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

survey

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This paper explored the intersection of science and pseudoscience in online discourse about detoxification, investigating how and to what extent they coexist on the web. Drawing on previous studies of internet health scams, it examines the discursive strategies used to either validate or refute alternative detox treatments. Using a corpus-assisted discourse studies approach, the present study analyses a corpus of texts (167,177 tokens) about detoxification randomly collected from the web.

The results show that corrective messages debunking the detox myth make up less than 10% of the corpus. Furthermore, many keywords in the corpus, such as “toxin(s),” are subject to constant renegotiation. Advocates of so-called alternative medicine (SCAM) use the term “toxin(s)” to justify detox treatments, while scientists criticize it as pseudoscientific.

The authors conclude thaat their study highlights how terminological ambiguity facilitates the mixing of science and pseudoscience, confusing readers. It also highlights the role of language in health-related misinformation and calls for interdisciplinary research to develop educational tools for health professionals.

Corpus-assisted discourse studies (CADSs) are related historically and methodologically to the discipline of corpus linguistics. Their principal endeavor is the investigation and comparison of features of particular discourse types, integrating into the analysis the techniques and tools developed within corpus linguistics. These include the compilation of specialised corpora and analyses of word and word-cluster frequency lists, comparative keyword lists and, above all, concordances. A broader conceptualisation of corpus-assisted discourse studies would include any study that aims to bring together corpus linguistics and discourse analysis.

The findings of this CADS can hardly surprise anyone who has been following this blog. We have often discussed the problem of pseudo-scientific language and the confusion it creates. Likewise, we have repeatedly dealt with the ‘detox myth’ and how it is being used by advocates of SCAM.

What is new is the finding that only 10% of of the discourse seems to come from people who debunk the ‘detox myth’. This is, of course, disappointing but not really surprising considering how much virtually the entire SCAM business relies on it.

So, to make it clear yet again:

As always, I would be delighted to learn more and to correct these statements, provided someone shows me good evidence to the contrary.

The fact that animal parts are used for so-called alternative medicine (SCAM) is well-known. The problem has so far been related mostly to China and TCM. A recent article reminds us of the fact that the abuse of animals for SCAM is also an African issue:

The use of animals for zootherapeutic purposes has been reported worldwide, and with the patronage of complementary and alternative medicines being on the ascendency, the trade and use of animal parts will only escalate. Many more of these animals used in traditional medicine will be pushed to extinction if policies for their sustainable use and conservation are not formulated. There have been studies across the world which assessed the trade and use of animals in traditional medicine including Ghana. However, all previous Ghanaian studies were conducted in a few specific cities. It therefore makes it imperative for a nationwide study which would provide more comprehensive information on the trade and use of animals in traditional medicine and its conservation implications. Using direct observation and semi-structured questionnaires, data were collected from 133 vendors of animal parts used in traditional medicines in 48 markets located across all 16 administrative regions of Ghana. Analysis of the data showed that the trade in wild animal parts for traditional medicine was more prevalent in the urban centres of Ghana. Overall, 75 identifiable animal species were traded on Ghanaian traditional medicine markets. Using their relative frequency of citation values, chameleons (Chamaeleo spp.; 0.81), lions (Panthera leo; 0.81) and the West African crocodile (Crocodylus suchus; 0.67) were the most commonly traded animals in Ghana. Majority of the vendors (59.1%) indicated that their clients use the animal parts for medicinal purposes mainly for skin diseases, epilepsy and fractures, while clients of 28.2% of the vendors use the animal parts for spiritual or mystical purposes, such as protection against spiritual attacks, spiritual healing and money rituals. Up to 54.2% of the animals were classified as Least Concern by IUCN, 14.7% were threatened, with 51.2% of CITES-listed ones experiencing a decreasing population trend. This study also found that 68.5% of the traded animal species are not listed on CITES, but among those listed, 69.6% are classified under Appendix II. Considering the level of representation of animals of conservation concerns, the harvesting and trade of animal parts for traditional medicine must be regulated. This call is even more urgent since 40.0% of the top ten traded animals are mammals; a class of animals with long gestation periods and are not prolific breeders.

The authors concluded that the trade of animal parts and products for traditional medicine in Ghana is widespread, especially in market centres in the urban area. These animals are used mainly for medicinal purposes, especially skin diseases, but their use for mystical purposes is also prevalent. Again, with the topmost traded animals being those in CITES Appendices I and II, means there is some laxity in the enforcement of laws that are to ensure sustainable use of animal resources. Although a majority of animals traded for traditional medicine may not be currently of conservation concern and not listed under CITES, policymakers and other stakeholders in Ghana and beyond would have to start working on ensuring the survival of the threatened ones and prevent the sliding of the non-threatened species into extinction so the biodiversity will be conserved for the use of the future generation.

All I want to add here is the fact that there is not a shred of evidence that animal parts in SCAM have any positive health effects. It is high time that this barbaric and useless trade stops!

I have only recently become aware of the fact that ‘Google Scholar’ offers a thing called ‘my profile‘. In my case, it contains a host of information about my published research – but, I have to admit, I only understand some of it (yes, I am not all that savvy on the Internet).

It tells me, for instance, that I have been cited just over 1000 times – not in total but in 2025! In total, the amount is more than 89000. Most satisfying and easy to understand.

My ‘H-Index’ is currently 149. This means that 149 of my papers have been cites at least 149 times – also not too difficult to comprehend. The Index is an attempt to account for both the quality and the quantity of a researchers published work. What I don’t comprehend is why, from time to time, the Index and citation numbers diminish and then climb up again. [A researcher’s h-index is defined as the highest number of h such that the researcher has h papers, each of which has been cited at least h times. But if this were true, the Index could never go down.] It might be caused by the time frame on which all this is based and that shifts as time goes on – does anyone know?

What I find interesting about my ‘profile’ is the fact that the three most-cited papers of mine are all outside the realm of so-called alternative medicine (SCAM). All are quite old; one was published as far back as 1993.

Another interesting aspect is that the frequency of my citations per year increased almost linearly from 1997 (the first year that my ‘profile’ displays) when it was just 228 to 2021 when it had reached the dizzy heights of 4826. This is remarkable because I retired in 2012/13 when I all but stopped publishing citable papers.

The most fascinating things about my ‘profile’ is, in my view, that it also offers informations about (some of) the people who were my co-authors [it would be interesting to know why some are mentioned and others aren’t]. Several of those were once members of my team, and it is brilliant to see how well some of them did. Here are the H-Indeces of those you appear on my ‘profile’ page:

This, I think, is a good occasion to thank not just those who are mentioned above, but also all of those members of my team who (mysteriously) are missing on this list.

The primary aim of this ‘mixed-methods, feasibility pilot study’ was to evaluate the feasibility of providing Reiki at a behavioral health clinic serving a low-income population. The secondary aim was to evaluate outcomes in terms of patients’ symptoms, emotions, and feelings before and after Reiki.
The study followed a pre-post experimental design. Reiki was offered to adult outpatients at a community behavioral health center in Rochester, Minnesota. Patients with a stable mental health diagnosis completed surveys before and after the Reiki intervention and provided qualitative feedback. Patients were asked to report their ratings of:
  • pain,
  • anxiety,
  • fatigue,
  • feelings (eg, happy, calm)

on 0- to 10-point numeric rating scales. Data were analyzed with Wilcoxon signed rank tests.

Among 91 patients who completed a Reiki session during the study period, 74 (81%) were women. Major depressive disorder (71%), posttraumatic stress disorder (47%), and generalized anxiety disorder (43%) were the most common diagnoses. The study was feasible in terms of recruitment, retention, data quality, acceptability, and fidelity of the intervention. Patient ratings of pain, fatigue, anxiety, stress, sadness, and agitation were significantly lower, and ratings of happiness, energy levels, relaxation, and calmness were significantly higher after a single Reiki session.
The authors concluded that the results of this study suggest that Reiki is feasible and could be fit into the flow of clinical care in an outpatient behavioral health clinic. It improved positive emotions and feelings and decreased negative measures. Implementing Reiki in clinical practice should be further explored to improve mental health and well-being.
One might have expected better science from the Mayo Clinic, Rochester; in fact, this is not science at all; it’s pure pseudo-science! Here are some critical remarks:
  • What on earth is a ‘mixed-method, feasibility, pilot study’? A hallmark of pseudo-researchers seems to be that they think they can invent their own terminology.
  • There is no objective, validated outcome measure.
  • The conclusion that ‘Reiki is feasible‘ has been known and does not need to be tested any longer.
  • The conclusion that ‘Reiki improved positive emotions and feelings and decreased negative measures’ is false. As there was no control group, these improvements might have been caused by a whole lot of other things than Reiki – for instance, the extra attention, placebo effects, regression towards the mean or social desirability.
  • The conclusion that ‘implementing Reiki in clinical practice should be further explored to improve mental health and well-being’ is therefore not based on the data provided. In fact, as Reiki is an implausible esoteric nonsense, it is a promotion of wasting resources on utter BS.

Does it matter?

Why not let pseudo-scientists do what they do best: PSEUDO-SCIENCE?

I think it matters because:

  • Respectable institutions like the Mayo Clinic should not allow its reputation being destroyed by quackery.
  • The public should not be misled by charlatans.
  • Patients suffering from mental health problems deserve better.
  • Resources should not be wasted on pseudo-research.
  • ‘Academic journals like ‘Glob Adv Integr Med Health’ have a responsibility for what they publish.
  • ‘The ‘Academic Consortium for Integrative Medicine & Health‘ that seems to be behind this particular journal claim to be “the world’s most comprehensive community for advancing the practice of whole health, with leading expertise in research, clinical care, and education. By consolidating the top institutions in the integrative medicine space, all working in unison with a common goal, the Academic Consortium is the premier organizational home for champions of whole health. Together with over 86 highly esteemed member institutions from the U.S., Australia, Brazil, Canada and Mexico, our collective vision is to transform the healthcare system by promoting integrative medicine and health for all.” In view of the above, such statements are a mockery of the truth.

 

This study was aimed at investigating how Spanish media reinforce a positive image of dietary supplements in the treatment of  children, potentially leading to harmful health attitudes and behaviors.

The researchers conducted a quantitative content analysis of 912 news articles published between 2015 and 2021 in Spanish media outlets discussing dietary supplements for children. They used a frequency analysis and a proportion comparison to analyze variables such as the reach of news, tone of news, mentions of health professional consultation, association with natural products, media specialization, intertextuality, and headline mentions.

The study found a 60% increase in publications discussing dietary supplements for children during the study period. The content analysis indicates that these articles predominantly present dietary supplements in a positive light, often without robust scientific evidence. Furthermore, many do not emphasize the need for medical consultation, which may contribute to unsupervised consumption of supplements, particularly among minors. This highlights the critical importance of professional guidance when considering dietary supplements for children. Additionally, the frequent emphasis on the “natural” attributes of these products raises concerns regarding consumer perceptions and potential safety risks.

The authors concluded that their study reveals a problem regarding the portrayal of dietary supplements for children in Spanish media. The overly optimistic image, lack of scientific basis, and failure to recommend medical supervision may contribute to unsupervised consumption among minors, risking their health due to misinformed decisions influenced by media portrayal.

I would add that this problem exists not just for children and not just in Spain. It has long been noted to put consumers of all ages and from all countries at risk. The authors kindly cite our own study from 2006 that concluded: “UK national newspapers frequently publish articles on CATs for cancer. Much of this information seems to be uncritical with a potential for misleading patients.”

Even several years before that, my late friend Thomas Weimayr and I published this study in the BMJ:

The media strongly influences the public’s view of medical matters. Thus, we sought to determine the frequency and tone of reporting on medical topics in daily newspapers in the United Kingdom and Germany. The following eight newspapers were scanned for medical articles on eight randomly chosen working days in the summer of 1999: the Times, the Independent, the Daily Telegraph, and the Guardian in the United Kingdom, and Frankfurter Allgemeine Zeitung, Süddeutsche Zeitung, Frankfurter Rundschau, and Die Welt in Germany. All articles relating to medical topics were extracted and categorised according to subject, length, and tone of article (critical, positive, or neutral).

A total of 256 newspaper articles were evaluated. The results of our analysis are summarised in the table. We identified 80 articles in the German newspapers and 176 in the British; thus, British newspapers seem to report on medical topics more than twice as often as German broadsheets. Articles in German papers are on average considerably longer and take a positive attitude more often than British ones. Drug treatment was the medical topic most frequently discussed in both countries (51 articles (64%) in German newspapers and 97 (55%) in British). Surgery was the second most commonly discussed medical topic in the UK newspapers (32 articles; 18%). In Germany professional politics was the second most commonly discussed topic (11 articles; 14%); this category included articles about the standing of the medical profession, health care, and social and economic systems—that is, issues not strictly about treating patients.

Because our particular interest is in complementary medicine, we also calculated the number of articles on this subject. We identified four articles in the German newspapers and 26 in the UK newspapers. In the United Kingdom the tone of these articles was unanimously positive (100%) whereas most (3; 75%) of the German articles on complementary medicine were critical.

This analysis is, of course, limited by its small sample size, the short observation period, and the subjectivity of some of the end points. Yet it does suggest that, compared with German newspapers, British newspapers report more frequently on medical matters and generally have a more critical attitude (table). German newspapers frequently discuss medical professional politics, a subject that is almost totally absent from newspapers in the United Kingdom.

The proportion of articles about complementary medicine seems to be considerably larger in the United Kingdom (15% v 5%), and, in contrast to articles on medical matters in general, reporting on complementary medicine in the United Kingdom is overwhelmingly positive. In view of the fact that both healthcare professionals and the general public gain their knowledge of complementary medicine predominantly from the media, these findings may be important.,

25 years later, the call on journalists to behave more responsibly when reporting about so-called alternative medicine (SCAM) is as loud and clear as it is neglected and ignored.

Use of so-called alternative medicines (SCAM) is, as we have frequently discussed on this blog, associated with an anti-vax attitude or vaccine hesitancy. However, the nature of—and reasons for—this association are  not entirely clear, not least because both SCAM and vaccine hesitancy are complex, heterogeneous phenomena.

A recent study aimed to determine which aspects of SCAM predict vaccine hesitancy and to probe the psychological roots of their association. In a two-stage survey (N1 = 1905, N2 = 1443), participants from Argentina, Germany and the USA reported vaccine/SCAM health behaviors, intentions and beliefs. They also responded to scales probing attitudes to science, individual differences in cognitive styles, and anomalous beliefs.

An Item-Response Theoretic model of vaccine responses revealed that, outside of either total acceptance or outright refusal of vaccines, hesitancy reflected a gap between past vaccination behaviors and future behavioral intentions. More than SCAM-use, vaccine hesitancy was predicted by SCAM-relevant health beliefs. An oppositional view of natural vs. biomedical care was central in this regard. Unscientific mindsets—both in attitudes to expertise and in anomalous beliefs—underpinned the psychological similarity of SCAM beliefs and vaccine hesitancy.

The authors concluded that the relationship between SCAM and vaccine hesitancy is primarily a matter of health-relevant beliefs centered on natural vs. scientific medicine. This relationship—and in particular, a gap between past vaccine behaviors and future be havioral intentions—reflects fundamentally unscientific mindsets. Thus, a key challenge in addressing this form of vaccine hesitancy is one of perspective taking: Scientists must find persuasive reasons to vaccinate which appeal to people who do not see science as the main route to medical knowledge.

These findings should seem fairly obvious to those of us who have followed the discussions on this blog and elsewhere around vaccines and vaccinations. In the present study, belief in ‘naturalness’ predicted vaccine acceptance – and did so consistently across countries – more than other health beliefs. The associations between vaccine acceptance and SCAM were not strongly related to  sociodemographic factors. The only regular pattern was for gender, with women being both more vaccine resistant and more pro-SCAM than men.

Negative attitudes towards vaccines and belief in ‘naturalness’ were associated with a cluster of ‘anti-expert’ variables including distrust in science. Vaccine resistance was also associated with a range of anomalous beliefs or biased belief updating styles. These negative attitudes to scientific sources of information and unscientific belief contents are different aspects of an unscientific mindset.

I think, this makes sense and seems to confirm previous findings about the association between SCAM-use and vaccine hesitancy: the two are linked indirectly by a common denominator.

So-called alternative medicine (SCAM) is, according to the authors of this paper, gaining popularity among patients experiencing pain, alongside traditional treatments. Their survey aimed to explore the views of pain clinicians and researchers on SCAM interventions.

An anonymous, online survey was distributed to 46 223 authors who had published pain-related research in MEDLINE-indexed journals. The survey included multiple-choice questions and open-ended sections to gather detailed opinions.

A total of 1024 participants responded, most identifying as either pain researchers (43.59%) or both researchers and clinicians (39.88%). Many held senior positions (61.55%). Among the SCAM modalities, mind-body therapies such as meditation, yoga, and biofeedback were viewed as the most promising for pain prevention, treatment, and management, with 68.47% of participants endorsing these approaches. While a majority (43.89%) believed that most SCAM therapies are safe, only 25.55% expressed confidence in their effectiveness. There was broad agreement on the need for more research into SCAM therapies, with 45.88% agreeing and 42.53% strongly agreeing that further investigation is valuable. Additionally, many respondents supported the inclusion of SCAM training in clinician education, either through formal programs (46.40%) or supplementary courses (52.71%). Mind-body therapies received the most positive feedback, while biofield therapies were met with the most skepticism.

The authors concluded that these findings highlight the interest in SCAM among pain specialists and emphasize the need for more research and education tailored to this area.

It is not often that I come across an article that makes me laugh out loud. Here are some of the reasons for my amusement:

  • Since when is 44% a majority?
  • In fact, the majority of respondents seems not to believe that SCAM is safe;
  • only 26% were confident that SCAM is effective, yet we are made to believe that “many respondents supported the inclusion of SCAM training in clinician education”.

The biggest laugh needs to go to the response rate of this survey: 46 223 people received the questionnaire and 1024 responded to it! This gives a response rate of just over 2%! and seems to indicate that the vast majority of pain researchers are not bothered about SCAM. If that is so, should we not adjust the conclusion accordingly? Perhaps something like this would fit the data much better:

These findings highlight the disinterest in SCAM among pain specialists and emphasize that no more research and education tailored to this area are required.

The aim of this study was to review the deaths associated with chiropractic treatment in Australia. The National Coronial Information System (NCIS) was searched for cases in Australia for which chiropractic treatment was determined to have contributed to death. Closed, completed Australian cases between 1 July 2000 and 31 December 2019 were evaluated (approximately 356,000 cases).

The findings revealed only one case in which chiropractic treatment was considered to have contributed to death. The case was that of an adult male who died from a dissected left vertebral artery following chiropractic manipulation for neck pain.

In addition, postmortem records at Forensic Science SA (FSSA) were searched for similar cases over the same time period (approximately 30,000 cases). No cases definitely attributable to chiropractic manipulation of the neck were found, but a case with thrombus in the left vertebral artery would not be entirely excluded as being related to chiropractic treatment.

Deaths associated with chiropractic manipulation in Australia therefore appear rare. Although there is a reported incidence of stroke associated with vertebrobasilar artery system occlusion following chiropractic manipulation, stroke associated with vertebrobasilar artery occlusion has also been observed following a visit to a primary care physician. This could be explained by vertebrobasilar artery pathology causing neck pain that initiated consultation.

The authors concluded that the present study only demonstrates a rare temporal, but not causal, relationship between attending a chiropractor and vertebral artery dissection causing death. Non-lethal injuries were not assessed.

This is an interesting paper. Many chiropractors steadfastly deny that their manipulations can cause serious problems. This analysis clearly shows that this assumption is untrue. It also suggests that deaths are rare. The question is: how reliable is this conclusion?

The authors searched NCIS and the FSSA for cases for which chiropractic treatment was determined to have contributed to death. In other words, fatalities for which chiropractic treatment had not been determined to have contributed to death were not considered. Because the link between a person’s death and a spinal manipulation might often not be made, further cases of deaths might need to be added to the total.

A further question is this: even if – as we all hope – deaths are very rare, does that mean chiropractic manipulations are safe? Here the answer is clearly NO! Death is merely the most dramatic outcome. Spinal manipulations can cause strokes, and most of these events do result in neurological deficits but not death.

Finally, we need to consider the risk/benefit balance of chiropractic manipulations. As often discussed here, the benefits of spinal manipulation are, depending on the indication, small or uncertain. This means that even rare but serious adverse events weigh heavily and tilt the balance into the negative. In short, this means that chiropractors should be avoided.

In conclusion, this paper leaves no doubt that chiropractic manipulations can be deadly. One would very much hope that such fatalities are extremely rare events, however, the data provided are not convincing.

I was fascinated and horrified in equal measure to watch Donald Trump speaking at the CPAC talking about a medical topic – autism to be precise. Here are his words (minus the gibberish he always adds to disguise the stupidity of his phrases):

…15 years ago, there was one case per 10 000, some say 20 000 US citizens. Now the figure is 1 in 36. There’s something wrong. Bobby (Robert F. Kennedy Jr.) is gonna find it, working with Dr. Oz; by the way, working with Dr. Oz…

The audience of conservatives cheered blissfully!

What Trump said at the CPAC was not original. He uttered almost identical nonsense before (except he also claims the rate is now 1 in 34); it seems to be one of his set pieces for amusing the intellactually challenged.

A few days ago Trump signed an executive order (EO) calling for the creation of a ‘Make America Healthy Again’ Commission, which the White House says will be “tasked with investigating and addressing the root causes of America’s escalating health crisis.” In the EO, the figures are, however, a little different: “Autism spectrum disorder now affects 1 in 36 children in the United States — a staggering increase from rates of 1 to 4 out of 10,000 children identified with the condition during the 1980s.”

  • 15 years ago was not the 1980s;
  • 1 in 10 000 is not the same as 1 to 4 out of 10,000 children.

But, as we are often told, we must not take Trump literally; it’s the ‘BIG PICTURE’ that counts!

A little research reveals that the 1 in 36 prevalence figure originates from this survey. It was not focussed on autism but on autism spectrum disorder (ASD).

  • Autism is a specific disorder within the broader category of ASD.
  • ASD refers to a range of conditions that share some commonalities.
  • Autism has distinct characteristics and symptoms.
  • ASD includes conditions like autism, Asperger’s syndrome, childhood disintegrative disorder, and an unspecified form of pervasive developmental disorder.

Is it really too difficult for Trump to differentiate between autism and ASD?

Or is the reason that this would not fit his agenda?

The survey concluded that “findings from the ADDM Network 2020 surveillance year indicate higher ASD prevalence than previous estimates from the ADDM Network and continuing evidence of a marked shift in the demographic composition of children identified with ASD compared with previous years. Although earlier ADDM Network reports have shown higher prevalence among higher-SES White children compared with other groups, the latest data indicate consistently higher prevalence among Black and Hispanic children compared with White children, and no consistent association between ASD and SES. Furthermore, this is the first ADDM Network report in which the prevalence of ASD among girls has exceeded 1%. Since 2000, the prevalence of ASD has increased steadily among all groups, but during 2018–2020, the increases were greater for Black and Hispanic children than for White children. These data indicate that ASD is common across all groups of children and underscore the considerable need for equitable and accessible screening, services, and supports for all children.”

The authors of the survey caution that the findings in their report are subject to at least seven limitations.

  • First, the methods rely on the availability, quality, and completeness of existing information and records to ascertain ASD cases and other indicators. Although all sites had access to special education classification data, certain sites did not have access to education records for their entire population, limiting the ability to identify children with ASD exclusively identified and served through their schools. Sites requested records from public school special education programs but did not review private school education records. Incomplete information could lead to misclassifying children’s cognitive ability, overestimating the age when they were first evaluated or when ASD was diagnosed, or failing to ascertain that the children were identified as having ASD. Sex information reflects what is represented in children’s records and might not reflect their gender identity.
  • Second, the case definition for intellectual disability was measured using a child’s latest cognitive test or examiner statement of a child’s cognitive ability. Diagnostic and special education eligibility criteria for intellectual disability requires concurrent adaptive functioning deficits. IQ scores are not necessarily stable measures of intellectual ability over time, can increase among children with ASD in response to intensive early therapeutic interventions, and might be unstable during early childhood. The age at which children had their most recent test or examiner impression of cognitive ability varied by site.
  • Third, the ADDM Network sites are not intended to be representative of the states in which the sites are located. ADDM Network sites are selected through an objective and competitive process, and findings do not necessarily generalize to all children aged 8 years in the United States. Interpretations of temporal trends can be complicated by changing surveillance areas, case definitions, data source access, and diagnostic practices.
  • Fourth, small numbers result in imprecise estimates for certain sites and subgroups, and estimates falling below the selected threshold for statistical precision were suppressed.
  • Fifth, the surveillance data system does not collect the number of ASD ICD codes a child received at a specific source, limiting comparability to analyses of claims/billing databases that consider number of ICD codes received.
  • Sixth, the COVID–19 pandemic resulted in reduced access to records from some sources at certain sites; it was often possible to electronically obtain some data elements from these sources but not manually review the full contents of records. Disruptions in services and school closures during 2020 might have resulted in less documentation of ASD in records, which could decrease ASD ascertainment by ADDM sites.
  • Seventh, the prevalence of undetected ASD in each community as well as false-positive ASD diagnoses and classifications are unknown.

So, Trump charged Robert F. Kennnedy Jr. to investigate why ASD is on the increase. As it happens, Kennedy already knows the conclusion of this investigation. He has often stated widely debunked claims that autism is caused by vaccinations. For instance, in a 2023 interview with Fox News, he squarely claimed that “autism comes from vaccines”. This theory was popularised by the discredited ex-doctor Andrew Wakefield based on a fraudulent paper that was later retracted by the Lancet. Multiple studies have subsequently demonstrated that there is no link between vaccines and autism.

Luckily Kennedy has Dr. Oz – yes the very Dr. Oz who has featured many times on my blog (see for instance here, here and here) – to help him get to the bottom of what Trump believes to be a mystery. Those two will be quite an unbeatable team (neither of them has ever done proper research in this area; Oz promotes any quackery that fills his pockets, and Kennedy would not recognise reliable science, if it bit him in his behind)! Perhaps they could start their investigation by reading the many papers that have already found at least some of the plausible reasons for the above-cited figures, e.g:

Oh, I almost forgot: they don’t need to read such demanding papers. They already have the answer to the autism mystery!

 

PS

The objective of this study was to test the feasibility and initial effect sizes of so-called alternative medicine (SCAM) for patients at two children’s hospitals.
Using convenience sampling at two academic centers and accepting the wide age range of patients traditionally treated in children’s hospitals, the researchers examined the feasibility of SCAM as well as outcomes of quality of life (QOL) and symptoms with validated surveys and two physiologic measures. A priori feasibility thresholds were 90% accrual rate and 60% completion of at least two surveys and one SCAM session.
Over 18 months 100 participants (Site 1, n=34; Site 2, n=66) were included who completed 811 assessments. Participants were aged 2-29 years (M=13.5, SD=5.6), 65% female, 23% from underrepresented populations, 52% with cancer versus other serious illness. Accrual rate was 94%, completion rate was 87%, acceptability was 96%. Ninety-nine participants received 191 total SCAM sessions:
  • acupuncture (39%),
  • aromatherapy (35%),
  • creative arts (20%),
  • massage therapy (5%)
  • hypnosis (1%).

After SCAM treatments, heart rate decreased and symptom scores improved for anxiety, fatigue, nausea, pain, and sadness (Cohen’s d effect sizes 0.22-0.99). Adjusted mixed-effects models suggested that the Faces Scale scores improved over time (b= -0.19, p<.01).

The authors concluded that prospective two-site data collection in relationship to SCAM exceeded feasibility thresholds and was acceptable. When given the choice, SCAMs were popular and may have contributed to improved QOL immediately and longitudinally. These preliminary findings support further study of CHI for targeted symptoms in distinct populations with rigor.
On the one hand, I want to congratulate the authors for publishing a feasibility study that actually evaluated feasibility – this is a truly rare event in SCAM research. On the other hand, I need to criticize the authors because they too could not stop themselves from reporting outcomes such as:
  • after SCAM treatments, heart rate decreased and symptom scores improved for anxiety, fatigue, nausea, pain, and sadness;
  • adjusted mixed-effects models suggested that the Faces Scale scores improved over time.

Of note is that they formulate these findings cleverly. Yet, the language nevertheless implies that SCAM was the cause of the observed effects.

To this I object!

In fact, I postulate that the findings show that SCAM treatments :

  • delayed improvements in heart rate decreased, symptom scores, anxiety, fatigue, nausea, pain, and sadness.
  • hindered the Faces Scale scores from improving over time.

On what grounds, you ask?

As the study had no control group, the basis for my claim is just as solid as the suggestions of causality made by the authors!

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