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

risk

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I regularly scan the new publications in alternative medicine hoping that I find some good quality research. And sometimes I do! In such happy moments, I write a post and make sure that I stress the high standard of a paper.

Sadly, such events are rare. Usually, my searches locate a multitude of deplorably poor papers. Most of the time, I ignore them. Sometime, I do write about exemplarily bad science, and often I report about articles that are not just bad but dangerous as well. The following paper falls into this category, I fear.

The aim of this systematic review was to assess the efficacy and safety of herbal medicines for the induction of labor (IOL). The researchers considered experimental and non-experimental studies that compared relevant pregnancy outcomes between users and non-user of herbal medicines for IOL.

A total of 1421 papers were identified and 10 studies, including 5 RCTs met the authors’ inclusion criteria. Papers not published in English were not considered. Three trials were conducted in Iran, two in the USA and one each in South Africa, Israel, Thailand, Australia and Italy.

The quality of the included trial, even of the 5 RCTs, was poor. The results suggest, according to the authors of this paper, that users of herbal medicine – raspberry leaf and castor oil – for IOL were significantly more likely to give birth within 24 hours than non-users. No significant difference in the incidence of caesarean section, assisted vaginal delivery, haemorrhage, meconium-stained liquor and admission to nursery was found between users and non-users of herbal medicines for IOL.

The authors concluded that the findings suggest that herbal medicines for IOL are effective, but there is inconclusive evidence of safety due to lack of good quality data. Thus, the use of herbal medicines for IOL should be avoided until safety issues are clarified. More studies are recommended to establish the safety of herbal medicines.

As I stated above, I am not convinced that this review is any good. It included all sorts of study designs and dismissed papers that were not in English. Surely this approach can only generate a distorted or partial picture. The risks of herbal remedies for mother and baby are not well investigated. In view of the fact that even the 5 RCTs were of poor quality, the first sentence of this conclusion seems most inappropriate.

On the basis of the evidence presented, I feel compelled to urge pregnant women NOT to consent to accept herbal remedies for IOL.

And on the basis of the fact that far too many papers on alternative medicine that emerge every day are not just poor quality but also dangerously mislead the public, I urge publishers, editors, peer-reviewers and researchers to pause and remember that they all have a responsibility. This nonsense has been going on for long enough; it is high time to stop it.

The ‘CANADIAN COLLEGE OF HOMEOPATHIC MEDICINE’ has posted an interesting announcement:

Homeopathic Treatment of Asthma with Homeopath Kim Elia www.wholehealthnow.com/bios/kim-elia

In asthma, bronchial narrowing results in coughing, wheezing, shortness of breath, and a sense of tightness in the chest. Traditional treatments, such as bronchodilator and steroidal inhalers, reasonably control the condition, but cure is elusive. Side effects and long-term use can eventually be quite damaging, including impairment of immune function and growth rate in children. Homeopathy has an excellent track record in treating this debilitating illness, and offers the hope of weaning off of traditional injurious treatments, replacing them with a far gentler and deeper-acting solution.

About Kim Elia

Students from around the world have expressed appreciation and admiration for Kim’s superb knowledge of the history of homeopathy, his deep understanding of homeopathic prescribing, and his extensive knowledge of materia medica. He is known for his dynamic and distinctive teaching methods which reflect his immense knowledge of the remedies and his genuine desire to educate everyone about this affordable and effective healing modality.

END OF QUOTE

There a few facts that the college seems to have forgotten to mention or even deliberately distorted:

  1. Asthma is a potentially lethal disease; each year, hundreds of patients die during acute asthma attacks.
  2. The condition can be controlled with conventional treatments.
  3. The best evidence fails to show that homeopathy is an effective treatment of asthma.
  4. Therefore, encouraging homeopathy as an alternative for asthma, risks the unnecessary, premature death of many patients.

And who is Kim Elia?

Here is some background (from his own website):

  • Apparently, he was inspired to study homeopathy when he read Gandhi’s quote about homeopathy, “Homeopathy cures a greater percentage of cases than any other method of treatment. Homeopathy is the latest and refined method of treating patients economically and non-violently.” He has been studying homeopathy since 1987 and graduated from the New England School of Homeopathy.
  • Kim is the former Director of Nutrition at Heartwood Institute, California.
  • He was the Director of Fasting at Heartwood.
  • Kim was a trainer at a company providing whole food nutritional supplements.
  • Kim serves as CEO of WholeHealthNow, the distributors of OPUS Homeopathic Software and Books in North America.
  • Kim provides and coordinates software training and support, and oversees new software development with an international team of homeopaths and software developers.
  • He was inspired to create the Historic Homeopathic Timeline, and is responsible for a growing library of recorded interviews and presentations with today’s world renowned homeopaths.
  • Kim was the principal instructor and developer of the four year classical homeopathy program at the Hahnemann Academy in Tokyo and Osaka, Japan.
  • He is currently developing new homeopathy projects.

What the site does not reveal is his expertise in treating asthma.

The Canadian College of Homeopathic Medicine claims to be dedicated to the training of homeopaths according to the highest standard of homeopathic education, emphasizing the art and practice of homeopathy as outlined in Hahnemanns’s Organon of the Medical Art. We aim to further the field of homeopathy as a whole through the provision of quality, primary homeopathic care.

If that is what the highest standard of homeopathic education looks like, I would prefer an uneducated homeopath any time!

Twenty years ago (5 years into my post at Exeter), I published this little article (BJGP, Sept 1998). It was meant as a sort of warning – sadly, as far as I can see, it has not been heeded. Oddly, the article is unavailable on Medline, I therefore take the liberty of re-publishing it here without alterations (if I had to re-write it today, I would not change much) or comment:

Once the omnipotent heroes in white, physicians today are at risk of losing the trust of their patients. Medicine, some would say, is in a deep crisis. Shouldn’t we start to worry?

The patient-doctor relationship, it seems, is at the heart of this argument. Many patients are deeply dissatisfied with this aspect of medicine. A recent survey on patients consulting GPs and complementary practitioners in parallel and for the same problem suggested that most patients are markedly more happy with all facets of the therapeutic encounter as offered by complementary practitioners. This could explain the extraordinary rise of complementary medicine during recent years. The neglect of the doctor-patient relationship might be the gap in which complementary treatments build their nest.

Poor relationships could be due to poor communication. Many books have been written about communications skills with patients. But never mind the theory, the practice of all this may be less optimal than we care to believe. Much of this may simply relate to the usage of language. Common terms such as ‘stomach’, ‘palpitations’, ‘lungs’, for instance, are interpreted in different ways by lay and professional people. Words like ‘anxiety’, ‘depression’, and ‘irritability’ are well defined for doctors, while patients view them as more or less interchangeable. At a deeper level, communication also relates to concepts and meanings of disease and illness. For instance, the belief that a ‘blockage of the bowel’ or an ‘imbalance of life forces’ lead to disease is as prevalent with patients as it is alien to doctors. Even on the most obvious level of interaction with patients, physicians tend to fail. Doctors often express themselves unclearly about the nature, aim or treatment schedule of their prescriptions.

Patients want to be understood as whole persons. Yet modern medicine is often seen as emphazising a reductionistic and mechanistic approach, merely treating a symptom or replacing a faulty part, or treating a ‘case’ rather than an individual. In the view of some, modern medicine has become an industrial behemoth shifted from attending the sick to guarding the economic bottom line, putting itself on a collision course with personal doctoring. This has created a deeply felt need which complementary medicine is all too ready to fill. Those who claim to know the reason for a particular complaint (and therefore its ultimate cure) will succeed in satisfying this need. Modern medicine has identified the causes of many diseases while complementary medicine has promoted simplistic (and often wrong) ideas about the genesis of health and disease. The seductive message usually is as follows: treating an illness allopathically is not enough, the disease will simply re-appear in a different guise at a later stage. One has to tackle the question – why the patient has fallen ill in the first place. Cutting off the dry leaves of a plant dying of desiccation won’t help. Only attending the source of the problem, in the way complementary medicine does, by pouring water on to the suffering plant, will secure a cure. This logic is obviously lop-sided and misleading, but it creates trust because it is seen as holistic, it can be understood by even the simplest of minds, and it generates a meaning for the patient’s otherwise meaningless suffering.

Doctors, it is said, treat diseases but patients suffer from illnesses. Disease is something an organ has; illness is something an individual has. An illness has more dimensions than disease. Modern medicine has developed a clear emphasis on the physical side of disease but tends to underrate aspects like the patient’s personality, beliefs and socioeconomic environment. The body/mind dualism is (often unfairly) seen as a doctrine of mainstream medicine. Trust, it seems, will be given to those who adopt a more ‘holistic’ approach without dissecting the body from the mind and spirit.

Empathy is a much neglected aspect in today’s medicine. While it has become less and less important to doctors, it has grown more and more relevant to patients. The literature on empathy is written predominantly by nurses and psychologists. Is the medical profession about to delegate empathy to others? Does modern, scientific medicine lead us to neglect the empathic attitude towards our patients? Many of us are not even sure what empathy means and confuse empathy with sympathy. Sympathy with the patient can be described as a feeling of ‘I want to help you’. Empathy, on these terms, means ‘I am (or could be) you’; it is therefore some sort of an emotional resonance. Empathy has remained somewhat of a white spot on the map of medical science. We should investigate it properly. Re-integrating empathy into our daily practice can be taught and learned. This might help our patients as well as us.

Lack of time is another important cause for patients’ (and doctors’) dissatisfaction. Most patients think that their doctor does not have enough time for them. They also know from experience that complementary medicine offers more time. Consultations with complementary practitioners are appreciated, not least because they may spend one hour or so with each patient. Obviously, in mainstream medicine, we cannot create more time where there is none. But we could at least give our patients the feeling that, during the little time available, we give them all the attention they require.

Other reasons for patients’ frustration lie in the nature of modern medicine and biomedical research. Patients want certainty but statistics provides probabilities at best. Some patients may be irritated to hear of a 70% chance that a given treatment will work; or they feel uncomfortable with the notion that their cholesterol level is associated with a 60% chance of suffering a heart attack within the next decade. Many patients long for reassurance that they will be helped in their suffering. It may be ‘politically correct’ to present patients with probability frequencies of adverse effects and numbers needed to treat, but anybody who (rightly or wrongly) promises certainty will create trust and have a following.

Many patients have become wary of the fact that ‘therapy’ has become synonymous with ‘pharmacotherapy’ and that many drugs are associated with severe adverse reactions. The hope of being treated with ‘side-effect-free’ remedies is a prime motivator for turning to complementary medicine.

Complementary treatments are by no means devoid of adverse reactions, but this fact is rarely reported and therefore largely unknown to patients. Physicians are regularly attacked for being in league with the pharmaceutical industry and the establishment in general. Power and money are said to be gained at the expense of the patient’s well-being. The system almost seems to invite dishonesty. The ‘conspiracy theory’ goes as far as claiming that ‘scientific medicine is destructive, extremely costly and solves nothing. Beware of the octopus’. Spectacular cases could be cited which apparently support it. Orthodox medicine is described as trying to ‘inhibit the development of unorthodox medicine’, in order to enhance its own ‘power, status and income’. Salvation, it is claimed, comes from the alternative movement which represents ‘… the most effective assault yet on scientific biomedicine’. Whether any of this is true or not, it is perceived as the truth by many patients and amounts to a serious criticism of what is happening in mainstream medicine today.

In view of such criticism, strategies for overcoming problems and rectifying misrepresentations are necessary. Mainstream medicine might consider discovering how patients view the origin, significance, and prognosis of the disease. Furthermore, measures should be considered to improve communication with patients. A diagnosis and its treatment have to make sense to the patient as much as to the doctor – if only to enhance adherence to therapy. Both disease and illness must be understood in their socio-economic context. Important decisions, e.g. about treatments, must be based on a consensus between the patient and the doctor. Scientists must get better in promoting their own messages, which could easily be far more attractive, seductive, and convincing than those of pseudo-science.These goals are by no means easy to reach. But if we don’t try, trust and adherence will inevitably deteriorate further. I submit that today’s unprecedented popularity of complementary medicine reflects a poignant criticism of many aspects of modern medicine. We should take it seriously

This study was aimed at evaluating group-level and individual-level change in health-related quality of life among persons with chronic low back pain or neck pain receiving chiropractic care in the United States.

A 3-month longitudinal study was conducted of 2,024 patients with chronic low back pain or neck pain receiving care from 125 chiropractic clinics at 6 locations throughout the US. Ninety-one percent of the sample completed the baseline and 3-month follow-up survey (n = 1,835). Average age was 49, 74% females, and most of the sample had a college degree, were non-Hispanic White, worked full-time, and had an annual income of $60,000 or more. Group-level and individual-level changes on the Patient-Reported Outcomes Measurement Information System (PROMIS) v2.0 profile measure were evaluated: 6 multi-item scales (physical functioning, pain, fatigue, sleep disturbance, social health, emotional distress) and physical and mental health summary scores.

Within group t-tests indicated significant group-level change for all scores except for emotional distress, and these changes represented small improvements in health. From 13% (physical functioning) to 30% (PROMIS-29 Mental Health Summary Score) got better from baseline to 3 months later.

The authors concluded that chiropractic care was associated with significant group-level improvement in health-related quality of life over time, especially in pain. But only a minority of the individuals in the sample got significantly better (“responders”). This study suggests some benefits of chiropractic on functioning and well-being of patients with low back pain or neck pain.

These conclusions are worded carefully to avoid any statement of cause and effect. But I nevertheless feel that the authors strongly imply that chiropractic caused the observed outcomes. This is perhaps most obvious when they state that this study suggests some benefits of chiropractic on functioning and well-being of patients with low back pain or neck pain.

To me, it is obvious that this is wrong. The data are just as consistent with the opposite conclusion. There was no control group. It is therefore conceivable that the patients would have improved more and/or faster, if they had never consulted a chiropractor. The devil’s advocate therefore concludes this: the results of this study suggest that chiropractic has significant detrimental effects on functioning and well-being of patients with low back pain or neck pain.

Try to prove me wrong!

PS

I am concerned that a leading journal (Spine) publishes such rubbish.

Bee venom acupuncture is a form of acupuncture in which bee venom is applied to the tips of acupuncture needles, stingers are extracted from bees, or bees are held with an instrument exposing the stinger, and applied to acupoints on the skin.

Bee venom consisting of multiple anti-inflammatory compounds such as melittin, adolapin, apamin. Other substances such as phospholipase A2 can be anti-inflammatory in low concentrations and pro-inflammatory in others. However, bee venom also contains proinflammatory substances, melittin, mast cell degranulation peptide 401, and histamine.

Bee venom acupuncture has been used to treat a number of conditions such as lumbar disc disease, osteoarthritis of the knee, rheumatoid arthritis, adhesive capsulitis, lateral epicondylitis, peripheral neuropathies, stroke and Parkinson’s Disease. The quality of these studies tends to be so poor that any verdict on the effectiveness of bee venom acupuncture would be premature.

A new clinical trial of bee-venom acupuncture for rheumatoid arthritis (RA) might change this situation. A total of 120 cases of RA patients were randomized into bee-sting acupuncture group (treatment) and western medicine group (control). The patients of the control group were treated by oral administration of Methotrexate (10 mg, once a week) and Celecoxlb (0.2 g, once a day). Those of the treatment group received 5 to 15 bee stings of Ashi-points or acupoints according to different conditions and corporeity, and with the bee-sting retained for about 5 min every time, once every other day. The treatment lasted for 8 weeks. The therapeutic effect was assessed by examining:

  • symptoms and signs of the affected joints as morning stiffness duration,
  • swollen/tender joint counts (indexes),
  • handgrip strength,
  • 15 m-walking time,
  • visual analogue scale (VAS),
  • Disease Activity Score including a 28-joint count (DAS 28),
  • rheumatoid factor (RF),
  • erythrocyte sedimentation rate (ESR),
  • C-reactive protein (CRP),
  • anti-cyclic citrullinated peptide antibody (ACCPA).

For assessing the safety of bee-venom acupuncture, the patients’ responses of fever, enlargement of lymph nodes, regional red and swollen, itching, blood and urine tests for routine were examined.

Findings of DAS 28 responses displayed that of the two 60 cases in the control and bee-venom acupuncture groups, 15 and 18 experienced marked improvement, 33 and 32 were effective, 12 and 10 ineffective, with the effective rates being 80% and 83. 33%, respectively. No significant difference was found between the two groups in the effective rate (P>0.05). After the treatment, both groups have witnessed a marked decrease in the levels of morning stiffness duration, arthralgia index, swollen joint count index, joint tenderness index, 15 m walking time, VAS, RF, ESR, CRP and ACCPA, and an obvious increase of handgrip strength relevant to their own levels of pre-treatment in each group (P<0.05). There were no significant differences between the two groups in the abovementioned indexes (P>0.05). The routine blood test, routine urine test, routine stool test, electrocardiogram result, the function of liver and kidney and other security index were within the normal range, without any significant adverse effects found after bee-stinging treatment.

The authors (from the Department of Acupuncture and Moxibustion, Bao’an Hospital of Traditional Chinese Medicine, Shenzhen, China) concluded that bee-venom acupuncture therapy for RA patients is safe and effective, worthy of popularization and application in clinical practice.

Where to start? There is so much – perhaps I just comment on the conclusion:

  • Safety cannot be assessed on the basis of such a small sample. Bee venom can cause anaphylaxis, and several deaths have been reported in patients who successfully received the therapy prior to the adverse event. Because there is no adverse-effect monitoring system, the incidence of adverse events is unknown. Stating that it is safe, is therefore a big mistake.
  • The trial was a non-superiority study. As such, it needs a much larger sample to be able to make claims about effectiveness.
  • From the above two points, it follows that popularization and application in clinical practice would be a stupid exercise.

So, what is left over from this seemingly rigorous RCT?

NOTHING!

(except perhaps a re-affirmation of my often-voiced fear that we must take TCM-studies from China with more than just one pinch of salt)

Traditional Chinese Medicine (TCM) is the umbrella term for modalities historically used in ancient China. TCM includes many therapeutic and some diagnostic modalities. Even though, these modalities differ in many respects, they are claimed to have in common that they are based on assumptions most of which originate from Taoist philosophy:

  • The human body is a miniature version of the universe.
  • Harmony between the two opposing forces, yin and yang, means health.
  • Disease is caused by an imbalance between these forces.
  • Five elements—fire, earth, wood, metal, and water—symbolically represent all phenomena, including the stages of human life, and explain the functioning of the body and how it changes during disease.
  • The vital energy, qi or chi, flows through the body in meridians, is essential for maintaining health.

TCM is a construct of Mao Zedong who lumped all historical Chinese treatments together under this umbrella and created the ‘barefoot doctor’ to practice TCM nationwide – not because he believed in TCM, but because China was desperately short of real doctors and needed at least a semblance of healthcare.

Over the past few years, China has been aggressively promoting TCM for expanding its global influence and for a share of the estimated US$50-billion global market (of products of dubious quality). A recent article in ‘Nature’ explains that the WHO’s governing body, the World Health Assembly, is set to adopt the 11th version of the organization’s global compendium — known as the International Statistical Classification of Diseases and Related Health Problems (ICD). For the first time, the ICD will include information about TCM. Chapter 26 of the ICD will feature a classification system on TCM, largely based not on science or facts, but on obsolete nonsense.

The WHO’s support applies to all traditional medicines, but its relationship with Chinese medicine, and with China, has grown especially close, in particular during the tenure of Margaret Chan, who ran the organization from 2006 to 2017 and made sure that several documents favourable to TCM were passed. The WHO’s declarations about traditional medicine are puzzling. Various of these WHO documents call for the integration of “traditional medicine, of proven quality, safety and efficacy”, while being silent as to which traditional medicines and diagnostics are proven. Wu Linlin, a WHO representative in the Beijing office, told Nature that the “WHO does not endorse particular traditional and complementary medicine procedures or remedies”.

But this is evidently not the case and in sharp contrast to the WHO’s actions in other areas. The agency provides, for instance, specific advice on what vaccines and drugs to use and what foods to avoid. With traditional medicines, however, such specifics are missing. The message therefore can only be that the WHO endorses TCM as safe and effective.

The evidence, however, tells us a different story. On this blog, we have repeatedly discussed that:

China’s drug regulator gets more than 230,000 reports of adverse effects from TCM each year, and Chinese herbal medicines carry multiple direct risks:

To this, we have to add the indirect risk of employing useless treatments for otherwise treatable conditions.

In view of all this, the WHO’s endorsement of TCM and its obsolete concepts is not just not understandable, it is a dangerous step backwards and, in my view, even intolerable.

The AMERICAN INSTITUTE OF HOMEOPATHY (AIH) is the oldest national medical association in the United States. The AIH’s mission is “to promote the science and art of homeopathic medicine, to safeguard the interests of the homeopathic medical profession, to improve the standards of homeopathic medical education, to educate the medical and scientific communities about the scientific basis for homeopathic medicine, and to increase public knowledge and acceptance of homeopathy as a medical specialty.”

The AIH is about to hold its annual conference. This year’s theme is “Tackling Patients with Severe Pathology”. The announcement reads as follows:

Homeopathy has been found to be effective in the great majority of patients suffering from infectious and autoimmune diseases. The limits of homeopathic treatment are encountered in the treatment of patients with Parkinson’s disease, ALS and late-stage cancers. After finding a way to treat patients with Parkinson’s disease with homeopathy, Dr. Saine began to apply this approach to cancer patients in stages III and IV. In this seminar, he will review case analysis, posology and case management for this cohort of patients.

We are fortunate to have the opportunity to learn from Dr. Saine in this seminar. He is recognized as one of the foremost homeopathic teachers and clinicians in the world, with special expertise in extremely difficult cases of severe and advanced pathology.

Who, for heaven sake, is this foremost homeopathic teachers and clinicians in the world, Dr Saine?, I asked myself after reading this (and even more so after listening to the rather spectacular video provided with the announcement). Here is what I found out about him:

Dr. Saine is a 1982 graduate of the National College of Naturopathic Medicine in Portland, Oregon. He is board-certified in homeopathy (1988) by the Homeopathic Academy of Naturopathic Physicians and has been teaching and lecturing on homeopathy since 1985. He is considered one of the world’s foremost experts on the subject of homeopathy.

And this is what non-doctor* Saine writes about medicine etc.:

The Organon of Medicine is a blueprint on how to practice medicine rationally and wisely through an integration of all the fundamental principles of medicine into a comprehensive whole. Unfortunately, to the detriment of the sick, very few homeopaths have delved, as Hahnemann did, into the practice of lifestyle medicine and the use of complementary care to homeopathy.

With rare exceptions, patients will present with a portion of their disease that ensues from an unhealthy environment or ways of living. The role of the physician is to determine in the equation of disease what is primarily due to an untuned vital force versus a causa occasionalis, as both will have to be addressed in due time.

After reading and listening to all this I am mildly shocked.

It does not seem to me that the AIH is fit for purpose. Neither am I convinced that non-doctor Saine should be let near any patient, let alone one with cancer or another severe pathology.

There should be a law protecting patients from this sort of thing!

[*in the context of healthcare, a doctor is for me someone who has studied medicine]

Central retinal artery occlusion, nystagmus, Wallenberg syndrome, ophthalmoplegia, Horner syndrome, loss of vision,  diplopia, and ptosis are all amongst the eye-related problems that have been associated with chiropractic upper spinal manipulations. Often the damage leaves a permanent deficit – happily, not in this instance.

US ophthalmologists published the case of a 59-year-old Caucasian female who presented with the acute, painless constant appearance of three spots in her vision immediately after a chiropractor performed cervical spinal manipulation using the high-velocity, low-amplitude technique. The patient described the spots as “tadpoles” that were constantly present in her vision. She noted the first spot while driving home immediately following a chiropractor neck adjustment, and became more aware that there were two additional spots the following day.

Slit lamp examination of the right eye demonstrated multiple unilateral pre-retinal haemorrhages with three present inferiorly along with a haemorrhage over the optic nerve and a shallow, incomplete posterior vitreous detachment. Optical Coherence Tomography (OCT) demonstrated the pre-retinal location of the haemorrhage.

These haemorrhages resolved within two months.

The specialists concluded that chiropractor neck manipulation has previously been reported leading to complications related to the carotid artery and arterial plaques. This presents the first case of multiple unilateral pre-retinal haemorrhages immediately following chiropractic neck manipulation. This suggests that chiropractor spinal adjustment can not only affect the carotid artery, but also could lead to pre-retinal haemorrhages.

In the discussion section of their paper, the authors stated: Upper spinal manipulation with the HVLA technique involves high velocity, low-amplitude thrusts on the cervical spine administered posteriorly. No other aetiology of the pre-retinal haemorrhages was found on work-up (no leukemic retinopathy, hypertension, diabetes, or retinal tear). The temporal association immediately while driving home from the chiropractic procedure makes other causes less likely, although we cannot exclude Valsalva retinopathy or progressive posterior vitreous detachment. Given the lack of any retinal vessel abnormalities or plaques along with the temporal association, we postulate that the chiropractor neck manipulation itself induced vitreo-retinal traction that likely led to pre-retinal haemorrhages which were self-limited. It is also possible that the HVLA technique could have mechanically assisted with induction of a posterior vitreous detachment.

If the authors are correct, one has to wonder: how often do such problems occur in patients who simply do not bother to report them, or doctors who do not correctly diagnose them?

The ‘Healing Revolution’ began, according to BIO KING’s website, more than 25 years ago with the establishment of King Bio. Its founder, Dr. Frank King, was inspired to find the root causes of illness and empower the whole person. He cultivated an interest in developing pure water-based homeopathic medicines – a type of natural product that was not, to his knowledge, being produced anywhere else. Committed to researching and developing this new homeopathic medicine, Dr. King moved to Asheville, North Carolina, and opened King Bio in 1989. For more than 25 years, King Bio’s mission has remained true to the empowerment of whole person health, most recently including breakthroughs in whole food dietary supplements. Dr. King’s vision for the company has always centered around three core guiding principles: health, wholeness, and innovation.

On their website, BIO KING also explains: Homeopathy … is energy medicine. Rather than going through digestion, homeopathic remedies deliver their messages almost instantly along the body’s nerve pathways. Like acupuncture, it works bioenergetically (“bio” means “life,” so “bioenergetic” means “life energy”). If the biochemical aspects of the body are like the building blocks of a home, bioenergy is like the invisible electricity that powers it. (A deceased person may have the same biochemical constituents as a living person, but the bioenergy is missing.)

BIO KING is on a mission! To be precise, the mission, as stated on the website, is this:

  • To provide safe, all-natural medicines without harmful side effects.
  • To offer affordable natural medicines that help people overcome common health challenges.
  • To achieve the trust and respect of our customers and uphold the best product quality.
  • To empower people with the most effective ways to achieve abundant health.

Safe medicines?

Without side-effects?

Trust and respect?

Best product quality?

Dr King has been reported to be voluntarily recalling 32 different infant and kids medicines after they tested positive for a microbial contamination. Use of these products could, it is feared, cause life-threatening infections.

Quite a ‘Healing Revolution’!

It is no secret to regular readers of this blog that chiropractic’s effectiveness is unproven for every condition it is currently being promoted for – perhaps with two exceptions: neck pain and back pain. Here we have some encouraging data, but also lots of negative evidence. A new US study falls into the latter category; I am sure chiropractors will not like it, but it does deserve a mention.

This study evaluated the comparative effectiveness of usual care with or without chiropractic care for patients with chronic recurrent musculoskeletal back and neck pain. It was designed as a prospective cohort study using propensity score-matched controls.

Using retrospective electronic health record data, the researchers developed a propensity score model predicting likelihood of chiropractic referral. Eligible patients with back or neck pain were then contacted upon referral for chiropractic care and enrolled in a prospective study. For each referred patient, two propensity score-matched non-referred patients were contacted and enrolled. We followed the participants prospectively for 6 months. The main outcomes included pain severity, interference, and symptom bothersomeness. Secondary outcomes included expenditures for pain-related health care.

Both groups’ (N = 70 referred, 139 non-referred) pain scores improved significantly over the first 3 months, with less change between months 3 and 6. No significant between-group difference was observed. After controlling for variances in baseline costs, total costs during the 6-month post-enrollment follow-up were significantly higher on average in the non-referred versus referred group. Adjusting for differences in age, gender, and Charlson comorbidity index attenuated this finding, which was no longer statistically significant (p = .072).

The authors concluded by stating this: we found no statistically significant difference between the two groups in either patient-reported or economic outcomes. As clinical outcomes were similar, and the provision of chiropractic care did not increase costs, making chiropractic services available provided an additional viable option for patients who prefer this type of care, at no additional expense.

This comes from some of the most-renowned experts in back pain research, and it is certainly an elaborate piece of investigation. Yet, I find the conclusions unreasonable.

Essentially, the authors found that chiropractic has no clinical or economical advantage over other approaches currently used for neck and back pain. So, they say that it a ‘viable option’.

I find this odd and cannot quite follow the logic. In my view, it lacks critical thinking and an attempt to produce progress. If it is true that all treatments were similarly (in)effective – which I can well believe – we still should identify those that have the least potential for harm. That could be exercise, massage therapy or some other modality – but I don’t think it would be chiropractic care.


References

Comparative Effectiveness of Usual Care With or Without Chiropractic Care in Patients with Recurrent Musculoskeletal Back and Neck Pain.

Elder C, DeBar L, Ritenbaugh C, Dickerson J, Vollmer WM, Deyo RA, Johnson ES, Haas M.

J Gen Intern Med. 2018 Jun 25. doi: 10.1007/s11606-018-4539-y. [Epub ahead of print]

PMID: 29943109

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