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

malpractice

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Project 2025 is a set of proposals from the US Heritage Foundation to reform the US according to right-wing ideology and to consolidate executive power shouldTrump win the 2024 presidential election. The project is a most frightening blueprint for fascism in the US and would have serious implications for the rest of the world. It would also profoundly impact on healthcare (my expertise) in multiple ways.

Here are some of them:

According to Project 2025, the federal government should prohibit Medicare from negotiating drug prices and promote the Medicare Advantage program, which consists of private insurance plans. Federal healthcare providers should deny gender-affirming care to transgender people and eliminate insurance coverage of the morning-after-pill Ella. Project 2025 also suggests a number of ways to cut funding for Medicaid, such as caps on federal funding, limits on lifetime benefits per capita, and letting state governments impose stricter work requirements for beneficiaries of this program. Other proposals include limiting state use of provider taxes, eliminating preexisting federal beneficiary protections and requirements, increasing eligibility determinations and asset test determinations to make it harder to enroll in, apply for and renew Medicaid, providing an option to turn Medicaid into a voucher program, and eliminating federal oversight of state medicaid programs.

Project 2025 insists that life begins at conception. The Mandate says that the Department of Health and Human Services (HHS) should “return to being known as the Department of Life”. Project 2025 says it would reposition department policies “by explicitly rejecting the notion that abortion is health care and by restoring its mission statement under to include furthering the health and well-being of all Americans ‘from conception to natural death’.”

The project opposes any initiatives that, in its view, subsidize single parenthood. Project 2025 encourages the next administration to rescind some of the provisions of the Family Planning Services and Population Research Act of 1970, which offers reproductive healthcare services, and to require participating clinics to emphasize the importance of marriage to potential parents.

According to Project 2025, the Food and Drug Administration is “ethically and legally obliged to revisit and withdraw its initial approval” of the abortion pills mifepristone and misoprostol. It recommends that the Centers for Disease Control and Prevention “update its public messaging about the unsurpassed effectiveness of modern fertility awareness-based methods” of contraception, such as smartphone applications that track a woman’s menstrual cycle. The project also seeks to restore Trump-era “religious and moral exemptions” to contraceptive requirements under the Affordable Care Act, including emergency contraception, which it deems an abortifacient, to defund Planned Parenthood, and to remove protection of medical records involving abortions from criminal investigations if the owners of said records cross state lines.

Project 2025 aims to prohibit sending abortion pills and medical equipment used for abortions through the mail; the plan would allow criminal prosecution for senders and receivers of abortion pills. Project 2025 does not explicitly promote the prohibition of abortion, but some legal experts and abortion rights advocates said adopting the Project’s plan would cut off access to medical equipment used in surgical abortions to create a de facto national abortion ban.

Project 2025 advises the federal government to deprecate what it considers promotion of abortion and high-risk sexual behaviors among adolescents. It also seeks to remove the role of the Department of Health and Human Services in shaping sex education in the United States, arguing that this is tantamount to creating a monopoly.

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If you think this part on healthcare (within my area of expertise) is crazy or dangerous, you should see the rest of the document (not my area of expertise)!

Donald Trump tried hard to deny that he has anything to do with the project. But this as been largely in vain. However, the Democratic National Committee is rolling out a media blitz connecting him to it. This campaign will erect splashy billboards in major cities throughout the battleground states including Atlanta, Las Vegas, Raleigh, Charlotte, Philadelphia, Detroit, Lansing, Grand Rapids, Green Bay, and Phoenix.

Project 2025 is being staffed with countless members of Trump’s administration as well as close advisers. “I know nothing about Project 2025. I have not seen it, have no idea who is in charge of it, and, unlike our very well received Republican Platform, had nothing to do with it,” “Trump’s Plan to be a dictator day one: Project 2025. Google it,” reads one billboard. Another explains how Project 2025 will eviscerate our checks and balances, enable a Trump revenge tour, and ban abortion nationally. It is, in the truest sense, a blueprint for a fascist America.

It has been announced that advertisements for three supplement brands claiming to treat a range of medical conditions, including autism and ADHD, have been banned in the UK.

A paid-for Facebook advert for Aspire Nutrition in April said: “The secret weapon parents of ASD kids swear by”, while text in the form of a review attributed to “Tara K. Verified Buyer”, read: “This has helped my five-year-old with level two autism so much. “Within the first week his meltdowns decreased by 80%. He is communicating so much better… he is starting to show kindness and empathy to his little sister.” Further text read: “As parents of children with autism, we all share the same dream: to see our children thrive in school.”

Another paid-for Facebook ad in January, for Drop Supplements, stated: “For people with stress, anxiety, brain fog, ADHD … Happy Mind Drops – your new secret adaptogen against stress! Prepare yourself to unleash your true potential and banish your mental barriers.”

A third paid-for Facebook ad for Spectrum Awakening stated: “My five-year-old son Scout is diagnosed with receptive expressive language disorder and sensory disorder. Until I found Spectrum Awakening he could barely put a sentence together with very limited speech and words and lots of jargon.” It went on: “The first supplement we tried was Power and Focus and within the first three days he started using way more words. Within a week he was speaking sentences. I’m absolutely amazed that I can’t wait to order more.”

The Advertising Standards Authority (ASA) found that the claims that each supplement, or substances in them, could help to prevent, treat or cure autism breached regulations after investigations.

Aspire Nutrition said they had stopped sending adverts to UK residents who visited their website and had withdrawn the ad entirely for all audiences after being informed of the complaint. Drop Supplements said their adverts featuring Happy Mind made no direct or implied statements about curing, treating or preventing ailments or diseases. However, the ASA said the advert’s claims would be understood by most consumers as implied claims that the product could prevent, treat or cure human disease. Spectrum Awakening did not respond to the ASA’s inquiries.

The ASA told each firm to ensure their future advertising did not claim that food – in these cases in the form of a supplement – could prevent, treat or cure human disease.

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Such work by the ASA is most laudable, in my view. Misleading advertising is endangering the health of consumers thousands of times every day. However, the firms affected by the ASA reprimands are probably not all that worried. In fact, I imagine that they are laughing their heads off:

  • The chances of getting caught for misleading advertising are truly minimal.
  • If they are unlucky and do get caught the punishment is negligible.
  • There is little to stop them re-offending.

It is time that the ASA (and the equivalent organisations in other countries) get more power, more support and more money to effectively go after offenders in such a way that others think twice before breaking advertising rules.

To accuse anyone of an abuse of science is a hefty charge, I know. In the case of proponents of so-called alternative medicine (SCAM) doing science, it is, however, often justified. Let me explain this by using the example of chiropractors (I could have chosen homeopathy, faith heaalers, acupuncturists or almost any other type of SCAM professional, but in recent times it was the chiros who provided the clearest examples of abuse).

Science can be seen as a set of tools that is used to estabish the truth. In therapeutics, science is employed foremost to answer three questions:

  1. Is the therapy plausible?
  2. Is the therapy effective?
  3. Is the therapy safe?

The way to answer them is to falsify the underlying hypotheses, i.e. to demonstrate that:

  1. The therapy is not plausible.
  2. The therapy is not effective.
  3. The therapy is not safe.

Only if rigorous attempts at falsifying these hypotheses have falied can we conclude that:

  1. The therapy is plausible.
  2. The therapy is effective.
  3. The therapy is safe.

I know, this is rather elementary stuff. It is taught during the first lessons of any decent science course. Yet, proponents of SCAM are either not being properly taught or they are immune to even the most basic facts about science. On this blog, we regularly have the opportunity to observe exactly that when we read and are bewildered by the comments made by SCAM proponents. This is often clearest in the case of chiropractors.

  1. They cherry-pick the evidence to persuade us that their hallmark intervention, spinal manipulation, is plausible.
  2. They cherry-pick the evidence to persuade us that their hallmark intervention, spinal manipulation, is effective.
  3. They cherry-pick the evidence to persuade us that their hallmark intervention, spinal manipulation, is safe.

If they conduct research, they set up their investigations in such a way that they confirm their beliefs:

  1. Spinal manipulations are plausible.
  2. Spinal manipulations are effective.
  3. Spinal manipulations are safe.

In other words, they do not try to falsify hypotheses, but they do their very best to confirm them. And this, I am afraid, is nothing other than an abuse of science.

QED

And how can the average consumer (who may not always be in a position to realize whether a study is reliable or not) tell when such abuse of science is occurring? How can he or she decide who to trust and who not?

A simplest but sadly not fool-proof advice might consist in 2 main points:

  1. Never rely on a single study.
  2. Check whether there is a discrepancy in the results and views of SCAM proponents and independent experts; e.g.:
    • Chiropractors claim one thing, while independent scientists disagree or are unconvinced.
    • Homeopath claim one thing, while independent scientists disagree or are unconvinced.
    • Acupuncturists claim one thing, while independent scientists disagree or are unconvinced.
    • Energy healers claim one thing, while independent scientists disagree or are unconvinced.
    • Naturopaths claim one thing, while independent scientists disagree or are unconvinced.
    • Etc., etc.

In all of those cases, your alarm bells should ring and it might be wise to be cautious and avoid the treatment in question.

Yesterday, I stumbled across this remarkable notice. As it is in German, I took the libery of translating it for you:

Am 6. April 2024 war es wieder soweit: Die ÖGHM und die Schwabe Austria GmbH luden zur Verleihung des mit 4.000,- Euro dotierten Dr. Peithner Preises ein.

Dieses Mal wurde der Forschungspreis für die zwei eingereichte Arbeiten „Recommendations in the design and conduction of randomized controlled trials in human and veterinary homoeopathic medicine“ und „Recommendations for Designing, Conducting and Reporting Clinical Observational Studies in Homeopathic Veterinary Medicine“ an Katharina Gaertner, Klaus von Ammon, Philippa Fibert, Michael Frass, Martin Frei-Erb, Christien Klein-Laansma, Susanne Ulbrich-Zuerni und Petra Weiermayer vergeben.

Wir freuen uns sehr und gratulieren den Preisträger:innen zum verdienten Erfolg. Ein herzliches Dankeschön geht auch an die ÖGHM und die Schwabe Austria, die nicht nur mit diesem traditionellen Forschungspreis die Wissenschaft unterstützt.

Here is my translation:

On 6 April 2024, the time had come again: the ‘Austrian Society for Homeopathic Medicine’ (ÖGHM) and Schwabe Austria GmbH hosted the award ceremony for the Dr Peithner Prize, which is endowed with 4,000 euros.

This time, the research prize was awarded to Katharina Gaertner, Klaus von Ammon, Philippa Fibert, Michael Frass, Martin Frei-Erb, Christien Klein-Laansma, Susanne Ulbrich-Zuerni and Petra Weiermayer for the two submitted papers “Recommendations in the design and conduction of randomised controlled trials in human and veterinary homoeopathic medicine” and “Recommendations for Designing, Conducting and Reporting Clinical Observational Studies in Homeopathic Veterinary Medicine”.

We are delighted and congratulate the prizewinners on their well-deserved success. A big thank you also goes to the ÖGHM and Schwabe Austria, who support science with this traditional research prize.

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And where is the irony?

Firstly, homeopaths are not exactly the experts on how to conduct research.

Secondly, there are recommendations and guidelines for conducting clinical research (e.g. here), and there is no reason for homeopathy to not to adopt those.

Thirdly, and most importantly, to award a prize to Michael Frass for telling us how to do research is more than a little ironic. If anything, Frass could teach us a thing or two about how to falsify, fabricate and manipulate research results!

Jay Kennedy is an experienced chiropractor of some standing.

In “2018, ‘The American Chiropractor’ wrote this about Jay Kennedy:

Jay Kennedy, DC, is a 1987 graduate of Palmer Chiropractic College and maintains afull time practice in western Pennsylvania. He is the principal developer of the Kennedy Decompression Technique. Dr. Kennedy teaches his non-machine specific technique to practitioners who want to learn clinical expertise required to apply this increasingly mainstream therapy. Kennedy Decompression Technique Seminars are approved for CE through various Chiropractic Colleges.

‘The Dynamic Chiropractor’ published plenty of articles authored by Jay Kennedy.

I am telling you this because Jay Kennedy recently posted a comment which is far too important to be burried in the many other comments on this blog. I think it deserves full recognition and loud applause. I have therefore decided to take the unusual step and re-post it here as an entirely seperate post.

Here we go:

I was a DC for 30+ years and a notable one for the last 20 years. I taught 200+ seminars, wrote innumerable articles and taught at many chiropractic colleges. I had (3) private practices and was a technique “guru”: “Kennedy decompression technique” or KDT. We “certified” nearly 5000 DCs to be “decompression experts”!

Kdt still sells farcical traction-tables I developed and designed (labeled as “decompression systems”) as well as useless lasers, ultrasonic vibrators and other scam modalities to confound the DCs and milk the public. (I have been out of it for several years now).

I am not proud of the fact I made a lot of money both in practice and as a lying cultist-entrepreneur.

I have read your blog for several years and many of your books, especially related to Chiropractic. You are not mistaken and I do NOT believe you are biased, the fact that you define the practice as SCAM and a cult is absolutely the case. As has been said before it is “the world’s largest non-scientific healthcare delivery system”. I was fortunate many years ago to meet Stuart McGill PhD. It changed my practice considerably. I opened a gym and focused dramatically on exercise. I also had other income steams from selling bullshit equipment. The regrettable feature is chiropractors sell “treatments”…. Some of which superficially alter pain signals temporarily like many OTHER less expensive and less mendacious things. This “traps” many patients into an erroneous paradigm….one a DC is ready, willing and able to exploit. “Chiropractic treatments” NEVER get to the root of a problem, alter any disease-process or substantially improve a patient. Regrettably selling exercise simply WILL NOT garner the income that selling (and coercing) subluxation-elimination treatments will (and virtually NO DC has the experience or expertise a PT PhD has in that arena).

Interestingly when you do seminars as a chiropractor, most states make you sign a waiver stating that you will not disparage Chiropractic or discuss information that minimize the value of Chiropractic. Can you imagine medical seminars or a scientific seminar having such a waiver? Chiropractic is and has always been a moneymaking scheme. That doesn’t exclude the fact there are many chiropractors who buy into it as a supreme truth….just like Muslims who murder with the thought of getting directly to Heaven to start porking some virgins.

I have discovered most DCs are on the low IQ scale, have poor critical thinking skills and rarely question their golden-goose (or perhaps more sympathetically; never venture outside the bounds of the profession and its rhetoric and hyperbole. They have been effectively able to compartmentalize Chiropractic from rightful and accurate criticism). Most of the successful ones are of course entrepreneurs with ravenous appetites for money, prestige and approval (and have little or no interest in the “truth”…..oops I described myself I guess).

The majority however struggle to get by and are constantly seeking SOMETHING that might actually work. Thus 70%+ use and advertise “decompression”, Activators (and other ridiculous “adjusting guns”), drop-tables, energy-techniques, orthotics and whatever other nonsense some company advertises in Chiropractic Economics with a testimonial of how much money can be made. It always fascinated me that if “subluxation-reduction or elimination” was the solution for disease and pain WHY did the profession embrace all of these other nonsensical modalities? If your guess is: “chiropractic doesn’t really work”…give yourself a beer.

When you graduate as a DC you CAN ONLY be in private SCAM practice….no other opportunities exist. Is it really any wonder that lying is the only avenue available to support a practice and an income stream? Nope.

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I wish to express my thanks to Jay for his courage and honesty in writing these lines.

In a recent comment, our resident chiro, ‘Dr.’ Dale Thompson (alias ‘DC’), in an attempt to provide a rationale for the approach, provided a link to a definition of MAINTENANCE CARE:

Maintenance care is care given to people with chronic illnesses to maintain or slow a decline in their health or function. For example, exercise and physical therapy can minimize abnormal or painful positioning of the joints and may prevent or delay curvature of the spine in a person with muscular dystrophy.

Let’s for the moment ignore that this definition is not necessarily related to CHIROPRACTIC maintenance care and assume it describes the approach adequately. In this case, chiropractic maintenance care would be:

care given to people with chronic illnesses to maintain or slow a decline in their health or function.

That sounds almost reasonable and is very different from what I recently implied it is, namely sly scare mongering of greedy chiros to fleece vulnerable individuals.

So, who is closer to the truth, Dale or Edzard?

How is chiropractic maintenance care employed in ‘real life’?

One way of finding out might be to look at social media and see how chiropractic maintenance care is being promoted or written about. Here are the texts of recent Tweets that I found on 23/6 informing us on this issue:

  • Chiropractic care encompasses three main phases:  1. Acute / Intensive Care  2. Healing / Corrective Care  3. Wellness / Maintenance Care
  • Maintenance is key! Once you’ve completed your care plan, routine chiropractic visits can help keep you feeling your best. Think of it as preventative maintenance for your body; you deserve it!
  • Chiropractic maintenance care now encompasses all sorts of patients; no matter their history, symptoms or reasons for seeking a chiropractor
  • Chiropractic care goes beyond back pain relief!  It’s all about proactive health maintenance, not just reactive illness treatment. Discover the pathway to a healthier, more balanced life
  • Understanding the proper documentation and coding of maintenance care in your office will help you sleep better at night knowing you are doing this correctly.
  • Staying well with chiropractic has never been easier! Researchers have discovered that people who receive maintenance chiropractic care have better long term outcomes and may even be able to prevent future episodes of back pain. Interested in learning more? Give us a call today.
  • Researchers have discovered that people who receive maintenance chiropractic care have better long term outcomes and may even be able to prevent future episodes of back pain. Interested in learning more? Give us a call today!
  • Many patients willingly choose to keep getting regular, maintenance Chiropractic care. Just like going to the dentist periodically, spinal hygiene and chiropractic adjustments are part of a healthy lifestyle.
  • Consider your body as a biological machine, just like a car needing maintenance. Chiropractic care at The Joint provides essential upkeep, not just alleviating existing pain but also preventing future discomfort.
  • We advocate regular maintenance Chiropractic care to keep your spine and posture in as great shape as possible. If you have not been to the clinic for a while, why not call our reception team
  • When you finally get that special car you always wanted; you don’t want to trust just anybody for care & maintenance. The same is true with your healthcare.
  • Around 22 million Americans turn to chiropractic care each year for pain relief, holistic healing, and preventive maintenance!  Experience natural, non-invasive solutions that keep you feeling your best. Discover the benefits today!
  • We believe in the beauty of regular maintenance care. Nurture your well-being & witness the transformative difference in your life
  • Chiropractic and Maintenance Care “Do I need to keep coming back for treatment to prevent this from happening again?” This method of chiropractic care is known as Maintenance care.
  • If you are wanting to improve your overall quality of life. Maintenance care is very important
  • Chiropractic “discharge” plans are always something else. “Patient has no pain or complaints and is released from regular chiropractic care. She is recommended to return 4x/mo for maintenance care“. I’m not sure there is a profession that I think less of.

I ought to stress that most of these Tweets were accompanied by pictures of patients receiving spinal manipulations.

Who then is correct, Dale or Edzard?

I let you decide.

An article in ‘METRO’  caught my eye – not least because it quotes me. Here are a few edited excerpts:

Peter Stott lost his first wife to cancer in 1998. Her death, he believes, was due to geopathic stress (GS) – harmful energies that originate from the Earth. ‘I found out that the house where we had lived had a serious GS problem,’ he says. The discovery prompted him to become a professional ‘dowser’, devoting his life to finding and managing geopathic stress.

But what exactly is this mysterious force erupting from the surface of the Earth – and can it really harm people?Geopathic stress is said to cause discomfort and health issues for certain individuals. These energies, also called ‘harmful Earth rays’ by believers, can be detrimental, beneficial or neutral according to those who think they are ‘in the know’.

Peter Stott
Peter Stott is a professional dowser

The word ‘geopathic’ is derived from the Greek words ‘Geo’ meaning the Earth and ‘pathos’, meaning disease or suffering – hence the term pathogens, the medical terms for bugs that make us ill.

Dowsing, practitioners say, is a method used to detect the presence of various subtle Earth energies and assess their nature and quality. They argue that some of these energies can be linked to geomagnetic anomalies caused by flowing underground water, dry faults and fissures, subterranean cavities, or mineral and crystal deposits.

Dowsing is carried out by a dowser, practitioners who try to find the source of these energies using special tools, such as pendulums, rods, and bobbers – essentially sexed-up tree branches. The person holds the tool, waiting for it to move or react, which they take as a sign that they’ve found what they’re looking for. The odd practice can allegedly also be used to identify leaks, stress fractures, environmental pollutants, electromagnetic fields, nutritional deficiencies, black spots, and, rather oddly, sexing pigeons.

Peter claims that a skilled dowser effectively advises on the optimal placement of buildings and structures to mitigate the impact of geopathic stress, and often possesses the ability to reduce or eliminate it through the use of various methods. He emphasises the fact that GS ‘does not affect everybody in the same way. Cancer has been described as “a disease of location”,’ he says. ‘And if there is a family history of cancer – as there was in my late wife’s case – a person can be more susceptible to GS being a contributing factor in succumbing to the disease.’ Peter believes that GS impacts our immune system, depleting its resources and hindering its ability to function optimally. By eliminating GS from our surroundings, we allow our immune system to operate more efficiently, he contends. Our susceptibility to GS varies, he says, with some experiencing mild symptoms like sleep disturbances and fatigue, while others may face more severe health issues such as arthritis, multiple sclerosis and cancer.

17th Century dowsing illustration
Dowsing has been around for millennia (Picture: Getty)

In 2017, rather incredibly, a report revealed that 10 out of 12 water companies in the UK were employing the practice of water dowsing to identify and locate leaks. Even more incredibly, last year, it emerged that Thames Water and Severn Trent Water were still using this form of ‘witchcraft’ for leak detection, despite scientific research indicating its lack of efficacy.

But water companies aren’t the only ones turning to dowsers for help. Peter believes that ‘it is also possible to carry a token or amulet on your person that has been imbued with the powers of protection by someone who is proficient in [dowsing]’. ‘This can protect you from GS and other detrimental energies wherever you go anywhere throughout the world,’ he claims. ‘Other protection techniques can also offer a degree of protection.’

However, Dr Edzard Ernst, a man who has dedicated years of his life to examining questionable, science-based claims, won’t be enlisting the services of a GS specialist or house healer anytime soon. ‘Geopathic stress cannot cause health problems for the simple reason that it does not exist,’ says the retired physician. ‘It is a sly invention of quacks who exploit gullible consumers. The methods to diagnose GS are as bogus as the ones that allegedly treat it. But the quacks don’t mind – as long as the consumer pays.’

Peter fully acknowledges ‘that dowsing and this work in general is not a catch-all solution for every ailment or every person’s situation’. ‘However, often we are approached by people who are “at the end of their tether” due to their exasperation of experiencing events or circumstances in their lives that are not well catered for in the mainstream wellbeing sector,’ he says. ‘I can only speak personally, I cannot speak for the possibly tens of thousands of dowsers around the world. If our work can help ease a person’s experience of life then that is a good enough reason to continue to help where I can’. He adds that ‘we are never going to change the minds of people like Dr Edzard Ernst’, someone ‘who seems to focus exclusively on debunking anything for which there is not a scientific explanation’. Moreover, science, he notes, ‘is moving on with research done into quantum physics and the theory that everything in the universe is connected and is also accessible to everyone’.

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Oh, dear Peter!

Perhaps you should learn the difference between critical evaluation and debunking (this ‘debunker’ has shown more forms of so-called alternative medicine (SCAM) to be worthy of integrating into the NHS than anyone else).

Perhaps you should read up about the difference between evidence and belief?

And perhaps the chapter on dowsing in my book could help you in this endeavour:

Dowsing is a common but unproven method for divining water and other materials. In alternative medicine, it is sometimes used as a technique for diagnosing diseases or the causes of health problems.

      1. Dowsers employ a motor automatism, amplified through a pendulum, divining rod or similar device. The effect is that the device seemingly provides an independent, visible reaction, while the dowser is, in fact, its true cause.
      2. Dowsing is used by some homeopaths as an aid to prescribe the optimal remedy and as a tool for identify a miasm or toxin load.
      3. The assumptions upon which dowsing is based lack plausibility.
      4. Dowsing has not often been submitted to clinical trials.
      5. All rigorous attempts to test water dowsing have failed, and it is no longer considered a viable method for this purpose.
      6. The only randomized double-blind trial that has tested whether homeopaths are able to distinguish between a homeopathic remedy and placebo by dowsing failed to show that it is a valid method. Its authors (well-known homeopaths) drew the following conclusion: “These results, wholly negative, add to doubts whether dowsing in this context can yield objective information.”[1]
      7. If dowsing is employed for differentiating between truly effective treatments (rather than homeopathic remedies), the risk of false choices would be intolerably high, and serious harm would inevitably be the result.

[1] McCarney et al. (2002).

 

‘Chiropractic economics’ might be when chiropractors manipulate their bank accounts or tax returns, I thought. But, no, it is a publication! And a weird one at that – it even promotes the crazy idea of maintenance care:

The concept of chiropractic maintenance care has evolved significantly. Initially seen as a method for managing chronic pain, it now includes a broader range of patients and focuses on overall wellness. Modern maintenance care aims to keep patients healthy regardless of their symptoms or history, alleviating and preventing pain through regular, prolonged care. This approach is largely preventive, serving as both secondary and tertiary care.  Studies show chiropractic maintenance care often includes diverse treatments such as manual therapy, stress managementnutrition advice and more, with flexible intervals typically around three months. This evolution underscores the importance of evidence-based, individualized patient care. This article shares the evolution of chiropractic maintenance care, looks at what a modern maintenance care appointment can include and explores best practices for DC maintenance care in 2024. 

Knowledge of chiropractic maintenance care has evolved over the years. In the past, maintenance care in the chiropractic world was often viewed as a way to keep patients going; particularly those suffering from chronic conditions that needed routine care for pain management and prevention. In the last several years, chiropractic maintenance care has changed; no longer does it only involve pain prevention and management for those with chronic conditions. It now encompasses all sorts of patients; no matter their history, symptoms or reasons for seeking a DC…

An interview study of Danish chiropractic care showed maintenance care sessions included a range of treatment modalities, including manual treatment and ordinary examinations alongside multiple packages of holistic additions, like stress management, diet, weight loss, advice on ergonomics, exercise and more. In other anecdotal accounts, chiropractic maintenance care seemed to follow a more traditional guideline of lower back pain management and adjustment. The study hypothesized that maintenance care could also help patients from a knowledge perspective, stating, “DCs could obviously play an important role here as ‘back pain coaches,’ as the long-term relationship would ensure knowledge of the patient and trust towards the DC.” 

Researchers found that three-month intervals were the most common spacing of maintenance care treatments for patients. Most commonly, patients sought or scheduled chiropractic maintenance care over the course of one to three months.  

Chiropractic maintenance care has evolved past simply being a method of ongoing chronic pain management. Today’s patients want to achieve overall wellness, and regular trips to their DC can become a part of that if you work to transition patients into a wellness plan after their acute phase of care is over. 

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The author of this article seems to have forgotten two little details:

  1. Chiropractic maintenance care is not supported by sound evidence, particularly in relation to economics (even the above cited paper stated: “We found no studies of cost-effectiveness of Maintenance Care”).
  2. Chiropractic maintenance only serves one economic purpose: it boosts the chiropractors’ income.

Yes, easy to forget, particularly if your name is ‘Chiropractic Economics’.

And also easy to forget that maintenance care would, of course, require informed consent. How would that look like?

Chiro (C) to patient (P):

If you agree, we will start a program that we call maintenance care.

P: Can you explain?

C: It consists of regular sessions of spinal manipulations.

P: That’s all?

C: No, I will also give you advice on keeping fit and living healthily.

P: Why do I need that?

C: It’s a bit like servicing your car so that it works reliably when you need it.

P: Is it proven to work?

C: Yes, of course, there are tons of evidence to show that a healthy life style is good for you.

P: I know, but I don’t need a chiro for that – what I meant do the manipulations keep my body healthy even if I have no symptoms?

C: The evidence is not really great.

P: And the risks?

C: Well, yes, if I’m honest, spinal manipulations can cause harm.

P: So, to be clear: you ask me to agree to a program that has no proven benefit and might cause harm?

C: I would not put it like that.

P: And how much would it cost?

C: Not much; just a couple of hundred per year.

P: Thanks – but no thanks.

It goes without saing that an article entitled Homeopathic Cancer Therapy Research From 2018 To 2022: A Review of the Literatureinterests me. It turned out to be a revellation in BS. Let me just show you its conclusion:

There continues to be an enormous interest in homeopathic treatment for cancer around the world. This is reflected by the number or studies and the increasingly better quality of studies investigating homeopathic cancer therapy. Some studies appear to signal a concern about lacking information among conventionally trained physicians on homeopathy and their limited ability to respond adequately to the increased demand among patients for homeopathic services. While it is still primarily patients rather than physicians that drive this mounting interest, studies reflect a rise in interest and call for innovation, in provision of integrative cancer treatment by combining multiple conventional and unconventional therapies. According to the majority of available studies, homeopathy can safely be added to conventional cancer treatment, and patients can benefit significantly in countering the adverse effects from that treatment, as well as improvement of their quality of life and survival.

In one our previous reviews of scientific research on homeopathic cancer treatment we had concluded that available studies confirm, “homeopathic drugs have proven biological action in cancer; in vitro and in vivo; in animals and humans; in the lower, as well as in the higher potencies. Cancer patients are faced with a life-and-death decision when choosing their treatment. Since most conventional treatments continue to be associated with severe adverse and sometimes fatal effects, while homeopathy has been found to be free from such effects, it would seem plausible and worthwhile, even urgent, to step up the research on, and even the provision of, homeopathic treatment of cancer and other diseases.”

This conclusion continues to apply to the time period covered in this review of published research on homeopathic cancer treatment.

What a remarkable few sentences!

Please allow me put the record straight on a few points:

  1. enormous interest in homeopathic treatment for cancer around the world – NOT TRUE.
  2. increasingly better quality of studies investigating homeopathic cancer therapy – WISHFUL THINKING, NOT SUPPORTED BY EVIDENCE.
  3. concern about lacking information among conventionally trained physicians on homeopathy and their limited ability to respond adequately to the increased demand – CONCERN IS, IN FACT, DIRECTED AT CHARLATANS USING OR PROMOTING HOMEOPATHY.
  4. homeopathy can safely be added to conventional cancer treatment – YES, BECAUSE IT IS A PLACEBO.
  5. patients can benefit significantly in countering the adverse effects from that treatment, as well as improvement of their quality of life and survival – ONLY IF, LIKE PROFESSOR MICHAEL FRASS, ONE FALSIFIES DATA.
  6. homeopathic drugs have proven biological action in cancer – NO.
  7. it would seem plausible and worthwhile, even urgent, to step up the research on, and even the provision of, homeopathic treatment of cancer and other diseases – NO, ACCORDING TO A BROAD INTERNATIONAL CONSENSUS, SUCH RESEARCH WOULD BE AN UNETHICAL WASTE OF RESOURCES.

The truth of the matter is that homeopathy for cancer is a dangerous misconception that could hasten the death of many vulnerable patients.

Those who promote it are amongst the worst charlatans on the planet.

As pointed out previously on this blog, unethical research practices are prevalent in China, but little research has focused on the causes of these practices.

Drawing on the criminology literature on organisational deviance, as well as the concept of cengceng jiama, which illustrates the increase of pressure in the process of policy implementation within a top-down bureaucratic hierarchy, this article develops an institutional analysis of research misconduct in Chinese universities. It examines both universities and the policy environment of Chinese universities as contexts for research misconduct. Specifically, this article focuses on China’s Double First-Class University Initiative and its impact on elite universities that respond to the policy by generating new incentive structures to promote research quality and productivity as well as granting faculties and departments greater flexibility in terms of setting high promotion criteria concerning research productivity. This generates enormous institutional tensions and strains, encouraging and sometimes even compelling individual researchers who wish to survive to decouple their daily research activities from ethical research norms. The article is written based on empirical data collected from three elite universities as well as a review of policy documents, universities’ internal documents, and news articles.

The interviewer, sociologist Zhang Xinqu, and his colleague Wang Peng, a criminologist, both at the University of Hong Kong, suggest that researchers felt compelled, and even encouraged, to engage in misconduct to protect their jobs. This pressure, they conclude, ultimately came from a Chinese programme to create globally recognized universities. The programme prompted some Chinese institutions to set ambitious publishing targets, they say. In 2015, the Chinese government introduced the Double First-Class Initiative to establish “world-class” universities and disciplines. Universities selected for inclusion in the programme receive extra funding, whereas those that perform poorly risk being delisted, says Wang.

Between May 2021 and April 2022, Zhang conducted anonymous virtual interviews with 30 faculty members and 5 students in the natural sciences at three of these elite universities. The interviewees included a president, deans and department heads. The researchers also analysed internal university documents.

The university decision-makers who were interviewed at all three institutes said they understood it to be their responsibility to interpret the goals of the Double First-Class scheme. They determined that, to remain on the programme, their universities needed to increase their standing in international rankings — and that, for that to happen, their researchers needed to publish more articles in international journals indexed in databases such as the Science Citation Index. As the directive moved down the institutional hierarchy, pressure to perform at those institutes increased. University departments set specific and hard-to-reach publishing criteria for academics to gain promotion and tenure. Some researchers admitted to engaging in unethical research practices for fear of losing their jobs. In one interview, a faculty head said: “If anyone cannot meet the criteria [concerning publications], I suggest that they leave as soon as possible.”

Zhang and Wang describe researchers using services to write their papers for them, falsifying data, plagiarizing, exploiting students without offering authorship and bribing journal editors. One interviewee admitted to paying for access to a data set. “I bought access to an official archive and altered the data to support my hypotheses.” An associate dean emphasized the primacy of the publishing goal. “We should not be overly stringent in identifying and punishing research misconduct, as it hinders our scholars’ research efficiency.”

The larger problem, says Xiaotian Chen, a library and information scientist at Bradley University in Peoria, Illinois, is a lack of transparency and of systems to detect and deter misconduct in China. Most people do the right thing, despite the pressure to publish, says Chen, who has studied research misconduct in China. The pressure described in the paper could just be “an excuse to cheat”.

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It is hard not to be reminded of what I reported in a recent post where it has been announced that a Chinese acupuncture review was retracted:

The research “Acupuncture for low back and/or pelvic pain during pregnancy: a systematic review and meta-analysis of randomised controlled trials,” published in the open access journal BMJ Open in 2022, has been retracted.

This research was press released in November 2022 under the title of “Acupuncture can relieve lower back/pelvic pain often experienced during pregnancy.”

Following publication of the research, various issues concerning its design and reporting methods came to light, none of which was amenable to correction, prompting the decision to retract.

The full wording of the retraction notice, which will be published at 23.30 hours UK (BST) time Tuesday 11 June 2024, is set out below:

“After publication, multiple issues were raised with the journal concerning the design and reporting of the study. The editors and integrity team investigated the issues with the authors. There were fundamental flaws with the research, including the control group selection and data extraction, not amenable to correction.” doi:10.1136/bmjopen-2021-056878ret

Please ensure that you no longer cite this research in any future reporting.

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After studying Chinese TCM papers for more than 30 years, I feel increasingly concerned about the tsumani of either very poor quality or fabricated research coming out of China. For more details, please read the following posts:

 

 

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