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

legal action

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It has been reported by several outlets that a young woman is fighting for her life after a chiropractic adjustment went horribly wrong. Caitlin Jensen had only recently graduated from University. When she went for what was meant to be a simple chiropractic adjustment on June 16, she suffered four dissected arteries in her neck, this damage led to cardiac arrest, stroke and her being without a pulse for over 10 minutes, requiring resuscitation.

She was rushed to the Memorial Hospital in Savannah, Georgia, where she was operated on. She was then taken to the neuro ICU in a critical condition with a traumatic brain injury. Every day since she’s been fighting. Currently, she is conscious and able to respond to verbal commands by blinking her eyes, as well as wiggling the toes of her left foot. However, most of her body remains paralyzed.

Her mother Darlene has been posting updates about her daughter’s condition on Facebook. On Saturday Darlene shared the latest news on the condition of her daughter. “She gave her best effort to smile today, and it was the most beautiful thing I’ve ever seen,” Darlene said. “She is progressing with her movements on the left side – wiggling and flexing. She can’t lift her arm yet, or turn her head. Her right side is unchanged – still no movement. Her face doesn’t move very much yet, but she can open her eyes widely to show surprise, and the left corner of her mouth tries to smile. Adorable. Still working on the pneumonia. The antiplatelet therapy seems to be going OK. We don’t see any signs of internal bleeding and are praying that it stays that way.”

And the day before, Darlene posted: “Two weeks ago tonight we didn’t know if Caitlin would make it through the night,” Darlene said. “Dire and catastrophic are two of the words that we heard from our ICU team. We knew they didn’t casually throw around words like that. But – she is alive, and every day is a little better. The accomplishments are both small and monumental at the same time. Today, she gave us a thumbs up. We have been working on this, and she got it! She also nodded again today. It helps to see these things because it reassures us that she is working hard to stay with us and recover. Caitlin is strong, disciplined, and well practised in exercising her brain, and I truly believe that her science background and all of her time studying is going to help her in this long journey. “

Studies have found that traumatic cervical artery dissection is one of the leading causes of stroke in patients under the age of 45, and recent chiropractic neck manipulation is among factors that can be associated with risk of vertebral artery dissection.

Following the tragedy, Caitlin’s mother, Darlene, launched a GoFundMe and has raised more than US$20,000 (AU $29,334 or £16,512) for her ongoing medical expenses.

It is clear that these news reports lack important medical details. What is equally clear is the fact that most such cases are never reported in the medical literature and are thus available only in this fragmented form. The reason for this lamentable situation is obvious: there is no post-marketing surveillance system for chiropractic (such a safeguard would be bad for business, of course).

Consequently, chiropractors across the globe continue to be able to say that such reports are unreliable. The medical literature, they are keen to point out, holds only very few case studies of serious risks of chiropractic spinal manipulation. Hence they falsely claim on every possible occasion that their adjustments are safe. The end effect is that many consumers continue to wrongly assume that chiropractic manipulations might be worth a try.

Almost 10 years ago, I posted this:

When I decided to become a doctor I, like most medical students, did so mainly to help suffering individuals. When I became a researcher, I felt more removed from this original ideal. Yet I told myself that, by conducting research, I might eventually contribute to a better health care of tomorrow. Helping suffering patients was still firmly on the agenda. But then I realised that my articles in peer-reviewed medical journals somehow missed an important target: in alternative medicine, one ought to speak not just to health care professionals but also to consumers and patients; after all, it is they who often make the therapeutic decisions in this area.

Once I had realised this, I started addressing the general public by writing for The Guardian and other newspapers, giving public lectures and publishing books for a lay audience, like TRICK OR TREATMENT…The more I did this sort of thing, the more I noticed how important this activity was. And when a friend offered to help me set up a blog, I did not hesitate for long.

So, the reason for my enthusiasm for this blog turns out to be the same as the one that enticed me to go into medicine in the first place. I do believe that it is helpful for consumers to know the truth about alternative medicine. Considering the thousands of sources of daily misinformation in this area, there is an urgent need for well-informed, critical information. By providing it, I am sure I can assist people to make better therapeutic decisions. In a way, I am back where I started all those years ago: hoping to help suffering patients in the most direct way my expertise allows.

Helping vulnerable patients often means warning them from dangerous charlatans, and this is precisely what I frequently try to do with this blog. But how successful are my endeavors?

More often than not, I have no idea and can only hope for the best. Sometimes I do get some feedback that is encouraging and motivates me to carry on. Rarely, however, do I witness immediate, tangible success. And this is why the recent story is so remarkable:

  • On 6 June, an Australian acquaintance from the FRIENDS OF SCIENCE IN MEDICINE sent me some material about a planned lecture in the UK by someone promoting dangerous quackery.
  • I looked into it and published a blog post about it a few hours later.
  • A reader then suggested in the comments section of this post alerting the UK press to it.
  • Another reader contacted THE TIMES, and I wrote to several other journalists.
  • THE TIMES turned out to be interested in the story.
  • They did some research and interviewed Michael Marshall from the GOOD THINKING SOCIETY (and myself).
  • Today, THE TIMES published an article about the planned event.
  • Finally, a kind person made the article available to those who don’t want to pay for it.

The whole thing amounts to superb teamwork, in my view. It shows how like-minded people who do not even all know each other can manage to achieve a respectable result with little more than goodwill and dedication.

A respectable result?

Of course, the optimal result would be to stop Barbara O’Neill’s UK lectures. Let’s hope this is what eventually will happen – and please let me know if you know more.

I did not know what a ‘body modification provider’ is. My first guess was that it is a car mechanic who specializes in making my vehicle look ok again after I had a minor accident. But I was wrong! In fact, it is a new healthcare profession – one that we are well-advised to avoid, as it turns out. A Media Release from the Health Care Complaints Commission of Australia dated 27 May, 2022 informed us that:

The NSW Health Care Complaints Commission (Commission) investigated the conduct of Mr Brendan Russell, a body modification provider.

In his capacity as a body modification provider, conducting invasive surgical procedures and administering sedation, Mr Russell is a non-registered health practitioner and subject to the Code of Conduct for non-registered health practitioners (Code of Conduct) set out in schedule 3 of the Public Health Regulation 2012.

Mr Russell was charged with criminal offences relating to services provided to three clients. One related to the removal of part of a client’s labia. Another related to the death of a client following a subdermal implant of a silicone object into the client’s right hand. Mr Russell also performed abdominal surgery on another client making incisions into her abdominal tissue to remove fat.

Following convictions in November 2021 for Intentionally Causing Grievous Bodily Harm, Aid/Abet/Counsel or Procure Female Genital Mutilation and Manslaughter, Mr Russell has breached numerous clauses of the Code of Conduct, and it has been determined that he poses a risk to the health and safety of members of the public.

An Interim Prohibition order has been in place to protect the public during the criminal proceedings.  The Commission has now imposed a Permanent Prohibition Order under section 41A(2)(a) of the Health Care Complaints Act 1993 (Act):

Mr Brendan Russell, a body modification provider, is permanently prohibited from providing any health services, either in paid employment or voluntarily, to any member of the public.

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What is all this about? Has this man gone doolally? In particular, what is the removal of a woman’s labia supposed to be for? Here is what Wikipedia says about it:

Labiaplasty (also known as labioplastylabia minora reduction, and labial reduction) is a plastic surgery procedure for altering the labia minora (inner labia) and the labia majora (outer labia), the folds of skin surrounding the human vulva. There are two main categories of women seeking cosmetic genital surgery: those with congenital conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their genitals because they believe they do not fall within a normal range.[1]

The size, colour, and shape of labia vary significantly, and may change as a result of childbirth, aging, and other events.[1] Conditions addressed by labiaplasty include congenital defects and abnormalities such as vaginal atresia (absent vaginal passage), Müllerian agenesis (malformed uterus and fallopian tubes), intersex conditions (male and female sexual characteristics in a person); and tearing and stretching of the labia minora caused by childbirth, accident, and age. In a male-to-female sexual reassignment vaginoplasty for the creation of a neovagina, labiaplasty creates labia where once there were none.

A 2008 study reported that 32 percent of women who underwent the procedure did so to correct a functional impairment; 31 percent to correct a functional impairment and for aesthetic reasons; and 37 percent for aesthetic reasons alone.[2] According to a 2011 review, overall patient satisfaction is in the 90–95 percent range.[3] Risks include permanent scarring, infections, bleeding, irritation, and nerve damage leading to increased or decreased sensitivity. A change in requirements of publicly funded Australian plastic surgery requiring women to be told about natural variation in labias led to a 28% reduction in the number of surgeries performed.[4] Unlike public hospitals, cosmetic surgeons in private practice are not required to follow these rules, and critics say that “unscrupulous” providers are charging to perform the procedure on women who would not want it if they had more information.[4]

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So, now we know. The procedure belongs in the hands of plastic surgeons, not some ‘body modification provider’. S0-called alternative medicine (SCAM) really is a scam where anything goes. Homeopaths claim to cure cancer, chiropractors believe they can treat anything from deafness and heart disease, acupuncturists feel they can reduce body weight, and now ‘body modification providers’ think they are plastic surgeons. What is more, the amazing thing is: there are always some people gullible enough to believe them.

Brave new world!

I have written about Bioscan before; for instance here. Now there is more news about the device. In Germany, the manufacturers of Bioscan have been sued and found guilty of fraud.

The two managing directors of the company were sentenced to imprisonment for two and three years respectively and together they have to pay a fine of over 2.5 million euros. The presiding judge considered it proven that the manufacturers had sold useless devices. He said, “A measuring device that measures nothing is about as useful as a car that does not drive.” In addition, a former sales director was sentenced to a fine of 90 daily rates.

The three leading employees of the company were charged with commercial fraud and violations of the Therapeutic Products Advertising Act. The company from Pliezhausen had claimed that their device would measure blood and nutrient values in the body in an uncomplicated way and thus replace a time-consuming laboratory diagnosis.

The Bioscan device consists of two metal rods. You have to take them in your hand, according to the company’s instructions. They would then measure magnetic waves and produce a result. More than 200 medically important health data could allegedly be recorded, for example, cholesterol or testosterone levels. The court had summoned several experts to assess the device. However, they found that the device measured nothing except the current flowing through the cables.

The manufacturers had been doing a huge business with the device for years. The company is said to have earned almost 6 million euros. The devices are still being sold today, for instance, in Austria and Switzerland, among other countries. Despite all the criticism and the court case, the two managing directors had not stopped sales.

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When I googled ‘Bioscan’ yesterday (30/5), the website informed me that:

The BioScan system is an FDA cleared, state of the art testing machine that scans the body’s organs and functions for imbalances using electrodermal screening (EDS).

BioScan SRT

What Is Stress Reduction Testing?

SRT is a remarkable new procedure that combines the disciplines of Acupuncture, Biofeedback and Homeopathy with Laser Light technology. A computerized scan or test is done to see what your body is sensitive to, and how it is out of balance, then help it learn not to be.

Are there any side effects?

No. A small percentage of clients report slight flushing or congestion for a short time (an hour or so) after their session, but this is actually a sign that the body is detoxifying (a good thing)! This process is safe, fast, non-invasive and painless. Unlike skin tests the actual substance is not used, so the body perceives its presence, it as if it were there, but does not act upon it.

What does the BioScan SRT treat?

The BioScan SRT Wellness System does not diagnose or treat any specific condition. Through the use of our FDA-cleared biofeedback technology, the BioScan SRT is able to assess with a very high degree of specificity which substances create increased levels of stress to the body.These specific stress inducing substances are often times what trigger the nervous systems fight or flight reactions which are expressed in a myriad of symptoms that have been scientifically proven to be associated with high levels of stress.

What substances can the BioScan SRT identify as stressors? 

The BioScan SRT contains tens of thousands of substances in the main procedure libraries and up to an additional 50,000 substances in the advanced procedure libraries. This technology can identify almost every known substance that could possibly cause a stress reaction.

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And on the Internet, it takes just a minute to find a Bioscan device for sale. It would set you back by 119.98 Euros.

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Say no more!

I have been sent a press release dated 26/5/2022 that might interest some of my readers. As it is in German, I took the liberty of translating it:

The 126th German Medical Congress today in Bremen deleted the additional designation of homeopathy from the further education regulations for doctors (MWBO). The request brought by Bremen delegates was decided by the physician parliament with a large majority.

The Bremen delegates justified their request with the fact that 13 of 17 state medical associations have already deleted the additional designation of homeopathy from their further education regulations. The further education regulation is to create uniform rules for the post-graduate training of doctors. However, there is no longer any question of uniformity if 13 state medical associations do not follow the MWBO.

In the debate, Dr. Johannes Grundmann once again pointed out that it is not a matter of prohibiting people from using homeopathic remedies. “However, it is the task of the medical associations to define and check verifiable learning objectives,” Grundmann said to great applause.

In September 2020, the Bremen Medical Association had become the first such chamber in Germany to remove homeopathy from its education regulations. The complaint of a Bremen physician against it had subsequently been rejected in two instances. Most recently, the Bremen health insurance was the first to terminate three selective contracts for the remuneration of homeopathic services.

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I feel that this is a nice victory of reason over unreason. I might even go as far as assuming that our petition of 2021 might have helped a little to bring it about:

Dear President Dr Reinhardt,

Dear Ms Lundershausen,

Mrs Held,

Dear Ms Johna,

We, the undersigned doctors, would like to draw your attention to the insistence of individual state medical associations on preserving “homeopathy” as a component of continuing medical education. We hope that you, by virtue of your office, will ensure a nationwide regulation so that this form of sham treatment [1], as has already happened in other European countries, can no longer call itself part of medicine.

We justify our request by the following facts:

    1. After the landmark vote in Bremen in September 2019 to remove “homeopathy” from the medical training regulations, 10 other state medical associations have so far followed Bremen’s example. For reasons of credibility and transparency, it would be desirable if the main features of the training content taught were not coordinated locally in the future, but centrally and uniformly across the country so that there is no “training tourism”. Because changes to a state’s own regulations of postgraduate training are only binding for the examination committee of the respective state, this does not affect national regulations but is reduced to only a symbolic character without sufficient effects on the portfolio of medical education nationwide.
    2. Medicine always works through the combination of a specifically effective part and non-specific placebo effects. By insisting on a pseudo-medical methodology – as is “homeopathy” represents in our opinion – patients are deprived of the specific effective part and often unnecessarily deprived of therapy appropriate to the indication. Tragically, it happens again and again that the “therapeutic window of opportunity” for an appropriate therapy is missed, tumors can grow to inoperable size, etc.
    3. Due to the insistence of individual state medical associations on the “homeopathic doctrine of healing” as part of the medical profession, we are increasingly exposed to the blanket accusation that, by tolerating this doctrine, we are supporting and promoting ways of thinking and world views that are detached from science. This is a dangerous situation, which in times of a pandemic manifests itself in misguided aggression reflected not just in vaccination skepticism and vaccination refusal, but also in unacceptable personal attacks and assaults on vaccinating colleagues in private practice.

[1] Homöopathie – die Fakten [unverdünnt] eBook : Ernst, Edzard, Bretthauer, Jutta: Amazon.de: Kindle-Shop

Responsible:

Dr. med. Dent. Hans-Werner Bertelsen

Prof. Dr. med. Edzard Ernst

George A. Rausche

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The first reported reactions from politicians are positive, while those of homeopaths are predictably the opposite:

German Health Minister Karl Lauterbach (SPD) expressly welcomed the delegates’ decision, writing via Twitter. “Good medicine stands on the ground of science. For homeopathy, there is no place there. In such a question, one must show one’s colors.”

Paula Piechotta, a Green Party member of parliament, was equally pleased. “… it is good when in times of Fake Facts and right-wing conspiracy theories clarity is provided where clarity is needed. Thank you Ärztetag,” she tweeted.

Michaela Geiger, chairwoman of the German Central Association of Homeopathic Physicians, noted the decision “with astonishment.” Homeopathy has a high acceptance among the population, she claimed.

 

I was alerted to the following short article from ‘The Blackpool Gazette‘:

Criminals have been using the brand name Pfizer to sell fake homeopathic vaccines to residents, according to police. The white tablets are sold under the pretence that they are an alternative to traditional vaccines, but actually contain no active ingredient. Analysis conducted by Lancashire Police revealed the tablets were nothing more than sugar pills. “Please note Pfizer do not produce any tablets as a cure or prophylactic for COVID-19,” a spokesman for the force added.

What is homeopathy?

Homeopathy is a “treatment” based on the use of highly diluted substances, which practitioners claim can help the body heal itself, according to the NHS. A 2010 House of Commons Science and Technology Committee report on homeopathy said that homeopathic remedies perform no better than placebos. In 2017, NHS England said it would no longer fund homeopathy on the NHS as the lack of any evidence for its effectiveness did not justify the cost. This was backed by a High Court judgement in 2018.

I think there might be a slight misunderstanding here. The homeopathic remedy might not be fake, as it was produced according to the concepts of homeopathy. It is homeopathy itself that is fake. To me, it looks as though we are dealing with the German product I mentioned a while ago. Let me remind you:

Many people believe that homeopathy is essentially plant-based – but they are mistaken! Homeopathic remedies can be made from anything: Berlin wall, X-ray, pus, excrement, dental plaque, mobile phone rays, poisons … anything you can possibly think of. So, why not from vaccines?

This is exactly what a pharmacist specialized in homeopathy thought.

It has been reported that the ‘Schloss-Apotheke’ in Koblenz, Germany offered for sale a homeopathic remedy made from the Pfizer vaccine. This has since prompted not only the Chamber of Pharmacists but also the Paul Ehrlich Institute and Pfizer to issue statements. On Friday (30/4/2021) morning, the pharmacy had advertised homeopathic remedies based on the Pfizer/Biontech vaccine. The Westphalia-Lippe Chamber of Pharmacists then issued an explicit warning against it. “We are stunned by this,” said a spokesman. The offer has since disappeared from the pharmacy’s website.

On Friday afternoon, the manufacturer of the original vaccine also intervened. The Paul Ehrlich Institute released a statement making it clear that a vaccine is only safe “if it is administered in accordance with the marketing authorization.”

The Schloss-Apotheke had advertised the product in question with the following words:

“We have Pfizer/BioNTech Covid-19-Vaccine in potentized form up to D30 as globules or dilution (for discharge) in stock.”

The chamber of pharmacists countered with a warming under the heading “Facts instead of Fake News” on Facebook and Instagram:

“Whatever they might contain: These remedies are no effective protection against Covid-19.”

Pharmacy manager, Annette Eichele, of the Schloss-Apotheke claimed she had not sold homeopathic Corona vaccines and stressed that effective vaccines of this kind do not exist. According to Eichele, only an additional “mini drop” of the original Biontech vaccine had been used and “highly potentized” and prepared homeopathically. According to Eichele, Corona vaccinations that had already been administered were thus to have a “better and more correct effect with this supplementary product, possibly without causing side effects … but this is not scientifically proven”. The homeopathic product had been produced only on customer request and had been sold less than a dozen times in the past weeks. Ten grams of the remedy were sold for about 15 Euros. On Twitter, Eichele stated: „Wir haben nichts Böses getan, wir wollten nur Menschen helfen!“ (We have done nothing evil, we only wanted to help people). I am reminded yet again of Bert Brecht who observed:

“The opposite of good is not evil but good intentions”.

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If I am right, the remedy is not truly fake but a genuine product of a fake concept, namely homeopathy. In that case, the term ‘criminal’ might need to be applied to homeopathy itself – an interesting thought!

Harad Matthes, the boss of the anthroposophical Krankenhaus Havelhoehe and professor for Integrative and Anthroposophical Medicine at the Charite in Berlin, has featured on my blog before (see here and here). Now he is making headlines again.

Die Zeit‘ reported that Matthes went on German TV to claim that the rate of severe adverse effects of COVID-19 vaccinations is about 40 times higher than the official figures indicate. In the MDR broadcast ‘Umschau’ Matthes said that his unpublished data show a rate of 0,8% of severe adverse effects. In an interview, he later confirmed this notion. Yet, the official figures in Germany indicate that the rate is 0,02%.

How can this be?

Die ZEIT ONLINE did some research and found that Matthes’ data are based on extremely shoddy science and mistakes. The Carite also distanced themselves from Matthes’ evaluation: “The investigation is an open survey and not really a scientific study. The data are not suitable for drawing definitive conclusions regarding incidence figures in the population that can be generalized” The problems with Matthes’ ‘study’ seem to be sevenfold:

  1. The data are not published and can thus not be scrutinized.
  2. Matthes’ definition of a severe adverse effect is not in keeping with the generally accepted definition.
  3. Matthes did not verify the adverse effects but relied on the information volunteered by people over the Internet.
  4. Matthes’ survey is based on an online questionnaire accessible to anyone. Thus it is wide open to selection bias.
  5. The sample size of the survey is around 10 000 which is far too small for generalizable conclusions.
  6. There is no control group which makes it impossible to differentiate a meaningful signal from mere background noise.
  7. The data contradict those from numerous other studies that were considerably more rigorous.

Despite these obvious flaws Matthes insisted in a conversation with ZEIT ONLINE that the German official incidence figures are incorrect. As Germany already has its fair share of anti-vaxxers, Matthes’ unfounded and irresponsible claims contribute significantly to the public sentiments against COVID vaccinations. They thus endangering public health.

In my view, such behavior amounts to serious professional misconduct. I, therefore, feel that his professional body, the Aerztekammer, should look into it and prevent further harm.

I think this press release might interest you:

Science advocates have filed a groundbreaking lawsuit against Boiron, Inc., one of the largest manufacturers of homeopathic products in the world, for deceiving vulnerable consumers with useless products dressed up to look like real medicine. The Center for Inquiry (CFI), which fights on behalf of consumers against pseudoscience, says Boiron routinely made false claims about what its products will treat and heal, misleading the public about the absurd pseudoscientific basis for Boiron products, and even lying about the ingredients their products contain.

“The facts could not be more clear. Boiron profits massively by deceiving consumers in their time of need,” said CFI Vice President and Legal Counsel Nick Little. “Boiron knows its products are worthless junk, so they do everything they can to obscure the truth in order to offload their snake oil upon the unwitting, the ill-informed, and the vulnerable. They can’t be allowed to get away with it any longer.”

Adherents of homeopathy claim, without evidence, that a substance which causes harm to a healthy person will cure anyone else suffering the same type of harm. In homeopathic products, the “active” ingredients are highly diluted mixtures of the so-called cures; the ingredient ends up so diluted, often literally no trace of the original substance remains. Manufacturers like Boiron then sell miniscule amounts of the already incredibly diluted ingredients and promise astounding results.

In its lawsuit, brought under the District of Columbia Consumer Protection Procedures Act, CFI alleges that Boiron sold a plethora of materially identical products, each made up of sugar pills and powders. Despite no scientifically detectable active ingredient, Boiron falsely promised consumers that each item would treat and cure a particular illness, injury, or health condition.

“Boiron sells little pills of sugar with grandiose claims. It’s hard to believe anyone would try to pass off such junk as a surefire way to treat painful skin problems, heal mental health issues, and even to counteract menopause,” said CFI Staff Attorney Aaron D. Green. “But Boiroin has been doing just that by tricking consumers into risking their health and throwing away their money on its fancy faux ‘medicines.’ It’s time for Boiron and all homeopathy hucksters to be held accountable.”

In its complaint, CFI notes that Boiron sells Saccharum officinale as a treatment for “nervous agitation in children after overindulgence.”

“Most parents would rightfully be skeptical of this product if Boiron told them what Saccharum officinale actually is,” said Green. “Table sugar.”

According to recent industry accounts, 85 percent of consumers who purchased homeopathic products did not realize they were homeopathic, and nine out of ten consumers did not even know what the term homeopathic meant.

Apart from selling products they know are useless, Boiron also misrepresented the products’ ingredients. Four Boiron products were analyzed by an independent lab, and, not only were no traces of the supposed active ingredient found, even one of the inactive ingredients could not be scientifically detected.

The Center for Inquiry is currently engaged in other lawsuits regarding homeopathy, including consumer protection cases against megaretailers CVS and Walmart for their sale and marketing of homeopathic products, the matter recently heard by the DC Court of Appeals. CFI is also engaged in an active Freedom of Information Act lawsuit that demands the Department of Health and Human Services grant the public access to the Homeopathic Pharmacopoeia of the United States (HPUS), the “bible of homeopathy” upon which federal regulation of homeopathy is based and to which the industry restricts access but for those willing to pay thousands of dollars for the privilege.

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All I can add to this is: good luck to the CFI and let’s hope reason will prevail!

This paper is an evaluation of the relationship between chiropractic spinal manipulation and medical malpractice. The legal database VerdictSearch was queried using the terms “chiropractor” OR “spinal manipulation” under the classification of “Medical Malpractice” between 1988 and 2018. Cases with chiropractors as defendants were identified. Relevant medicolegal characteristics were obtained, including legal outcome (plaintiff/defense verdict, settlement), payment amount, nature of plaintiff claim, and type and location of the alleged injury.

Forty-eight cases involving chiropractic management in the US were reported. Of these, 93.8% (n = 45) featured allegations involving spinal manipulation. The defense (practitioner) was victorious in 70.8% (n = 34) of cases, with a plaintiff (patient) victory in 20.8% (n = 10) (mean payment $658,487 ± $697,045) and settlement in 8.3% (n = 4) (mean payment $596,667 ± $402,534).

Over-aggressive manipulation was the most frequent allegation (33.3%; 16 cases). A majority of cases alleged neurological injury of the spine as the reason for litigation (66.7%, 32 cases) with 87.5% (28/32) requiring surgery. C5-C6 disc herniation was the most frequently alleged injury (32.4%, 11/34, 83.3% requiring surgery) followed by C6-C7 herniation (26.5%, 9/34, 88.9% requiring surgery). Claims also alleged 7 cases of stroke (14.6%) and 2 rib fractures (4.2%) from manipulation therapy.

The authors concluded that litigation claims following chiropractic care predominately alleged neurological injury with consequent surgical management. Plaintiffs primarily alleged overaggressive treatment, though a majority of trials ended in defensive verdicts. Ongoing analysis of malpractice provides a unique lens through which to view this complicated topic.

The fact that the majority of trials ended in defensive verdicts does not surprise me. I once served as an expert witness in a trial against a UK chiropractor. Therefore, I know how difficult it is to demonstrate that the chiropractic intervention – and not anything else – caused the problem. Even cases that seem medically clear-cut, often allow reasonable doubt vis a vis the law.

Apologists will be quick and keen to point out that, in the US, there are many more successful cases brought against real doctors (healthcare professionals who have studied medicine). They are, of course, correct. But, at the same time, they miss the point. Real doctors treat real diseases where the outcomes are sadly often not as hoped. Litigation is then common, particularly in a litigious society like the US. Chiropractors predominantly treat symptoms like back troubles that are essentially benign. To create a fair comparison of litigations against doctors and chiros, one would therefore need to account for the type and severity of the conditions. Such a comparison has – to the best of my knowledge – not been done.

What has been done, however – and I did previously report about it – are comparisons between chiros, osteos, and physios (which seems to be a more level playing field). They show that complaints against chiros top the bill.

The pandemic has shown how difficult it can be to pass laws stopping healthcare professionals from giving unsound medical advice has proved challenging. The right to freedom of speech regularly conflicts with the duty to protect the public. How can a government best sail between Scylla and Charybdis? JAMA has just published an interesting paper addressing these issues. Here is an excerpt from the article that might stimulate some discussion:

The government can take several actions, including:

  • Imposing sanctions on COVID-19–related practices by licensed professionals that flout substantive laws in connection with providing medical services, even if those medical services include speech. This includes physicians failing to comply with COVID-19–related public health laws applicable to medical offices and health facilities, such as mask wearing, social distancing, and restrictions on elective procedures.
  • Sanctioning recommendations by professionals that patients take illegal medications or controlled substances without following legally required procedures. The government can also sanction the marketing by others of prescription medications for unapproved indications. However, “off-label” prescribing by physicians (eg, for hydroxychloroquine or ivermectin) remains lawful as long as a medication is approved by the US Food and Drug Administration for any indication and no specific legal conditions on use are in effect.
  • Enforcing tort law actions (eg, malpractice, lack of informed consent) in cases of alleged patient injury that result from recommending a potentially dangerous treatment or failing to recommend a necessary treatment.
  • Imposing sanctions on individualized medical advice by unlicensed individuals or organizations if giving that advice constitutes the unlawful practice of medicine.

In addition, the government probably can:

  • Impose sanctions for false or misleading information offered to obtain a financial or personal benefit, particularly if giving the information constitutes fraud under applicable law. This would encompass physicians who knowingly spread false information to create celebrity or attract patients.
  • Threaten disciplinary action by licensing boards against health professionals whose speech to patients conveys incorrect science or substandard medicine.
  • Specify the information that may and may not be imparted by private organizations and professionals as part of specific clinical services paid for by government, such as special programs for COVID-19 testing or treatment.
  • Reject legal challenges to, and enforce through generally applicable contract or employment laws, any restrictions private health care organizations place on speech by affiliated health professionals, particularly in the absence of special laws conferring “conscience” protections. This would include medical staff membership and privileges, hospital or other employment agreements, and insurance network participation.
  • Enforce restrictions on speech adopted by private professional or self-regulatory organizations if the consequences for violations are limited to revoking organizational membership or accreditation.

However, the government probably cannot:

  • Compel or limit health professional speech not made in connection with patient care, even if the speech is false or misleading, regardless of its alleged effect on public trust in health professions.
  • Sanction speech to the general public rather than to patients, whether or not by health professionals, especially if conveyed with a disclaimer that the speech is “not intended as medical advice.”
  • Sanction speech by health professionals to patients conveying political views or skepticism of government policy.
  • Enforce restrictions involving information by public universities and public hospitals that legislatures, regulatory agencies, and professional licensing boards would not be constitutionally permitted to impose directly.
  • Adopt restrictions on information related to overall clinical services funded by large government health programs, such as Medicare and Medicaid.

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The article was obviously written with MDs in mind and applies only to US law. As we have seen in previous posts and comments, the debate is, however, wider. We should, I think, also have it in relation to practitioners of so-called alternative medicine (SCAM) and medical ethics. Moreover, it should go beyond advice about COVID and be extended to any medical advice given by any type of healthcare practitioner.

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