malpractice
When I was still at Exeter, I used to do an average of about 4 peer reviews per week of articles that had been submitted to all sorts of journals for publication. Now I reject most of these invitations and do perhaps just one per month.
Why?
Conducting a peer review is by no means an easy task. You have to realize that the authors have usually put a lot of hard work into their paper and a lot may depend on it in terms of their future. They thus have the right to receive a fair and responsible review. To do the job properly, it took me (even with plenty of experience in reading scientific papers) between 1 and 3 hours per article. Crucially, low-quality articles typically submitted to low-quality journals are more work than papers that adhere to a certain standard.
I do not think that the journal editors who send the submissions out for review appreciate how much work they ask from the reviewers. They normally pay nothing (even if they charge exorbitant handling fees from the authors) and offer you no benefit at all. In addition, many have systems that are more than tedious asking you to register, create a pin number, etc., etc. Then you have to follow certain rules and formats that differ from journal to journal. In a word, they add an administrative burden to the task of reading, understanding, checking a paper, and composing your judgment on it.
All this can be cumbersome but it’s not the reason why I do less and less peer reviews. The true reason is that research papers on so-called alternative medicine (SCAM) are now mostly published in one of the many 3rd class SCAM journals that have recently sprung up. There are so many of them that they, of course, struggle to get enough articles to fill their pages. In turn, this means that they are far too keen to publish anything regardless of its quality or validity. As a consequence, the quality of these articles and their authors are often dismal.
Here is an example of a (rather shocking but not unusual) email I received only today; it might show you what I mean:
Dear Professor!
…
I want to publish some papers in “Areas related to your research field”. Can you help me? I can provide a thank you fee!
For example, I will give you a $2000 thank you fee for helping me write articles. For example, if you add my name to your article, I will give you a $1000 thank you fee. Or I can help you pay for APC.
I know this email is presumptuous, but my friends and I need to publish dozens of papers every year. If you can help me, we can cooperate for a long time. I’m not kidding, I’m very sincere!
If you are offended, please forgive me!
Look forward to your reply!
Warmly Wishes, …
When I do a review for a low-quality SCAM journal and find major defects in an article, my experience has been that the editor then decides to publish it nonetheless. When this happens, I feel frustrated and ask myself: WHY DID THEY ASK FOR MY OPINION IF THEY DO NOT ABIDE BY IT?
Thus I decided that these journals are just as well off without my contributions. So, if you are an editor of a SCAM journal, do me a favor and do not molest me with your invitations to conduct a peer review and
COUNT ME OUT!
‘Agoro’ is a German (all texts are my translations from German) website that claims this:
“We specialize in alternative methods of treatment from the field of natural medicine. Our mission is to ensure that the ancient wisdom of our grandparents and ancestors is not forgotten.”
Unsurprisingly, this subject interests me. In particular, I was fascinated by an article entitled
Nux vomica Globuli in der Homöopathie
Nux Vomica in homeopathy
Nux vomica is (after arnica) amongst the most popular remedies in homeopathy. Therefore, we should all be keen to learn all about it.
Here is the translation of this article:
Nux vomica is one of the homeopathic remedies that you can get in all pharmacies. It can help you with various diseases, such as stomach pain. You can also use this homeopathic remedy for nausea and heartburn. You can buy it in the city pharmacies, but you can also make it easy for yourself and use the online pharmacy for globules. Here you will be well advised on the dosage of homeopathic remedies. Similarly, you can also contact the homeopath or naturopath for good advice.
Nux vomica is a remedy derived from the medicinal plant nux vomica. You can use the homeopathic remedy in the potencies D6 and D12. In some cases, it can be recommended to you also in C6, C12, or C30.
You can use the homeopathic remedy in many ways, including for constipation or exhaustion. You will find out which dosage you can take if you consult a professional. In this way, you will be recommended the appropriate potency to experience help from it.
It is crucial that you always seek advice before taking the remedy. As already mentioned, you can use several contact points for this. Whether it is the pharmacy, the naturopath, or the homeopath. In addition, there are many family doctors who now also use homeopathy and could recommend you the appropriate dosage. The consultation is important in any case because the homeopathy must be adapted to your complaints. Otherwise, the remedy will not work or will not work properly.
If you want to use the remedy for yourself, you always need patience. Homeopathic remedies need a little time to work, that is their only disadvantage. How long this always depends on the person and the remedy. Sometimes it takes only a few hours, sometimes a few days or weeks. You can also get advice on this.
Indications for nux vomica
Stomach and intestinal problems
You can use the remedy for you in case of abdominal pain, mild biliousness, and various stomach and intestinal problems. The remedy can also be of great help for nausea, flatulence, nausea, and constipation.
Headaches and migraines
The remedy Nux vomica can help you if you suffer from headaches that are located just above the eye. It can also help you with migraines. Even with a hangover, the remedy could help.
Moods
If you suffer from autumn depression or are often easily frustrated, you can use the remedy.
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Yes, I do get easily frustrated with texts like this!
But I doubt that nux vomica can help me with this or any other problem.
Some might say that doubting is not good enough, evidence is needed!
I agree but was unable to find sound evidence to show that homeopathic nux vomica was better than a placebo for any condition (in case any of our regular defenders of homeopathy know more, please let me know). On the contrary, I only found studies that suggested its ineffectiveness. Here is an example:
In a monocenter prospective randomized double-blind clinical trial the efficacy of homeopathic treatment was investigated on children with adenoid vegetations justifying an operation. Patients were treated with either homeopathic remedies such as Nux vomica D200, Okoubaka D3, Tuberculinum D200, Barium jodatum D4 and Barium jodatum D6 or with placebo. The duration of the study for each patient was 3 months. Examination of the ears using a microscope, rhinoscopy, stomatoscopy and pharyngoscopy, as well as tympanometry and audiometry were performed after 4, 8 and 12 weeks. Out of a total of 97 children studied between the ages of 4 to 10 years 82 could be analyzed. At the end of the study no operation was required in 70.7% of the placebo-treated children and in 78.1% of the children treated with homeopathic preparations. These results show no statistical significance.
So, where does that leave us in relation to the “ancient wisdom of our grandparents and ancestors“? I fear, that this story shows yet again that, when it comes to homeopathy, the scrutiny of ancient wisdom quickly turns it into old bullshit.
I recently came across this editorial from the NEJM. I find it extremely relevant to the many discussions we have about so-called alternative medicine (SCAM) we have on this blog. I, therefore, take the liberty to copy a small section of it here without further comment, and encourage everyone to read the full paper:
…expertise and authority are increasingly seen as means for elites to establish and support existing hierarchies. There is, of course, some substance to this argument: although orthodox doctors may believe that their dominance and privilege are attributable to the rigor of the methods they use and that other schools of medicine were vanquished because of the superior results achieved by science-based practice, another version of the story sees the suppression of other approaches to healing (e.g., naturopathy, homeopathy, or chiropractic) as the result of ruthless actions by the American Medical Association and other forms of organized medicine. These critiques aren’t new; as Lewis Grossman writes in Choose Your Medicine, “medical freedom” arguments have long been used to oppose institutions intended to protect consumers, such as medical licensure and the FDA.3 The difference today is that the antiexpertise perspective has moved into the mainstream. With Google and Amazon having created a world in which people can frictionlessly obtain both information and nearly any product they want, it’s not hard to portray expert gatekeepers as barriers to patients’ ability to exercise choice.
Perhaps the most substantial threat to expertise is that members of the public are coming to believe that facts don’t exist — that all facts are political and therefore a matter of opinion. This mindset is fundamentally incompatible with the scientific practice of medicine, which depends on a shared commitment to backing up hypotheses with empirical evidence. Indeed, modern medicine owes much of its privileged position to a broad acceptance that the methods it uses can be relied on to make medical choices that are likely to do more good than harm.
A 1902 Supreme Court case, American School of Magnetic Healing v. McAnnulty, offers an instructive example of what could happen if all medical facts were seen as purely matters of opinion. The American School of Magnetic Healing in Nevada, Missouri, received 3000 pieces of mail every day, largely consisting of checks, money orders, and cash to purchase the healing services that the school advertised in newspapers throughout the United States. Patients who sent payments were instructed to lie down at a specified time wherever they were, and the healers at the magnetic school would, from Nevada, channel the healing energy of the universe into their bodies to heal them.3 The Post Office Department (which predated the Postal Service) concluded that this practice was a fraudulent operation using the mail and, after a hearing conducted by the postmaster general, stopped delivering mail to the school. The school sued, and the case went to the Supreme Court, which found in its favor.
Writing for the Court, Justice Rufus Peckham essentially rejected the existence of medical facts. “Just exactly to what extent the mental condition affects the body,” he wrote, “no one can accurately and definitely say.… Because the [school] might or did claim to be able to effect cures by reason of working upon and affecting the mental powers of the individual… who can say that it is a fraud?… Those who might deny the existence or virtue of the remedy would only differ in opinion from those who assert it. There is no exact standard of absolute truth by which to prove the assertion false and a fraud.”4 Although this decision was never expressly overruled, both Congress and the courts have since rejected the premise that the efficacy of treatments is purely a matter of opinion.
Differences of opinion within medicine are necessary for progress, and both licensing and certifying boards must therefore be careful to leave room for the expression of divergent views. Moreover, there is ongoing debate regarding the extent to which free-speech protections cover professional speech. But despite the existence of divergent views and areas for legitimate debate, there are some opinions that have been so thoroughly repudiated by existing evidence as to be considered definitively wrong.5 Constructive debates are possible only within a shared epistemic framework and with a commitment to the idea of verifiable facts. It’s incumbent on licensing and certifying boards to defend the existence of facts and to give the public a way to know when practitioners are making claims that are incompatible with reality.
When it comes to disciplining doctors, boards haven’t always lived up to public expectations — but that’s not a reason they should fall short yet again, especially during a lethal pandemic. Although there are many gray areas in medicine, some propositions are objectively wrong. For example, when a licensed physician insists that viruses don’t cause disease or that Covid-19 vaccines magnetize people or connect them to cell towers, professional bodies must be able to take action in support of fact- and evidence-based practice.
The public relies on the medical profession in times of grievous vulnerability and need. For the profession to earn and maintain the public’s trust — along with the privileges associated with the status of being licensed practitioners — medical boards must be able to differentiate practitioners who are providing fact-based advice from those who are not.
On this blog, we are often told that only a few chiros still believe in Palmer’s gospel of subluxation. This 2023 article seems to tell a different story.
The authors claim that the term demonstrates the widespread use and acceptance of the term subluxation and
acknowledges the broader chiropractic interpretation by recognition and adoption of the term outside the profession. In particular, it emphasizes the medical recognition supported by some of the medical evidence incorporating the
construct of a chiropractic vertebral subluxation complex and its utilization in practice.
The vertebral subluxation concept is similar to the terms spinal dysfunction, somatic dysfunction, segmental dysfunction or the vague vertebral lesion. These terms are primarily used by osteopaths, physiotherapists, and medical doctors to focus their manipulative techniques, but they relate primarily to the physical-mechanical aspects. In this respect, these terms are limited in what they signify. The implication of just plain osseous biomechanical dysfunction does not incorporate the wider ramifications of integrated neural, vascular, and internal associations which may involve greater ramifications, and should be more appropriately referred to as a vertebral subluxation complex (VSC).
The authors also claim that, in recognition of acceptance of the subluxation terminology, a 2015 study in North America found that a majority of the 7,455 chiropractic students surveyed agreed or strongly agreed (61.4%) that
the emphasis of chiropractic intervention in practice is to eliminate vertebral subluxations/vertebral subluxation complexes. A further 15.2% neutral, and only 23.3% disagreeing. It is suggested that ‘modulation’ of vertebral subluxations may have attracted an even higher rate of agreement.
The authors conclude that the evidence indicates that medicine, osteopathy, and physiotherapy have all
used the term ‘subluxation’ in the chiropractic sense. However, the more appropriate, and inclusive descriptive term of vertebral subluxation complex is widely adopted in chiropractic and the WHO ICD-10. It would be most incongruous for chiropractic to move away from using subluxation when it is so well established.
A move to deny clarity to the essence of chiropractic may well affect the public image of the profession. As Hart states ‘Identifying the chiropractic profession with a focus on vertebral subluxation would give the profession uniqueness not duplicated by other health care professions and, therefore, might legitimatise the existence of chiropractic as a health care profession. An identity having a focus on vertebral subluxation would also be consistent with the original intent of the founding of the chiropractic profession.’
The term ‘vertebral subluxation’ has been in general use and understanding in the chiropractic profession as is ‘chiropractic subluxation’ and ‘vertebral subluxation complex’ (VSC). It is a part of the profession’s heritage. Critics of concepts regarding subluxation offer no original evidence to support their case, and that appears to be just political opinion rather than providing evidence to substantiate their stand.
The evidence presented in this paper supports the contention that there would be no vertebrogenic symptoms associated with physiologically normal vertebral segments. The term designated by chiropractors to identify abnormal or pathophysiological segmental dysfunction is the vertebral subluxation. It has been a part of chiropractic heritage for over 120 years.
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Vis a vis such a diatribe of compact BS, I am tempted to point out that “critics of concepts regarding subluxation offer no original evidence to support their case” mainly because it is not they who have to produce the evidence. It is the chiropractic profession that needs to do that.
But they are evidently unable to do it.
Why?
Because chiropractic subluxation is a myth and an invention by their chief charlatan.
It is true that this fabrication is intimately linked to the identity of chiropractic.
It is furthermore true that chiros feel unable to throw it overboard because they would lose their identity.
What follows is simple:
Chiropractic is a fraud.
Kratom (Mitragyna speciosa) belongs to the coffee family. It’s found in Southeast Asia and Africa. Traditionally, people have:
- Chewed kratom leaves.
- Made kratom tea to fight tiredness and improve productivity.
- Used kratom as medicine.
- Substituted kratom for opium.
- Used kratom during religious ceremonies.
Low doses of kratom can make you more alert, and higher doses can cause:
- Decreased pain.
- Pleasure.
- Sedation.
The mechanism of action seems to be that two of the compounds in kratom (mitragynine and 7-hydroxymitragynine) interact with opioid receptors in your brain.
Kratom is thus being promoted as a pain remedy that is safer than traditional opioids, an effective addiction withdrawal aid, and a pleasurable recreational tonic. But kratom is, in fact, a dangerous and unregulated drug that can be purchased on the Internet, a habit-forming substance that authorities say can result in opioid-like abuse and death.
The Food and Drug Administration (FDA) warned that kratom possesses the properties of an opioid, thus escalating the government’s effort to slow the usage of this alternative pain reliever. The FDA stated that the number of deaths associated with kratom use has increased. Now further concerns have emerged.
This review enumerates seven outbreaks of kratom (Mitragyna speciosa) product adulteration and contamination in the context of the United States Dietary Supplement Health and Education Act (DSHEA).
At least seven distinct episodes of kratom product contamination or adulteration are known:
- (1) krypton, a kratom product adulterated with O-desmethyltramadol that resulted in at least nine fatal poisonings;
- (2) a suspected case of kratom contamination with hydrocodone and morphine;
- (3) a case of kratom adulteration with phenylethylamine;
- (4) contamination of multiple kratom products with heavy metals;
- (5) contamination of kratom products by multiple Salmonella enterica serotypes;
- (6) exposure of federal agents raiding a synthetic cannabinoid laboratory to kratom alkaloids;
- (7) suspected kratom product adulteration with exogenous 7-hydroxymitragynine.
The authors concluded that inadequate supplement regulation contributed to multiple examples of kratom contamination and adulteration, illustrating the potential for future such episodes involving kratom and other herbal supplements.
A recent article in ‘The Lancet Regional Health‘ emphasized the “need for reimagining India’s health system and the importance of an inclusive approach for Universal Health Coverage” by employing traditional medicine, including homeopathy. This prompted a response by Siddhesh Zadey that I consider worthy of reproducing here in abbreviated form:
… Since the first trial conducted in 1835 that questioned homeopathy’s efficacy, multiple randomized controlled trials (RCTs) and other studies compiled in several systematic reviews and meta-analyses have shown that there is no reliable and clinically significant effect of non-individualized or individualized homeopathic treatments across disease conditions ranging from irritable bowel syndrome in adults to acute respiratory tract infections in children when compared to placebo or other treatments. Even reviews that support homeopathy’s efficacy consistently caution about low quality of evidence and raise questions on its clinical use. The most recent analysis of reporting bias in homeopathic trials depicted problematic trial conduction practices that further obscure reliability and validity of evidence. Homeopathic treatments have also been linked to aggravations and non-fatal and fatal adverse events.
The Lancet has previously published on another kind of harm that uptake of homeopathy encourages in India: delay to evidence-based clinical care that can lead to fatality. Authors have pointed out that evidence for some of the alternative systems of medicine may not come from RCTs. I agree that more appropriate study designs and analytical techniques are needed for carefully studying individualized treatment paradigms. However, the need for agreement on some consistent form of evidence synthesis and empirical testing across diverse disciplines cannot be discounted. Several other disciplines including psychology, economics, community health, implementation science, and public policy have adopted RCTs and related study designs and have passed the empirical tests of efficacy. Moreover, the ideas around mechanism of action in case of homeopathy still remain controversial and lack evidence after over a century. On the contrary, biochemical, molecular, and physiological mechanistic evidence supporting allopathic treatments has grown abundantly in the same period.
Owing to lack of evidence on its efficacy and safety, the World Health Organization had previously warned against the use of homeopathic treatments for severe diseases. Additionally, multiple countries, including Germany where the practice originated, have initiated mechanisms that discourage uptake of homeopathy while others are considering banning it. Homeopathy doesn’t work, could be harmful, and is not a part of Indian traditional medicine. While we should welcome pluralistic approaches towards UHC, we need to drop homeopathy.
(for references, see original text)
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Yes, in the name of progress and in the interest of patients, “we need to drop homeopathy” (not just in India but everywhere). I quite agree!
I have featured the ‘Münster Circle‘ before. The reason why I do it again today is that we have just published a new Memorandum entitled HOMEOPATHY IN THE PHARMACY. Here is its summary which I translated into English:
Due to questionable regulations in German pharmaceutical law, homeopathic medicines can be given the status of a medicinal product without having to provide valid proof of efficacy. As medicinal products, these preparations may then only be dispensed to customers in pharmacies, which, however, creates an obligation to also supply them on request or prescription. Many pharmacies go far beyond this and advertise homeopathic medicines as a useful therapy option by advertising them prominently in the window. In addition, customers are recommended to use them, corresponding lecture events are supported, and much more. Often, homeopathic preparations are even produced according to pharmacies’ own formulations and marketed under their own name.
For pharmacists and pharmaceutical technical assistants (PTAs) to perform their important task in the proper supply of medicines to the population, they must have successfully completed a scientific study of pharmacy or state-regulated training. This is to ensure that customers are informed and properly advised about their medicines according to the current state of knowledge.
After successfully completing their training or studies, PTAs and pharmacists are undoubtedly able to recognize that homeopathic medicines cannot be effective beyond placebo. They do not have any significant content of active ingredients – if, for example, the high potencies that are considered to be particularly effective still have any active ingredients at all. Consequently, pharmacists and PTAs act against their better knowledge to the detriment of their customers if they create the impression through their actions that homeopathic medicines represent a sensible therapeutic option and customers are thereby encouraged to buy and use them.
Although homeopathics have no potential for direct harm in the absence of relevant amounts of pharmacologically active substances in the preparations, their distribution should nevertheless be viewed critically. The use of homeopathy can mean losing valuable time and delaying the start of effective therapy. It is often accompanied by criticism, even rejection of scientifically oriented medicine and public health, for example when homeopathy is presented as the antithesis to a threatening “pharmaceutical mafia”.
The Münster Circle appeals to pharmacists and PTAs to stop advertising homeopathic medicines as an effective therapeutic option, to stop producing and marketing them themselves, and to advise their customers that homeopathic preparations are not more effective than placebo. The professional organizations of pharmacists and other providers of further training are called upon to no longer offer courses on homeopathy – except for convincingly refuting the often abstruse claims of the supporters.
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I have pointed out for at least 20 years now that pharmacists have an ethical duty toward their clients. And this duty does not involve misleading them and selling them useless homeopathic remedies. On the contrary, it involves advising them on the basis of the best existing evidence.
When I started writing and talking about this, pharmacists seemed quite interested (or perhaps just amused?). They invited me to give lectures, I published an entire series of articles in the PJ, etc. Of late, they seem to be fed up with hearing this message and the invitations have well and truly stopped.
They may be frustrated with my message – but not as frustrated as I am with their inertia. In my view, it is nothing short of a scandal that homeopathic remedies and similarly bogus treatments still feature in pharmacies across the globe.
I came across an article that seems highly relevant to our recurring debates about the dangers of chiropractic. Since few of us might be readers of the Louisville Courier, I take the liberty of reproducing here a shortened version of it:
Amber Burgess, then 33, had never set foot in a chiropractor’s office when she went to Dr. Adam Fulkerson’s Heartland Family Chiropractic in Elizabethtown on May 18, 2020. In contrast, Becca Barlow, 31, had seen Dr. Leah Wright at Louisville Family Chiropractic 29 times for adjustments over three years when she went there on Jan. 7, 2019, seeking relief for “nursing mother’s neck.” Both say they will never see a chiropractor again. “That visit was my first – and last,” said Burgess, a former utility bucket-truck assembler.
In separate lawsuits, they claim they suffered strokes after chiropractic adjustments; Barlow, herself a nurse, said she realized she was having one before she even left the office and told Wright’s staff to call 911.
Citing studies on human cadavers and other research, chiropractors claim adjustments are physically incapable of causing tears to arteries that in turn cause strokes by blocking the flow of blood to the brain and other organs. In an opening statement in the trial of Barlow’s suit last March, attorney John Floyd Jr., counsel for Wright and the National Chiropractic Mutual Insurance Co., said no one has ever proved adjustments cause the tears – known as dissection – only that there is an “association” between them. “We associate the crowing of roosters with sunrise,” he told the jury. “But that doesn’t mean roosters cause the sun to come up.” Floyd also cited studies he said prove that when a patient strokes out immediately after adjustments, like Barlow, it is because they already were suffering from artery injuries when they sought treatment from their chiropractor.
Louisville attorney Brian Clare, who represents both Barlow and Burgess, previously settled two cases in Jefferson County, and has another suit pending in Warren Circuit Court. He said in an interview that “every time chiropractors perform adjustments on the neck they are playing with fire. They can go too far, too fast, turning the neck past therapeutic limits,” he said.
The jury in Barlow’s case emphatically rejected the chiropractic profession’s defenses. “We found those claims to be unbelievable,” said jury foreman Joseph Tucker, a lawyer, who noted Barlow had no symptoms before her adjustments. By a 9-3 vote, the jury awarded her $1,130,800, including $380,000 in medical expenses and $750,000 for pain and suffering.
Witnesses testified that Barlow fell off the table and vomited almost immediately after her adjustment, showing classic stroke symptoms, including vertigo, dizziness, numbness, and nausea. She lost consciousness, had to be intubated in an ambulance, then raced to Norton Brownsboro Hospital, where she underwent emergency surgery to restore the flow of blood to her arteries and save her life. Three of the four arteries in her neck had been dissected.
Burgess, in Elizabethtown, suffered a stroke in her spine that her expert, Dr. Louis Caplan, a neurology professor at Harvard University, said also was caused by her cervical manipulations. Caplan says he’s cared for more than 15,000 stroke patients over 45 years.
Fulkerson has denied liability; his lawyer, James Grohman, said he couldn’t comment because the case is pending; the trial is set for Aug. 28 in Hardin Circuit Court Caplan said in a report that Burgess’s stroke left her with partial but permanent paralysis in her arms and legs. She uses a wheelchair and walker with wheels to get around. She said she can’t work, can’t drive, and that while she can dress herself, it takes hours to get ready. She fears they will have to give up their plans to have a baby.
By any measure, strokes associated with adjustments are rare, although their incidence is disputed. The American Chiropractic Association says arteries are damaged in only one to three adjustments out of 100,000 But a 2001 report in the New England Journal of Medicine estimated dissections occur in 1 of 20,000 adjustments. And Dr. Alan Brafman, an Atlanta chiropractor, has said they occur more often than that. Brafman wrote that he’s consulted in 1,100 cases, including Barlow’s, and found in most of them, chiropractors were at fault, causing vascular damage that is “a tragic, life-altering situation for all parties involved.” Wright’s experts themselves divulged they had been retained in 200 cases, according to Clare, which he said suggests chiropractic-related strokes are more common than suspected. A survey at Stanford University in 2008 of 177 neurologists found 55 had patients who suffered strokes after seeing chiropractors, while a 2018 study in West Virginia found one in 48 chiropractors experienced such an event. Neurologists and other physicians point to a 2001 study in STROKE of 582 stroke patients that found they were five times more likely to have seen a chiropractor in the previous five days before their artery dissection than a control group without such injuries. The American Heart Association and other medical groups recommend that patients also be warned about the risks; Barlow said she never would have undergone her final manipulation if she had been informed.
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Yet again, I am impressed by the number of cases that go to court where a settlement of some sort is reached and further reporting of the incident is prevented. As a consequence, these cases are not published in the medical literature. In turn, this means that chiropractors can continue to claim that these complications do not exist or are exceedingly rare.
- The truth, however, is that NOBODY can provide accurate incidence figures.
- The truth is that, even if such complications were rare, they are devastating.
- The truth is that neck manipulations do not generate any or very little benefit.
- The truth is that their risk/benefit balance is not positive.
- The truth is that we, therefore, have an ethical duty to tell potential patients about it.
I feel that I cannot repeat my warning often enough:
AVOID CHIROPRACTORS.
THEY CAUSE MORE HARM THAN GOOD!
This happens with such a regularity that I have decided to write about it; in fact, I shall do that in the form of an ‘open letter‘ to all concerned.
Background
A person or group of persons compose a complaint about my work in which they allege that I am engaged in a decade-long vendetta specifically against their particular form of so-called alternative medicine (SCAM). This letter is sent to me, or to a publisher of my articles/books, or to my peers at the university, or to anyone else they consider appropriate. Such interventions can at times be quite entertaining or even hilariously funny, but if they occur too often, they are also mildly irritating and wasteful. Foremost, they are based on a fundamental misunderstanding that might be worth clearing up with this …
Open Letter
Dear advocate of the specific SCAM in question,
Dear professional organization of the specific SCAM in question,
I am sorry that my lecture/article/blog post/book/interview caused concern and led you to feel that I am running a long-term campaign or vendetta against the specific SCAM that you advocate. This letter is to assure you that your feeling is entirely erroneous: I am in no way targeting your specific SCAM.
If you have a look at my most recent book, for instance, you will see that, in it, I discuss a total of 202 different forms of SCAM and that – with good reason – I am highly critical of the vast majority of these methods. Imagine what it would mean to run a vendetta or campaign against all of these specific SCAMs. I would need a sizable team of co-workers involving lawyers, researchers, administrators, etc. to manage the task. I would also need plenty of funds to support the campaign, and I would most likely have more legal cases going than I have hair on my head.
The truth is that, since my retirement ~10 years ago, I do my research with no assistance whatsoever, I get no financial support or compensation for my work, and I am in contact with lawyers only when they ask me to serve as an expert witness. There simply is no evidence for the campaign that you feel does exist and you evidently misjudge my motives for criticizing your specific SCAM.
My aim is not to defame your specific SCAM or SCAM in general. I have no reason to do this. My aim is simply to inform the public responsibly and to prevent vulnerable people from getting harmed or ripped off. As I have studied the subject systematically for three decades, I feel I am competent, entitles, and duty-bound to try and do this.
I sincerely hope you are able to see the difference: you seem to think that I am destructively out to get you or your SCAM, while in truth I am constructively doing what responsible healthcare professionals (should) do.
Now that this misunderstanding has been cleared up, I thank you for reconsidering your position and stopping to claim things about me that are not true.
Best regards
Edzard Ernst
It has been reported that a young woman’s visit to a chiropractor left her unable to walk due to a torn artery.
Mariah Bond, 29, went to visit a chiropractor in the hope to get some relief from her neck pain. During the appointment, the chiropractor quickly twisted her neck from side to side. “It cracked both ways and I’d seen chiropractor videos so I thought it was normal but when I stood up I got super dizzy,” Mariah recalled. Next, Mariah started profusely vomiting and her hand began to tingle. Then she was rushed to a hospital.
It took a few hours before the doctors could find the diagnosis. “I was still throwing up constantly, it was non-stop. I couldn’t open my eyes because if I did I’d start throwing up because I was so dizzy,” Mariah said. “I was transferred via ambulance to another hospital where they did a CT scan and confirmed that I was having a stroke.”
It turned out that Mariah’s chiropractor dissected an artery in her neck which then limited the blood supply to the brain. Mariah was kept in the hospital for five days while her condition was monitored. During that time, she was left unable to walk. But slowly she did become able to rely on a zimmer frame to get around. “I couldn’t walk properly or correctly use my hands to eat, it was like I was a child. It was very weird. My brain was there but I couldn’t do it,” she stated. “My first stroke was a cerebral stroke and they were saying that I probably had a mini-stroke as I was having weird feelings in my legs. They were very confused because that wasn’t common with the stroke I had, so they said that I probably had two.”
Within a fortnight, Mariah was able to walk again but had to have physiotherapy for two months before she could return to work. After her last CT scan, she received the good news that the dissected vessel had completely healed. She said: “I was very strong-willed at the time because everyone was telling me how well I was handling this. I think my husband was more scared than I was, poor thing.”
Mariah has vowed never to visit a chiropractor again and is doing her best to raise awareness of the damage they can cause. “I was shocked because I’m so young and you don’t really hear about young people having strokes, especially from the chiropractor. I’m pretty paranoid with my neck now. I know I probably shouldn’t be but sometimes if I have a weird feeling in my head, it would probably be called PTSD, I automatically start thinking am I having a stroke? I start freaking out. I’d tell people not to go to a chiropractor. I’ve already told a million people not to do it. Just don’t go or at least don’t let them do your neck.”
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I would be surprised if this case ever got written up as a proper case report and published in a medical journal. We did a survey years ago where we found over 35 cases of severe complications after chiropractic in the UK within a period of 12 months. The most amazing result was that none of these cases had been published. In other words, under-reporting was precisely 100%.
Mariah’s case might be a true rarety, or it might be a fairly common event. It might be a most devastating occurrence, or there could be far worse events.
We simply do not know because under-reporting is huge.
Meanwhile, chiropractors – the professionals who should long have made sure that under-reporting becomes minimal or non-existent – claim that there is no evidence that strokes happen at all or regularly or often. They can do this because the medical literature seems to confirm their opinion. The only reporting system that seems to exist, the “chiropractic patient incident reporting and learning system” (CPiRLS), is for several reasons woefully inadequate and also plagued by under-reporting.
So, what advice can I possibly give to consumers in such a situation? I feel that the only thing one can recommend is to
stay well clear of chiropractors
until they finally present us with sufficient and convincing data.
