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

legal action

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One of my last posts re-ignited the discussion about the elementary issue of informed consent, specifically about informed consent for chiropractors. As it was repeatedly claimed that, in Australia, informed consent is a legal requirement for all chiros, I asked on Wednesday 11 November 2020 at 07:12

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):
https://www.chiropracticboard.gov.au/Codes-guidelines/Code-of-conduct.aspx
https://www.chiropracticboard.gov.au/Search.aspx?q=Informed+consent
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):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2051308/
Quick advanced PubMed with filters set to “Chiropractic” AND “Informed consent”.
https://www.ncbi.nlm.nih.gov/pmc/?term=(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).
https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-00342-5
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:
https://edzardernst.com/2020/11/informed-consent-why-chiropractors-dont-like-it/

“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:
https://www.ahpra.gov.au/Publications/Panel-decisions.aspx

“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:
https://edzardernst.com/2017/04/we-have-an-ethical-legal-and-moral-duty-to-discourage-chiropractic-neck-manipulations/
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:

3.5 Informed consent
Informed consent is a person’s voluntary decision about healthcare that is made with knowledge and understanding of the benefits and risks involved. A useful guide to the information that chiropractors need to give to patients is available in the National Health and Medical Research Council (NHMRC) publication General guidelines for medical practitioners in providing information to patients.3 The NHMRC guidelines cover the information that chiropractors should provide about their proposed management or approach, including the need to provide more information where the risk of harm is greater and likely to be more serious, and advice about how to present information. Good practice involves:
a) providing information to patients in a way they can understand before asking for their consent
b) providing an explanation of the treatment/care recommended, its likely duration, expected benefits and cost, any alternative(s) to the proposed care, their relative risks/benefits, as well as the likely consequences of no care
c) obtaining informed consent or other valid authority before undertaking any examination or investigation, providing treatment/care (this may not be possible in an emergency) or involving patients in teaching or research, including providing information on material risks
 d) consent being freely given, without coercion or pressure
 e) advising patients, when referring a patient for investigation or treatment/ care, that there may be additional costs, which they may wish to clarify before proceeding
 f) obtaining (when working with a patient whose capacity to give consent is or may be impaired or limited) the consent of people with legal authority to act on behalf of the patient, and attempting to obtain the consent of the patient as far as practically possible
 g) being mindful of additional informed consent requirements when supplying or prescribing products not approved or made in Australia, and
h) documenting consent appropriately, including considering the need for written consent for procedures that may result in serious injury or death.
_______________________________________
This does indeed clarify some of my questions. Related to the fictional patient with neck pain who consults a chiropractor in my previous post, this means the chiro must inform the patient that:
  • 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

  1. not supported by sound evidence for effectiveness,
  2. 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:

Who monitors Informed Consent?
 
The short answer here is nobody monitors informed consent.  Typically informed consent is a side issue whenever a negligence claim is made.  Similarly, clinical records are a side issue as well.   Thus, when a patient alleges they were injured a complaint is lodged.  As part of the investigation consideration is given regarding the consent process.  If the analysis determines that the adverse outcome was maloccurence rather than negligence  but valid consent was not obtained, the practitioner will still face disciplinary action. 
 
As we are all too well aware, the Boards show little or no desire to be proactive.  I have yet to see any results from the pilot advertising audit project which began approximately 2 years ago.
 
What published evidence have we ab​out compliance?
 
Good question.  To my knowledge Langworthy & Flemming’s 2005 paper is the only one looking at compliance.  Their results suggest that the majority of respondents would be unable to successfully defend a negligence in consent liability charge.  In my experience providing expert opinions in Australian cases, valid consent was not obtained in a single case.  The most bizarre case had the practitioner their expert argue that consent obtained 7 years prior to the injury was still valid.  
 
Langworthy J.M., Cambron J. Consent: its practices and implications in United Kingdom and the United States chiropractic practice. J Manip Physiol Ther. 2007;(6):419–431.

_____________________________________

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.

I was alerted to an outstanding article by an unusual author, a law firm, on the subject of chiropractic. Allow me to quote a few passages from it (without changing a word or adding a comment):

When Katie May passed away suddenly from a stroke at just 34 years old, it was initially ruled an accident. After further investigation, a coroner determined the stroke that claimed the model and single mother’s life was caused by injuries sustained during neck manipulation by a chiropractor. And Ms. May is not the first to be affected by this seemingly harmless procedure…

What health issues can be caused by chiropractic manipulation?

Chiropractors typically use their hands to apply pressure to joints, aiming to help alleviate pain and improve body function. This is referred to as a chiropractic adjustment.

Adjustments are commonly performed for neck and/or back pain. Although the Mayo Clinic says the risk of a serious complication is relatively small, these complications can include:

  • A herniated disk, or worsening of an existing herniated disk
  • Compression of nerves in the lower spinal column
  • Stroke, which can result in paralysis or death

The last item on this list is particularly concerning.

Patients who receive neck manipulation are at risk for a stroke caused by vertebral artery dissection. Located in the neck, the vertebral arteries supply blood to the brain and can be torn by stretching and sudden force applied during a neck adjustment.

Studies have shown that vertebral artery dissection occurs in approximately 1 in 100,000 people and can be caused by something as simple as cracking your neck.

How could a chiropractor be responsible for a patient’s injury?

Although the risk of being seriously injured by a chiropractor is low, tragic accidents can and do happen. If you or a loved one believe you have been the victim of medical malpractice, please contact an experienced personal injury attorney.

Explaining how an injury or medical error occurred will help your attorney determine the potential liability of a chiropractor and any other involved parties. A chiropractor’s liability could fall into a legal category such as:

  • Failure to Diagnose a Medical Condition – The chiropractor breaches a duty of care to their patients by failing to diagnose an underlying medical condition. This could occur when a patient reveals or exhibits symptoms of a severe issue, such as a stroke, and is not referred for appropriate medical attention.
  • Lack of Informed Consent – A patient is treated without being properly informed of the potential risks or side effects, and experiences an injury from that treatment.
  • Negligent Manipulation – The patient’s body is adjusted by the chiropractor in such a way that it causes a new injury or worsens an existing injury. This could also include manipulation of a patient who is pregnant and goes into premature labor.
  • Chiropractic Induced Injury – A patient suffers injury, permanent irreversible damage such as paralysis or wrongful death as the direct result of a chiropractic manipulation.

To find out whether or not you may have a case, please discuss your concerns with a qualified personal injury attorney.

What should I do if I think I have been injured by chiropractic manipulation?

A personal injury attorney can help recover compensation for victims of medical malpractice, including those who have experienced a chiropractic injury. Surviving loved ones can also pursue their case after a family member’s wrongful death.

An attorney will help you collect documents, photos and other items pertaining to your case – but staying organized early in the process will be helpful. Try to preserve important documents, such as:

  • Photographs before and after treatment
  • Medical records and medical bills
  • Receipts, appointment confirmations and other paperwork from your chiropractor

There is a time limit to file a medical malpractice lawsuit, referred to as a statute of limitations…

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.

ANXIETY

  • Massage
  • Music therapy
  • Various relaxation techniques

DEPRESSION

  • 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:

Stramonium

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.

Lactuca Virosa

As if swimming in the air or walking above the ground.

Chloralum

Night terrors. Sees visions of arches. Hears voices when in the dark or when eyes are shut.

Lac Can

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.

Sabadilla

Erroneous impressions as to the state of her body e.g. that she is pregnant when she is merely swollen with flatus.

Platinum

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.

Camphor

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.

Calcarea Carb

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.

Ailanthus

Feels as if a rat or something small is crawling up the limb and over the body.

Anacardium

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.

Indecisive

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.

Helleborus Nig

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.

Causticum

Conscience stricken as if she had committed a crime.

Ferrum Iod:

As if body had grown 30 feet high.

Baptisia T:

Feels as if body scattered into pieces.

Chamomilla

Hearing voices of absent persons which disturb his sleep.

Zincum Met

Voices from within him speaking in abusive and filthy language.

Belladonna

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.

Spigelia

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.

Thuja

Sensation as though a living child were in the abdomen. Feels body thin and delicate, frail, easily breakable as if made of glass.

Cannabis Ind

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.

Arsenic Alb

Imagines house full of thieves. Runs through the house in search of them or hides himself in the house on account of fear.

Cicuta Virosa

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.

Viscum Alb

Delusion as if upper part of the body is floating in the air.

Coculus

Delusion as if something is rolling on walls, chairs, floor or elsewhere and will also roll on him.

Hyoscyamus

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.

Cocaine

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.

Alumina

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.

Glonoine

Chin feels elongated to knees. Touching the chin repeatedly to be sure that it was not so.

Carboneum Sul

Hears voices and believes he has committed robbery.

Lachesis

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.

Melilotus

Delusion; thinks everyone is looking at her; fears to talk aloud; wants to run away.

Agnus C

Delusion of smell as of herring (kind of fish) or musk.

Coca

Delusion; of worms on the skin or clothing.

Aethusa

Delusion; sees cats and dogs; wants to jump out of bed or window.

Asarum Europ

As if hovering in the air. Vertigo as if drunk.

Baryta Carb

As if everything rocks with him, as in a ship.

Crocus

As if something alive is in abdomen. Imaginary pregnancy. Alternating mood.

Morphinum

As if room filled with babies. Man at foot of bed. Cannot describe symptoms.  Sobs at trifles.

Medorrhinum

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.

Mercurius

Feels as if worm rising in throat; apple-core stuck in throat; ice hi ear; cold water running from ears.

Palladium

Feels that she has been neglected. Wounded pride.

Petroleum

Imagines that another person or a child is in bed with her. Dreams that she is two or more. That her limbs are double.

Psorinum

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.

Cyclamen

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.

Staphisagria

When he walks he feels as if someone were following him. This causes anxiety and fear and he cannot look behind.

Sulphur

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.

Cannabis Sat

Hears hissing whisper to kill himself. This is an order from the Most High Command.

Cuprum Aceticum

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.

Oleander

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.

Pyrogenium

Hallucination that he is very wealthy and has a large sum of money in the bank.

Nux Moschata

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?

No?

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.

____________________________

 

 

PS

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.

The issue of informed consent has made regular appearances on this blog. It is important and has many intriguing aspects, particularly for so-called alternative medicine (SCAM). On the one hand, it is a ‘conditio sine qua non’ for any form of healthcare, while, on the other hand, it is a near impossibility in SCAM practice.

In this new article published in a chiro-journal, the authors review the origins of informed consent and trace the duty of disclosure and materiality through landmark medical consent cases in four common law (case law) jurisdictions. The duty of disclosure has evolved from a patriarchal exercise to one in which patient autonomy in clinical decision making is paramount. Passing time has seen the duty of disclosure evolve to include non-medical aspects that may influence the delivery of care. The authors argue that a patient cannot provide valid informed consent for the removal of vertebral subluxation. Further, vertebral subluxation care cannot meet code of conduct standards because it lacks an evidence base and is practitioner-centered.

The uptake of the expanded duty of disclosure has been slow and incomplete by practitioners and regulators. The expanded duty of disclosure has implications, both educative and punitive for regulators, chiropractic educators and professional associations. The authors discuss how practitioners and regulators can be informed by other sources such as consumer law. For regulators, reviewing and updating informed consent requirements is required. For practitioners it may necessitate disclosure of health status, conflict of interest when recommending “inhouse” products, recency of training after attending continuing professional development, practice patterns, personal interests and disciplinary findings.

The authors conclude that, ultimately such matters are informed by the deliberations of the courts. It is our opinion that the duty of a mature profession to critically self-evaluate and respond in the best interests of the patient before these matters arrive in court.

In their paper, the authors also provide a standard list of items required for ‘informed’ consent:

(1) emphasizing the patient’s role in shared decision-making

(2) disclosure of information

a. explaining the patient’s medical status including diagnosis and prognosis

b. describing the proposed diagnostic and therapeutic intervention, including the likelihood and effect of associated risks and benefits of the proposed action, including material risks

c. discussing alternatives to the proposed intervention, including doing nothing

(3) prompting and answering patient questions related to the proposed course of action (NB. this involves probing for understanding, not simply asking ‘do you have any questions’), and

(4) eliciting the patient’s preference (usually by signature). (NB. A signed form is not consent. The conversation between the clinician and the patient or carer is the true process of obtaining informed consent. The signature on the consent form is proof that the conversation took place and that the patient understood and agreed.)

The authors of this article – I do commend it to all chiropractors – take a mostly judicial view of informed consent (for an ethical perspective on the subject, I recommend our book). They do not discuss, whether chiropractors do, in fact, adhere to the ethical imperative of informed consent. As I have stated before, there is not much research on this issue. But the little that does exist fails to show that chiropractors care much about it.

But why?

If it’s an ethical imerative, why do chiropractors not abide by it?

The answer to this question is not difficult to find. Just imagine a conversation between a chiropractor (C) and a patient with neck pain (P):

  • P: What’s your diagnisis?
  • C: You are suffering from acute neck pain.
  • P: Thanks, that much was clear to me. What do you suggest I do?
  • C: I will perform a manipulation of your neck, if you agree.
  • P: Why would this help?
  • C: It can realign the vertebrae that are out of place, simply put.
  • P: And my pain will disappear?
  • C: Sometimes it does, yes.
  • P: But will it disappear quicker than without manipulation.
  • C: Some of the evidence says so.
  • P: Ok, but what does the most reliable evidence say?
  • C: It is not entirely clear cut.
  • P: Hmm, that does not sound too good.
  • P: So, tell me, are there any risks?
  • C: About 50% of patients suffer from minor to moderate pain for 2-3 days afterwards.
  • P: That’s a lot!
  • P: Anything else?
  • C: In some cases, neck manipulation was followed by a stroke.
  • P: Gee that’s bad; how often has this happened?
  • C: We know of about 500 such cases.
  • P: Heavens!
  • C: Now, do you want the treatment or not?
  • P: How much will you charge?
  • C: Only 60 Euros per session.
  • P: You mean I have to come back for more, each time risking a stroke?
  • C: Well… You don’t have to.
  • P: Thanks for the info; I am off. Cherio!

I rest my case. 

 

Dr Mathias Rath, the German born purveyor of multiple food supplements, and his organisation puzzle me a great deal. As previously reported, the ‘Dr Rath Foundation’ published an article about me. In it, the author got my name right, but not much more. Here is its opening passage [the numbers in square brackets refer to my comments below].

Professor Edzard Ernst: A Career Built On Discrediting Natural Health Science? [1]

Professor Edzard Ernst, a retired German [2] physician and academic, has recently [3] become a prominent advocate of plans that could potentially outlaw [4] the entire profession of naturopathic doctors [5] in Germany. Promoting the nonsensical idea that naturopathic medicine somehow poses a risk to public health, Ernst attacks its practitioners as supposedly having been educated in “nonsense” [6]. Tellingly, however, given that he himself has seemingly not published even so much as one completely original scientific trial of his own [7], Ernst’s apparent attempts to discredit natural healthcare approaches are largely reliant instead on his analysis or review of handpicked negative studies carried out by others [8].

  1. When I was appointed at Exeter to research alternative medicine in 1993, I had already been a full professor at Hannover, Germany and subsequently at Vienna, Austria. If anything, coming to Exeter was a big step down in terms of ‘career’, salary, number of co-workers etc. (full details in my memoir)
  2. I am German-born, became an Austrian citizen in 1990, and since 2000 I am a British national.
  3. I have been critical about the German ‘Heilpraktiker’ for more than 20 years.
  4. This refers to the recent ‘Muensteraner Memorandum’ which is the work of an entire team of multidisciplinary experts and advocates reforming this profession.
  5. ‘Heilpraktiker’ are certainly not doctors; they have no academic or medical background.
  6. This is correct, and I stand by my statement that educating people in vitalism and other long-obsolete concepts is pure nonsense.
  7. Since I am researching alternative medicine, I have conducted and published about 40 ‘scientific trials’, and before that time (1993) I have published about the same number again in various other fields.
  8. This refers to systematic reviews which, by definition, include all the studies available on a defines research question, regardless of their conclusion (their aim is to minimise random and selection biases)  .

Rath states about himself that “Dr. Rath heads a research and development institute in nutritional and Cellular Medicine. His institute is conducting basic research and clinical studies to scientifically document the health benefits of micronutrients in fighting a multitude of diseases.”

But this is equally puzzling.

Firstly, because research does not aim ‘to scientifically document the health benefits of ‘ anything; it is for testing hypotheses; Rath surely must know that. Secondly, on Medline, I find dozens of publications by Rath. These refer mostly to mechanistic in-vitro or animal studies about the mode of action of vitamins and other natural compounds.

But ‘clinical studies‘?

None!

Hold on! My Medline searches did deliver one clinical trial – just one – (Rath himself lists more, but they seem to be meaningless observational studies without a control group). It was published as an abstract on his own website. Here is the abstract:

Healing of bone fractures is a prolonged process that can be affected by nutrition. Our objective was to critically evaluate the effect of supplementation with an essential nutrient complex, containing ascorbic acid, lysine, proline, and vitamin B6 on healing time of tibial fractures.

Design:

Random double-blind placebo-controlled study

Setting:
Dr. Jamdar Hospital, Jabalpur, India

Subjects and Intervention:
113 patients with unilateral displaced closed or grade I open tibial fractures were randomized to receive either standard care with placebo or with supplementation with an essential nutrient complex containing ascorbic acid, lysine, proline, and vitamin B6. Qualifying patients, on admission to the study, were clinically examined, radiographs of the affected limbs taken, fractures reduced under anesthesia, and above knee plaster casts applied. Radiographs were taken at each follow-up visit to confirm reduced alignment of fracture and proper callus formation.

Primary Outcome Measure:
The primary outcome measure was the number of weeks required for fracture to be healed. Healing was defined as absence of abnormal mobility at fracture site clinically, absence of pain elicited by stressing the fracture or by walking, and radiographic confirmation of callus formation.

Results:
Data analysis demonstrated reduced fracture-healing time associated with experimental supplementation. For PP analysis group, fracture healing time in 75% of the supplemented group of patients (N=21) was 17 weeks or less and 19 weeks or less in 75% of the placebo group patients (N=36). The percentage of patients with fractures healing in 10 weeks or less was 33.3% for the supplemented group and 11.1% for the placebo group. However, the difference in healing time between the two groups did not reach statistical significance.

Conclusion:
Results showed encouraging trends that fracture-healing time is reduced by supplementation with an essential nutrient complex containing ascorbic acid, lysine, proline, and vitamin B6. In addition, the nutrient supplemented participants reported improved feeling of well-being with use of the supplement.

This is odd in several ways:

  1. Even though the conclusions hide it quite well, the trial was in fact negative, i. e. it failed to show a significant difference between the verum and the placebo in the primary outcome measure.
  2. The trial was never published as a peer-reviewed full paper. The website refers to its publication as a ‘letter to the editor’ (LTTE) in the notorious JACM (a LTTE is not normally peer-reviewed).
  3. Why was it never properly published?
  4. Could it be because there was no ethics approval [none was mentioned in the LTTE]?
  5. Could it be because there was no informed consent [none was mentioned in the LTTE]?
  6. The LTTE mentions that a larger study with 200 patients is planned. This was 16 years ago, and to date there is no trace of such a trial.

Rath’s latest contribution to the world of science is a paper implying that his supplements could play a role in the fight against the present pandemic; it is entitled ‘Effective and safe global public health strategy to fight the COVID-19 pandemic: Specific micronutrient composition inhibits Coronavirus cell-entry receptor (ACE2) expression’. Here is the abstract which clearly shows that Rath has not a jot of clinical evidence:

Optimum micronutrient intake is the only scientifically proven way to improve general immune resistance against infections, a fact documented in every leading textbook of biology.  This study provides scientific evidence that, in addition, specific micronutrient compositions are powerful tools in the fight against the COVID-19 pandemic.

Both, SARS-CoV-2 – the virus that causes the current pandemic – and other coronaviruses enter body cells via a specific receptor, the Angiotensin-Converting-Enzyme 2 (ACE2). The ACE2 receptor is expressed by many cell types, including lung epithelial cells as well as endothelial cells of the vascular system.

Based on our earlier research that demonstrated that specific micronutrients can block several mechanisms of viral infections, we tested the efficacy of these natural compounds in suppressing the expression of the ACE2 receptor on human endothelial cells and small airway epithelial cells.

Our results show that a micronutrient composition comprising vitamin C as well as certain amino acids, polyphenols, and trace elements is able to suppress this viral ‘entry door’ into the body under both normal and inflammatory conditions, which are associated with infections.

Thus, vitamin-rich nutrition and micronutrient supplementation should be implemented as effective, safe and affordable public health strategies to fight the COVID-19 pandemic and help prevent future outbreaks.  Optimizing the micronutrient status of the entire population should form the basis for any global strategy to help prevent future pandemics across the world, including the developing nations.

The Wiki-page on Rath lists 10 (!) legal cases in which he has been involved. This looks like he easily sues people who disagree with his often bizarre views and sales techniques. Considering this suspicion, I better be careful what I say here. Therefore let me conclude by meekly repeating the title of this post which comes from my friend Ben Goldacre who, together with THE GUARDIAN won a famous and expensive legal battle against Rath:

Rath is an example of the worst excesses of the alternative therapy industry.

 

 

 

PS

What I like best about the many supplements sold by Rath is the footnote in the patient leaflets:

THIS PRODUCT IS NOT INTENDED TO DIAGNOSE, TREAT, CURE OR PREVENT ANY DISEASE

Anyone who has followed the comments’ section of this blog knows that science communicators don’t always have it easy. In fact, they have to endure regular attacks. Now, this phenomenon has (as far as I know, for the first time) been investigated systematically.

The objective in this survey was to establish a taxonomy of common negative experiences encountered by those communicating medical science, and suggest guidelines so that they may be circumvented. A total of 142 prominent medical science communicators (defined as having >1000 Twitter followers and experience communicating medical science on social and traditional media platforms) were invited to take part in the survey. One hundred and one responses could be analysed.

The results show that:

  • 92% of the participants has experienced abusive behaviour (91.9%), including persistent harassment (69.3%) and physical violence and intimidation (5.9%).
  • 39% had received vexatious complaints to their employers, professional bodies or legal intimidation.
  • 62% reported negative mental health sequelae due to public outreach, including depression, anxiety and stress.
  • 20% had been obligated to seek police advice or legal counsel due to actions associated with their outreach work.
  • the majority targeted with vexatious complaints felt supported by their employer/professional body and 32% reported neutral, poor or non-existent support.

Here is a selection of the responses from the participants:

  • Accusations—including by one Senator—that [we are] uncaring, dismissive, neglectful, arrogant, or paid by pharma companies when advocating for vaccines. (Misrepresentation)
  • I find my expertise is questioned—this often seems to be when men find it difficult to accept women with intelligence and qualifications. Sexist insults are a typical go-to response. (Discreditation)
  • The worst one that hurt me professionally and personally was that activists gathered my emails using [Freedom of Information Requests] and handed chosen packets of them with a story to different reporters. (Misrepresentation/Discreditation/Dubious Amplification)
  • Persistent negative comments on twitter; usually it doesn’t last long but it can feel very intense while it’s happening! (Intimidation)
  • I have been served with a SLAPP lawsuit in order to silence my outreach work. Frequently receive harassing emails, malicious comments made on blog. (Malicious Complaints)
  • Social media co-ordinated intimidation, implied threats of legal action (for defamation). Mocking, undermining, condescension and attacks for being an industry shill, although. I am just a patient advocate. Being called a liar, that I never had cancer, that I deserved cancer due to my attitude, that I have been mutilated by conventional medical treatment, and that I am no longer a woman (having had mastectomy for cancer). That my cancer will return and I deserve that. (Dubious Amplification/Misrepresentation/Discreditation)
  • I have had anti-vaccine organizations and individuals attempt to prevent my public appearances and have been the subject of numerous online smear campaigns accusing me of being ‘a shill for Big Pharma’ etc. (Discreditation/Dubious Amplification)
  • Those who attack me very frequently try to do it by targeting me at my job, sending bogus complaints to my bosses and the university. From my observation, that is the go-to attack, the first thing these groups do. (Malicious Complaints)
  • I had to contact the police, who visited the person who was harassing me. I also involved social services. We bought a CCTV to monitor our front door after a strange envelope was hand delivered. The person involved has targeted several people before and continues to target individuals who advocate vaccination. (Intimidation)
  • Abuse and accusations of corruption are the most common adverse reaction I get. Sometimes a particular group petition one’s employer and try to create trouble for them. I have been lucky in the past when this happened to have had supportive universities who appreciate my outreach work. I have in the past had slightly unhinged individuals writing rambling, implicitly threatening letters to my office which ultimately required police intervention. (Discreditation/Malicious Complaints/Intimidation)
  • The worst are gendered insults (being called a cunt, etc.) and rape/death threats. I have had one empty legal threat that was widely publicized. (Intimidation/Malicious Complaints)
  • Regular threats to sue for defamation. (Malicious Complaints)
  • Attempts to get me fired, public records act requests for emails, verbal attacks on my children. (Malicious Complaints, Intimidation)
  • One of the most unpleasant things is that certain people or groupings will use very underhanded tactics to respond to perceived criticism. If they can’t refute the science, it isn’t uncommon for them to go after you personally, alleging all manner of things to anyone who’ll listen; that you’re incompetent, or unethical, or perverted. It seems they throw things wildly to see what sticks, but it can be extraordinarily unpleasant to endure. (Dubious Amplification/Discreditation)
  • My main concern has been obsessed individuals who declare their enmity and seem to be unconstrained by civil norms. (Intimidation)
  • Homeopathy advocates looked up my LinkedIn profile and called my employer to complain about my comments on the radio. My employer did not support me and I ended up having to stop the activity I had been planning. (Misrepresentation/Malicious Complaints)
  • Being threatened with physical violence. (Intimidation)
  • A delusional supporter of [an individual] I wrote about accused me and my lawyer of stalking him and killing his in-laws. He sent accusing emails to the faculty of my school and all the police departments in my state. [They] also accused me of being a terrorist and complained about me to the FBIs Terrorism Joint Task Force. That gave me many nervous, sleepless nights. (Discreditation/Malicious Complaints)
  • Death threats received, employer unhelpful, sorted myself. (Intimidation)
  • I haven’t experienced many negative encounters because I would say I am only lightly involved in public engagement. However the reason I don’t become more heavily involved in this area is fear of this kind of abuse and vexatious complaints to my employer or regulatory body. (Malicious Complaints)

The authors concluded as follows: The question of how we best communicate health science in the modern era is an area where more research is urgently required, especially on the role of social media, and optimum ways physicians, researchers and other public-facing figures can promote good medical science and mitigate falsehoods. The suggestions herein ought to be taken as a starting point, with discussion evolving as improved evidence materialises. There are wider problems implicit in all this that those communicating science cannot tackle in isolation; social media regulation particularly is a serious issue, both in regard to the spreading of misinformation/disinformation, and with respect to procedures preventing the potential weaponisation of social media platforms. Social media platforms must ultimately be made answerable to regulatory oversight, just as every other important aspect of life is; claims of innocence are unconvincing when their business model is so clearly dependent on advertising engagement at the cost of lives. The problem of poor reporting and false balance in conventional media outlets also must be considered, and there is significant scope for scientists and doctors to contribute to policy in these areas. There is ample evidence that physicians and scientists have an important role to play in combatting health disinformation, as has recently been argued by one of the authors in relation to vaccination for British Medical Journal opinion. But equally, it is crucial that those engaging in this vital work have the requisite support from their institutions, so that deleterious consequences of laudable outreach work might be circumvented. It is increasingly clear that disinformation about medicine and illness has become ubiquitous, with severe consequences for both our collective health and public understanding of medical science. Scientists and physicians must be at the vanguard of the pushback against these dangerous falsehoods—our societal well-being depends on it.

_______________________________________

This is an important paper, in my view. It is well worth reading in full.

I know many scientists who will no longer engage in science communication (other than publishing their papers and attending conferences) because they had one or two bad experiences. I certainly had hundreds of bad (some very bad) experiences, but I have taken the opposite decision.

Thus I started this blog, authored several books aimed at the consumer, give public lectures, etc. I have done this for many years despite the lack of support from my university and sometimes despite the opposite of support from my peers.

Why?

Why do I work tirelessly trying to inform consumers about so-called alternative medicine (SCAM)?

Because, in view of the plethora of (often dangerous) misinformation, it is hugely important to get the word out to the men and women in the street. I pity the ones who regularly allege that I do all this because of the money I earn from such activity (on the whole, it costs me money). In fact, I do what I do because I hope it might

  • stimulate rational thought,
  • help people to make wise therapeutic decisions,
  • make a small contribution to public health,
  • and perhaps occasionally even save a life.

And the threats which I continue to receive merely indicate that I might be doing this job well, and prove how important the task really is.

The Society of Homeopaths (SoH) is the UK’s professional organisation of ‘lay-homeopaths’, therapists who treat patients without having studied medicine. They prefer the term ‘professional homeopathy’, but there is little professional about them, it seems. The SoH has a long track record of endangering public health by promoting anti-vaxx nonsense.

A few months ago, it was reported that Linda Wicks, chair of the Society of Homeopaths (S0H), has shared a series of petitions claiming that childhood immunisations are unsafe. Mrs Wicks also posted a petition supporting Andrew Wakefield, the disgraced former doctor who falsely linked the MMR vaccine to autism claiming that the scientific establishment’s rejection of his flawed research was ‘the greatest lie ever told’.

In 2018, I pointed out that the SoH was violating its own code of ethics. At the time, two new members were appointed to the Society’s Public Affairs (PAC) and Professional Standards (PSC)  committees, and both were promoting the deeply anti-vaxx CEASE therapy.

Today, THE TELEGRAPH reports that Sue Pilkington, the SoH’s ‘Head of Standards’, has been promoting anti-vaxx propaganda online. On April 14, she posted anti-vaxx content made by the ‘Children’s Health Defense’ – an organisation accused by NBC News last year as being one of the largest global creators of spreading misinformation’. The page advised that any new vaccine could trigger “lethal” immune reactions.

In a separate post on Facebook, Pilkington shared a post that describes vaccines as “poison” – alongside medical advice declaring that no child should be vaccinated, if any member of their family has a skin disorder. Pilkington also tried to contact Health Secretary Matt Hancock, attempting to share with him a video of content from an American comedian claiming that it’s ‘realistic’ for vaccines to cause autism.

As though this were not enough nonsense, Pilkington also promotes homeopathy as a solution to the current epidemic. On her homeopathy business website, she has section on coronavirus which states the following: “The current primary homeopathic remedy advised for Coronavirus (2019-nCoV) symptoms is Gelsemium with a possible following remedy of Eupatorium Perforatum, Bryonia or Belladonna depending on how the symptoms progress”. Other homeopathic remedies are in common use for people with influenza and pneumonia, according to Pilkington, these do not “prevent viruses” but may “reduce the severity and length of illness”. She also claims that homeopathy has a “great track record of success in epidemics” – referencing both the Spanish influenza pandemic and the bird flu pandemic.

“In our opinion, the Professional Standards Authority (PSA) has a simple choice to make: remove the SoH and their uninformed vaccination paranoia from the register, or continue to allow homeopaths to make these dangerous claims with the tacit approval of the PSA.” said Michael Marshall, projector director of the Good Thinking Society.

A government health spokesperson was quoted in today’s TELEGRAPH article stating this: “Vaccine misinformation in any form – book, film, website or otherwise – is completely unacceptable.” The spokesperson added that NICE does not recommend homeopathy for the treatment of any health condition and noted that vaccines “save lives and are a foundation of public health.”

 

Yesterday’s blog disclosed the fact that the German ‘Natur und Medizin’, an organisation of the ‘Carstens Stiftung’, had published slanderous lies about me. Consequently, I published an ‘open letter’ urging them to correct their mistake so that they would spare us the agony and cost of using legal action.

I never doubted for a minute that they would do this (I do not assume they are stupid, just a tiny bit dishonest) – and, as it turned out, I was correct. Here is a reminder of what they had originally published:

… er ist dafür bekannt, dass er kein gutes Haar an komplementären Therapieverfahren lässt. Notfalls greift er auch zu absichtlichen Falschdarstellungen[17], erfindet Daten[18] oder behauptet einfach, klinische Studien, die nicht die Negativ-Ergebnisse erbringen, die er erwartet, seien schlicht und ergreifend Betrug.[19]…

My rough translation:

… he [Edzard Ernst] is known for not finding anything positive in SCAM. If all else fails, he uses deliberate misrepresentation [17], invents data [18], or simply claims that clinical trials which did not generate the negative findings he expected are simply falsifications [19]…

The corrected new text passage is a little longer and now reads as follows (my rough translation):

… he [Edzard Ernst] is known for not finding anything positive in SCAM. Analyses of his publications by independent scientists draw the conclusion that he represents case-reports demonstrably wrongly [17] and that he arbitrarily alters or omits data [18]. He claims occasionally that high-quality studies of SCAM which do not generate the negative findings he expected appeared to be scientifically sound, but are nevertheless not believable [19]…

… er ist dafür bekannt, dass er kein gutes Haar an komplementären Therapieverfahren lässt. Analysen seiner Publikationen durch unabhängige Wissenschaftler gelangen zu der Schlussfolgerung, dass er Fallberichte nachweislich falsch darstelle[17] und Daten willkürlich verändere oder auslasse[18]. Er selbst behauptet mitunter über methodisch hochwertige Studien zur Komplementärmedizin, die nicht die Negativ-Ergebnisse erbringen, die er erwartet, sie sähen zwar nach wissenschaftlichen Maßstäben überzeugend aus, seien aber dennoch ‚unglaubwürdig‘.[19]… 

I would like to take this occasion to sincerely thank the ‘Natur und Medizin’ and the ‘Carstens Stiftung’ for this – much obliged guys, you made my day!

  • They have shown wisdom in not wasting money on expensive lawyers (even though my brother, who is a lawyer, might have enjoyed the windfall).
  • They have shown courage to hide behind papers like the one by Robert Hahn which have been discussed on this blog and elsewhere and found to be deluded.
  • They have shown strength by not meekly apologising to me about their attempt to slander me and my work.
  • They show leadership and innovative spirit by employing Jens Behnke, the author of the above lines, who does not seem to let the truth get in the way of a good story.

Last not least, my personal thanks to dear Jens (after your generosity, I am thinking about dedicating an entire blog post to you; your employer needs to know what a genius they have in you – watch this space) for yet again having demonstrated that the phenomenon known as ERNST’ S LAW is 100% correct.

In his writings, DD Palmer (the father of chiropractic), left little doubt about how he felt about himself and his achievements. A few quotes will suffice to give an impression:

  • I was the first to adjust the cause of disease
  • Chiropractors adjust causes instead of treating effects
  • Vaccination and inoculation are pathological; chiropractic is physiological
  • It was my ingenious brain which discovered [chiropractic’s] first principle; I was its source; I gave it birth; to me all chiropractors trace their chiropractic lineage
  • Among the wonderful achievements of this century, the discovery and development of chiropractic is preeminent; it is destined to replace all methods which treat effects

With this post, I will simply outline DD’s extraordinary life. I intend to leave it to you, the reader of this post, to decide whether it was the life of a genius or that of a charlatan.

  • 1845, 7 March: birth in Port Perry, near Toronto, Canada
  • 1865, April: Palmer family immigrate to the US
  • 1867: DD Palmer starts as a teacher in Concord, Iowa
  • 1869, November: DD and his younger brother TJ become beekeepers in Letts, Iowa
  • 1871, 20 January: DD marries Abba Lord who calls herself a ‘psychometrist, clairvoyant physician, soul reader and business medium’.
  • 1872, 6 July: DD publishes an article in the ‘ Religio Philosophical Journal’ calling himself an atheist
  • 1872: DD later states that he started his career as a ‘healer’ during this period
  • 1873: Abba leaves DD and later becomes a ‘homeopathic physician’ in Mineapolis.
  • 1876, 7 October: DD marries Louvenia Landers, a widow; they have 4 children together, including BJ who later becomes DD’s partner in the chiropractic business.
  • 1878, 19 April: the Palmer’s 5-months old daughter dies
  • 1878, May: DD is elected president of the ‘Western Illonois and Eastern Iowa Society of Bee Keepers’
  • 1880: DD publishes a pamphlet about spiritualism and refers to himself as a ‘spiritualist’
  • 1881 BJ Palmer is born; he later all but took over the chiropractic business and is often referred to as the ‘developer of chiropractic’
  • 1882 DD sells his beekeeping business, moves to What Cheer, Iowa where the rest of his family live
  • 1883, 30 May: DD opens a grocery store in What Cheer
  • 1884, 20 November: Louvenia dies of consumption
  • 1885, February: DD sells his grocery store and ‘moves on’
  • 1885, 25 May: DD marries Martha Henning. The marriage is short-lived; on 8 July of the same year, DD posted a public notice in the ‘What Cheer Patriot’ disowning her
  • 1885: DD moves back to Letts where he teaches at the local school
  • 1886: DD moves to Iola, Kansas where he practices as a magnetic healer and calls himself ‘Dr Palmer, healer’
  • 1886, 3 September: DD advertises his services as a ‘vitalist healer’ in Burlington, Iowa
  • 1887, 9 October: DD advertises ‘dis-ease is a condition of not ease, lack of ease’, a theme that he later uses regularly for chiropractic
  • 1887, 25 October: one of DD’s patients has died and there is an inquest. The local paper describes DD with the term ‘dense ignorance’ and the coroner states that ‘we censure the so-called doctor, DD Palmer, attending physician, for his lack of treatment and ignorance in the case’. DD leaves Burlington to avoid persecution (a new law requires all healers to register with the state medical board. DD does not have such a registration)
  • 1887: DD moves to Davenport and advertises: DD Palmer, cures without medicine…’
  • 1888, 6 November: DD marries Villa; they stay together until her death in 1905
  • 1894: DD publishes his views on smallpox vaccination: ‘…the monstrous delusion … fastened on us by the medical profession, enforced by the state boards, and supported by the mass of unthinking people …’
  • 1894: DD publishes his views about ‘greedy doctors’ and the ‘medical monopoly’
  • 1895, January: DD starts a business selling gold fish
  • 1895, 18 September: DD administers the 1st spinal manipulation to Harvey Lillard (DD later seems confused about this date stating that this ‘was done about Dec. 1st, 1895’)
  • 1896, 14 January is the date when, according to DD, chiropractic received its name with the help of Reverent Weed
  • 1896: DD publishes an article in ‘The Magnetic’ stating ‘ the magnetic cure: how to get well and keep well without using poisonous drugs’
  • 1896: DD publishes on bacteria outlining his theory that bacteria cannot grow on healthy tissue; keeping tissue healthy is therefore the best prevention against infections; and this is best achieved by magnetic healing
  • 1896: DD claimed that 4 years earlier, in 1892, he had discovered the magnetic cure for cancer; it involved freeing the stomach and spleen of poisons
  • 1896: DD formulates his concept of treating the root cause of any disease
  • 1896, 10 July: DD, his wife and his brother turn the ‘Palmer School of Magnetic Cure’ in Davenport into an officially registered corporation
  • 1897: DD defines chiropractic as ‘a science of healing without drugs’
  • 1898: DD opens his first school of chiropractic in Davenport, the ‘Palmer School of Chiropractic’ which has survivied to the present day.
  • 1902, 27 April: DD first used the term ‘subluxation’ in a letter to his son BJ (‘… where you find the greatest heat, there you will find the subluxation causing the inflammation which produces the fever…’)
  • 1902: DD leaves suddenly for California, apparently to open a West Coast branch of the Palmer School; he stays for about two years and then returns to Davenport leaving behind substantial depts
  • 1902, 6 September: DD is arrested in Pasadena when a patient suffering from consumption dies after DD’s second adjustment; in October, the charges were dropped because of a technicality
  • 1903: DD opens the ‘Palmer Chiropractic School in Santa Barbara, California, together with his former student Oakley Smith
  • 1903 DD is charged with practising medicine without licence but, before the case goes to trial, DD goes to Chicago where he charters a school together two other chiropractors (Smith and Paxson); the project fails
  • 1903, 30 April: DD is back in Davenport for the wedding of BJ with Mabel
  • 1904, December: DD starts his new journal ‘The Chiropractor’ which survives until 1961. DD’s very first article is entitled ’17 Years of Practice’
  • 1905: DD’s former students Langworthy and Smith accuse DD of stealing the concepts of chiropractic from the Bohemian bonesetters of Iowa
  • 1905, 9 November: DD’s wife Villa overdoses on morphine and dies; the coroner is unable to tell whether she committed suicide or intended it for pain relief
  • 1906, 11 January: DD marries Mary Hunter, apparently his first love from Letts
  • 1906, 26 March: DD is again on trial for practising medicine without a licence. He is found guilty the next day. The penalty is US$ 350 or 105 days in jail. DD choses jail. However, his new wife, Mary, bails him out after 23 days.
  • 1906: DD sells his share in the chiropractic business to his son and moves to Medford Oklahoma. The reasons for this split are said to be personal, financial and professional
  • 1906, 4 June: in a letter to John Howard, DD accuses his son of dishonesty and of running the school badly
  • 1906: BJ and DD publish their opus maximus ‘Science of Chiropractic’; DD claims that most of the chapters were written by him
  • 1907, January: DD opens another grocery store
  • 1908: together with a colleague, DD opens the ‘Palmer-Gregory Chiropractic College’; it lasts only 9 weeks. DD leaves because he discovered that Alva Gregory, a medical doctor, was teaching medical ideas
  • 1908, 9 November: DD opens the ‘Palmer College of Chiropractic’ in Portland, Oregon
  • 1908, December: DD starts a new journal, ‘The Chiropractor’s Adjuster’; many of his articles focus on criticising BJ. The journal only seems to have survives until 1910
  • 1910, December: DD publishes his book ‘The Chiropractor’s Adjuster’.
  • 1911: DD toys with the idea of turning chiropractic into a religion, as this would avoid chiropractors being sued for practising medicine without a license
  • 1913: DD visits Davenport for the ‘Lyceum Parade’ where he is injured. Mary accuses BJ of striking his father with his car and thus indirectly causing his death, a version of events which is disputed
  • 1913, September: DD is back in California and writes to JB Olson that he gave 22 lectures in Davenport. DD also reports: ‘… On the return I cured a man of sun stroke by one thrust on the 5th dorsal. That is what I call definitive, specific, scientific chiropractic…’
  • 1913, 20 October: DD dies; the official cause of death is typhoid fever, a condition that he repeatedly claimed to be curable by a single spinal adjustment.
  • 1914: DD Palmer’s book ‘The Chiropractor’ is published.

Guest post by Richard Rasker

Almost two years ago, in March 2018, a group of 124 doctors and other medical professionals published an article in the French newspaper ‘Le Figaro’, warning the general public for the false promises, unproven claims and dangers of alternative medicine.

Homeopathy in particular is denounced as an unscientific belief in magic, utterly lacking in plausibility as well as in evidence of efficacy for any condition. Subjecting people to these kinds of unproven treatments is unethical, and may result in serious harm by delaying proper medical treatment. Also, homeopaths and other alternative practitioners often express anti-vaccine sentiments, endangering children by dissuading their parents from vaccination.

For these and several other reasons, these 124 medical professionals made an appeal for alternative and esoteric treatments to be excluded from the field of science-based medicine, and to stop reimbursement of homeopathic and other alternative treatments under France’s national health care insurance system.

In a somewhat belated response, French homeopaths are now filing no less than 63 disciplinary complaints with the French Medical Council against the signatories of the appeal in Le Figaro, apparently for “uncollegial behaviour” and “defiling medical ethics”. The homeopaths are represented by homeopathic doctor Daniel Scimeca, president of the French Federation of Homeopathic Societies, who also has close relations with Boiron laboratories, the biggest manufacturer of homeopathic products in the world.

At the time of this writing, 11 complaints have been adjudicated, resulting in 7 warnings, and 4 releases or dismissals. It is unclear how serious such a ‘warning’ should be taken, but it is clear that homeopaths are trying to punish real doctors for supporting and expressing an overwhelming scientific consensus, i.e. that there is no evidence whatsoever that homeopathy is actually good for anything.

And even though these French homeopaths do not resort to the sort of vile, underhanded media smear campaign perpetrated by the late Claus Fritzsche against Dr. Ernst, there are certain parallels – the most important of which is that proponents of unproven ‘medicine’ attempt to silence science-based criticism by unscientific means, instead of open discourse about the merits (or more precisely: the lack thereof) of their chosen profession.

I personally find it rather worrying that almost two-thirds of the complaints resulted in a slap on the wrist for the medical professional involved. Especially in a field that is so strongly dependent on both science and trust, well-founded criticism should be encouraged and made public, not punished and silenced.

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