulation can impact the nervous system and thus improve immunity. These beliefs often stem from nineteenth-century chiropractic concepts. The authors of the paper are aware of no clinically relevant scientific evidence to support such statements.
The investigators explored the internet and social media to collect examples of misinformation from Europe, North America, Australia and New Zealand regarding the impact of chiropractic treatment on immune function. They discussed the potential harm resulting from these claims and explore the role of chiropractors, teaching institutions, accrediting agencies, and legislative bodies.
The authors conclude as follows: In this search of public media in Europe, North America, New Zealand, and Australia, we discovered many cases of misinformation. Claims of chiropractic treatment improving immunity conflict with the advice from authorities and the scientific consensus. The science referenced by these claims is missing, flawed or has no clinical relevance. Consequently, their claims about clinical effectiveness are spurious at best and misleading at worst. However, our examples cannot be used to make statements about the magnitude of the problem among practitioners as our samples were not intended to be representative. For that reason, we also did not include an analysis of the arguments provided in the various postings. In view of the seriousness of the topic, it would be relevant to conduct a systematic study on a representative sample of public statements, to better understand these issues. Our search illustrates the possible danger to public health of misinformation posted on social media and the internet. This situation provides an opportunity for growth and maturation for the chiropractic profession. We hope that individual chiropractors will reflect on and improve their communication and practices. Further, we hope that the chiropractic teaching institutions, regulators, and professional organisations will always demonstrate responsible leadership in their respective domains by acting to ensure that all chiropractors understand and uphold their fiduciary duties.
Several previous papers have found similar things, e.g.: Twitter activity about SMT and immunity increased during the COVID-19 crisis. Results from this work have the potential to help policy makers and others understand the impact of SMT misinformation and devise strategies to mitigate its impact.
The pandemic has crystallised the embarrassment about chiropractic false claims. Yet, the phenomenon of chiropractors misleading the public has long been known and arguably is even more important when it relates to matters other than COVID-19. Ten years ago, we published this paper:
Background: Some chiropractors and their associations claim that chiropractic is effective for conditions that lack sound supporting evidence or scientific rationale. This study therefore sought to determine the frequency of World Wide Web claims of chiropractors and their associations to treat, asthma, headache/migraine, infant colic, colic, ear infection/earache/otitis media, neck pain, whiplash (not supported by sound evidence), and lower back pain (supported by some evidence).
Methods: A review of 200 chiropractor websites and 9 chiropractic associations’ World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States was conducted between 1 October 2008 and 26 November 2008. The outcome measure was claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment.
Results: We found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache/migraine. Unsubstantiated claims were made about asthma, ear infection/earache/otitis media, neck pain,
Conclusions: The majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.
It makes it clear that the misleading information of chiropractors is a serious problem. And I find it disappointing to see that so little has been done about it, and that progress seems so ellusive.
This, of course, begs the question, where does all this misinformation come from? The authors of the new paper stated that beliefs often stem from nineteenth-century chiropractic concepts. This, I believe, is very true and it gives us an important clue. It suggests that, because it is good for business, chiro schools are still steeped in obsolete notions of pseudo- and anti-science. Thus, year after year, they seem to churn out new generations of naively willing victims of the Dunning Kruger effect.
We have often heard it said on this blog and elsewhere that chiropractors are making great strides towards reforming themselves and becoming an evidence-based profession. In view of the data cited above, this does not ring all that true, I am afraid. Is the picture that emerges not one of a profession deeply embroiled in BS with but a few fighting a lost battle to clean up the act?
FOUR QUESTIONS TO DC + CRITICAL CHIRO (CC):
1) what does the law say about informed consent for Australian chiros?
2) what info exactly do you have to provide?
3) who monitors it?
4) what published evidence do we have about compliance?
CC then posted this reply:
Here we go again you demand evidence while providing little if any for your own assumptions (poor case studies do not count. The pleural of anecdote does not equal evidence whether it’s from chiro’s or you).
We have been over this many times over many years, I cite research/provide links yet you still find it challenging to take it onboard. It is human nature to feel obligated once making a public statement to defend it no matter how much evidence is sent your way. So not surprising.
“1) what does the law say about informed consent for Australian chiros?”
It is all freely available on the national regulators website (as you know and as I have referenced in the past):
Some research by chiropractors on this topic (cited many times in the past):
Risk Management for Chiropractors and Osteopaths. Informed consent
A Common Law Requirement (2004):
Quick advanced PubMed with filters set to “Chiropractic” AND “Informed consent”.
Not rocket science
Latest paper that you wrote an ill informed blog on and the comments were not going as you expected (So I expected you to double down like Donald Trump with a new blog within days. Your getting predictable).
This paper questions the legal implications of vertebral subluxations with high powered legal input and is a broadside by evidence based chiropractors against vitalistic chiropractors. You respond a snide fantasy informed consent dialogue when you should be supporting the authors:
“2) what info exactly do you have to provide?”
“4) what published evidence do we have about compliance?”
We have discussed this as well. It is a common law requirement for every profession and is checked upon re-registration by AHPRA every year and by the professional indemnity insurers every year. No informed consent, no registration and no professional indemnity insurance.
Checked AHPRA’s panel decisions and went back 5 YEARS and found ONE decision relating to informed consent:
“3) who monitors it?”
Another of your tired old arguments that we have discussed many times over the years.
In the UK there is the “‘Chiropractic Reporting and Learning System’ (CRLS)” but this is set up by the association representing chiropractors and not the registration board that advocates for patients. Right idea and step in the right direction, wrong organization.
Here years ago there was a trial of an adverse event reporting system in a Melbourne emergency department systematically collected relevant AE information on all professions which was sent to the relevant board for investigation.
It was supported by doctors and chiropractors while physio’s were not involved. A doctor involved told me it was killed off by ER doctors who “snivelled” about the extra paperwork.
There is no AE reporting system for physio’s, chiro’s, osteo’s, GP’s in private practice etc.
Over the years you have harped on and on about this topic as if it is a failing purely of the chiropractic profession when we have supported initiatives for its implementation.
You have also kept up with the research even commenting on an chiropractic researcher on AE’s Charlotte Leboeuf-Yde (who you highly regard) yet ignored until you could take issue with two sentences written in a blog then you wrote this hatchet blog:
So you are asking for evidence yet willfully ignore an author who “I have always thought highly of Charlotte’s work”.
Stop the cynical cherry picked blogs and start supporting the researchers and reformers otherwise you are just someone standing on the sidelines blindly throwing grenades. You do not care who you hit or the damage you do to the chiropractors leading the reform you demand yet consistently fail to support.
I thought the tone of this response was oddly aggressive and found that CC had failed to understand some of my questions. Yet the link to the chiro’s code of conduct https://www.chiropracticboard.gov.au/Codes-guidelines/Code-of-conduct.aspx was useful. This is what it says about informed consent:
- the chiro suggests a manipulation of the neck;
- this often involves forcing a spinal joint beyond its physiological range of motion;
- the treatment will be short but needs repeating several times during the coming weeks;
- the expected benefits are a reduction of pain and improvement of motion;
- the total cost of the treatment series will be xy;
- there are many other treatment options for neck pain;
- most of these have a better risk/benefit profile than neck manipulation;
- having no treatment for neck pain at all is likely to lead to full resolution of the problem over time.
Apart from any doubts that chiropractors would actually comply with these requirements, the question remains: is the listed information sufficient? Does it outline a truly a fully informed consent? I think that essential aspects of informed consent are missing.
- The code does not explicidly require an explanation about the possible harms of spinal manipulation (i.e. 50% of all patients will suffer mild to moderate adverse effects lasting 2-3 days, and occasionally patients will have a stroke of which some have died).
- Moreover, the code mentions EXPECTED benefits, but not benefits supported by evidence. Chiros may well EXPECT their treatment to work, but what does the evidence show? As often discussed on this blog, the evidence is negative or very week, depending how you want to interpret it. The code does not require a chiro to inform his patients about this fact.
So, the way I see it, the code does not expressedly demand the chiro to explain his patient that the treatment he is being asked to consent to is
- not supported by sound evidence for effectiveness,
- nor that the treatment is burdened with significant risks.
And what about the other questions listed above? An Australian chiropractor who will remain anonymous gave me the following answers:
Yet, Australian chiropractors claim that they abide by the ethical imperative of informed consent. Are they taking the Mickey?
Perhaps not. Perhaps they are merely trying to make sure they do not lose the majority of their clientele. As I already pointed out in my previous post, fully informed consent would make most chiropractic patients turn round and run a mile.
Today, HRH the Prince of Wales has his 72th birthday. As every year, I send him my best wishes by dedicating an entire post to a brief, updated summary of his achievements in the area of so-called alternative medicine (SCAM).
EARLY INFLUENCE OF LAURENCE VAN DER POST
Aged 18, Charles went on a journey of ‘spiritual discovery’ into the Kalahari desert. His guide was Laurens van der Post (later discovered to be a fraud and compulsive fantasist and to have fathered a child with a 14-year old girl entrusted to him during a sea voyage). Van der Post wanted to awake Charles’ mind and attune it to the ideas of Carl Jung’s ‘collective unconscious’, and it is this belief in vitalism that provides the crucial link to SCAM: virtually every form of SCAM is based on the assumption that some sort of vital force exists. Charles was impressed with van der Post that he made him the godfather of Prince William. After Post’s death, he established an annual lecture in his honour (the lecture series was quickly discontinued after van der Post was discovered to be a fraud).
CHIROPRACTIC and OSTEOPATHY
Throughout the 1980s, Charles lobbied for the statutory regulation of chiropractors and osteopaths in the UK. In 1993, this finally became reality. To this day, these two SCAM professions are the only ones regulated by statute in the UK.
THE BRITISH MEDICAL ASSOCIATION
In 1982, Prince Charles was elected as President of the British Medical Association (BMA) and promptly challenged the medical orthodoxy by advocating SCAM. In a speech at his inaugural dinner as President, the Prince lectured the medics: ‘Through the centuries healing has been practised by folk healers who are guided by traditional wisdom which sees illness as a disorder of the whole person, involving not only the patient’s body, but his mind, his self-image, his dependence on the physical and social environment, as well as his relation to the cosmos.’ The BMA-officials ordered a full report on alternative medicine which promptly condemned this area as implausible nonsense.
Six years later, a second report, entitled ‘Complementary Medicine – New Approaches to Good Practice’, heralded U-turn stating that: “the demand for non-conventional therapies had become so pressing that organised medicine in Britain could no longer ignore its contribution“. At the same time, however, the BMA set in motion a further chapter in the history of SCAM by insisting that it was “unacceptable” to allow the unrestricted practice of non-conventional therapies, irrespective of training or experience.
THE FOUNDATION OF INTEGRATED HEALTH
In 1993, Charles founded his lobby group which, after being re-named several times, ended up being called the ‘Foundation for Integrated Health’ (FIH). It was closed down in 2010 amidst allegations of money laundering and fraud. Its chief executive, George Gray, was later convicted and went to jail.
In 2001, Charles worked on plans to help build a model hospital of integrated medicine. It was to train doctors to combine conventional medicine and SCAMs, such as homeopathy, Ayurvedic medicine and acupuncture, and was to have around 100 beds. The prince’s intervention marked the culmination of years of campaigning by him for the NHS to assign a greater role to SCAM.
In 2001, Charles published an editorial in the BMJ promoting his ideas around integrative medicine. Its title: THE BEST OF BOTH WORLDS. Ever since, Charles has been internationally recognised as one of the world’s most vociferous champions of integrated medicine.
In 2004, Charles publicly supported the Gerson diet as a treatment for cancer. Prof Baum, an eminent oncologists, was invited to respond in an open letter to the British Medical Journal: ” …Over the past 20 years I have treated thousands of patients with cancer and lost some dear friends and relatives to this dreaded disease…The power of my authority comes with knowledge built on 40 years of study and 25 years of active involvement in cancer research. Your power and authority rest on an accident of birth. I don’t begrudge you that authority but I do beg you to exercise your power with extreme caution when advising patients with life-threatening diseases to embrace unproven therapies.”
THE SMALLWOOD REPORT
In 2005, the ‘Smallwood-Report’ was published; it had been commissioned by Charles and paid for by Dame Shirley Porter to inform health ministers. It stated that up to 480 million pounds could be saved, if one in 10 family doctors offered homeopathy as an “alternative” to standard drugs for asthma. Savings of up to 3.5 billion pounds could be achieved by offering spinal manipulation rather than drugs to people with back pain. Because I had commented on this report, Prince Charles’ first private secretary asked my vice chancellor to investigate the alleged indiscretion; even though I was found to be not guilty of any wrong-doing, all local support at Exeter stopped which eventually led to my early retirement.
WORLD HEALTH ORGANISATION
In a 2006 speech, Prince Charles told the World Health Organisation in Geneva that SCAM should have a more prominent place in health care and urged every country to come up with a plan to integrate conventional and alternative medicine into the mainstream. Anticipating Prince Charles’s sermon in Geneva, 13 of Britain’s most eminent physicians and scientists wrote an “Open Letter” which expressed concern over “ways in which unproven or disproved treatments are being encouraged for general use in Britain’s National Health Service.” The signatories argued that “it would be highly irresponsible to embrace any medicine as though it were a matter of principle.”
TRADITIONAL CHINESE MEDICINE (TCM)
In 2007, the People’s Republic of China recorded the visit of Fu Ying, its ambassador in London at the time, to Clarence House, and announced that the Charles had praised TCM. “He hoped that it could be included in the modern medical system . . . and was willing to make a contribution to it.”
In 2009, the Prince held talks with the health Secretary to persuade him to introduce safeguards amid a crackdown by the EU that could prevent anyone who is not a registered health practitioner from selling remedies.
In the same year, Charles urged the government to protect SCAM because “we fear that we will see a black market in herbal products”, as Dr Michael Dixon, medical director of the FIH and Charles’ advisor in SCAM, put it.
UK HEALTH POLITICS
In 2009, the health secretary wrote to the Prince suggesting a meeting on the possibility of a study on integrating SCAM in England’s NHS. The Prince had written to Burnham’s predecessor, Alan Johnson, demanding greater access to SCAM in the NHS alongside conventional medicine. Charles stated that “despite waves of invective over the years from parts of the medical and scientific establishment” he continued to lobby “because I cannot bear people suffering unnecessarily when a complementary approach could make a real difference”.
In June 2014, BBC NEWS published the following text about a BBC4 broadcast entitled ‘THE ROYAL ACTIVIST’ aired on the same day: Prince Charles has been a well-known supporter of complementary medicine. According to a… former Labour cabinet minister, Peter Hain, it was a topic they shared an interest in. He had been constantly frustrated at his inability to persuade any health ministers anywhere that that was a good idea, and so he, as he once described it to me, found me unique from this point of view, in being somebody that actually agreed with him on this, and might want to deliver it. Mr Hain added: “When I was Secretary of State for Northern Ireland in 2005-7, he was delighted when I told him that since I was running the place I could more or less do what I wanted to do. I was able to introduce a trial for complementary medicine on the NHS, and it had spectacularly good results, that people’s well-being and health was vastly improved. And when he learnt about this he was really enthusiastic and tried to persuade the Welsh government to do the same thing and the government in Whitehall to do the same thing for England, but not successfully,” added Mr Hain.
In October 2015, the Guardian obtained the infamous “black spider memos” which revealed that Charles had repeatedly lobbied politicians in favour of SCAM.
THE COLLEGE OF MEDICINE
In 2009, it was announced that the ‘College of Integrated Medicine’ (the successor of the FIH) was to have a second base in India. In 2011, Charles forged a link between ‘The College of Medicine’ and an Indian holistic health centre. The collaboration was reported to include clinical training to European and Western doctors in Ayurveda and homoeopathy and traditional forms of medicine to integrate them in their practice. The foundation stone for the extended campus of the Royal College known as the International Institution for Holistic and Integrated Medicine was laid by Dr Michael Dixon in collaboration with the Royal College of Medicine.
In 2020, Charles became the patron of the College of Medicine which, by then, had re-christened itself ‘College of Medicine and Integrated Health’. The College chair, Michael Dixon, was quoted stating: ‘This is a great honour and will support us as an organisation committed to taking medicine beyond drugs and procedures. This generous royal endorsement will enable us to be ever more ambitious in our mission to achieve a more compassionate and sustainable health service.”
DUTCHY ORIGINALS DETOX TINCTURE
In 2011, after the launch of Charles’ range of herbal tinctures, I had the audacity to publicly criticise Charles for selling the Duchy Herbals detox tincture which I named ‘Dodgy Originals Detox Tincture’.
In 2016, speaking at a global leaders summit on antimicrobial resistance, Prince Charles warned that Britain faced a “potentially disastrous scenario” because of the “overuse and abuse” of antibiotics. The Prince explained that he had switched to organic farming on his estates because of the growing threat from antibiotic resistance and now treats his cattle with homeopathic remedies rather than conventional medication. As some of you may be aware, this issue has been a long-standing and acute concern to me,” he told delegates from 20 countries “I have enormous sympathy for those engaged in the vital task of ensuring that, as the world population continues to increase unsustainably and travel becomes easier, antibiotics retain their availability to overcome disease… It must be incredibly frustrating to witness the fact that antibiotics have too often simply acted as a substitute for basic hygiene, or as it would seem, a way of placating a patient who has a viral infection or who actually needs little more than patience to allow a minor bacterial infection to resolve itself.”
In 2017, Charles declared that he will open a centre for SCAM in the recently purchased Dumfries House in Scotland. Currently, the College of Medicine and Integrated Health is offering two-day Foundation Courses at this iconic location. Gabriel Chiu, a US celebrity cosmetic and reconstructive surgeon, and his wife Christine, joined the Prince of Wales as he opened the integrated health and wellbeing centre on the Dumfries House Estate in East Ayrshire in 2019. As he unveiled a plaque, Prince Charles said: “I’m so glad that all of you have been able to get here today, particularly because I could not be more proud to see the opening of this new integrated health centre at Dumfries House. It’s something I’ve been wanting to do for the last 35 years. I’m also so proud of all the team at Dumfries House who built it, an all in-house team.”
Generations of royals have favoured homeopathy, and allegedly it is because of this influence that homeopathy became part of the NHS in 1948. Homeopathy has also been at the core of Charles’ obsession with SCAM from its beginning. In 2017, ‘Country News’ published an article about our heir to the throne stating that Prince of Wales has revealed he uses homeopathic treatments for animals on his organic farm at Highgrove to help reduce reliance on antibiotics, the article stated. He said his methods of farming tried wherever possible to ‘‘go with the grain of nature’’ to avoid dependency on antibiotics, pesticides and other forms of chemical intervention.
In the same year, it was revealed that UK farmers were being taught how to treat their livestock with homeopathy “by kind permission of His Royal Highness, The Prince Of Wales”
In 2019, the Faculty of Homeopathy announced that His Royal Highness The Prince of Wales had accepted to become Patron of the Faculty of Homeopathy. Dr Gary Smyth, President of the Faculty of Homeopathy commented, “As the Faculty celebrates its 175th anniversary this year, it is an enormous honour for us to receive the Patronage of His Royal Highness The Prince of Wales and I am delighted to announce this news today.” Charles’ move amazed observers who saw it as a deliberate protest against the discontinuation of reimbursement of homeopathy by the NHS.
In 2020, Charles fell ill with the corona-virus and happily made a swift recovery. It was widely reported that his recovery was due to homeopathy, a notion denied by Clarence House.
Happy Birthday Charles
Governments and key institutions have had to implement decisive responses to the danger posed by the coronavirus pandemic. Imposed change will increase the likelihood that alternative explanations take hold. In a proportion of the general population there may be strong scepticism, fear of being misled, and false conspiracy theories.
The objectives of this survey were to estimate the prevalence of conspiracy thinking about the pandemic and test associations with reduced adherence to government guidelines. The survey was conducted in May 2020 as a non-probability online survey with 2501 adults in England, quota sampled to match the population for age, gender, income, and region.
Approximately 50% of this population showed little evidence of conspiracy thinking, 25% showed a degree of endorsement, 15% showed a consistent pattern of endorsement, and 10% had very high levels of endorsement. Higher levels of coronavirus conspiracy thinking were associated with less adherence to all government guidelines and less willingness to take diagnostic or antibody tests or to be vaccinated. Such ideas were also associated with
- general vaccination conspiracy beliefs,
- climate change conspiracy belief,
- a conspiracy mentality, and distrust in institutions and professions.
Holding coronavirus conspiracy beliefs was also associated with being more likely to share opinions.
The authors concluded that, in England, there is appreciable endorsement of conspiracy beliefs about coronavirus. Such ideas do not appear confined to the fringes. The conspiracy beliefs connect to other forms of mistrust and are associated with less compliance with government guidelines and greater unwillingness to take up future tests and treatment.
The authors also state that the coronavirus conspiracy ideas ascribe malevolent intent to individuals, groups, and organisations based on what are likely to be long-standing prejudices. For instance, almost half of participants endorsed to some degree the idea that ‘Coronavirus is a bioweapon developed by China to destroy the West’ and around one-fifth endorsed to some degree that ‘Jews have created the virus to collapse the economy for financial gain’.
The survey did not include questions about so-called alternative medicine (SCAM). This is a great shame, in my view. We know from previous research that people who adhere to conspiracy theories feel strongly that SCAM is being suppressed via some sinister complot by the establishment. Moreover, we know that SCAM enthusiasts tend to believe in vaccination conspiracy theories. One might therefore expect that proponents of SCAM are also prone to conspiracy beliefs about coronavirus.
When reading some of the comments on this blog, I have little doubt that this is, in fact, the case.
It has been pointed out to me that my recent posts on the thorny subject of Donald Trump have angered many of his devoted fans. I am so sorry! Now that Trump is (almost) history, these poor, disappointed people need our help; they urgently need some effective anger management before they start firing those weapons they have been amassing.
This is why, in the spirit of building bridges and in the interest of peace, I have made an effort and put together a list of so-called alternative medicines (SCAMs) that might be useful.
Various pharmaceutical medications are available for treating anxiety, stress and anger problems:
Anxiolytics e.g. Alprazolam, Diazepam,
Antidepressants e.g. Paroxetine, Fluoxetine,
Antipsychotics e.g. Paliperidone, Risperidone,
Mood regulators e.g. Lithium, Valproate.
Oh, sorry! I have angered you again! I forgot, you are SCAM only. Let me have a look into my own book and find something that works for your problems.
- Music therapy
- Various relaxation techniques
- St John’s wort
Yes, these are the only SCAMs that are listed as being supported by sound evidence.
What, you say, you care a f**k about evidence? Of course, I should have known!
But my book offers nothing for delusional disorders, sorry.
Not good enough, you say? Alright, alright, keep your gun where it is. I better look elsewhere.
Found something. Thanks heavens for homeopathy! One can always rely on homeopaths to offer help, and they certainly know a thing or two about delusions! One website has this long list of remedies for delusional disorders:
Vision of animals, black dogs etc. (It also cured pneumonia on these symptoms). Thinks himself double, tall and a part missing and objects around him small. Cannot bear solitude and darkness; must have light and company. Sees ghosts, hears voices and talks with spirits. Feeling as if a long trail of bedbugs is pursuing her, and after them a procession of beetles and then comes crawling over her a host of cockroaches. Sees horrifying images at his side than in front of him. Sings amorous songs and utters obscene speeches. Hallucination and delirium. Attempts to stab and bite. Calls things by wrong names, his boots the logs of wood; his bedroom the stable. Has communication from God, delivers sermons, prophecies.
As if swimming in the air or walking above the ground.
Night terrors. Sees visions of arches. Hears voices when in the dark or when eyes are shut.
Delusions about snakes. Imagines he is surrounded by them. Afraid of closing the eyes for fear of being bitten by a snake. Feels to be walking in air. Tormenting thoughts. No reality in things; thinks that everything she says is a lie; she is not herself; her properties not her own; wears someone else’s nose.
Erroneous impressions as to the state of her body e.g. that she is pregnant when she is merely swollen with flatus.
Pride or over-estimate of one-self. Thinks she is superior to all others. Thinks her body is longer than those of others. Arrogant and haughty.
Everything that moves is a ghost and inanimate things in the room become alive and terrify him. Extreme nervousness. Fear of strangers and of the dark.
Sees and talks to persons who are not present. Imagines as if she is surrounded by dogs. Aversion to do any business. She is sad and melancholy. Full of fear, weary of life.
Feels as if a rat or something small is crawling up the limb and over the body.
The patient finds himself to be between good and evil will. His external will wants him to do something evil, but his internal will stops him from doing this.
One moment he thinks it is so and the next moment has enough reason left that it is not so. Low spirited, disheartened, fears he is pursued by someone; looks for thieves, expects enemies, fears everything and everybody. He is pursuaded by his evil will to do acts of violence and injustice, but is withheld and restrained by his good will. (See also Hyosc, Bell., and Stram.) Hears voices of sister and mother who are far away.
Stupefaction and sluggishness of the body and mind. Stupor from which he can be aroused with” difficulty and when so aroused he will talk about spirits or say that he sees devils with horns and tails. Hallucination.
Conscience stricken as if she had committed a crime.
As if body had grown 30 feet high.
Feels as if body scattered into pieces.
Hearing voices of absent persons which disturb his sleep.
Voices from within him speaking in abusive and filthy language.
Sees frightful faces and monsters. Bites and strikes. Patient will not injure himself or others unless he thinks he is acting in self-defence. He will attack the person who is “acting against the patient’s will.
For apprehensive and nervous persons. Will not use razor, as something is constantly urging him to cut throat with it. Urge to commit suicide with fork when at dining table and so on. Afraid of sharp and pointed instruments.
Sensation as though a living child were in the abdomen. Feels body thin and delicate, frail, easily breakable as if made of glass.
Errors of perception as to space and as to time. The patient feels as if he had not taken any food for the last six months, although he had just finished his meals. A mile distance looks as if it were a hundred miles. Mind is full of unfinished ideas. Delusion of rhinoceros and elephants following him up. Imagines he hears sweet music, shuts his eyes and is lost in most delicious thoughts and dreams. Imagines someone calling him. Imagines as if he exists without form throughout a vast extent of space. His body seems to expand and the arch of his skull to be broader than the vault of heaven. All seem unreal. Feels himself unreal. All impressions extremely exaggerated. Hears voices and most sublime music; sees vision of beauty and glory, only to be equalled in paradise.
Imagines house full of thieves. Runs through the house in search of them or hides himself in the house on account of fear.
Feels as if he were in a strange place and not living in ordinary conditions; everything appeared strange and almost frightful. Contempt of mankind. Runs away from his friends on account of disgust with their follies.
Delusion as if upper part of the body is floating in the air.
Delusion as if something is rolling on walls, chairs, floor or elsewhere and will also roll on him.
Talks to imaginary people as if they are sitting by his side. Talking to dead wife, sister or husband as if they were here again on earth. Imagines the things are worms, vermin, rats, cats, and mice. Feels as if his hands and fingers are too large.
Thinks he hears unpleasant remarks about himself; hallucination of hearing. Cannot sleep for hours after retiring. Sees and feels bugs and worms in his room and bed. Moral sense blunted.
When he says anything, he feels as if another person has said it. Similarly if he sees anything, he feels as if another person had seen it, or as if he could transfer himself into another person and then only he could see. Confusion of personal identity.
Chin feels elongated to knees. Touching the chin repeatedly to be sure that it was not so.
Hears voices and believes he has committed robbery.
When she sees anyone in whispering conversation, she thinks they are talking about her to her detriment. She thinks herself under superhuman control whose commands (partly in dream) she must obey. Fears that she is pursued by enemies; the medicine is a poison; that there are robbers in the house and she wants to jump out of window.
Delusion; thinks everyone is looking at her; fears to talk aloud; wants to run away.
Delusion of smell as of herring (kind of fish) or musk.
Delusion; of worms on the skin or clothing.
Delusion; sees cats and dogs; wants to jump out of bed or window.
As if hovering in the air. Vertigo as if drunk.
As if everything rocks with him, as in a ship.
As if something alive is in abdomen. Imaginary pregnancy. Alternating mood.
As if room filled with babies. Man at foot of bed. Cannot describe symptoms. Sobs at trifles.
Feels as if things done today were done a week ago; as if someone is whispering behind her, faces appearing from behind the furniture and look at her and say, “come”. Feels life unreal like a dream. Had committed unpardonable sin, and was going to hell. Not caring whether she goes to hell or heaven. Impatient, very selfish.
Feels as if worm rising in throat; apple-core stuck in throat; ice hi ear; cold water running from ears.
Feels that she has been neglected. Wounded pride.
Imagines that another person or a child is in bed with her. Dreams that she is two or more. That her limbs are double.
Feels as if brain separated from the body; as if there is not enough room in forehead; as if he heard with ears not his own.
Thinks herself impure and wants to take bath every time she touches somebody or something. Every thing seems double. As if person lying in bed. Ailments from duty not done or bad act committed.
When he walks he feels as if someone were following him. This causes anxiety and fear and he cannot look behind.
Everything turns into beauty. Old rag and old stick looks to be a beautiful piece of workmanship. Every thing looks pretty which the patient takes fancy to. Wishing to touch everything.
Hears hissing whisper to kill himself. This is an order from the Most High Command.
Delusion that a policeman has come to seize him. Hallucinations of all kinds of figures and premises, especially in the evening, when shutting eyes or when going to sleep.
Washes herself and her clothes after touching anything or any person, as she believes she has touched a dirty thing as a result of which she must wash.
Hallucination that he is very wealthy and has a large sum of money in the bank.
Seems as if he is two persons and watches his other self playing. He seems lost, and when spoken to would come to himself confused. Feels as if she has two heads.
Did you find something that fits?
Then let me help you: Pride or over-estimate of one-self. Thinks she is superior to all others. Arrogant and haughty. Yes, that must be for you; PLATINUM it is!!!
Hope you get better soon.
And, if I may, I suggest PYROGENIUM for your idol.
A personal note: during the last 4 years, I have turned down all invitations for lectures in the US and argued that I do not travel to counties with fascistoid leaders. Once the pandemic is under control, I’d be happy to reconsider.
Many people have pointed out that the US election was disappointing because, after Trump’s four years in office, people must have realised that he is a vile and dangerous president. Yet, a very large proportion of Americans voted for him. Some commentators even speak of a cult-like movement supporting Trump.
Many people have also pointed out that some forms of so-called alternative medicine (SCAM) are irrational and even harmful. Yet, a sizable proportion of the population continue to use them. Some experts even speak of a cult-like movement supporting SCAM.
Why do so many people make irrational choices?
Are they all stupid?
I don’t think so!
The way I see it, a key here must be critical thinking. Critical thinking means making decisions and judgements based on (often confusing) evidence. According to the ‘National Council for Excellence in Critical Thinking’ it is the intellectually disciplined process of actively and skilfully conceptualizing, applying, analysing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.
Critical thinking is not something one is born with; but most people can learn this skill. In one study, researchers measured the relationship between student’s religion, gender, and propensity for fantasy thinking with the change in belief for paranormal and pseudoscientific subjects following a science and critical thinking course. Following the course, overall beliefs in paranormal and pseudo-scientific subcategories were lower by 6.8–28.9%.
Though easily confused with intelligence, critical thinking has little to do with it. Critical thinking is a collection of cognitive skills that allow us to rationalise. Critical thinkers are flexible thinkers who require evidence to support their beliefs and recognize fallacious attempts to mislead them. Critical thinking is the skill of minimising cognitive biases.
If I am correct, those people who voted for Trump in the US (or similar politicians, such as Boris Johnson in the UK) and those consumers who spend their money on bogus SCAMs both are deficient in their ability to think critically. This does not mean that they are the same individuals. I merely suggest they have one characteristic in common.
It is crucial, I think, to realise that critical thinking can be improved with education. In the final analysis, disappointing results of any election in which (far too many) people voted for a dishonest, corrupt politician, and the disappointingly high usage of bogus SCAMs have, I believe, their roots in poor education. This means that, if we want to reduce the risk of the Trump disaster repeating itself, we need to invest effectively and generously in better educating our children (and adults). And if we want to minimise the risk of consumers wasting their money or damaging their health with bogus SCAMs, we need to make sure the public has a sufficient understanding of logic, reason, evidence and science.
Prof. Shailendra Ramchandra Vishampayan is the 1st author of the paper we discussed yesterday. He was kind enough to repeatedly join us in the comments section, and I was therefore keen to learn more about him. On his website, he says about himself that he is a renowned academician and famous homeopath, enriched with decades of ideal experiences and quality services. He is registered medical practitioner (M.D), performs all the duties of registered medical practitioner following the law of land in India. Globally he is considered as homeopath and known as “Dr.V”. He is a registered member of Society of Homeopaths (overseas).
Dr. V, is a practicing homeopath with clinical experience of over 20 years. In course of his years of practice he had successfully helped more than 250 happy families globally, with various kinds of cases like thyroid, immune compromised, epilepsy, endocrine disorders, paediatric, gynaecological disorders addictions, psychiatric disorder, children with special needs, pets and plants.
He is famous for his path breaking concept and novel idea of creating an organization called ‘Folk Homeopathy ‘, which is dedicated to professional enrichment of homeopathic practitioners helping them to improve their clinical acumen with spot on prescription.
His practical approach in solving cases has earned him accolades and fame throughout the globe.
Dr. V is the author of ‘Kinder Garten Materia Medica’ a reference book for beginners widely used by homeopathic students in India. It is a book with unique combination of pictorial and pneumonic.
He is a Professor (PG) at D.Y.Patil Homeopathy Medical College (Pune). He has a teaching experience of over 16 years in teaching UG and PG. He has drawn large number of followers through webinars which is accessible throughout the globe. He has given more than 50 international seminar ,workshops and webinars in countries like USA, Ireland, Malaysia, with presentations on Homeopathic approach to female hormonal imbalance cases at OMICS Conference of Alternative Medicine, presentation on Psychiatric cases at Asian Homeopathic League. And various presentation at University of Cyberjaya, Malaysia, California Homeopathic Medical society, San Diego and also at Corte Madera, 98th FOH Congress, Liverpool and Kinvara Co Galway, Ireland.
And on the same site, we also learn that ‘Dr V’ is particularly adept at treating diabetes:
India is now considered as the diabetes capital of the world. Approximately 8.7 percent of Indians between the age of 20 to 70 years are diabetic. This translates to approximately 62.5 million diabetics living in India, according to estimates by the World Health Organisation (W.H.O.) The economic burden of managing this disease is also substantial since this is a combination of cost of treatment and loss of productivity in such a high number of diabetics. Diabetes can affect multiple organ systems resulting in a wide range of serious issues in patients. Many of these complications in a diabetic do not have any specific treatment with conventional medicines. However, an indication of the popularity of homeopathy amongst diabetics is that the doctors at our clinic treat approximately two hundred cases of diabetes or diabetes related issues every day. We have, in fact, developed specific diabetes management protocols for patients based on the experience of thousands of cases we have seen over four decades.
This is interesting, I thought, and conducted a few Medline searches to see whether there is any evidence to show that homeopathy is an effective therapy for diabetes. I am afraid, I found no papers of ‘Dr V’ to suggest such an effect. But what I did find was certainly fascinating.
Last year, Italian diabetologists published an review entitled ‘Alternative treatment or alternative to treatment? A systematic review of randomized trials on homeopathic preparations for diabetes and obesity‘. Here is what they reported:
The searches failed to retrieve any trial comparing homeopathic remedies with placebo or any active drug for the treatment of either diabetes or obesity.
These authors commented that
… if homeopathy is used as an alternative to available and effective treatments, the consequences can be catastrophic, particularly in some conditions such as insulin-requiring diabetes. In conclusion, there is no scientific evidence on efficacy and no demonstration of safety of homeopathy in diabetes and obesity…
‘Dr V’ will probably point out that he is a fully qualified doctor and uses homeopathy merely as an adjunct to conventional anti-diabetic treatments; thus he kills nobody.
I certainly hope this is so! But, even in this case, I must still ask: WHERE IS THE EVIDENCE THAT HOMEOPATHY IS AN EFFECTIVE ADJUNCT TO CONVENTIONAL MEDICINE?
Recently, I have received this message via the comments section of my blog:
“you’re actually an evil old nut-job Ed—been following your pharma ‘science’ bullshit for years—all opinion and ignorance and anti-science”
Don’t get me wrong, such attacks do not bother me – not any more. On the contrary, they amuse me. At one stage, I even started collecting them. Nowadays, I usually ignore them.
But this one is somewhat special. Therefore, I decided to analyse it a bit. The author essentially makes 9 claims:
- I am evil.
- I am old.
- I am a nut-job.
- I am called Ed.
- I conduct pharma science.
- I publish bullshit.
- All I state is opinion.
- I am ignorant.
- I am anti-science.
Yes, that’s quite a list. Let me try to tackle it one by one.
- Am I evil? I have had many ad hominem attacks before but, as far as I remember, nobody has yet alleged that I am evil. I looked it up, evil means: wicked · bad · wrong · morally wrong · wrongful · immoral · sinful · ungodly · unholy · foul · vile · base · ignoble · dishonorable · corrupt · iniquitous · depraved · degenerate · villainous · nefarious · sinister · vicious · malicious · malevolent · demonic · devilish · diabolic · diabolical · fiendish · dark · black-hearted · monstrous · shocking · despicable · atrocious · heinous · odious · contemptible · horrible · execrable · lowdown · stinking · dirty · shady · warped · bent · crooked · dastardly · black · egregious · flagitious · peccable. I am obviously the wrong person to judge, but I do not think that these attributes describe me all that well.
- Yes, I am old, 72 to be precise.
- Am I a nut-job? I looked that one up too. It’s a mentally unbalanced person. Call me biased, but I don’t think that this applies to me at all.
- No, I am not called Ed.
- I am not quite sure what ‘pharma science’ is supposed to mean, but one thing I do know for sure: since I research so-called alternative medicine (SCAM) – and that’s about 30 years now – I have not taken research funds from the pharmaceutical industry. And before I very rarely did.
- As I have published a sizable amount of papers and blog-posts, there must have been a bit of BS in some of it. But I do not think it can be much.
- All I state is opinion? Oh really! Opinion comes into blog-posts regularly; without it my stuff would be boring like hell. But ALL of it? I don’t think so.
- Am I ignorant? Yes, certainly; there are lots of things I don’t know, even in medicine. But in SCAM I do know quite a bit – even if I say so myself.
- Anti-science? That last allegation is probably the most far-fetched of them all. No, I am not anti-science, never have been and never will be.
So, Paul – the author of the comment preferred to remain anonymous and simply calls himself Paul – I have tried to give you credit where I could but, on the whole, I fear your ad hominem attack is yet another victory of reason over unreason. I thank you Paul for two reasons:
- firstly for the just-mentioned victory; it always feels good to be on a winning side,
- secondly for the stimulus and motivation to carry on doing what I have been doing for many years; your comment has shown me how much needed my work is in disclosing quackery, correcting errors, teaching critical thinking and responsibly informing the public.
Guest post by Ken McLeod
‘Ayurvedic Medicine,’ or Ayurveda, is an alternative medicine system which originated in India as long as 5,000 years ago, according to its proponents. Science-based medicine refers to it as pseudoscientific and the Indian Medical Association (IMA) characterises it as quackery.  Ayurvedic practitioners claim that its popularity through the ages vindicates it as safe and effective.
That last bit is of course the appeal to antiquity, or the appeal to tradition (also known as argumentum ad antiquitatem.  This proposes that if something was supported by people for a long time it must be valid. That is bunkum; many ancient ideas have long since been discredited; the Earth is not flat, no matter for how long people thought it was.
Nevertheless, ‘Ayurvedic Medicine’ has many practitioners and supporters in the supposedly rational West, including Bondi Junction here in Australia. Despite the many warnings about it,  people still go to practitioners, and occasionally they are injured.
One such injury and the consequent complaint to the New South Wales regulator, the Health Care Complaints Commission, (HCCC), has resulted in a Public Warning dated 18 September concerning levels of heavy metals in Ayurvedic Medication. 
The HCCC said:
‘The NSW Health Care Complaints Commission is concerned about a complaint received regarding the prescription of “Manasamithra Vatika,” (Manasamitram Pills) an Ayurvedic medication.
‘The complaint related to prescription of this medication to a child for treatment of autism.
‘This medication was found to contain concerning levels of lead and other heavy metals.’
That’s all very bland, no headlines there. But then it got into:
“The Commission strongly urges those individuals seeking alternative therapies to be vigilant in their research prior to proceeding with any natural therapy medications or medicines and to discuss any such proposed therapies with their treating registered health practitioner.”
Not so bland there; that’s very comprehensive; ‘any natural therapy medications or medicines’ and ‘discuss any such proposed therapies with their treating registered health practitioner.” ‘Note the HCCC’s emphasis on “registered.” That rules out Ayurvedic Medicine practitioners, homeopaths, and other assorted cranks; go to a real doctor.
Surely that is headline material; a regulator responsible for promoting the health of citizens warns them to go to real doctors before going to these quacks.
Then it gets better, (or worse if you are an Ayurvedic Medicine practitioner). At the same time the HCCC issued an Interim Prohibition Order against Mr Rama Prasad (“Ayurveda Doctor Rama Prasad.”)  The HCCC’s Order says:
‘The NSW Health Care Complaints Commission (“the Commission”) is currently investigating Mr Rama Prasad in relation to his prescribing of the Ayurvedic Medication “Manasamithra Vatika” (Manasamitram Pills) to both children and adults and about his claims that his treatments can reverse several aspects of autism in children.
‘The Ayurvedic Medication “Manasmithra Vatika” (Manasamitram Pills) was found to contain elevated levels of lead and other heavy metals.
‘One case with mildly elevated blood level was notified to the South Eastern Sydney Public Health Unit after consuming this product.
‘Clients residing in NSW who are considered to have been placed at possible risk have now been contacted by NSW Health public health personnel.
‘The Commission has issued an interim prohibition order in relation to Mr Rama Prasad, under section 41AA of the Health Care Complaints Act 1993 (‘The Act’). Mr Prasad is currently prohibited from providing any health services, either in paid employment or voluntarily, to any member of the public.
‘This interim prohibition order will remain in force for a period of eight weeks and may be renewed where appropriate in order to protect the health or safety of the public.’
That should send chills down the spine of any Ayurvedic Medicine practitioner. A complete Prohibition Order ordering Prasad not to engage in providing any health service as defined in the Act  for eight weeks, which may be renewed or even made permanent, depending on what the investigation finds. The Act includes a comprehensive list of activities that comprise a ‘health service’:
‘health service includes the following services, whether provided as public or private services:
- (a) medical, hospital, nursing and midwifery services,
- (b) dental services,
- (c) mental health services,
- (d) pharmaceutical services,
- (e) ambulance services,
- (f) community health services,
- (g) health education services,
- (h) welfare services necessary to implement any services referred to in paragraphs (a)–(g),
- (i) services provided in connection with Aboriginal and Torres Strait Islander health practices and medical radiation practices,
- (j) Chinese medicine, chiropractic, occupational therapy, optometry, osteopathy, physiotherapy, podiatry and psychology services,
- (j1) optical dispensing, dietitian, massage therapy, naturopathy, acupuncture, speech therapy, audiology and audiometry services,
- (k) services provided in other alternative health care fields,
- (k1) forensic pathology services,’
Note the inclusion of ‘health education.’ This is where so many cranks fall foul of the law; setting yourself up as a health educator makes you subject to the Act. Even if you claim to be a master chef, homeopath or Ayurvedic Medicine Practitioner, you are not exempt.
It’s early days yet in this particular saga, and there are many questions to be answered, for example:
- – How did this “medicine” get past Australia’s Therapeutic Goods Administration, (Australia’s equivalent to the US FDA)?
- – Did the TGA list or register it?
- – If not why not? If it was who is responsible?
- – Was this detected only after a child was so sickened that they were taken to hospital?
- – Why is the practitioner concerned still advertising his Ayurvedic medicine courses?  Is this a breach of his Prohibition Order which prohibits ‘health education services’?’
So stay tuned for updates as this case progresses. In the meantime note that an Australian Health regulator is advising the public to seek advice from real doctors before going to alternative therapists, including ‘Ayurvedic Medicine’ practitioners. That is a real headline.
 Such as from the Victoria Dept of Health at https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ayurveda
 Health Care Complaints Act 1993 https://www.legislation.nsw.gov.au/view/html/inforce/current/act-1993-105
This randomized clinical trial tested the effects of laying on of hands (LooH) as a complementary therapy to kinesiotherapy, on pain, joint stiffness, and functional capacity of older women with knee osteoarthritis (KOA) compared to a control group.
Participants were assigned into 3 groups:
- LooH with a spiritual component (Group – SPG),
- LooH without a spiritual component (Group – LHG),
- a control group receiving no complementary intervention (Control Group – CG).
Patients were assessed at baseline, 8 weeks, and 16 weeks. Primary outcomes were joint stiffness and functional capacity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and pain (WOMAC and visual analogue scale). Secondary outcomes were anxiety, depression, mobility, and quality of life. Differences between groups were evaluated using an intention-to-treat approach.
A total of 120 women with KOA were randomized (40 participants per group). At 8 weeks, SPG differed significantly from the LHG for WOMAC Functional Status; Anxiety levels; and also from the CG for all outcomes with exception of WOMAC Stiffness. After 16 weeks, SPG differed significantly from the LHG only for WOMAC Functional Status and also from the CG for all outcomes with exception of WOMAC Stiffness and timed up-and-go.
The authors concluded that the results suggest that LooH with a “spiritual component” may promote better long-term functional outcomes than both LooH without a “spiritual component” and a control group without LooH.
This is an interesting study which seems well designed. Its findings are surprising and lack scientific plausibility. Therefore, sceptics will find it hard to accept the results and suspect some hidden bias or confounding to have caused it rather than the laying on of hands. SCAM enthusiasts would then probably claim that such an attitude exemplifies the bias of sceptics.
So, what can be done to find out who is right and who is wrong?
Whenever we are faced with a surprising finding based on a seemingly rigorous trial, it is wise to realise that there is a plethora of possible explanations and that speculations are usually not very helpful. There is always a danger of a clinical trial producing false or misleading findings. This could be due to a plethora of reasons such as error, undetected bias or confounding, fraud, etc.
What we really need is an independent replication – better two.