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

pseudo-science

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

On 8 March 2019, the Council of Australian Governments (COAG) Health Council (CHC) noted community concerns about spinal manipulation on children performed by chiropractors and agreed that there was a need to consider whether public safety was at risk.

On behalf of the CHC, the Victorian Minister for Health, the Hon. Jenny Mikakos MP, instructed Safer Care Victoria (SCV) to undertake an independent review of the practice of chiropractic spinal manipulation on children under 12 years. The findings of this review are to be provided to the Minister for reporting to the CHC. To provide expert guidance and advice to inform the review, SCV established an independent advisory panel. The panel included expertise in chiropractic care, academic allied health, health practitioner regulation, healthcare evidence, governance, paediatrics and paediatric surgery, and musculoskeletal care, and had consumer representation.

The main conclusions were as follows:

  • … spinal manipulation in children is not wholly without risk. Any risk associated
    with care, no matter how uncommon or minor, must be considered in light of any potential or likely
    benefits. This is particularly important in younger children, especially those under the age of 2 years in
    whom minor adverse events may be more common.
  • … the evidence base for spinal manipulation in children is very poor. In particular, no studies have been performed in Australia … The possible, but unlikely, benefits of spinal manipulation in the management of colic or enuresis should be balanced by the possibility, albeit rare, of minor harm.

The main recommendation was straight forward: “Spinal manipulation, as defined in Section 123 of National Law, should not be provided to children under 12 years of age, by any practitioner, for general wellness or for the management of the following conditions: developmental and behavioural disorders, hyperactivity disorders, autism spectrum disorders, asthma, infantile colic, bedwetting, ear infections, digestive problems, headache, cerebral palsy and torticollis.”

The Chiropractic Board of Australia nevertheless decided they would re-start manipulationg babies. On 11/6/2024 The Sydney Morning Harald reported:

Chiropractors have given themselves the green light to resume manipulating the spines of babies following a four-year interim ban supported by the country’s health ministers. In a move slammed by doctors as irresponsible, the Chiropractic Board of Australia has quietly released new guidelines permitting the controversial treatment for children under two. The Royal Australian College of General Practitioners (RACGP) hit out at the decision, saying there was no evidence supporting the spinal manipulation of babies and children and that the practice should be outlawed. ‘‘There is no way in the world I would let anyone manipulate a child’s spine,’’ said Dr James Best, the college’s Specific Interests Child and Young Person’s Health chair. ‘‘The fact that it hasn’t been ruled out by this organisation is very disappointing and concerning. It’s irresponsible.’’ …

Subsequently, it was reported that the federal health minister has intervened in the Chiropractic Board of Australia’s controversial decision to allow practitioners to resume spinal manipulation of children under two and is seeking an urgent explanation.

As pressure mounts on chiropractors to ditch the treatment, federal Health Minister Mark Butler confirmed on Thursday that he would also raise the issue with his state and territory colleagues at a meeting of health ministers in South Australia on Friday.

“The Health Minister is writing to the Chiropractic Board seeking an urgent explanation on its decision to allow a resumption of spinal manipulation of infants under two, in spite of two reviews concluding there was no evidence to support that practice,” a spokeswoman said.

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This course of events can only be surprising to those who are not familiar with the chiropractors’ general attitude. Chiropractors have always put income before ethics and safety. This, I fear, is not a phenomenon confined to Australia or to the care of children but one that beleagues this profession worldwide from the days of DD Palmer to the present.

In November 2022, we discussed a dodgy acupuncture review. Let me show you my post from back then again:

Acupuncture is emerging as a potential therapy for relieving pain, but the effectiveness of acupuncture for relieving low back and/or pelvic pain (LBPP) during pregnancy remains controversial. This meta-analysis aimed to investigate the effects of acupuncture on pain, functional status, and quality of life for women with LBPP pain during pregnancy.

The authors included all RCTs evaluating the effects of acupuncture on LBPP during pregnancy. Data extraction and study quality assessments were independently performed by three reviewers. The mean differences (MDs) with 95% CIs for pooled data were calculated. The primary outcomes were pain, functional status, and quality of life. The secondary outcomes were overall effects (a questionnaire at a post-treatment visit within a week after the last treatment to determine the number of people who received good or excellent help), analgesic consumption, Apgar scores >7 at 5 min, adverse events, gestational age at birth, induction of labor and mode of birth.

Ten studies, reporting on a total of 1040 women, were included. Overall, acupuncture

  • relieved pain during pregnancy (MD=1.70, 95% CI: (0.95 to 2.45), p<0.00001, I2=90%),
  • improved functional status (MD=12.44, 95% CI: (3.32 to 21.55), p=0.007, I2=94%),
  • improved quality of life (MD=−8.89, 95% CI: (−11.90 to –5.88), p<0.00001, I2 = 57%).

There was a significant difference in overall effects (OR=0.13, 95% CI: (0.07 to 0.23), p<0.00001, I2 = 7%). However, there was no significant difference in analgesic consumption during the study period (OR=2.49, 95% CI: (0.08 to 80.25), p=0.61, I2=61%) and Apgar scores of newborns (OR=1.02, 95% CI: (0.37 to 2.83), p=0.97, I2 = 0%). Preterm birth from acupuncture during the study period was reported in two studies. Although preterm contractions were reported in two studies, all infants were in good health at birth. In terms of gestational age at birth, induction of labor, and mode of birth, only one study reported the gestational age at birth (mean gestation 40 weeks).

The authors concluded that acupuncture significantly improved pain, functional status and quality of life in women with LBPP during the pregnancy. Additionally, acupuncture had no observable severe adverse influences on the newborns. More large-scale and well-designed RCTs are still needed to further confirm these results.

What should we make of this paper?

In case you are in a hurry: NOT A LOT!

In case you need more, here are a few points:

  • many trials were of poor quality;
  • there was evidence of publication bias;
  • there was considerable heterogeneity within the studies.

The most important issue is one studiously avoided in the paper: the treatment of the control groups. One has to dig deep into this paper to find that the control groups could be treated with “other treatments, no intervention, and placebo acupuncture”. Trials comparing acupuncture combined plus other treatments with other treatments were also considered to be eligible. In other words, the analyses included studies that compared acupuncture to no treatment at all as well as studies that followed the infamous ‘A+Bversus B’ design. Seven studies used no intervention or standard of care in the control group thus not controlling for placebo effects.

Nobody can thus be in the slightest surprised that the overall result of the meta-analysis was positive – false positive, that is! And the worst is that this glaring limitation was not discussed as a feature that prevents firm conclusions.

Dishonest researchers?

Biased reviewers?

Incompetent editors?

Truly unbelievable!!!

In consideration of these points, let me rephrase the conclusions:

The well-documented placebo (and other non-specific) effects of acupuncture improved pain, functional status and quality of life in women with LBPP during the pregnancy. Unsurprisingly, acupuncture had no observable severe adverse influences on the newborns. More large-scale and well-designed RCTs are not needed to further confirm these results.

PS

I find it exasperating to see that more and more (formerly) reputable journals are misleading us with such rubbish!!!

Now, it has been announced that the paper has been retracted:

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

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

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

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

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

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

One down, dozens of further SCAM papers to go!

Conspiracy theories have become a frequent theme on this blog, e.g.:

 

In fact, I have previously postulated that so-called alternative medicine (SCAM) can be understood as a conspiracy theory.

A new paper asked a relevant question: who believes in conspiracy theories? Conspiracy theories are ubiquitous and can have negative consequences. Thus, there is an increasing need for evidence-based recommendations with respect to interventions and prevention measures. Present Bayesian three-level meta-analysis includes a synthesis of the extant literature with respect to 12 personality correlates and their relationship with conspiracy beliefs. On average, people who believe in pseudoscience, suffer from paranoia or schizotypy, are narcissistic or religious/spiritual and have relatively low cognitive ability, are more likely to believe in conspiracy theories. Heterogeneity was partially explained by the examined moderators and no strong evidence for publication bias was found. Implications for developing tailored interventions are discussed in the article.

Conspiracy is a “secret plot by two or more powerful actors … Conspiracies typically attempt to usurp political or economic power, violate rights, infringe upon established agreements, withhold vital secrets, or alter bedrock institutions”. Conspiracy theories are used to describe and explain purported conspiracies.

People who believe in conspiracy theories are, according to this meta-analysis, more likely than other people to hold pseudoscientific beliefs, exhibit paranoid ideation, suffer from schizotypy, be narcissistic, be religious/spiritual and have lower cognitive ability.

Reading the comments sections of my blog, I agree with this conclusion.

It has been reported that HomeoCare Laboratories Inc. is recalling two batches of Homeopathic StellaLife Oral Care Products citing microbial contamination. The recall involves Homeopathic Stella Life Vega Oral Care Spray Unflavored and Advanced Formula Peppermint Oral Care Rinse manufactured in 2024, which are marketed to promote oral health, hydrate oral cavities and support healthy gums. The recall is to be performed at the consumer level.

StellaLife VEGA Oral Care, Spray Unflavored comes with NDC 69685-121-01, lot no. 2552 and expiration date of 02-2026. StellaLife Advanced Formula Peppermint VEGA Oral Care Rinse comes with NDC 69685-143-16, lot no. 2550, and expiration date of 02- 2026.

The affected products were manufactured at HomeoCare Laboratories, shipped nationwide, and distributed through various dental practices. As per the FDA, higher than acceptable levels of TAMC was found in the Advanced Formula Peppermint Vega Oral Care Rinse, while Bacillus sp was found in the StellaLife Vega Oral Spray, Unflavored. Bacillus is a common species found in the environment and are generally non-pathogenic, while patients with oral disease, undergoing dental surgical procedures or with compromised immune systems hold potential risks. In the immunocompromised population, the impacted product may cause severe or life-threatening adverse events due to the introduction of bacteria to the disrupted oral mucosa, possibly leading to bacteremia and sepsis. However, the manufacturer of homeopathic products has not received any reports of adverse events related to these two recalled products so far.

Dental practices and consumers, who have the recalled products, are urged to return the impacted products to HomeoCare Laboratories or to the place of purchase or discard them. The company said it is implementing enhanced quality control measures to prevent recurrence.

On the manufacturer’s website, we find the following:

Homeopathy is a safe, gentle, and natural system of healing that works with your body to relieve symptoms, restore itself, and improve your overall health. It is safe to use and has none of the side effects of many traditional medications, because it is made from the natural substances and is FDA regulated. Homeopathic medicines – known as “remedies” – are made from natural sources (e.g., plants, minerals), and are environmentally friendly and cruelty free.

Homeopathic remedies when used as directed, are completely safe for everyone. They are given in such small doses that they don’t cause side effects.* Homeopathy is not a general or “umbrella” term that describes a variety of different natural therapies. Although homeopathic remedies are derived from natural substances, homeopathy should not be confused with herbal medicine, Chinese medicine, or other types of natural medicines. It is its own, unique therapeutic system.

The FDA’s present policy does not require homeopathic medicines to go through the FDA approval process.  The homeopathic ingredients monographed in the Homeopathic Pharmacopoeia of the United States have been reviewed for homeopathic efficacy, toxicology, adverse effects and clinical use. The historical safety record with the use of homeopathic drugs, some for close to 200 years. The FDA drug monitoring process does not reveal any significant instances of problems with homeopathic drug products, thus establishing a positive safety profile.

Homeopathy’s Basic Principle: The Law of Similars It is accepted knowledge that every plant, mineral, and chemical can cause in overdose its own unique set of physical, emotional, and mental symptoms. It also is readily acknowledged that individuals, when ill, have their own idiosyncratic physical, emotional, and mental symptom patterns, even when people have the same disease. Homeopathic medicine is a natural pharmaceutical science in which a practitioner seeks to find a substance which would cause in overdose similar symptoms to those a sick person is experiencing. When the match is made, that substance then is given in very small, safe doses, often with dramatic effects.

Homeopaths define the underlying principle for this matching process as the “law of similars.” The “law” is not unknown to conventional medicine. Immunizations are based on the principle of similars. No less a person as Dr. Emil Adolph Von Behring, the “father of immunology,” directly pointed to the origins of immunizations when he asserted, “By what technical term could we more appropriately speak of this influence than by Hahnemann’s word “homeopathy.”

Homeopathy is a natural form of medicine used by over 200 million people worldwide.  The holistic nature of homeopathy means each person is treated as a unique individual and their body, mind, spirit and emotions are all considered in the management and prevention of disease. Taking all these factors into account a homeopath will select the most appropriate medicine based on the individual’s specific symptoms and personal level of health to stimulate their own healing ability.

Homeopathic medicines are safe to use as they rarely cause side-effects. This means when used appropriately under the guidance of a qualified homeopath they can be taken by people of all ages*.

* Claims based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated. Individual results may vary.

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I feel like congratulating the manufacturer: not only have they managed to produce normally harmless products in such a way that they are dangerous, but also they are promoting a plethora of untruth and misleading statements about homeopathy. A most remarkable effort!

 

The over-use of X-ray diagnostics by chiropractors has been the topic of previous posts, e.g.:

The authors of this review state that many clinicians use radiological imaging in efforts to locate and diagnose the cause of their patient’s pain, relying on X-rays as a leading tool in clinical evaluation. This is fundamentally flawed because an X-ray represents a “snapshot” of the structural appearance of the spine and gives no indication of the current function of the spine. The health and well-being of any system, including the spinal motion segments, depend on the inter-relationship between structure and function. Pain, tissue damage, and injury are not always directly correlated. Due to such a high incidence of abnormalities found in asymptomatic patients, the diagnostic validity of X-rays can be questioned, especially when used in isolation of history and/or proper clinical assessment. The utility of routine X-rays is, therefore, questionable. One may posit that their application promotes overdiagnosis, and unvalidated treatment of X-ray findings (such as changes in postural curvature), which may mislead patients into believing these changes are directly responsible for their pain. A substantial amount of research has shown that there is no association between pain and reversed cervical curves. Accuracy can also be questioned, as X-ray measurements can vary based on the patient’s standing position, which research shows is influenced by an overwhelming number of factors, such as patient positioning, patient physical and morphological changes over time, doctor interreliability, stress, pain, the patient’s previous night’s sleep or physical activity, hydration, and/or emotional state. Furthermore, research has concluded that strong evidence links various potential harms with routine, repeated X-rays, such as altered treatment procedures, overdiagnosis, radiation exposure, and unnecessary costs. Over the past two decades, medical boards and health associations worldwide have made a substantial effort to communicate better “when” imaging is required, with most education around reducing radiographic imaging. In this review, we describe concerns relating to the high-frequency, routine use of spinal X-rays in the primary care setting for spine-related pain in the absence of red-flag clinical signs.

Many chiropractors over-use X-rays (not least because it is a significant source of income) and claim to be able diagnose subluxations with X-ray diagnostics. The authors of the review state are unimpressed by this habit:

Spinal X-rays can lead to the detection of radiographic findings that can be used as an overdiagnosis for the patient, even though they may be asymptomatic. These include spinal anomalies, osteophytes, reduced disc heights, low-grade spondylolisthesis, transitional segments, and spina bifida occulta. The chiropractor can use all radiographic findings as “scare tactics” or “fear-mongering” to retain a patient under a specific frequency of care, thus creating unnecessary concern for the patient. Multiple studies have concluded that radiographic findings do not always correlate with a patient’s symptomatology. Brinjikji et al. (2015) concluded that disc degeneration was present in asymptomatic individuals, ranging from 37% in 20 year olds to 96% in 80 year olds.

Many chiropractors use “phases of degeneration” as a method of communication in order for patients to adhere to excessive treatment plans. It is unnecessary and unethical to scare patients to obtain compliance with chiropractic care. These “scare tactics” can negatively influence patients’ behavior, especially those who already experience reduced levels of self-efficacy. This unnecessary use of communication can cause negative thoughts, leading to fear of avoidance of physical activity and management advice as there is a concern for further damage. In addition, the likelihood that a patient will experience chronic pain may arise due to the belief that they won’t get better until the radiographic findings are resolved.

Vertebral subluxation is a term and condition created by chiropractors that refers to misalignment of the vertebra, a bone out of place, causing pressure on the spinal nerve and interference with mental impulses. Subluxation is a legitimate medical condition; however, this completely differs from the condition used by chiropractors. Over the years, there have been numerous definitions and takes on what “vertebral subluxation” is – even though the term and concept date back to 1902, it is still commonly used in the chiropractic community. It has been described that the misalignment of the vertebra causes occlusion of where the spinal nerve travels, thus causing nerve pressure and disrupting the “mental impulse,” which is part “intelligence,” a synonym for “spirit” and part of the “mental realm,” and part neural impulse; which is part of the physical realm. Many chiropractors believe that when bones press on nerves, the corresponding organ on the other end of the nerve will suffer disease. At this point, it appears more like religion; however, it is crucial that we include this as many clinicians use this “condition” as grounds to order unnecessary radiographic imaging. Extensive medical research has shown that bones do not slip out of place, squishing nerves causing various and different pathologies – and there is certainly no way to scientifically prove the interference of a “spirit” or life force. Nonetheless, none of this is grounds for ordering an X-ray and does not qualify as any type of “red flag,” raising concern about how and when chiropractors are using radiographic imaging.

The authors conclude that the importance of medical imaging cannot be overstated. Medical professionals, on the other hand, must adhere to ethical and responsible standards. These guidelines may be ambiguous in some situations, professions, and countries, resulting in many gray areas of practice. As discussed in this review, the ongoing justification many use to justify the excessive, repetitive, and ongoing use of X-rays for reasons that research does not support is highly concerning. This article highlights potential unvalidated practices within the chiropractic field relating to poor utility imaging.

 

Due to the unclear risk level of adverse events (AEs) associated with high-velocity, low-amplitude (HVLA) cervical manipulation, the aim of this study was to extract available information from randomized clinical trials (RCTs) and thereby synthesize the comparative risk of AEs following cervical manipulation to that of various control interventions.

 A systematic literature search was conducted in the PubMed and Cochrane databases. This search included RCTs in which cervical HVLA manipulations were applied and AEs were reported. Two independent reviewers performed the study selection, the methodological quality assessment, and the GRADE approach. Incidence rate ratios (IRR) were calculated. The study quality was assessed by using the risk of bias 2 (RoB-2) tool, and the certainty of evidence was determined by using the GRADE approach.

Fourteen articles were included in the systematic review and meta-analysis. The pooled IRR indicates no statistically significant differences between the manipulation and control groups. All the reported AEs were classified as mild, and none of the AEs reported were serious or moderate.

The authors concluded that HVLA manipulation does not impose an increased risk of mild or moderate AEs compared to various control interventions. However, these results must be interpreted with caution, since RCTs are not appropriate for detecting the rare serious AEs. In addition, future RCTs should follow a standardized protocol for reporting AEs in clinical trials.

I am more than a little puzzled by this paper. To explain why, I best show you our systematic review of a closely related subject:

Objective: To systematically review the reporting of adverse effects in clinical trials of chiropractic manipulation.

Data sources: Six databases were searched from 2000 to July 2011. Randomised clinical trials (RCTs) were considered, if they tested chiropractic manipulations against any control intervention in human patients suffering from any type of clinical condition. The selection of studies, data extraction, and validation were performed independently by two reviewers.

Results: Sixty RCTs had been published. Twenty-nine RCTs did not mention adverse effects at all. Sixteen RCTs reported that no adverse effects had occurred. Complete information on incidence, severity, duration, frequency and method of reporting of adverse effects was included in only one RCT. Conflicts of interests were not mentioned by the majority of authors.

Conclusions: Adverse effects are poorly reported in recent RCTs of chiropractic manipulations.

So, AEs are known to get seriously (and unethically) neglected in RCTs of chiropractic. Therefore, it must be expected that the new review finds only few of them in RCTs. No big deal! But why then conclude that HVLA manipulations do not impose an increased risk? Why do the authors claim that “case reports … do not imply causal relationships”? Why not be honest and simply state that RCTs are an inadequate tool for assessing the risks of spinal manipulation? And why ignore our review which, after all, is highly relevant and was published in a most visible journal? Did they perhaps read it and then decided to ignore it because it would have rendered their whole approach idiotic?

I don’t know the answer to any of these questions. What I do know, however, is that this new review arrives at a utterly misleading and possibly harmful conclusion. It thus is a significant disservice to our need to making progress in this important area.

Gastroesophageal reflux disease (GERD), also named Gastro-oesophageal reflux disease (GORD), is a common condition characterized by stomach contents flowing into the esophagus, causing distressing symptoms and potential complications. GERD is primarily linked to lower esophageal sphincter dysfunction, and its symptoms can impact quality of life. Treatment options include lifestyle changes, medications, and surgery. Homeopathy is sometimes advocated as an alternative to conventional orally administered drugs for GERD.

This review examined the clinical evaluation of homeopathic treatments for GERD, highlighting their potential role by analysing existing clinical studies. The authors conducted a comprehensive database search for clinical studies RCT, open label, retrospective, perspective, and observational studies on homeopathic treatments for GERD, adhering to inclusion criteria related to homeopathy in GERD treatment.

Six clinical studies were identified:

  • 1 open label study,
  • 3 retrospective studies,
  • 1 prospective study,
  • 1 observational study.

Renu Mittal’s study demonstrated significant symptom improvement and enhanced quality of life with homeopathic
treatment. Dr. Leena Dighe’s study reinforced the effectiveness of homeopathic medicines in GERD, Acid-Peptic Disorder (APD), and irritable bowel syndrome (IBS), while Sitharthan’s retrospective analysis supported the potential of homeopathy for gastrointestinal disorders. A study exploring Robinia pseudoacacia in GERD treatment showed positive results.

The authors conclused that these studies suggest the potential of homeopathic treatments in managing GERD and related gastrointestinal disorders. These findings encourage future studies and applications of homeopathic interventions in GERD management. Further research, including randomized trials, is needed to solidify homeopathy’s role in gastroenterological care.

Does anyone really think that this paper is worth publishing?

Its authors and the editors of the INTERNATIONAL JOURNAL OF HIGH DILUTION RESEARCH evidently do:

  • Parth AphaleDR D Y PATIL VIDYAPEETH PUNE
  • Dharmendra SharmaDr. D.Y. Patil Homoeopathic Medical College & Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India
  • Himanshu ShekharDr. D.Y. Patil Homoeopathic Medical College & Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India

But I don’t!

Why?

Because none of the primary studies come anywhere near of being reliable evidence.

I think that reviews of this nature drawing such unwarranted conclusions are counter-productive – counter-productive even to those people whose aim it is to promote homeopathy. Nobody with an ounce of critical thinking capacity can take such nonsense seriously. The only possible conclusion that can be drawn from the presented evidence is along the following lines:

This review failed to generate any sound evidence that homeopathy is an effective therapy for GERD.

 

This systematic review and meta-analysis investigated the impact of quality of life (QoL) on mortality risk in patients with esophageal cancer.

A literature search was conducted using the CINAHL, PubMed/MEDLINE, and Scopus databases for articles published from inception to December 2022. Observational studies that examined the association between QoL and mortality risk in patients with esophageal cancer were included. Subgroup analyses were performed for time points of QoL assessment and for types of treatment.

Seven studies were included in the final analysis.

  • Overall, global QoL was significantly associated with mortality risk (hazard ratio 1.02, 95% confidence interval 1.01–1.04; p < 0.00004).
  • Among the QoL subscales of QoL, physical, emotional, role, cognitive, and social QoL were significantly associated with mortality risk.
  • A subgroup analysis by timepoints of QoL assessment demonstrated that pre- and posttreatment global and physical, pretreatment role, and posttreatment cognitive QoL were significantly associated with mortality risk.
  • Moreover, another subgroup analysis by types of treatment demonstrated that the role QoL in patients with surgery, and the global, physical, role, and social QoL in those with other treatments were significantly associated with mortality risk.

The authors concluded that these findings indicate that the assessment of QoL in patients with esophageal cancer before and after treatment not only provides information on patients’ condition at the time of treatment but may also serve as an outcome for predicting life expectancy. Therefore, it is important to conduct regular QoL assessments and take a proactive approach to improve QoL based on the results of these assessments.

Am I missing something here?

Isn’t this rather obvious?

The way this paper is written, some practitioners of so-called alternative medicine (SCAM) might feel that, by improving QoL (for instance, by some fancy aromatherapy, reflexology, etc.), they can significantly better the cancer prognosis.

Patients with a poor prognosis are more seriously ill and therefore have a lowe QoL. Assessing QoL might be a useful marker, but would it not be better to ask why the QoL is in some patients less than in others?

For some time I have had the impression that research into SCAM is on its knees. Specifically, I seemed to notice that less and less of it is getting published in the best journals of conventional medicine. So, today I decided to put my impression to the test.

I went on Medline and serached for ‘COMPLEMENTARY ALTERNATIVE THERAPY + NEJM or Ann Int Med or Lancet or JAMA. This gave me the number of papers each of these four top medical journals published during the last decades. These figures alone seemed to indicate that I was on to something. To get a more reliable overall pivture, I added them up to get the total number of SCAM articles per year published in all four jurnals. As these figures indicated a lot of noise, I grouped them into periods of 4 years.

Here are the results:

  • Number of papers in the four journals published between 1999 and 2002 =115
  • Number of papers in the four journals published between 2003 and 2006 = 44
  • Number of papers in the four journals published between 2007 and 2010 = 20
  • Number of papers in the four journals published between 2011 and 2014 = 23
  • Number of papers in the four journals published between 2015 and 2018 = 38
  • Number of papers in the four journals published between 2019 and 2022 = 36

These figures confirm my suspicion: top medical journals publish far less SCAM articles than they once used to. But how do we interpret this finding?

The way I see it, there are several possible explanations:

  1. The editors are becoming increasingly anti-SCAM.
  2. Less and less SCAM research is of high enough quality to merit publication in a top journal.
  3. Numerous SCAM journals have sprung up which absorb most of the SCAM research but which are largely ignored by the broader medical community.

Personally, I think all of these explanations apply. They are the expression of a phenomenon that I discussed often before: over the years, SCAM has managed to discredit and isolate itself. Thus, it is no longer taken seriously and in danger of becoming a bizarre cult.

I fear that serious healthcare professionals get increasingly irritated by:

  • the embarrassing unreliability of much of SCAM research (as discussed so many times on this blog);
  • the fact that some research group manage to publish nothing but positive results (see my ‘ALTERNATIVE MEDICINE HALL OF FAME);
  • the news that a substantial proportion of SCAM research seems fabricated (see, for instance, here);
  • the fact that too much of SCAM research is of dismal quality (as disclosed regularly on this blog);
  • the fact that many SCAM proponents are unable of (self)critical thinking (as demonstrated regualrly by the comments left on this blog).

If I am correct, this would mean that, in the long-term, one of the biggest enemy of SCAM are the SCAM researchers who, instead of testing hypotheses, abuse science by trying to confirm their hypotheses. As Bert Brecht said: the opposite of good is not evil, but good intentions.

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