So-called alternative medicine (SCAM) is widely used in Saudi Arabia. One of the common practices is the use of camel urine alone or mixed with camel milk for the treatment of cancer, which is often supported by religious beliefs.
This study observed cancer patients who insisted on using camel urine, and to offer some clinically relevant recommendations. The authors observed 20 cancer patients (15 male, 5 female) from September 2020 to January 2022 who insisted on using camel urine for treatment. They documented the demographics of each patient, the method of administering the urine, reasons for refusing conventional treatment, period of follow-up, and the outcome and side effects.
All the patients had radiological investigations before and after their treatment with camel urine. All of them used a combination of camel urine and camel milk, and their treatment ranged from a few days to 6 months. They consumed an average of 60 ml urine/milk per day. No clinical benefit was observed after the treatment; 2 patients developed brucellosis. Eleven patients changed their mind and accepted conventional antineoplastic treatment and 7 were too weak to receive further treatment; they died from the disease.
The authors concluded that camel urine had no clinical benefits for any of the cancer patients, it may even have caused zoonotic infection. The promotion of camel urine as a traditional medicine should be stopped because there is no scientific evidence to support it.
If you suspected that this was a hoax, you were wrong!
Here is a recent paper on the ‘therapeutic potentials of camel urine’:
Camel urine has traditionally been used to treat multiple human diseases and possesses the most beneficial effects amongst the urine of other animals. However, scientific review evaluating the anticancer, antiplatelet, gastroprotective and hepatoprotective effects of camel urine is still scarce. Thus, this scoping review aimed to provide scientific evidence on the therapeutic potentials of camel urine. Three databases were searched to identify relevant articles (Web of Science, PubMed and Scopus) up to September 2020. Original articles published in English that investigated the effects of camel urine in various diseases were included. The literature search identified six potential articles that met all the inclusion criteria. Three articles showed that camel urine possesses cytotoxic activities against different types of cancer cells. Two studies revealed camel urine’s protective effects against liver toxicity and gastric ulcers, whilst another study showed the role of camel urine as an antiplatelet agent. All studies demonstrated significant positive effects with different effective dosages. Thus, camel urine shows promising therapeutic potential in treating human diseases, especially cancer. However, the standardised dosage and potential side effects should be determined before camel urine could be offered as an alternative treatment.
I have often asked myself the question whether some SCAMs are too absurd to merit scientific study. Over the years, I changed my mind on it; while initially I tended to answer it in the negative, I now think that YES: some ideas – even those that are ancient and, as Charles Windsor would argue, have thus stood the ‘test of time’ – are not worth the effort. Camel urine as a therapy might well be one of them.
The KFF provides reliable, accurate, and non-partisan information to help inform health policy in the US. The KFF has just released its ‘Health Misinformation Tracking Poll Pilot‘ examining the public’s media use and trust in sources of health information and measuring the reach of specific false and inaccurate claims surrounding three health-related topics: COVID-19 and vaccines, reproductive health, and gun violence. It makes grimm reading indeed. Here are but a few excerpts pertaining to health/vaccination:
Health misinformation is widespread in the US with 96% of adults saying they have heard at least one of the ten items of health-related misinformation asked about in the survey. The most widespread misinformation items included in the survey were related to COVID-19 and vaccines, including that the COVID-19 vaccines have caused thousands of deaths in otherwise healthy people (65% say they have heard or read this) and that the MMR vaccines have been proven to cause autism in children (65%).
Regardless of whether they have heard or read specific items of misinformation, the survey also asked people whether they think each claim is definitely true, probably true, probably false, or definitely false. For most of the misinformation items included in the survey, between one-fifth and one-third of the public say they are “definitely” or “probably true.” The most frequently heard claims are related to COVID-19 and vaccines.
Uncertainty is high when it comes to health misinformation. While fewer than one in five adults say each of the misinformation claims examined in the survey are “definitely true,” larger shares are open to believing them, saying they are “probably true.” Many lean towards the correct answer but also express uncertainty, saying each claim is “probably false.” Fewer tend to be certain that each claim is false, with the exception of the claim that more people have died from the COVID-19 vaccines than from the virus itself, which nearly half the public (47%) recognizes as definitely false.
Across the five COVID-19 and vaccine related misinformation items, adults without a college degree are more likely than college graduates to say these claims are definitely or probably true. Notably, Black adults are at least ten percentage points more likely than White adults to believe some items of vaccine misinformation, including that the COVID-19 vaccines have caused thousands of sudden deaths in otherwise healthy people, and that the MMR vaccines have been proven to cause autism in children. Black (29%) and Hispanic (24%) adults are both more likely than White adults (17%) to say that the false claim that “more people have died from the COVID-19 vaccine than have died from the COVID-19 virus” is definitely or probably true. Those who identify as Republicans or lean towards the Republican Party and pure independents stand out as being more likely than Democratic leaning adults to say each of these items is probably or definitely true. Across community types, rural residents are more likely than their urban and suburban counterparts to say that some false claims related to COVID vaccines are probably or definitely true, including that the vaccines have been proven to cause infertility and that more people have died from the vaccine than from the virus.
Educational attainment appears to play a particularly important role when it comes to susceptibility to COVID-19 and vaccine misinformation. Six in ten adults with college degrees say none of the five false COVID-19 and vaccine claims are probably or definitely true, compared to less than four in ten adults without a degree. Concerningly, about one in five rural residents (19%), adults with a high school education or less (18%), Black adults (18%), Republicans (20%), and independents (18%) say four or five of the false COVID-19 and vaccine misinformation items included in the survey are probably or definitely true.
If you have followed some of the comments on this blog, you might find it hard to be surprised!
I do encourage you to read the full article.
The increasing demand for fertility treatments has led to the rise of private clinics offering so-called alternative medicine (SCAM) treatments. Even King Charles has recently joined in with this situalion. One of the most frequently offered SCAM infertility treatment is acupuncture. However, there is no good evidence to support the effectiveness of acupuncture in treating infertility.
This study evaluated the scope of information provided by SCAM fertility clinics in the UK. A content analysis was conducted on 200 websites of SCAM fertility clinics in the UK that offer acupuncture as a treatment for infertility. Of the 48 clinics that met the eligibility criteria, the majority of the websites did not provide sufficient information on:
- the efficacy,
- the risks,
- the success rates
of acupuncture for infertility.
The authors concluded that this situation has the potential to infringe on patient autonomy, provide false hope and reduce the chances of pregnancy ever being achieved as fertility declines during the time course of ineffective acupuncture treatment.
The authors are keen to point out that their investigation has certain limitations. The study only analysed the information provided on the clinics’ websites and did not assess the quality of the treatment provided by the clinics.
Therefore, the study’s fndings cannot be generalized to the quality of the acupuncture treatment provided by the clinics.
Nonetheless the paper touches on very important issues: far too many health clinics that offer SCAM for this or that indication operate way outside the ethically (and legally) acceptable norm. They advertise their services without making it clear that they are neither effective nor safe. Desperate consumers thus fall for their promises. In the case of infertility, this might result merely in frustration and loss of (often substantial amounts of) money. In the case of serious disease, such as cancer, this often results in premature death.
It is time, I think, that this entire sector is regualted in a way that it does not endanger the well-being, health, or life of consumers.
Spiritual healing has been defined as the direct interaction between one individual (the healer) and a patient, with the intention of improving the patient’s condition or curing the illness. Treatment can occur through personal, direct contact between healer and patient or at a (sometimes large) distance. Spiritual healers, who are usually not medically qualified, believe that the therapeutic effect results from the channelling of ‘energy’ from an undefined source via the healer to the patient. The main problem with this concept is that there is no evidence that this energy actually exists. Therefore, the assumptions on which spiritual healing is based lack plausibility.
The central claim of healers is that they promote or facilitate self-healing and wellbeing, both of which could be relevant to patients with any type of condition. An article by enthusiasts of spiritual healing explains: “All conditions can be treated by spiritual healing—but not all people. Some people are more receptive than others to this treatment, due to a number of factors such as karma and mental outlook. As such the results of healing can vary a great deal. If the patient has faith in the technique and the healer, this will of course aid the healing process, but is not necessary; this is not faith healing as practiced in some religions—it is based instead on spiritual energy. This being the case, it is possible for a skeptic to receive healing and benefit from it.”
The evidence from clinical trials of spiritual healing is contradictory. Many studies have serious flaws, and the most reliable trials fail to show effects beyond placebo. Research papers often fail to differentiate between different types of paranormal healing. One Cochrane, for instance, review “found inconclusive evidence that interventions with spiritual or religious components for adults in the terminal phase of a disease may or may not enhance well-being. Such interventions are under-evaluated. All five studies identified were undertaken in the same country, and in the multi-disciplinary palliative care interventions it is unclear if all participants received support from a chaplain or a spiritual counsellor. Moreover, it is unclear in all the studies whether the participants in the comparative groups received spiritual or religious support, or both, as part of routine care or from elsewhere. The paucity of quality research indicates a need for more rigorous studies.”
Many people believe that spiritual healing is harmless. Sadly, this is not the case. The BBC’s ‘Women’s Hour’ reported on 9 August this year about serious abuses of spiritual healers. Here you can find the published test of the broadcast:
Spiritual healing is extremely popular in many countries in the Middle East and North Africa. But the practice is unregulated and that means women are vulnerable to sexual exploitation. An investigation by BBC News Arabic has uncovered allegations of widespread sexual abuse by healers in Sudan and Morocco. Clare McDonnell is joined by the BBC’s Hanan Razek and Senior Women’s Rights Researcher at Human Rights Watch, Rothna Begum, to discuss.
And here you can listen to the actual broadcast. Briefly, what it reveales is deeply shocking:
- Spiritual healing is extremely popular in Sudan and Morocco.
- Healers charge hefty sums and healing is big business.
- Anyone regardless of background or training can call themselves a healer.
- There is no regulation whatsoever.
- Healers claim to cure illnesses, expell evil spirits, help with emotional problems, etc.
- For the programme, the BBC asked 80 women who had received healing.
- They accused 60 different healers of sexual transgression, including rape.
- Undercover recording revealed a healer placing his hand on a woman’s abdomen and then putting a finger “all the way down”.
- The police refuses to investigate if a women complains.
- The authorities refuse to take notice of the problem.
- A minister was quoted stating that there is no need for regulation.
- Another one said that the political athmosphere is not allowing to investigate the issue.
The references for the evidence cited above can be found here.
“We are hugely concerned about the welfare of doctors and healthcare workers with long COVID”. These are the first words of a comprehensive survey of UK doctors with post-acute COVID health complications. It reveals that these doctors experience symptoms such as:
- muscular pain,
- nerve damage,
- joint pain,
- respiratory problems.
Around 60% of doctors said that post-acute COVID ill health has affected their ability to carry out day-to-day activities on a regular basis. 18% reported that they were now unable to work due to their post-acute COVID ill-health, and only 31% said they were working full-time, compared with more than half before the onset of their illness.
The report demands financial support for doctors and healthcare staff with post-acute COVID, post-acute COVID to be recognized as an occupational disease in healthcare workers, with a definition that covers all of the debilitating disease’s symptoms and for improved access to physical and mental health services to aid comprehensive assessment, appropriate investigations and treatment. The report also calls for greater workplace protection for healthcare staff risking their lives for others and better support for post-acute COVID sufferers to return to work safely if they can, including a flexible approach to the use of workplace adjustments.
In November 2021, an online survey investigating the emotional states of depression, anxiety, stress, compassion satisfaction, and compassion fatigue was administered to 78 Italian healthcare workers (HCWs). Between 5 and 20% of the cohort showed the effects of the adverse psychological impact of the pandemic and more than half of them experienced medium levels of compassion fatigue as well as a medium level of compassion satisfaction. The results also show that those with fewer years of clinical practice might be at greater risk of burnout, anxiety, and stress symptoms and might develop a lower level of compassion satisfaction. Moreover, the factors that potentially contribute to poor mental health, compassion fatigue, and compassion satisfaction seem to differ between residents and specialist physicians.
A cross-sectional study was conducted from September 2021 to April 2022 and targeted all physicians working at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. Patient Health Questionnaire-9 and General Anxiety Disorder-7 were used to elicit self-reported data regarding depression and anxiety, respectively. In addition, sociodemographic and job-related data were collected. A total of 438 physicians responded, of which 200 (45.7%) reported symptoms of depression and 190 (43.4%) of anxiety. Being aged 25-30 years, female, resident, and reporting a reduction in work quality were factors significantly associated with both anxiety and depression. Female gender (AOR = 3.570; 95% CI = 2.283-5.582; P < 0.001), working an average 9-11 hours/day (AOR = 2.130; 95% CI = 1.009-4.495; P < 0.047), and self-perceived reduction in work quality (AOR = 3.139; 95% CI = 2.047-4.813; P < 0.001) were significant independent predictors of anxiety. Female gender (AOR = 2.929; 95% CI = 1.845-4.649; P < 0.001) and self-perceived reduction in work quality (AOR = 3.141; 95% CI = 2.053-4.804; P < 0.001) were significant independent predictors of depression.
An observational, multicenter cross-sectional study was conducted at eight tertiary care centers in India. The consenting participants were HCWs between 12 and 52 weeks post-discharge after COVID-19 infection. The mean age of the 679 eligible participants was 31.49 ± 9.54 years. The overall prevalence of COVID sequelae was 30.34%, with fatigue (11.5%) being the most common followed by insomnia (8.5%), difficulty in breathing during activity (6%), and pain in joints (5%). The odds of having any sequelae were significantly higher among participants who had moderate to severe COVID-19 (OR 6.51; 95% CI 3.46-12.23) and lower among males (OR 0.55; 95% CI 0.39-0.76). Besides these, other predictors for having sequelae were age (≥45 years), presence of any comorbidity (especially hypertension and asthma), category of HCW (non-doctors vs doctors), and hospitalization due to COVID-19.
Such data are scary. Not only will we have a tsunami of long-Covid patients from the general public, and not only do we currently lack effective causal treatments for the condition, but also is the number of HCWs who are supposed to deal with all this drastically reduced.
Most if not all countries are going to be affected by these issues. But the UK public might suffer the most, I fear. The reasons are obvious if you read a previous post of mine: in the UK, we have significantly fewer doctors, nurses, hospital beds, and funding (as well as politicians who care and would be able to do something about the problem) than in other comparable countries. To me, this looks like the emergence of a perfect storm.
Although the use of so-called alternative medicine (SCAM) is said to be rising among older adults, many do
not discuss these healthcare practices with their primary care practitioners (PCPs). This recent US survey sought to determine the prevalence of SCAM use and to identify factors associated with SCAM disclosure among patients ages 65 and older.
Participants completed an anonymous survey, which evaluated their SCAM use over the past year and disclosure of SCAM to a PCP. Additional questions queried demographics, patient health, and relationships with one’s PCP. Analyses included descriptive statistics, chi-square tests, and logistic regression.
One hundred seventy-three participants answered surveys (response rate=23%). The Main findings were as follows:
- Sixty percent reported the use of at least one form of SCAM in the past year.
- Among those using SCAM, 64% disclosed use to their PCP.
- Patients disclosed supplements/herbal products and naturopathy/homeopathy/acupuncture at a higher rate than bodywork techniques and mind-body practices (71.9% and 66.7% vs. 48% and 50%).
- The only factor significantly associated with disclosure was trust in one’s PCP (odds ratio=2.97; confidence interval=1.01–8.73).
- The most commonly used types of SCAM were herbal products/dietary supplements (37.0%), mind-body therapies (28.9%), bodywork techniques (26.6%), and naturopathy/acupuncture/homeopathy (8.7%).
The authors concluded that clinicians may improve SCAM disclosure rates in older adults by inquiring about all types of SCAM and continuing to invest in their patient relationships, specifically by building trust.
The one-year prevalence of SCAM use – 60% – is extraordinary and considerably higher than in other surveys. How can this be explained?
I think that two factors might have played a role: firstly the survey was tiny, and secondly, its response rate was dismal. People who have no interest in SCAM would probably have not responded. Thus the prevalence figure is way too high and the survey is not representative of any population.
Having said that, I believe that some of the conclusions are still correct. As I have pointed out so often already:
- doctors need to ask their patients about SCAM usage;
- once they have identified a SCAM user, they need to advise him/her responsibly;
- to do that, they need to know about SCAM;
- as most doctors have little knowledge about the subject, they need to learn;
- failing to do that is not ethical behavior.
This analysis was aimed at quantifying how many studies registered on the Open Science Framework (OSF) up to November 2017 are performed but not shared after at least 4 years. Examining a sample of 315 registrations, of which 169 were research studies, the researchers found that 104 (62%) were published. They estimated that 5550 out of 9544 (58%) registered studies on the OSF are published.
Researchers use registries to make unpublished studies public, and the OSF policy to open registrations after a four-year embargo substantially increases the number of studies that become known to the scientific community. In responses to emails asking researchers why studies remained unpublished logistical issues (e.g., lack of time, researchers changing jobs) were the most common cause, followed by null results, and rejections during peer review.
The authors concluded that their study shows that a substantial amount of studies researchers perform remain unpublished.
I find this truly shocking!
Researchers are able to do research only because they receive financial and other support from elsewhere. Therefore they have an ethical obligation to publish it. The reasons frequently given for not publishing research are nothing well and truly invalid:
- Lack of time is a mere excuse; if researchers had the time to get the grants, permissions, etc. they simply must have the time to finish the job properly.
- Researchers changing jobs is an equally flawed excuse; if someone changes position, he/she is obliged to finish the job they were doing. A surgeon can also not leave mid-surgery because he has a better offer.
- ‘Null results’ is even worse as a reason. Null results are just as important as positive findings – occasionally they are even more important. If researchers fail to realize this, they simply disqualify themselves as researchers.
- ‘Rejections during peer review’ is complete nonsense. Everyone who submits papers for publication gets rejected once in a while. In this case, one learns from the peer-review comments, improves the paper in question, and re-submits it to another journal.
I have seen many studies of so-called alternative medicine (SCAM) that, for this or that reason, never were published. And I feel strongly that this is a serious violation of research ethics – so much so that I would ban researchers who are guilty of this crime from conducting research in the future. I also feel that, in order to receive the necessary support (financial and other), researchers should sign that they will publish their findings within a given time after finishing their study. Failing to comply could then incur a penalty such as paying back part of the funds wasted. I think such measures would very quickly clear up the current intolerable situation.
This survey evaluated the attitude of healthcare professionals toward the use of so-called alternative medicine (SCAM) to improve current care. A questionnaire on the current practice and opinions about SCAM use was sent to healthcare professionals in Amsterdam UMC, who work for the department of hematology or oncology. Oncologists, hematologists, residents, (specialized) nurses, dieticians, (hospital)pharmacists, and pharmacy technicians were asked to participate.
Among eligible healthcare professionals, 77 responded to the questionnaire (34%). Overall, 87% of healthcare
professionals indicated it is important to be aware of their patient’s SCAM use, and all find the potential of drug–herb interactions important. However, more than half of the healthcare professionals inquire about the patient’s SCAM use infrequently. In addition, only 15% of the healthcare professionals stated they had sufficient knowledge of SCAM to advise patients on their use of SCAM.
The authors concluded that healthcare professionals are aware of the potential risks of SCAM use in combination with anti-cancer treatment. However, SCAM use is not yet discussed with every patient. This may be due to healthcare professionals’ lack of knowledge about SCAM.
This survey would in itself be fairly irrelevant; it employed only a tiny convenience sample and its findings cannot be generalized. Yet, it produced results that have been shown dozens of times before, and it might therefore be a good idea to remind ourselves of their relevance and implications.
- Patients use SCAM whether we want it or not.
- Contrary to what is often said, SCAM is not harmless.
- Therefore conventional healthcare professionals need to know about their patients’ SCAM use.
- To find out, healthcare professionals need to ask specific questions about SCAM.
- Next, they must advise their patients responsibly (this is an ethical obligation, not a choice).
- In order to do that they need to learn the essentials about SCAM.
- Failing to do this means failing their patients.
The General Chiropractic Council (GCC) “regulates chiropractors in the UK to ensure the safety of patients undergoing chiropractic treatment”. One might have assumed that they thus fulfill the important role of controlling the profession. Yet, one would have assumed wrongly. Instead of controlling, the GCC usually prefers promoting the profession. Their recent Chiropractic Patient Satisfaction and Experience is a good example. Let me show you several important sections of this document:
The outcomes reported here highlight two key findings:
• Overwhelmingly, chiropractic patients report high levels of satisfaction and positive experiences with their care. This was true both in the literature that examined international patient cohorts as well as the specific data collected from UK based chiropractic patients.
• A strong therapeutic relationship and good communication between patient and chiropractor underpins high satisfaction scores and a positive experience. This was confirmed both in the international literature and through both quantitative and qualitative analysis of specific data collected from UK based chiropractic patients.
This report shows that both existing literature and de novo data collection from patients receiving chiropractic care in the UK highlight excellent perceived experience and high satisfaction with such care.
Factors such as therapeutic alliance and communication are strongly associated with these positive perceptions by patients although other factors such as treatment beliefs were also significantly associated with satisfaction scores.
• To offer the highest quality of care, both in terms of clinical outcomes and patient experience, chiropractors should be explicitly skilled at curating excellent therapeutic alliances and communication with patients.
• Such skills and competences within chiropractic care delivery should receive higher visibility within the chiropractic profession generally and more specifically through advocacy within leading institutions and core emphasis within chiropractic curricula.
By changing a few words, I have adapted the above excerpts to become a Customer Satisfaction and Experience Report of a fictitious hamburger joint published by the Hamburger General Council (HGC) of Great Britain which regulates hamburger joints in the UK to ensure the safety of consumers undergoing hamburger nutrition:
The outcomes reported here highlight two key findings:
• Overwhelmingly, customers report high levels of satisfaction and positive experiences with their restaurant. This was true both in the literature that examined international consumer cohorts as well as the specific data collected from UK based customers.
• A strong professional relationship and good communication between customer and service personell underpins high satisfaction scores and a positive experience. This was confirmed both in the international literature and through both quantitative and qualitative analysis of specific data collected from UK based hamburger consumers.
This report shows that both existing literature and de novo data collection from consumers eating hamburgers in the UK highlight excellent perceived experience and high satisfaction with such service.
Factors such as personal alliance and communication are strongly associated with these positive perceptions by consumers although other factors such as appetite were also significantly associated with satisfaction scores.
• To offer the highest quality of service, both in terms of profit and patient experience, hamburger vendors should be explicitly skilled at curating excellent professional alliances and communication with customers.
• Such skills and competences within hamburger delivery should receive higher visibility within the gastronomic trade generally and more specifically through advocacy within leading institutions and core emphasis within servers’ curricula.
If you get the impression that I am taking the Mickey of the GCC, you are not mistaken. Yet, this post also has slightly more serious purposes. I wanted to 1) show how, in the chiropractic profession, pure BS is often disguised as research, and 2) question whether the GCC is fit for purpose.
On a more constructive note: there are many open questions that urgently need addressing in the realm of chiropractic (e.g. do chiropractors more good than harm?). I, therefore, suggest that the GCC stops publishing idiotic promotional documents disguised as research and gets on with its responsibilities.
Previous research revealed that cognitive abilities are negatively related to right-wing and prejudiced attitudes. No study has, however, investigated if emotional abilities also show such a relationship, although this can be expected based on both classic and recent literature. The aim of the present study was 2-fold:
(a) to investigate the relationship between emotional abilities and right-wing and prejudiced attitudes, and
(b) to pit the effects of emotional and cognitive abilities on these attitudes against each other.
Results from 2 adult samples (n = 409 and 574) in which abilities scores were collected in individual testing sessions, revealed that emotional abilities are significantly and negatively related to social-cultural and economic-hierarchical right-wing attitudes, as well as to blatant ethnic prejudice. These relationships were as strong as those found for cognitive abilities. For economic-hierarchical right-wing attitudes, emotional abilities were even the only significant correlate.
The authors concluded that the study of emotional abilities has the potential to significantly advance our understanding of right-wing and prejudiced attitudes.
The researchers found that individuals with weaker emotional abilities — particularly emotional understanding and management — tended to score higher on a measure of right-wing authoritarianism and social dominance orientation. Right-wing authoritarianism is a personality trait that describes the tendency to submit to political authority and be hostile towards other groups, while social dominance orientation is a measure of a person’s preference for inequality among social groups.
The results of this study were univocal. People who endorse authority and strong leaders and who do not mind inequality — the two basic dimensions underlying right-wing political ideology — show lower levels of emotional abilities,” said Van Hiel, the lead author of the study. “Those with lower emotional and cognitive abilities were also more likely to agree with blatantly prejudiced statements such as “The White race is superior to all other races.”
Of course, the study only collected correlational data, preventing inferences of causality from being made. “Caution should be exercised in the interpretation of such results,” Van Hiel said. “One cannot discredit any ideology on the basis of such results as those presently obtained. Only in a distant future, we will be able to look back upon our times, and then we can maybe judge which ideologies were the best. Cognitively and emotionally smart people can make wrong decisions as well. The results have been obtained in one particular context. Would similar results be obtained in other contexts besides in a Western country with a long-standing stable democracy? Whether these tendencies are universal, or limited to particular contexts, is very intriguing.”