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

neglect

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Guest post by Richard Rawlins

Ever since its inception, Homeopathy has struggled to establish principled medical ethics amongst its practitioners. For sure, Samuel Hahnemann was good doctor who achieved much by denying his patients the bleeding, emetics, expectorants, laxatives and poly-pharmacy conventional at the turn of the nineteenth century. But he then lost his way in spiritism and vitalism, devised a system of care which could not, and did not, provide any benefit beyond placebo responses, and inveigled many colleagues to share his delusion. Many derided him.

As medicine in all developed countries became better regulated, so the associated ethics became better focussed. “First do no harm” is common to all systems, but in the UK, the four ‘A’s of avoiding adultery with a patient, alcohol whilst in a clinical situation, advertising, and association formed the next domain. ‘Association’ meant having a professional medical relationship with anyone not also a GMC registrant. Times, and standards have changed, but quackery, charlatanism and health care fraud has always been unethical. The problem for society has been the GMC’s reluctance to take any action against its registrants who lack integrity, promote quackery, or seek to defraud. The general response has been “we only act on complaints by a patient, health authority or fellow registrant – and complaints have to be specific.”

So it is that about 400 registrants of the GMC continue practising homeopathy with impunity. Sir Simon Stevens has now all but banned homeopathy from the NHS, but a medically qualified practitioner, in the private sector can do as they please, no matter how vulnerable and gullible the patient.

Doctors are of course required to obtain fully informed consent to treatment, and that should mean advising patients that homeopathic remedies are but placebos. Many patients so treated will declare they “feel better” and are content – but in practice, no explanation is offered to patients attending homeopaths. A classic charlatonnade (a charade promulgated by a charlatan).

But perhaps the vicissitudes of Covid-19 is exposing the hypocrisy of the GMC’s position, and might yet enable some redress for patients seeking redress for unethical medically qualified homeopathic attention.

The Guardian and Sunday Times of 22nd March 2020 reported that Dr Mark Ali allegedly made £1.7M profit in one week from selling kits to test for COVID -19.

“The GMC said no doctor should try to ‘profit from the fear and uncertainly caused by the pandemic…We would be concerned to learn that doctors are exploiting patient’s vulnerability or lack of medical knowledge, in order to profit from fear and uncertainty…’ “

The rationale for that fear is surely irrelevant – any health practice which takes advantage of the patient’s vulnerability or lack of medical knowledge is unethical. Simple.

“We also expect doctors… not to offer or recommend tests that are unproven, clinically unverified or otherwise unreliable.”

This is in the context of the serious issues of SARS-CoV-2 (the name of the corona virus which causes the illness COVID-19) – but it is helpful that the GMC’s ethical principles have been clearly stated.

May we take it the GMC will be equally as stringent with their registrants (doctors) who take advantage of the patient’s vulnerability or lack of medical knowledge, and recommend tests such as homeopathic provings “that are unproven, clinically unverified or otherwise unreliable.”?

And if not, why not?

All homeopathic remedy prescriptions are ‘tests’: “Take this, see how you go, I’ll adjust if needed…”. The German word pruefung used by Hahnemann (meaning ‘testing’ or ‘examination’) has been translated into English as ‘proving’. But the word for ‘to prove’ is beweisen, and that is not the word Hahnemann used. The use of ‘proving’ in English implies merit which is not deserved. All part of the delusion.

Clearly, any doctor who recommends homeopathic remedies, but does not explain the conventional view of the remedy, lacks integrity and is unethical – by definition. If the doctor is GMC registered (which a ‘doctor’ does not have to be – e.g., dentists are not) – they should be subject to sanction by the GMC. The GMC should do its duty to protect the public, and not wait for a crisis to stir them into action.

Sadly, if practitioners are not GMC registered, caveat emptor.

What Quacks Don’t Tell You is that ‘What Doctors Don’t Tell You‘ and ‘Get Well‘ magazines misinform the public in a scandalously dangerous fashion. If one ever needed evidence for this statement, it is provided by their latest action, explained on their website:

Lynne McTaggart and Bryan Hubbard, editors of What Doctors Don’t Tell You and Get Well magazines, are pleased to announce a series of four FREE weekly webinars, via Zoom, starting Thursday, April 2 designed to maximize your health and wellness in every way during these challenging times.

In these free hour-long sessions, Lynne and Bryan will interview a number of pioneering doctors and specialists, who will give you detailed advice about natural substances that kill viruses, the best supplements, foods and exercises to boost your immune system, and the best techniques to stay calm and centered during these challenging times.

Sign up to be sent the link for the live webinar where you can have the ability to ask your questions to these pioneers, get access to the recording of the webinars and receive a handout of helpful relevant tips to that webinar.

Part 1: Supercharging Yourself With Natural Virus Killers
Thursday, April 2, 2020
9 am PDST/12pm EDST/5 pm BST/6 pm CSTThis webinar will feature the best substances and supplements proven to prevent the spread of viruses. Joining Lynne and Bryan are noted pioneer Dr. Damien Downing, president of the Society for Environmental Medicine, who was part of a team of orthomolecular doctors who devised a special supplement preventative against the coronavirus; Dr. Sarah Myhill, a British integrative doctor noted expert on vitamin C and other natural virus killers; and Dr. Robert Verkerk PhD, the founder and president of the Alliance for Natural Health and an expert on food and health.
This hardly need a comment. Perhaps just this: there are no dietary supplements that have been shown to prevent the spread of the corona virus. Claiming otherwise might be commercially motivated or it might stem from a deep delusion. In any case, it risks the life of those consumers who believe in such bogus claims and, wrongly feel they are protected, and thus neglect effective measures of protection.

Yesterday, it was announced that Prince Charles, a long-time advocate of so-called alternative medicine (SCAM), has been taken ill with the corona virus. Since then, I have been inundated with messages about this fact. Many thought that, because Charles and I have a bit of history (details here), I might now ‘have a cup of tea and a malicious smile on [my] face thinking about it’, as someone put it on Twitter. Others made sarcastic comments suggesting that he will be fine because of all the help of the homeopathic cult.

I cannot join these sentiments. On the contrary, I sincerely wish him well – not because he is royalty, but because I wish everyone well who has been infected with this virus.

And I honestly do not think that Charles will be popping homeopathic placebos to save his life. Whenever a member of his (usually pro-homeopathy) family had fallen seriously ill in the past, they very quickly sought the help of the very best evidence-based medicine could offer. Charles’ present illness will be no exception, I am sure. If his infection becomes serious, he will have the benefit of everything modern scientific healthcare has to offer.

When he recovers – and I do hope he does – he will have plenty of time to think. Chances are that he never before had been afflicted with a killer disease. This should make him see things from an entirely new perspective. He must realise that so-called alternative medicine (SCAM) is an option only as long as one is healthy. Once the battle for saving a life is on, real medicine must save the day.

I am a born optimist, and therefore I hope that Charles on his sick-bed might even think a little further. He might realise that a health crisis, like the current corona pandemic, regularly brings out the charlatans who are trying to flog their wares or services to the unsuspecting public. On my blog, I have discussed some of these irresponsible rogues:

With a bit of luck, Charles might even reflect that his past endorsement of these quacks has been less than helpful; in the present crisis, it might even cost lives. Charles, I hope, will thus reconsider his attitude towards medicine, heaven knows, he might even become an outspoken advocate fro EBM!

So yes, I am an incurable optimist. Yet, I realise, of course, that Charles might not have any of these insights. That would be regrettable, but it does not deter me from wishing him a speedy recovery:

GET WELL SOON, CHARLES!

[If you do not like black humour or sarcasm, please do NOT read this post!!!]

Donald Trump just announced that, at Easter, he wants to see churches packed, his way of saying the lock-down is over because it is damaging the economy. Many others have put forward similar arguments and have pointed out that caring for the vulnerable, sick, old, etc. creates an economic burden that might eventually kill more people than it saves (see for instance ‘Economic crash could cost more lives than coronavirus, study warns‘).

Many people have also argued that homeopathy is unjustly vilified because it is truly a wholesome and safe medicine that should be used routinely. The notion here is that, alright, the evidence is not brilliant, but 200 years of experience and millions of fans cannot be ignored.

I have been wondering whether these two lines of thinking could not be profitably combined. Here is my suggestion based on the following two axioms.

  1. The economy is important for all our well-being.
  2. Homeopaths have a point in that the value of experience must not be ignored.

What follows is surprisingly simple: in view of the over-riding importance of the economy, let’s prioritise it over health. As it would look bad to deny those poor corona victims all forms of healthcare, let’s treat them homeopathically. This would make lots of people happy:

  • those who think the economy must take precedent,
  • those who fear the huge costs of saving corona patients (homeopathy is very cheap),
  • those who argued for decades that we never gave homeopathy a fighting chance to show its worth.

There is a downside, of course. There would be a most lamentable mortality rate. But, to paraphrase Dominic Cummings, if a few oldies have to snuff it, so be it!

Once we get used to this innovative approach – I suggest we call it integrative medicine – we might even consider adopting it for other critical situations. When we realise, for instance, that the pension pots are empty, we could officially declare that homeopathy is the ideal medicine for anybody over 60.

What do you think?

 

Some homeopaths are so deluded that I am tempted to characterise them as criminally stupid. This does, in my view, apply to those homeopaths who continue to advise their patients to treat or prevent coronavirus infections homeopathically. This website is only one example of many:

So what homeopathic remedy should I take for Coronavirus?

If you are living in an area which is not yet affected by Coronavirus, you should not be taking any remedy for now.

Based on the analysis above, I believe Bryonia alba 6CH or 30CH, can serve as a prophylactic.

It can be given (only to affected population) once a day, till days become warmer and the epidemic subsides (hopefully). People are mobile in endemic or epidemic areas should take the medicine daily. People who are in self quarantine and not having social contact, can take it for 3-5 days and then take it if and when they venture out. If a patient has flu-like symptoms, you can take the same remedy in 6 or 30 potency, 6 hourly. If the vitality is very low, more freuent repetition may be required. Also consider Camphora in such a case.

If a patient develops tightness in chest and shortness of breath, Lycopodium 30CH is likely to help.

The remedy suggestions are based on the available data. Homeopathy needs much deeper individualization, and clinical experience of treating Coronavirus Covid-19 patients with homeopathy, may bring up a different group of remedies.

Some recent data from Iran shows that many patients are showing sudden collapse. Dr. Rajan Sakaran as well as Dr. Sunirmal Sarkar have suggested that Camphora be considered as a medicine and prophylactic there. So if Covid-19 patients in your country are showing signs of sudden collapse with respiratory distress, vertigo and cold sweat, you may consider Camphora.

I do not recommend self-medication. You can show this article to your homeopath for a better clinical judgment that he/she will make for you.

If you suspect yourself to have Corona virus infection, please consult the concerned medical authorities in your country immediately.

If you have a flu-like illness and wish to take homeopathic treatment, please consult a qualified homeopathy doctor in person.

As I already stated: there are many websites with similarly barmy information. If you don’t believe me, see for yourself and run a quick google search.

Some people will say that this is not so bad – if it does not help, it cannot harm!

I would disagree.

Harm is being done by these charlatans in several ways. Firstly, the truth is a most valuable asset, and we must not allow homeopaths to vandalise it. Secondly, if patients believe in these bogus claims, they might take effective preventative measures less seriously and thus increase the danger for us all. Thirdly, anyone following the idiotic advice of homeopaths would have to forge out money for their service, and that money could be put to better use elsewhere.

My conclusion is that these homeopaths try to profit from the panic of vulnerable people. They are therefore crooks of the worst kind.

The ‘Corona-Virus Quackery Club’ (CVQC) is enjoying a fast-growing membership. As mentioned in previous posts, it consists of:

homeopaths,

colloidal silver crooks,

TCM practitioners,

orthomolecular quacks,

Unani-salesmen.

Chiropractors have been keen to join since weeks. They have a long tradition of claiming that their ‘adjustments’ boost the immune system, and therefore it was to be expected that they also jump on the corona-bandwagon.

Some chiropractors seem to believe that the corona-virus pandemic is a fine business opportunity or, as one put it, the perfect opportunity to have a heart to heart with patients about their immune and nervous systems! Remember, if germs automatically caused disease, the human race wouldn’t be around to debate the issue. Many forget that Louis Pasteur, the father of the germ theory recanted his belief. On his deathbed he observed, “It’s the soil, not the seed.” In other words, without the right environment, germs can do little harm.

Chiropractors and other health care workers are at greater risk due to patient or client interactions and are encouraged to take extra precautions when it comes to cleaning and disinfecting surfaces and skin or close contact.

“Every chiropractic practice has been touched by coronavirus [fears],” says Bill Esteb, DC, who has created and is circulating a coronavirus and chiropractic guide on how to avoid contracting the virus.

“We wanted to create a tool that chiropractors could use as a conversation springboard. Chiropractors need to remind their patients that germs don’t automatically cause disease. And that ‘catching’ the coronavirus, or anything else, requires a hospitable environment.”

The only way to catch anything, says Esteb, is to become a hospitable host. Flipping the message, Esteb in his coronavirus and chiropractic guide says here is “How to Catch the Coronavirus”:

  • Eat a Poor Diet — Make sure your body lacks the vitamins, minerals, enzymes and micronutrients needed to keep itself in good repair.
  • Avoid Adequate Rest — Stay up late and use sugar, tobacco, coffee and energy drinks as needed.
  • Become Dehydrated — Reduce the effectiveness of your natural defense mechanisms by shunning adequate water.
  • Stop Exercising — Reduce the efficiency of your lymphatic system, which requires movement to circulate this important germ-fighting fluid.
  • Think Negative Thoughts — Worry that you’ll be a victim. Closely monitor news reports about outbreaks, fearing the advancing pandemic.
  • Rarely Wash Your Hands — Use your dirty hands and fingers to rub your eyes, pick your nose or wipe your lips.
  • Skip Your Chiropractic Adjustments — Handicap your nervous system, the master system that controls your entire body. Wait until symptoms are clearly present.

“Following these suggestions is the way to become a suitable host for any number of germs or microbes,” Esteb says. “The tongue-in-check approach keeps the subject light. It stimulates more instructive patient conversations. It helps reduce appointment cancellations.

“Most people have an inappropriate fear of germs. And while this poster and patient handout won’t eliminate it, use it to explore the value of ongoing chiropractic care as a preventive strategy.”

——–

The Internet is full with messages of this type. Here is just one example: The best defense for the Corona Virus is to be healthy when you are exposed to the virus. Get adjusted to boost your immune system. Check out this video blog on what you can do to be healthy and prepare your body to fight off the corona virus.

——–

Perhaps the worst excesses can be found on Twitter:

James Langford 
@JamesLangford15·

Did you know that a properly aligned body supports and activates our immune system. During this time of concern from the corona virus, making sure your body is healthy is the best way to combat this illness. #health #immunesystem
Oxford Chiropractic
@OxfordChiropra1·

Scared of the corona virus? Practice a little preventative care like mama always used to tell you and get your spine adjusted!!! It’s boosts your immune by 200%!!!!! Why aren’t we talking… instagram.com/p/B9pjMqdATmBn
——–
So, considering this concerted effort, I am happy to announce that, from today, my friends the chiros are official members of the CVQC.
CONGRATULATIONS GUYS!
PS
Whether Boris Johnson will be allowed in, depends on future announcements; so far, his chances are not bad.

Boris Johnson said we should take the coronavirus ‘on the chin’ and count on ‘herd-immunity’. This, he claimed, is what his scientific advisers recommended.

I find this very hard to believe and have many doubts and questions.

To start with, I doubt that this is what Johnson’s scientific advisers recommend – it is a solution that SOME of his scientific advisers recommend. And it is a solution that seems easy to follow. It is, however, by no means the only strategy for tacking the pandemic; it is just one of several options.

The fact that all other countries have opted for other solutions, suggests to me that it is an unusual path to go down to. The modellers who obviously like it had to make a number of assumptions; that’s what modellers always have to do and rarely tell us about. But what if not all of these assumptions are correct?

The herd-immunity strategy counts on the fact that, once a certain percentage of the population has taken the infection ‘on the chin’, it is immune and therefore the transmission of the virus within such a population will be dramatically reduced or even zero. The percentage of the population needed for that to happen depends on how contagious the virus is. For the measles virus, herd immunity requires 90% of the population to be immune. For the coronavirus, the figure is said to be 60 – 70%. Is that an assumption or a fact? If it is a current fact, would the figure change, if the virus mutates? Could it be that a mutated virus can re-infect formerly immune people?

But let’s postulate that the herd-immunity assumption is both correct and stable. Johnson’s herd-immunity strategy would thus require that about 40 million Brits get infected with the virus to generate the required herd-immunity. Assuming a mortality rate of 1 – 2%, this means that Johnson is cheerfully accepting 400 000 – 800 000 fatalities.

But, as I said, this scenario is based on wild assumptions. It applies only if the virus does not mutate. And it only applies, if we do not run out of intensive care (IC) beds. However, running out seems possible, perhaps even likely, considering that we have only about half of the French and just one third of the German IC capacity. Sod’s law has it that both might happen. In this case, we might easily have far in excess of 800 000 fatalities. How should we take that ‘on the chin’, Mr Johnson?

Sadly, this is not all; I have further doubts about our PM’s ideas.

The present strategy regarding diagnosis of coronavirus cases is to self-isolate once suspicious symptoms start. Even if someone is seriously ill (with high fever etc.), they are told to stay at home and sit it out. This means we will never know whether these patients had or had not suffered from a coronavirus infection. How then can we ever be sure that the 60% target of infection has been reached? And if we are uncertain about it, how can we be sure that herd-immunity will work in the way the modellers predicted?

Moreover, we now know that people who caught the virus are infective BEFORE they develop symptoms. If that is so, the strategy of self-isolation will be far less effective than predicted. And, given this fact, are we not much more likely to have a sharp peak of cases early on which would make us run out of IC capacity? When that happens, even the pessimistic death rates might turn out to be too optimistic.

It seems to me that Johnson’s herd-immunity strategy is risky to the point of being reckless. It also seems to me that there are very good reasons why other countries have not adopted it.

But what is the solution?

In my view, the solution cannot be to uncritically adopt the theories and assumptions of modellers. This is not a computer game; we are talking about human lives, many human lives!

I wish I new what the best solution is – but I don’t. I merely fear that ‘taking it on the chin’ is not a solution at all. In any case, a wise move for Johnson and his team might be to consider that foreigners might be at least as clever as they are. Subsequently they could carefully study the actions of those countries which managed to bring down their death-rates despite being attacked by the coronavirus.

Wiki states that George Vithoulkas has been described as “the maestro of classical homeopathy” and is “widely considered to be the greatest living homeopathic theorist”. Others call him a “contemporary master of homeopathy” or credit him with the revival of the credibility of homeopathy.

A few days ago, THE MAESTRO has given an interview about the coronavirus which, I believe, is too hilarious to miss:

Q. What is your opinion of coronavirus, what homeopathy can do ?

A. Unless we have selected the real symptoms of the different stages of this influenza from the clinicians who are dealing at this moment with the infected cases, we cannot do anything substantial.

We should know the symptomatology of the beginning stages -before the pneumonia- and propose remedies for this stage in order to reduce the victims of going to the second stage. Also we should know the symptomatology of the later stage of pneumonia or diarrhea to propose different remedies for this advanced stage.

But the symptomatology has to be taken by an experienced homeopath in order to be reliable.

I think the best would be to establish contact with the clinicians in order to give us a fist hand information.

To give at random remedies as a prophylaxis and to make people think that they are protected it is irresponsible.

Q. What do you think about those homeopaths who advertise that are treating cancer cases  using homeopathic remedies while at the same time the patients are treated with allopathic drugs?

Advertising that cancer cases can be cured by homeopathy in spite of the fact patients are treated with conventional drugs is an unethical act that should be avoided at all costs by any honest homeopath.

The reasons are simple.

A.   The homeopathic remedy will act if it is prescribed according to the symptoms of the case. But in such a situation where the patient is under chemotherapy, the symptoms are suppressed by the allopathic drugs. Therefore the prescriptions at best are not prescribed according to the law of similars but are given in an arbitrary way, therefore instead of the similimum, several remedies are prescribed at random. Actually in this way, the case becomes more and more confused and the organism is more and more disorganised.

B.   The homeopathic remedy acts on the energy level -on  the vital force-  inciting the organism to increase its response (initial aggravation) so the two treatments are antagonistic, the one suppresses the defense mechanism, the other strengthens it.

C.   Out of such a confusion within the organism, no one can say what actually has happened in such a patient.

Of course each doctor is free to apply any treatment that according to his understanding will benefit the patient, but to claim publicly that homeopathy can cure cancer under such conditions is totally immoral.

Obviously patients will flock around such physicians in the beginning and can make them rich but in the end the disappointments will be for both parties, the doctors and the patients but mostly on the part of doctors.

Q. Perhaps because of the guilt for all the lies and false hopes?

Homeopathy is an amazing therapeutic system, that can make doctors and patients extremely happy but has limits and the doctors should not transgress these boundaries for material gain.

It is a great pity that homeopathy will be reduced to a routine massive therapy with meagre results by those who are advertising polypharmacy with such mongrel practices like the ones with prearranged therapeutic protocols or mixopathy.

If such practices prevail, finally the real classical homeopathy, that can have such amazing results, if it is learned and practiced correctly, will die out amidst an aggressive and competitive society.

So, essentially the great Vithoulkas seems to be saying that treating even the most serious diseases with homeopathy is fine, as long as homeopaths use no treatments other than homeopathy and as long as they do exactly what Vithoulkas proclaims or – even better – Vithoulkas does it himself.

I know, this is very similar to what Hahnemann, the creator of this cult, stated about 200 years ago … but it is nevertheless totally bonkers.

Deep venous thrombosis (DVT) is usually a blood clot in a deep vein of a leg. It is a potentially life-threatening condition, because the clot can detach itself and end up in the lungs thus causing a pulmonary embolism which can be fatal. A DVT therefore is a medical emergency which is typically managed by immobilising the patient and putting him/her on anticoagulants.

Yet, homeopaths seem to have discovered another approach. Indian homeopaths just published a case report of a DVT in an old patient totally cured exclusively by the non-invasive method of treatment with micro doses of potentized homeopathic drugs selected on the basis of the totality of symptoms and individualization of the case. The authors concluded that, since this report is based on a single case of recovery, results of more such cases are warranted to strengthen the outcome of the present study.

The patient was advised by his doctor to have surgery which he refused. Instead, he consulted a homeopath who treated him homoeopathically. No conventional treatments were given. The patient recovered, yet his recovery is almost certainly unrelated to the homeopathics he received. Spontaneous recovery after DVT is not uncommon, and it is almost certain that it is this what the case report describes.

It is simply not plausible, nor is there evidence that homeopathy can alter the natural history of a DVT. This means that what the Indian homeopaths have described in their paper is nothing less than a case of gross negligence. Had the patient died of a pulmonary embolism due to an untreated DVT, it could have put them behind bars.

While it is, of course, most laudable that homeopaths have taken to publishing even their most serious errors, it would be more reassuring, if they developed some sort of insight into their mistakes. Instead, they seem naively confident and stupidly ignorant of the danger they pose to the public: homeopathy can play significant therapeutic roles in very serious diseases like DVT, provided the drugs are needs to be carefully selected on the basis of i) individualization of cases, ii) the totality of symptoms and personalized data, and iii) taking into consideration the pathogenicity level and proper diagnosis of the disease. Further, homeopathy may also be safely used in patients with conventional drug allergy (antibiotics) or other physical conditions preventing intake of conventional medicines.

My conclusion and recommendation: stay away from homeopaths, folks!

A team of chiropractic researchers conducted a review of the safety of spinal manipulative therapy (SMT) in children under 10 years. They aimed to:

1) describe adverse events;

2) report the incidence of adverse events;

3) determine whether SMT increases the risk of adverse events compared to other interventions.

They searched MEDLINE, CINAHL, and Index to Chiropractic Literature from January 1, 1990 to August 1, 2019. Eligible studies were case reports/series, cohort studies and randomized controlled trials. Studies of high and acceptable methodological quality were included.

Most adverse events are mild (e.g., increased crying, soreness). One case report describes a severe adverse event (rib fracture in a 21-day-old) and another an indirect harm in a 4-month-old. The incidence of mild adverse events ranges from 0.3% (95% CI: 0.06, 1.82) to 22.22% (95% CI: 6.32, 54.74). Whether SMT increases the risk of adverse events in children is unknown.

The authors concluded that the risk of moderate and severe adverse events is unknown in children treated with SMT. It is unclear whether SMT increases the risk of adverse events in children < 10 years.

Thanks to their ingenious methodology, the authors managed to miss 11 of the 13 studies included in the review by Vohra et al which reported 9 serious adverse events and 20 cases of delayed diagnosis associated with SMT. Another review reported 15 serious adverse events and 775 mild to moderate adverse events following manual therapy. As far as I can see, the authors of the new review make just one reasonable point:

We recommend the implementation of a population-based active surveillance program to measure the incidence of severe and serious adverse events following SMT treatment in this population.

In the absence of such a surveillance system, any incidence figures are not just guess-work but also a depiction of the tip of a much bigger iceberg. So, why do the authors of this review not make this point clearly and powerfully? Why does the review read mostly like an attempt to white-wash a thorny subject? Why do they not provide a breakdown of the adverse events according to profession? The answer to these questions can be found at the very end of the paper:

This study was supported by the College of Chiropractors of British Columbia to Ontario Tech University. The College of Chiropractors of British Columbia was not involved in the design, conduct or interpretation of the research that informed the research. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program to Pierre Côté who holds the Canada Research Chair in Disability Prevention and Rehabilitation at Ontario Tech University, and from the Canadian Chiropractic Research Foundation to Carol Cancelliere who holds a Research Chair in Knowledge Translation in the Faculty of Health Sciences at Ontario Tech University.

This study was supported by the College of Chiropractors of British Columbia to Ontario Tech University. The College of Chiropractors of British Columbia was not involved in the design, conduct or interpretation of the research that informed the research. This research was undertaken, in part, thanks to funding from the Canada Research Chairs program to Pierre Côté who holds the Canada Research Chair in Disability Prevention and Rehabilitation at Ontario Tech University, and funding from the Canadian Chiropractic Research Foundation to Carol Cancelliere who holds a Research Chair in Knowledge Translation in the Faculty of Health Sciences at Ontario Tech University.

I have often felt that chiropractic is similar to a cult. An investigation by cult members into the dealings of a cult is not the most productive of concepts, I guess.

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