prevention
Spinal manipulative therapies, including chiropractic and osteopathic maneuvers, are widely practiced for musculoskeletal complaints. However, serious complications such as cerebrospinal fluid (CSF) leak with subsequent intracranial hypotension (IH) have been described. The pathophysiological mechanism is presumed to involve mechanical stress on the spinal dura during high-velocity movements, leading to dural tears, particularly in the cervicothoracic region.
A team of Italian neuroscientists conducted a scoping review in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines, through a comprehensive search of PubMed and Scopus. They complemented the review with an illustrative case from their own institution.
The researchers identified 21 eligible papers, including 21 patients with IH following spinal manipulation. Most patients were women (81%), aged 29-54 years, and the majority underwent cervical maneuvers.
SMT techniques vary, most often involving high-velocity cervical maneuvers. The most frequent were axial tension with rotation in seven cases (33.3%), unspecified cervical manipulation in four cases (19%), and thoracic spinal manipulation in two cases (9.5%). Less common single-case techniques included rotation with hyperextension, combined cervical and thoracic mobilization, axial tension with lateral flexion, and occipital/shoulder tension technique (n = 1 case each).
Symptom onset was typically within the first week, and all presented with orthostatic headache, often accompanied by nausea, neck pain, tinnitus, or visual disturbances. Neuroimaging consistently revealed features of IH, with pachymeningeal enhancement and subdural collections as the most frequent findings; spinal imaging frequently demonstrated extradural CSF collections. Management was conservative in about one-third of cases, but most required epidural blood patching, which was effective in the majority. Surgical repair was necessary in rare, refractory cases, particularly in the presence of structural spinal abnormalities. Overall prognosis was favorable, with 95% of patients achieving full recovery.
The authors’ illustrative case highlights the potential for severe complications such as subdural hematomas and recurrence if the underlying leak is not addressed:
A 65-year-old patient without a previous history of headache presented with a progressively worsening headache, with orthostatic features, poorly responsive to medical therapy, that has lasted for the past 20 days. The patient denied any recent trauma. He reported having undergone cervical osteopathic manipulations within the past 3 months for recurrent cervicalgia. A brain MRI without contrast was performed, showing a large bilateral subdural hematoma with significant mass effect on the cortical gyri. The patient was admitted to the emergency department and underwent neurosurgical evacuation of a bilateral chronic subdural hematoma via burr holes. Subsequently, endovascular embolization of the middle meningeal arteries was performed as an adjunctive treatment to reduce the risk of recurrence. The surgical procedure was performed without complications. A cranial CT scan showed a reduction in the volume of the hematoma. Therefore, the patient was discharged. However, after a transient improvement in the symptoms, the patient continued to present a fluctuating headache without positional features, with four to five episodes per month. He was readmitted to our clinic and, upon arrival at the ER, a head CT scan showed an increase in pneumocephalus and a recurrence of the hematoma. The following day, an MRI of the neuraxis with contrast was performed, which revealed radiological findings suggestive of IH: pachimeningeal enhancement, subdural fluid collection, dural venous engorgement, cervical spinal longitudinal extradural collection, and effacement of the suprasellar cistern. The Bern score was 7. Given these findings, a surgical revision of the previous burr holes was performed without periprocedural complications. After the first day, a non-targeted epidural blood patch (EBP) was performed under local anesthesia by injecting 16 mL of autologous blood into the L3–L4 epidural space. The procedure was uneventful. A cranial CT scan showed satisfactory surgical outcomes, highlighting a reduction in the volume of the hematoma and of the pneumoencephalus. The patient was subsequently discharged with complete resolution of the headache.
The authors concluded that clinicians should recognize the possibility of CSF leaks after spinal manipulation, especially in patients with new-onset orthostatic headache.
I feel compelled to point out that, considering the multiple risks of upper spinal manipulations and the almost total lack of evidence of benefit from such treatments, the risk/benefit balance of spinal manipulation is clearly not positive. It follows, I think, that it would be wise for patients not to allow such therapies being carried out, and for healthcare professionals to discourage them.
On the same day as we celebrated the defeat of the Nazis 81 years ago, a Holocaust denier has been elected to public office. In the Sefton Council UK local elections held this week, Jay Leslie Cooper, a Reform UK candidate for Bootle West ward, secured a seat with 705 votes. This outcome is remarkable due to Cooper’s prior social media posts denying the Holocaust. The ward, which elects three councillors, saw Cooper join two Labour victors, marking Reform’s local gain amid broader scrutiny of its candidate vetting.
Pre-election reporting by the Liverpool Echo exposed Cooper’s controversial statements. In one post, he described the Holocaust as a “hoax” and “propaganda,” claiming “there were not 6 million Jews in Europe at the time.” He also promoted 9/11 conspiracy theories, labelling them part of a broader “hoax” narrative. The Echo detailed these views in an April 24 article titled “The vile views of this Bootle West Reform UK candidate,” noting Cooper’s online history as well as his candidacy announcement.
Reform UK leader Nigel Farage, who himself has been accused of vile antisemitic statements made during adolescence, responded swiftly post-election saying that Cooper was “not welcome” in the party and adding, “with thousands of candidates some problems can slip through vetting.” Reform announced an investigation into the allegations, while Farage acknowledged the optics were poor in a YouTube clip: “Nigel Farage says new Merseyside councillor who said Holocaust was a hoax…”.
The episode highlights the issue of extremism in British politics. Labour figures condemned the events, including MP Steve Reed who tweeted: “A holocaust denier is now an elected councillor. Reform must act.” This case also highlights tensions in UK local elections, where voter priorities like cost-of-living can overshadow candidate scrutiny. Reform’s strong showing during the local elections raises worrying questions about Nazi ideologies in populist movements.
As of today, Cooper remains a councillor pending party action.
Sources
Reform candidate who said Holocaust was a hoax wins seat in local elections – Liverpool Echo
(20+) Reform WIN more than 80% of available seats – Liverpool Echo News | Facebook
Violence and abuse are no longer confined to the margins of society; they have permeated workplaces, public services, streets, homes, schools, online forums, places of worship, and even political discourse. From retail staff and healthcare workers to religious minorities and women trapped in abusive relationships, aggression has become disturbingly commonplace.
The evidence is difficult to dismiss. Retail workers are subjected to abuse in unprecedented numbers, NHS staff face rising levels of physical assault, and antisemitic incidents have reached alarming levels. The Community Security Trust has documented record levels of antisemitism in recent years, underscoring that hatred of Jews is not merely a relic of the Nazi past but a resurgent and escalating threat. Domestic abuse remains equally pervasive: while some forms of physical violence may have declined, coercive control, stalking, economic abuse, and digitally enabled harassment have proliferated.
A growing body of research points to broader social and political drivers. A decade of austerity under Conservative governments, coupled with institutional erosion, strained public services, ongoing geopolitical conflicts, and the pressures of the cost-of-living crisis, has generated widespread frustration. When people feel neglected or abandoned, that frustration can readily turn into aggression directed at those closest at hand: a nurse, a shop assistant, a neighbour, a partner, or a stranger who looks like a “foreigner”
An additional—and perhaps even more troubling—factor is the brutalisation of public discourse. Donald Trump’s rhetoric has normalised cruelty, humiliation, racism, and dehumanisation. It does not merely tolerate aggression; it performs and rewards it, thereby encouraging its replication. This erosion of basic norms of decency matters because language does not simply describe violence—it facilitates it. When political leaders frame opponents as enemies, casually invoke the destruction of entire societies, or treat facts as optional, they lower the threshold for violence well beyond the political arena. To assume that such influences remain confined to the United States is both naïve and demonstrably false; they reverberate globally.
This dynamic is particularly dangerous in relation to racism and its most virulent form, antisemitism. The recent rise in antisemitic abuse in the UK has not occurred in a vacuum. It has been fuelled by conspiratorial thinking, online radicalisation, the trivialisation of antisemitic rhetoric as mere “banter” by public figures such as Nigel Farage, and a broader climate in which prejudice is normalised, disseminated, and converted into aggression. The language of quasi-fascist politics echoes familiar racist tropes, weaponizing grievance and casting minorities as threats. The result is not only an increase in hatred but also a social environment in which violence becomes a logical extension of that rhetoric.
The persistence of this problem is exacerbated by our tendency to compartmentalise it, thereby obscuring its systemic nature. Antisemitism and racism are treated as “community issues,” retail abuse as an occupational hazard, and domestic violence as a private tragedy. Such fragmentation diminishes the perceived scale of the crisis and encourages piecemeal responses that fail to address its underlying causes. Governments may introduce targeted legislation, create new offences, or publish strategies for individual sectors, yet neglect the broader social conditions from which violence emerges. In reality, violence is not a collection of discrete pathologies but part of a continuum that often begins with discontent and culminates in aggression.
A culture that tolerates aggressive rhetoric, routine incivility, and online abuse fosters an emotional climate in which more serious forms of violence become easier to justify, excuse, and ultimately perpetrate. For this reason, the rise in racial and antisemitic attacks, the abuse of frontline workers, and the persistence of domestic violence should not be viewed as separate phenomena. They are manifestations of the same underlying pathology.
What we are witnessing is not a series of isolated epidemics of violence but a broader crisis of social cohesion. If that diagnosis is correct, then the response cannot be limited to stricter laws alone. It must also include education, the rebuilding of social institutions, a renewed emphasis on mutual responsibility, and a cultural shift that rejects the normalisation of aggression as a marker of strength.
Recent excesses of antisemitism in the UK and elsewhere prompt me to occasionally deviate from the core subject of this blog. I hope you share my concerns and understand my decision.
Nigel Farage had a checkered political career. Currently, he is the Leader of Reform UK. His ascent is marked not least by a tension between multiple accusations of antisemitism and his contemporary efforts to cultivate support within the Jewish community. Navigating this divide requires distinguishing between corroborated documentation, historical allegations, and the evolving rhetorical strategies of his adult career.
The most severe and graphic allegations of racism regarding Farage’s early life stem from his time at Dulwich College during the early 1980s. Numerous former classmates have provided testimonies claiming that Farage exhibited overt neo-fascist and antisemitic behaviour, including allegations that he sang racist songs and directed antisemitic slurs at Jewish students.
Specific Alleged Statements:
- Growled “Hitler was right” or “Gas them” at Jewish classmate Peter Ettedgui, sometimes adding a hissing sound to mimic gas showers.
- Used racial slurs like the “W-word” (for Black people) and “P-word” (for South Asians).
- Had a “big issue with anyone called Patel,” targeting those with South Asian names.
Specific Alleged Actions:
- Led or taught younger cadets the “Gas ’em all” song (“Gas them all, gas them out, gas them all, into the chambers they crawl”) on CCF coaches and trips.
- Marched through a Sussex village at night shouting Hitler Youth songs, as reported in a 1981 teacher’s letter opposing his prefect appointment.
- Made the Nazi salute in public and school settings, while praising Adolf Hitler.
- Mocked Black, Jewish, and Asian students; picked on Asian juniors by asking their origin and gesturing “that’s the way back.”
- Put a pupil in detention for not joining in with racist behavior, as prefect.
While Farage has consistently denied these accounts, characterizing them as exaggerated “schoolboy banter” rather than genuine malice, the credibility of these reports is heightened by contemporary evidence. Specifically, a 1981 letter from a teacher, Chloe Deakin, formally warned the school’s headmaster against appointing Farage as a prefect, citing his “publicly professed racist” and “neo-fascist” views. While this document confirms that faculty were deeply concerned about his extremist sentiments at seventeen, the specific content of his alleged taunts remains grounded in testimonial accounts rather than verified transcripts.
As Farage transitioned into public life, criticisms shifted from interpersonal school behaviour to his use of specific political rhetoric. In various broadcasts between 2009 and 2018, Farage discussed topics that critics argue invoked traditional antisemitic tropes. For instance, his comments regarding the influence of a “Jewish lobby” on American foreign policy and his frequent, pointed attacks on billionaire philanthropist George Soros—framed through the lens of “globalist” interference—have been described by advocacy groups as “dog-whistling,” a practice of signaling coded messages to extremist elements. Farage has consistently defended these remarks as legitimate critiques of ideological and political influence, asserting that his focus is on the power dynamics of global institutions rather than on ethnic groups.
In recent years, particularly as leader of Reform UK, Farage has made a concerted effort to align himself with the British Jewish community. This strategy is evidenced by the 2026 launch of the “Reform Jewish Alliance,” an organization aimed at courting Jewish voters by emphasizing shared concerns regarding security and the protection of Judeo-Christian values. Farage has positioned himself as a defender of Israel and a critic of the UK government’s response to rising antisemitism, often arguing that the primary threats to Jewish life in Britain stem from mass migration.
The question, I feel, is whether these policy stances opportunistically replace one form of racism with another, or whether they reflect a real effort to build a political alliance. In any case, to me his current posture seems more of a strategic pivot than a true departure from the antisemitic rhetoric of his past.
So, is Nigel Farage a racist and an antisemite?
I let you decide.
The Spanish Agency for Medicines and Medical Products (AEMPS) has just published a comprehensive technical report entitled “Homeopathy and Homeopathic Products: Evaluation of Evidence on Their Efficacy and Safety”, which categorically concludes that there is no scientific evidence supporting the efficacy of homeopathy as a therapeutic tool. After a systematic review of scientific literature and evaluations by state agencies internationally, the report states that the observed effects are comparable to placebo.
The report, which analyzed 64 systematic reviews published since 2009, highlights that most studies suggesting benefits from homeopathy have low methodological quality, often invalidated by small samples, short follow-up periods, or biases in randomization. Furthermore, it notes that as the quality and rigor of clinical trials increase, the supposed effect of homeopathy diminishes until it disappears entirely.
From a scientific standpoint, the principles of homeopathy clash with the laws of physics and current pharmacology. In typical dilutions like 12 CH—where one part of the original substance is mixed with 100 parts of solvent twelve times consecutively—it is mathematically impossible for a single molecule of the original ingredient to remain in the preparation, breaking any cause-and-effect relationship between the product and the therapeutic effect.
To illustrate this disproportion, the report points out that a dilution of just 6 CH (far less extreme than 12 CH) equates to dissolving a packet of sugar in the entire Mediterranean Sea. For this reason, the AEMPS classifies theories like “water memory”—the belief that the liquid retains the properties of a substance even without its molecules—as empirically baseless postulates that challenge scientific and rational thinking.
In compliance with European and national regulations, the AEMPS has completed a regularization process that has resulted in the market withdrawal of numerous products. As of the report’s publication date, no homeopathic product with authorized therapeutic indications exists in Spain. The 976 that remain registered did so via a simplified procedure, based on extreme dilutions ensuring the preparation’s innocuousness, which does not require proof of therapeutic effect and legally prohibits any therapeutic claims on labeling.
Spain aligns with a global trend of health institutions adopting critical stances:
- United Kingdom: The Science and Technology Committee recommended halting public funding and requiring labeling warnings about lack of efficacy.
- Australia: The National Health and Medical Research Council concluded that homeopathy should not be used for chronic or serious diseases.
- France: The Haute Autorité de Santé eliminated public reimbursement for these products in 2021 due to lack of demonstrated efficacy.
- Germany: Approval is expected in 2026 for the definitive removal of homeopathy coverage from statutory health insurance.
- United States: The Food and Drug Administration (FDA) considers these products “unapproved new drugs,” and the Federal Trade Commission requires warnings that there is no scientific evidence of their functioning.
Although there is a popular belief that these preparations are innocuous because they are “natural,” serious adverse reactions have been reported, including poisonings from poor dosing and infant deaths linked to teething products in other countries.
However, the AEMPS warns that the main associated risk is the abandonment or delay of proven effective medical treatments. Citizens opting for homeopathy to treat serious or chronic conditions may endanger their health by replacing evidence-based therapies with products lacking such evidence.
The AEMPS report reaffirms the Ministry’s commitment to public health protection and evidence-based medicine. In line with other international agencies, it emphasizes the need for transparent information so citizens can make safe health decisions. The conclusion of the report is firm:
Given the lack of evidence of efficacy, homeopathy cannot be considered a valid therapeutic alternative, and its use must not lead to delaying or abandoning treatments proven to be effective.
Trump and his allies have produced many claims that experts have flagged as false, misleading, or dangerously unscientific. Below is a (probably incomplete) selection:
- In April 2020, Trump suggested during a press briefing that scientists explore whether injecting or “bringing disinfectant inside the body” could treat COVID‑19. Medical experts immediately warned that this would be dangerous or lethal.
- At the same briefing, he also floated the idea of “hitting the body with a very powerful light,” including using UV light inside the body to kill the virus, a suggestion that clinicians stressed had no scientific basis and could be harmful.
- Throughout 2020, Trump repeatedly claimed the virus would “just disappear” like a “miracle,” even as case counts and deaths surged.
- He heavily promoted hydroxychloroquine as a “game changer” long after clinical trials had shown it to be ineffective against COVID‑19 and associated with serious adverse effects.
- In February 2020, Trump claimed the number of COVID‑19 cases in the US would soon be “down to close to zero.”
- Trump frequently claimed that COVID‑19 was “just like the flu,” despite the fact that its mortality rate and impact on health systems were substantially higher.
- In late 2025 and early 2026, the Trump administration falsely claimed that acetaminophen use during pregnancy was linked to a much higher risk of autism, despite the lack of clear evidence and warnings from experts that this messaging was misleading.
- The administration also promoted leucovorin as a treatment for autism, a claim that has little robust evidence and is not supported by mainstream medical guidelines.
- Following the appointment of RFK Jr. to HHS in late 2024, federal vaccine guidance was rolled back in several areas, including flu recommendations for some groups and changes to how RSV and other vaccines were positioned. This created confusion and encouraged a further “decoupling” of some state health policies from traditional CDC guidance.
- Trump has claimed that the noise from wind turbines causes cancer, a statement that has no credible scientific basis.
- Trump has claimed that sea levels will rise by only “1/8 of an inch over the next 200 to 300 years,” contradicting widely accepted projections that show substantially higher rise even over the next 30 years along US coasts.
- Trump has also claimed that the human body is like a battery with a finite amount of energy, and that exercise is harmful because it “depletes” that energy, a view that runs counter to mainstream physiology and public‑health guidance.
- Trump claimed that drinking fizzy diet soda “kills cancer cells” because the drinks kill grass when spilt, implying they might do the same to cancer inside the body.
- In 2026, Dr. Mehmet Oz, as head of CMS, falsely claimed that 5 million New Yorkers were using Medicaid personal‑care services—nearly 75% of all enrolees—when the actual figure is far lower.
- RFK Jr. has spent decades claiming that thimerosal, a mercury‑based preservative in some vaccines, causes autism. Thimerosal was removed from nearly all childhood vaccines in 2001 as a precaution, yet autism rates continued to rise, and large studies have found no causal link.
- RFK Jr. frequently claims that no vaccines have ever been tested against a true saline placebo. In fact, many vaccines have been tested against saline placebos in clinical trials, and others were tested against earlier versions or standard care, in line with evolving ethical standards.
- RFK Jr. pushed for the removal of fluoride from all US water systems, falsely labelling it an “industrial waste” and a key cause of lower IQ, bone fractures, and cancer, despite the bulk of evidence supporting its safety and dental benefits at standard levels.
- RFK Jr. has also falsely claimed that polyunsaturated fats such as canola or soybean oil are toxic and the primary driver of obesity and inflammation in America, a view that contradicts large‑scale dietary and epidemiological data.
- RFK Jr. has falsely claimed that WiFi causes “leaky brain” and that 5G is a tool for mass surveillance and causes cancer, assertions that have no support from mainstream science.
- RFK Jr. has become an advocate for the federal legalisation of raw milk, downplaying the risks of Salmonella, E. coli, and Listeria. Yet pasteurization remains a cornerstone of public‑health measures to prevent foodborne illness.
- RFK Jr. has wrongly suggested a link between the use of SSRIs and the rise in mass shootings, a claim not supported by credible data.
- Janette Nesheiwat (JN), a Fox News contributor and Trump’s nominee for US Surgeon General, withdrew her nomination in May 2025 following allegations that she had significantly misrepresented her credentials. Her official bio and LinkedIn profile claimed she received her medical degree from the University of Arkansas for Medical Sciences; in fact she attended the American University of the Caribbean School of Medicine in St. Maarten.
- JN repeatedly described herself as “double board‑certified,” but investigators found verified certification only in family medicine.
- Casey Means (CM), Trump’s nominee for Surgeon General, is a Stanford‑educated physician who left surgical residency before completion and whose medical license has been inactive since 2019. She has not practiced clinical medicine in years and has limited experience overseeing large‑scale public‑health systems.
- CM has built a profile as a health‑tech entrepreneur and co‑founder of Levels, promoting “functional medicine” and the MAHA movement.
- CM has made strong claims that continuous glucose monitoring and metabolic optimization can prevent or “cure” a wide range of modern diseases, a view that overstates the evidence and oversimplifies complex chronic conditions.
As indicated in the title of this post: if you waant to say healthy, it is wise to ignore the incompetent president and his equally incompetent cronies.
I have repeatedly warned that Trump and his cronies are systematically destroying science and medicine in the US and beyond. Recently, I looked into Medline to see what other experts are publishing on this issue. I did not expect to find much and was surprised that a plethora of articles are now available that discuss the issues from vastly different perspectives. Here are the Medline-listed papers published in 2026 that include an abstract:
A reduction in U.S. foreign aid under the “America First” policy of President Donald Trump, who took office in 2025, has significantly impacted global health. As the world’s largest provider of foreign aid, the U.S. has frozen development aid to evaluate its alignment with national interests. This has led to the termination of numerous international health programs, including those addressing malaria, HIV, tuberculosis, and polio, and has caused funding shortages for non-profit and international organizations like GAVI and the World Bank. Projections indicate dire consequences. According to USAID, a potential 18 million additional malaria cases and 166,000 deaths could occur annually. Paralytic polio cases are expected to increase by 200,000 per year, and new tuberculosis cases could rise by 10.7 million by 2030. Recent studies estimate that new HIV infections and between 770,000 and 2.93 million HIV-related deaths from 2025 to 2030. This crisis presents an opportunity for the global community to rethink its approach to aid. Other forms of financing, such as private sector investment, CSR activities, and innovative mechanisms like the Global Fund, could fill the gap left by reduced ODA. The article also stresses the importance of strengthening governance in recipient countries, promoting self-reliance, and fostering international collaboration through shared data platforms and multilateral programs. Ultimately, the document argues that providing foreign aid is not just a moral obligation, but is also in the national security and economic interest of donor countries, including the United States.
A Science analysis shows more than 10,000 STEM Ph.D.s in the federal government left or lost their jobs after President Donald Trump took office.
Following the 2016 U.S. Presidential election of Donald Trump, prejudice toward groups targeted during his campaign (e.g., Asian Americans, Mexicans) become more acceptable. By contrast, both Trump and Clinton voters reported less prejudice of their own. We conducted a 2024 conceptual replication, measuring perceived norms of prejudice and own-prejudice toward 128 groups, both before (N = 362) and after (N = 261) the U.S. election. We separately measured the negativity of Trump’s campaign rhetoric toward these groups (N = 188). Levels of prejudice and perceived norms of prejudice acceptability were mostly stable pre-/post-election, but Trump’s negative rhetoric predicted an increase in perceived acceptability of prejudice among targeted groups (replicating the 2016 results), and a rise in self-reported prejudice in the same groups post-election (reversing the 2016 results). Despite changes in the sociopolitical context between elections, the election of a leading politician who campaigned on prejudice was again associated with increases in the acceptability of prejudice.
The withdrawal of the United States from the World Health Organization (WHO) raises crucial questions about its future as the governing international organization for health. The executive order on withdrawal was one of President Donald Trump’s first acts in his second term. Because the United States is WHO’s biggest funder and most powerful state backer, withdrawal could indicate an existential threat. However, almost simultaneously member states passed a new international Pandemic Agreement expanding WHO’s authority. How should these conflicting signals be understood? Analyzing WHO’s decline in a context of broader US and geopolitical shifts, the authors find that withdrawal is the outcome of the end to broader political orders of neoliberal internationalism on which WHO depended for legitimacy rather than idiosyncratic Trump politics. WHO’s reliance on certain international norms and power structures leave it compromised. US normative and institutional shifts are far more difficult for WHO to navigate than in past political eras. Therefore, international relations research suggests that avoiding catastrophic impacts depends on reform actions by WHO officials, other member states, and US actors. States and others in the United States will face harm from WHO decline, and the authors suggest that US actors have legal standing to challenge withdrawal. Complacency and inaction may be WHO’s biggest risk.
Throughout the first months of President Donald Trump’s second term in office, his administration has taken swift action to undermine the role that government health agencies play in the health policy-making process. This article makes the case that the Trump administration’s efforts to undermine government health agencies’ regulatory authority reflect a dislike and distrust of the people who serve in key civil service roles. It also provides evidence that efforts to roll back regulatory authority are part of a long-standing political strategy to cater to public dislike and distrust of scientific, medical, and academic experts. While the public could provide policy makers with an incentive to protect public health agencies and the people who staff them, recent public opinion research shows that many Americans simply do not know or do not care enough about the Trump administration’s actions to call for their elected officials to stop them. This article concludes by offering several health communication strategies and directions for future research (the “science of standing up for science”) that might inspire public concern about efforts to roll back government health agencies’ regulatory authority and might motivate people to show support for the civil servants who staff those agencies.
This paper focuses on how, during his second mandate, far-right leader Donald Trump tells a story of his nation as having been disrespected in the recent past by national elites and global ones, while the leader and their close circle have the mission to repair that status as part of United States foreign policy (i.e. respect for the status of the US). When narrating a better future, Trump travels to a remote national past to show the possibility of reinstating US stature in the international. While constructing that better future, Trump also starts to unfold a foreign policy story of success to cement the brighter future in a retrospective way given this future has purportedly been previously lived in a more remote national past. Relied on here is symbolic interactionist role theory, strategic narrative analysis and the notion of ‘heartland’ from populism scholarship; this paper also contributes to the study of narratives of roles and populism in the field of foreign policy analysis by engaging with the IR notion of ‘status’. Taking an interpretative analysis approach, this case study shows how far-right leaders like Trump can conceive and play the status or master role of their states in foreign policy via strategic narratives.
On the one hand, it is encouraging that the Trump-inflicted damage is being noticed and that there is strong opposition to Trump’s various actions. On the other hand, it is depressing to realise how deep and far-reaching the damage has already become
The suppression of scientific data within US federal agencies represents a fundamental tension between independent public health expertise and political ideology. This conflict seems to have now reached a boiling point at the ‘Centers for Disease Control and Prevention’ (CDC), where the Trump administration’s political leadership has indefinitely delayed the publication of an important report demonstrating the continued benefits of the COVID-19 vaccine. This action marks a pivotal shift in how the US manages public health information, signalling an era where data is scrutinized not just for its accuracy, but for its alignment with a specific political narrative.
The controversy centres on a study conducted by career scientists within the CDC’s ‘National Center for Immunization and Respiratory Diseases’. It analyzed data from the winter of 2025 and showed that COVID-19 vaccinations reduced the risk of hospitalization by 55% and emergency room visits by 50% among healthy adults. These figures provide a compelling argument for the vaccine’s role in mitigating the burden on the US healthcare system. However, despite being scheduled for release in the agency’s Morbidity and Mortality Weekly Report (MMWR) in mid-March, the study remains unpublished.
The primary figure behind this delay is the Acting CDC Director, Dr. Jay Bhattacharya. Appointed by the Trump administration and a vocal advocate for the “Great Barrington Declaration,” Bhattacharya has challenged the report’s methodology, specifically the “test-negative design”. This is an observational study design often used to estimate vaccine effectiveness. It compares people who seek care and are test-positive for the target infection with similar people who seek care but are test-negative. The key idea is simple:
- Recruit people with similar symptoms who come for testing.
- Split them into cases, who test positive, and controls, who test negative.
- Compare the odds of prior vaccination or another exposure between the two groups.
If vaccinated people are less common among the test-positive group than among the test-negative group, that suggests the vaccine is effective. This design is efficient because both cases and controls come from the same care-seeking population which reduces confounding. It is also practical during outbreaks, since cases and controls can be identified quickly from testing records.
While Bhattacharya frames his criticism as a commitment to rigorous quality control, the scientific community begs to differ and stress that the test-negative design has been the gold standard for assessing vaccine effectiveness for over twenty years. Indeed, a flu vaccine study using the exact same methodology was approved for publication by the same leadership just days prior, suggesting a double standard applied specifically to COVID-19 data.
This scandalous incident does not exist in a vacuum; it is a manifestation of a broader overhaul of US public health spearheaded by Health Secretary Robert F. Kennedy Jr. Under this leadership, the administration has sought to deprioritize standard immunization schedules and has integrated vaccine skeptics into the Advisory Committee on Immunization Practices (ACIP). By suppressing data that proves vaccine efficacy, the administration creates a vacuum of information that can be filled by more skeptical, politically convenient narratives.
The consequences of all this are profound. When political appointees act as gatekeepers for scientific data, it erodes the public’s trust in the CDC as a neutral, evidence-based institution. High-profile resignations, such as that of Dr. Fiona Havers, suggest a demoralized workforce of career scientists who feel their objective research is being censored. Furthermore, by withholding data that quantifies the protection offered by vaccines, the government limits the ability of healthcare providers and citizens to make informed decisions about their own health risks.
In conclusion, the suppression of the 2026 CDC vaccine report is a watershed moment for scientific integrity in government. It illustrates the danger of a system where data is viewed through a lens of political utility rather than public safety. As the administration continues to reshape federal health policy, the ongoing struggle between career researchers and political leadership will likely define the future of public health transparency in the US. The losers, no doubt, will be the people – primarily in the US but likely also globally.
Pediatric vertebral artery dissection (VAD) following chiropractic cervical manipulation (CCM) is a rare phenomenon. As chiropractic care of pediatric populations increases internationally, it is imperative to increase awareness of this cause of VAD.
This case-report describes a patient encountered in the Department of Neurological Surgery, Indiana University School of Medicine, USA. He was a 20-month-old male who presented nonspecifically with acute onset of
- lethargy,
- vomiting,
- cyanosis,
- respiratory distress.
Cerebrovascular imaging revealed a luminal irregularity in the V4 segment of the right vertebral artery, consistent with dissection. The patient’s guardian later provided history of taking the child for cervical chiropractic corrections immediately prior to the patient’s presentation to the emergency department.
The patient was managed non-operatively. Intubation was performed due to respiratory distress and managed with fluids, vasopressors, antimicrobials, and high-flow oxygen. The patient was extubated four days after presentation, and pressors were discontinued upon achievement of hemodynamic stability. A few days after extubation, the patient was ambulating and able to interact with objects and caretakers. Aspirin therapy was initiated and continued after discharge. The patient was followed with annual appointments and imaging. At two-year follow-up, CTA demonstrated an asymmetrically small right vertebral artery, accompanied by encephalomalacia of the right posterior occipital lobe. MRA demonstrated diffuse narrowing of the V4 segment of the right vertebral artery, albeit less pronounced than prior MRAs. Aspirin was discontinued by an outside following team due to stability of imaging findings. The parents were advised to avoid contact sports to avoid trauma and recurrent stroke.
The authors found 2 further cases of pediatric VAD in the published literature following CCM. Non-specific presentations were noted in both of them. Appropriate diagnosis of pediatric VAD requires increased surveillance in response to a thorough history and an acknowledgment of the plethora of possible patient presentations and etiologies.
The authors concluded that there is an increasing utilization of chiropractors among the pediatric population. In a pediatric patient with nonspecific symptoms, VAD should be considered as a differential diagnosis when there is a history of CCM.
The authors’ statement that “pediatric vertebral artery dissection (VAD) following chiropractic cervical manipulation (CCM) is a rare phenomenon” should be taken with a pinch of salt. As there is no monitoring, the frequency of adverse effects and complications is essentially unknown. Crucially. the risks of CCM for children is by no means confined to VADs. For a fuller account, I recomment reading my book which has an entire chapter on this very subject.
The key messages about CCM for kids might be summarised in the following simple three facts:
- CCM has no true benefit for children.
- Thus the risk/benefit balance fails to be positive.
- Therefore we should discourage partents from taking their kids to see chiropractors.
The Indian Ministry of Ayush was established in 2014 with a vision of reviving the profound knowledge of India’s ancient systems of medicine and ensuring the optimal development and propagation of the Ayush systems of healthcare. Earlier, the Department of Indian System of Medicine and Homoeopathy (ISM&H) formed in 1995, was responsible for the development of these systems. It was then renamed as the Department of Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homoeopathy (Ayush) in November 2003 with focused attention towards education and research in these therapies.
In the global landscape of public health, India’s Ministry of AYUSH stands as a profound anomaly. While most middle‑ and high‑income countries have converged around evidence‑based, scientifically grounded medicine, India has instead expanded this large, state‑run administrative apparatus where cultural nationalism and traditionalist narratives dominates over clinical efficacy and scientific rigor. The Ministry’s current trajectory reveals a troubling pattern: the systematic promotion of unproven therapies, flawed research, and notorious breaches of ethical principles, particularly with respect to the treatment of India’s most vulnerable populations.
The Homeopathy Anomaly
The most glaring anomaly must be the Ministry’s continued, high‑level support for homoeopathy. India is currently the only country in the world that maintains a dedicated national ministry and a statutory regulatory framework – via the National Commission for Homoeopathy – specifically to promote a system widely regarded as implausible, ineffective and harmful. Global assessments, including those by no less than 28 independent organisations worldwide, have concluded that there is no reliable evidence that homeopathic remedies work beyond placebo. Yet the AYUSH Ministry funds and publicizes a central research council (the Central Council for Research in Homoeopathy, CCRH) as well as a network of homoeopathic hospitals and teaching institutions, with annual budget allocations now exceeding ₹4,400 crore (roughly 470–480 million US dollars at current exchange rates). By directing substantial taxpayer funds to homoeopathic research and infrastructure, the state effectively endorses a “placebo‑as‑medicine” model, elevating it to the status of a national health strategy. This is not merely an academic dispute; it is a policy outlier that places India’s healthcare posture at odds with well‑established chemical and physical principles, as well as with the recommendations of leading international scientific bodies.
The Facade of Rigor
The Ministry tends to defend its approach by claiming a pivot toward “evidence‑based” or “scientific” AYUSH medicine, but an examination of its research output suggests a facade of rigor rather than its substance. Much of the work produced by bodies such as the Central Council for Research in Ayurveda (CCRA) and their counterparts in Unani and Siddha consists of investigations that are methodologically weak and wide open to bias. Key methodological flaws recur:
- Small sample sizes: Many trials involve fewer than 50–100 participants, rendering them statistically underpowered.
- Lack of blinding: A large proportion of studies is open‑label, where both clinicians and patients know the assigned intervention, amplifying placebo effects and observational bias.
- Selective reporting and publication bias: Negative findings – where AYUSH interventions fail to demonstrate benefit – are rarely published.
By branding such useless studies as “scientific proof,” the Ministry engages in a form of “science‑washing.” This practice misleads the public, uncritical clinicians, and policymakers into believing that AYUSH therapies have undergone the same rigorous, independent scrutiny as conventional therapies.
The Ethical Violations
In my view, the most serious concern is ethical. Under the banner of “Self‑Reliant India” (Atmanirbhar Bharat), the Ministry has aggressively promoted AYUSH products, for instance, during the COVID‑19 pandemic. This push could be viewed as an exercise in cultural pride and national self‑reliance but, in fact, it carries serious risks.
Medical ethics rely on two core principles: informed consent and non‑maleficence. When a state body, backed by cabinet‑level authority, “flogs” unproven and potentially dangerous treatments to a largely rural population with limited health literacy, it undermines both. Many patients are not able to distinguish between an ancient tradition and a clinically validated drug, yet they may be led by government‑sponsored messaging to defer or abandon evidence‑based treatments.
This is particularly dangerous in chronic conditions such as diabetes mellitus and hypertension, where effective pharmacological control and regular monitoring are both available and potentially life‑saving. If patients substitute proven allopathic regimens with state‑endorsed AYUSH alternatives of uncertain efficacy, the consequences can be dire. They include uncontrolled blood glucose, stroke‑risk elevation, organ damage, and avoidable mortality. The Ministry’s conduct, in effect, offloads these risks onto the most vulnerable while shielding itself behind appeals to tradition and national identity.
Conclusion
The Ministry of AYUSH has become the institutional vehicle for a “pluralistic” health model that, in practice, functions as a state‑funded rejection of the scientific method. This constitutes a regression in public‑health governance rather than a progressive pluralism. Until the Ministry subjects its therapies to the same scrutiny as any other medicine, and until it accepts transparent, independent evaluations without recourse to political or cultural vindication, it will remain less a health body and more a department of cultural preservation and doctrine.
