survey
This article explores how the sociological concept of trust, both externally and internally, presents challenges to the legitimacy and credibility of the chiropractic profession. This ethnographic study consisted of systematic observation and interviews of 40 chiropractors in South Carolina from Fall 2016 to Fall 2017. Additionally, interviews were conducted with staff members, patients, and other medical providers, such as physicians, physical therapists, massage therapists, and representatives from the insurance industry, about their understanding and experiences with chiropractic medicine. Phone interviews were also conducted with deans and provosts at seven chiropractic colleges around the country.
In total, over 100 interviews and informal conversations occurred during the course of the project. All identifiers of participants and chiropractic colleges in the study were removed to ensure anonymity. Instead, pseudonyms were created that were known only by the author of the study. Additionally, data from the South Carolina Department of Labor, Licensing and Regulation was obtained to document changes in the number of chiropractors who are no longer in practice in the state between 2016 and 2017.
The data from this study suggests that there may be a number of trust issues between the public and chiropractors, between chiropractors and physicians, and among chiropractors themselves. For example, comments and observations from respondent interviews suggests many patients do not fully trust their provider. Additionally, physicians claim the reason for the lack of trust is due to the absence of any meaningful accountability measures to control rogue chiropractors and the wide variance in types of treatment they offer. Among chiropractors themselves, there appears to be an absence of trust, as many providers see their colleagues as competitors and potential threats.
Trust is a key component to the success of any social relationship. Given the inability or unwillingness of the chiropractic profession to hold members accountable for questionable practices, along with the perception that chiropractic treatments may not be effective, the public, patients, and the medical profession will likely continue to view chiropractic medicine with suspicion.
In the paper, the author (Robert Hartmann McNamara, Ph.D. Department of Criminal Justice ) makes several further valuable points:
- The need for autonomy is a critical component to understanding why so many providers are unwilling to allow their profession to be regulated. It also seems apparent that there is no collective conscience, no real sense of solidarity, and there remain questions about the trustworthiness of chiropractors by patients, the public, the medical community and even among chiropractors themselves.
- Chiropractors point to some level of persecution by insurance companies—indicating that others in medicine engage in inappropriate billing and fraud, but that insurance companies target chiropractors because of their limited ability to stand up to them. While there may be some truth to these criticisms, there is also evidence to indicate that the identification of chiropractors for audits may be justified. For example, in a 2016 report by the Office of Inspector General, a division of the U.S. Department of Health and Human Services, the agency responsible for overseeing health programs like Medicare and Medicaid, of all the providers who were cited for fraud, abuse, and errors in Medicare billing, chiropractors were overwhelmingly the largest set of offenders. In fact, the report showed that for 2013, an estimated $359 million in Medicare payments for chiropractic services did not comply with Medicare requirements. Thus, one of the primary reasons for the creation of Medicare accountability teams is because the data indicated that chiropractors are at the center of the problem when it comes to inaccurate and fraudulent billing for treatment.
- The sociological literature points out that the development and enhancement of trust is a crucial component to establishing and sustaining social relationships, and thereby creating a sense of solidarity and morality. To the extent that chiropractors can better foster the development of trust, they will likely earn the respect of their colleagues in medicine and not be seen in a negative light by the public or their patients. This is accomplished, of course, by setting reasonable expectations of what chiropractors can legitimately do and holding the members of the profession accountable in adhering to those standards.
All of this ties in well with many of my previous posts on chiropractic. I might therefore just add this:
What can you expect from a profession that was founded by one of the most infamous snake oil salesmen in US history?
Reassurance-seeking behaviour as a symptom of health anxiety (HA) is proposed as one important reason for healthcare use in conventional healthcare. However, we know little about the association between HA and traditional and so-called alternative medicine (SCAM), especially for provider visits. This paper aims to address this knowledge gap by examining the association between HA and SCAM provider visits in a large, adult general population.
This cross-sectional study is based on the seventh survey (2015–2016) of the Tromsø Study, where 19 639 participants responded to questions about visits to SCAM providers during the past 12 months, as well as a questionnaire on HA. Whiteley Index-6-R was used to measure HA as a continuous construct ranging from 0 to 24. Logistic regression was used to analyse the associations. Mental and somatic illness, demographic and socioeconomic variables were included as confounders.
HA was significantly and positively associated with visits to all SCAM practitioners, where a 1-point increase in the HA score was associated with 5–7% higher odds for visits across all types of SCAM practitioner categories. The results were not significantly altered by adjusting for mental and somatic illness, demographic nor socioeconomic variables for the population as a whole, but interaction analyses showed that HA was not significantly associated with visits to TM providers in participants reporting multimorbidity. Moreover, HA was more strongly associated with SCAM provider use in men, than women.
The authors concluded that in our large, adult general population, we found consistent and significant associations between HA and visits to a SCAM provider. This can indicate that HA warrants recognition in SCAM visits.
The authors offer several possible explanations for their findings. HA includes having health concerns about both the present and the future. Whereas contact with conventional healthcare usually may concern current complaints, SCAM often also targets preventing disease and complaints which may appeal to people with higher HA. People often visit SCAM providers in addition to, rather than as an alternative, to conventional healthcare. This suggests that the findings might reflect the reassurance-seeking behaviour characteristic of HA. Another explanation for higher odds for SCAM provider visits in those with higher HA might be due to dissatisfaction with conventional healthcare, as found in previous research. Indeed, higher HA is seen as a risk factor for lower satisfaction in the healthcare sector – both by the patient and among general practitioners. Lower satisfaction with conventional healthcare is known to be a predictor for SCAM use. If people feel that they do not receive the expected treatment or diagnosis from the conventional healthcare system, they may also seek help from providers outside the conventional healthcare system.
Personally, I would have been surprised, if HA had NOT been associated with higher odds of consulting a SCAM provider. To me this seems so obvious that it hardly needs a sophisticated explanation: if one is concerned about ‘no matter what’, one is likely to seek advice on the issue in question!
The authoes further elaborate that “the correlation between higher HA score and visits to SCAM providers found in this study highlights a potential gap in the public healthcare services that could be addressed by enhancing the recognition and management of HA within conventional medical settings and SCAM communities”.
Really?
Why?
As I tried to point out above, concern about something will automatically prompt some reaction. It does not highlight a deficit, but is a normal human reaction.
So, what (if anything) is the relevance of the findings of this paper?
Contrary to the authors, I would suggest the relevance lies in the fact that consumers are prompted by their HA (and numerous other motivationsand drivers) to consult SCAM providers. As this is so, we ought to ask whether the many promises and claims these practitioners inevitably make are realistic. As we have often seen on this blog, we are then likely to establish that they are unrealistic, false, financially-motivated or even fraudulent and dangerous. If that is so, we must find ways of minimizing the risks that consumers are exposed to by irresponsible SCAM providers.
The ‘Bull World Health Organ’ has just published a theme issue on ‘Traditional Medicine’. Here are some extracts from the accompanying editorial that I thought were remarkable:
The World Health Organization’s (WHO) new Global traditional medicine strategy 2025–2034 aims to advance the contribution of evidence-based traditional, complementary and integrative medicine to the highest attainable standard of health and well-being…
Traditional medicine is the primary or preferred care for billions of people worldwide. Analysis of 71 nationally representative surveys shows its wide spread use for hypertension, diabetes and hypercholesterolemia, often alongside conventional care. The clinical potential is considerable …
However, challenges remain; for instance, while acupuncture is recommended for migraine, many guidelines show methodological and procedural gaps.
Traditional medicine is increasingly used in the health, wellness and bioeconomy sectors. Nonetheless, an analysis revealed that less than 1% of global health research funding is dedicated to traditional medicine, an inequity that undermines efforts to build the required evidence base.
Traditional medicine is more than a collection of therapies; it represents a worldview in which health is harmony within and between individuals, communities and ecosystems. Restoring this balance is a scientific, rights-based and sustainability imperative.
I think these lines (there are several other issues as well, and I recommend reading the full article) require a few comments.
The WHO aim to “advance the contribution of evidence-based traditional, complementary and integrative medicine” seems laudable, yet it also raises concerns: once any form of medicine is “evidence-based”, it is not “traditional, complementary and integrative”. Then it is by definition EBM, evidence-based medicine! Thus, the entire premise of the WHO Global traditional medicine strategy 2025–2034 makes no sense.
The fact that “traditional medicine is the primary or preferred care for billions of people worldwide” does not necessarily mean that its “clinical potential is considerable”. More likely it means that billions have to rely on obsolete forms of medicine from the dark ages because they cannot afford effective treatments. This is far from an opportunity; it is a challenge for us to improve this inhuman situation.
The fact that “acupuncture is recommended for migraine”, while the evidence for this (and almost all similar) recommendations are not supported by sound evidence, amounts to a scandal. One would have hoped that, instead of promoting unproven ‘traditional medicine’, an urgent task of the WHO would be to warn people of bogus and often dangerous claims that are ubiquitous in this sector.
The fact that “1% of global health research funding is dedicated to traditional medicine” might look unfair at first glance. But global health research funding is in the range of US$ 200 billion per year. Thus 1% would amount to 2 billion, and I suggest that one could do plenty of good research with this money. Instead, the sector tends to waste its funds on lousy pseudo-research, as anyone interested can confirm by reading this blog. Why does the WHO not point this out and take measures to stop pseudo-science in the realm of ‘traditional medicine’? Do they really think that offensive ideological platitudes such as “restoring balance is a scientific, rights-based and sustainability imperative” cuts the mustard?
My recommendation to the WHO is as simple as it is important: if you want to create meaningful articles, documents or strategies on ‘traditional medicine’ (or indeed any other subject), don’t charge biased proponents with the task but recruit a few well-informed critical thinkers as well.
The Indian government, in response to the coronavirus disease 2019 (COVID-19) pandemic, initiated campaigns to use complementary therapies for its prevention and control, such as large-scale distribution of the homeopathic medicine, Arsenicum album 30C, as potential prophylactic for COVID-19. This study estimated the individual adherence to using this homeopathic prophylactic within the Indian urban population.
A multi-center, cross-sectional, study was conducted across 23 cities in 19 Indian states and union territories from September to November 2022. Participants aged 18 years and above, who had received Arsenicum album 30C within the past month, were included. Adherence was assessed through self-reports. Data were collected in a structured data collection form. Factors influencing adherence were analysed using logistic regression.
A total of 23,101 participants completed the survey. Among the participants, 79.89% (n = 18,457) completed the prescribed three-dose regimen, demonstrating high adherence. Older adults (≥61 years) exhibited the highest adherence (84.63%), whereas younger individuals had lower adherence rates. Employment status, gender and socio-economic class were significant predictors of adherence. Participants with a lower perceived risk of COVID-19 showed higher adherence (adjusted odds ratio = 1.86; 95% confidence interval, 1.73 to 1.99; p < 0.0001). Adverse events were reported by 0.1% (n = 22) of participants, with no serious effects observed.
The authors concluded that the high adherence to Arsenicum album 30C highlights the effectiveness of a structured government distribution program and the potential of homeopathy as a welcomed medication in aiming to enhance public health.
Let’s be clear: during the recent pandemic, the Indian governement initiated a campaign to persuade Indians to use a totally implausible and ineffective therapy for COVID prevention. Instead of then demonstrating that placebos cannot prevent COVID, some homeopathy fans and government employees subsequently applaud themselves that their campaign was effective in misleading a sizable proportion of the population to adhere to this ill-conceived advice.
This is not science, but arguably it’s a crime and certainly it amounts to a huge violation of medical ethics. Informed consent would have required amongst other things to tell the public that homeopathy is girstly implausible and secondly of un- or even disproven effectiveness. The absence of this information is a monumental breach of ethics.
Which planet do these weirdos come from?
Here are their affiliations:
- 1Department of Epidemic Cell, Central Council for Research in Homoeopathy, Janakpuri, New Delhi, India.
- 2Department of Clinical Research, Dr. D.P Rastogi Central Research Institute of Homoeopathy, Noida, Uttar Pradesh, India.
- 3Regional Research Institute of Homoeopathy, Vikrampuri, Habsiguda, Hyderabad, Telangana, India.
- 4Regional Research Institute for Homoeopathy, Kharghar, Navi Mumbai, Maharashtra, India.
- 5Regional Research Institute for Homoeopathy, Puri, Odisha, India.
- 6Drug Proving Unit, Dr. A.C. Homoeopathic Medical College and Hospital Unit-III, Bhubaneswar, Odisha, India.
- 7Regional Research Institute for Homoeopathy Guwahati, Guwahati, India.
- 8Central Research Institute for Homoeopathy, Lucknow, Uttar Pradesh, India.
- 9Homoeopathy Research Institute for Disabilities, Chennai, Tamil Nadu, India.
- 10Regional Research Institute for Homoeopathy, Siliguri, Chhota Pathuram Jote, Darjeeling, West Bengal, India.
- 11Regional Research Institute for Homoeopathy, Gudivada, Dr GGH Medical College Campus, Gudivada, Andhra Pradesh, India.
- 12Dr Anjali Chatterjee Regional Research Institute for Homoeopathy, Kolkata, West Bengal, India.
- 13Clinical Research Unit (H), Puducherry, Puducherry, India.
- 14Central Research Institute for Homoeopathy, Jaipur, Rajasthan, India.
- 15Clinical Research Unit (H), Tirupati, India.
- 16Clinical Research unit (H), Port Blair, India.
- 17Clinical Research Unit (H), Gangtok, Sikkim, India.
- 18Regional Research Institute for Homoeopathy, Imphal East, Manipur, India.
- 19Regional Research Institute for Homoeopathy, Agartala, Tripura, India.
- 20National Homoeopathy Research Institute in Mental Health, Kottayam, Kerala, India.
- 21Clinical verification unit (H) Patna, Shree Gurugovind Singh Hospital, Patna, Bihar, India.
- 22Clinical Research Unit (H), Civil Hospital, Dawrpui Aizawl, Mizoram, India.
- 23Regional Research Institute for Homoeopathy, New Shimla, Himachal Pradesh, India.
And which journal supports such unethical activity by publishing their triumphant account? Yes, you probably guessed it, it’s the journal ‘HOMEOPATHY’.
SAY NO MORE!
We all have heard a lot about this year’s Nobel Prizes, I’m sure. One claim that I came across regularly is the notion that the US are the leading nation in Nobel awards. And for once, it’s not even fake news. Here is the list of the 10 leading countries :
Rank – Country – Number of laureates – Number of prizes
- United States 424 (427 prizes)
- United Kingdom 144 (145 prizes)
- Germany 116
- France 77 (78 prizes)
- Sweden 34
- Japan 33
- Russia/Soviet Union 30
- Canada 28
- Switzerland 27
- Austria 25
Impressive!
But hold on, that’s grossly misleading! Surely, we need to account for the size of each country!
Once we do that, the list looks very different, and the US fall into 15th place. Here is the list ranking countries by Nobel laureates per 10 million people, including all prizes and based on a common compilation up to 2013:
Since this blog is about so-called alternative medicine (SCAM), let’s also see what the contribution of SCAM has been. Here is a list of Nobel prizes in Physiology/Medicine by healthcare professions:
The global aging population faces increasing risks of supplement-drug interactions due to rising polypharmacy and widespread use of nutritional supplements. Older adults, particularly those with chronic conditions, frequently combine prescription medications with dietary supplements, yet healthcare providers often overlook these interactions, leading to preventable adverse effects.
This review synthesized evidence from 16 international studies spanning nearly three decades, examining the intersection of supplement and medication use in older adults. Key findings reveal a high prevalence of concurrent use (23-82.5%), significantly increasing the likelihood of adverse interactions, particularly with antithrombotics (e.g., warfarin and ginkgo) and absorption-disrupting minerals (e.g., calcium and levothyroxine). A critical systemic failure in patient-provider communication exacerbates these risks, as clinicians often neglect to inquire about supplement use. Despite widespread potential interactions, actual clinical harm appears concentrated in high-risk combinations. The review calls for proactive clinical strategies, including standardized supplement screening, targeted patient education, and pharmacist-led medication management. Its limitations include cross-sectional study designs and self-reported data, underscoring the need for longitudinal and intervention-based research.
The authors concluded that future studies should prioritize causal evidence, standardized methodologies, and data from low- and middle-income countries to mitigate risks in aging populations.
All of this is true. Yet, I feel that several important points is missing:
THE RISKS OF SUPPLEMENT/DRUG INTERACTIONS ARE BY NO MEANS CONFINED TO THE AGING POPULATION!
On the contrary, many surveys suggest that middle-aged, affluent consumers use more of both and therefore are at an even higher risk than the eldely.
Communication with your physician seems a logical solution, but is it? There is plenty of evidence to show that doctors rarely know much about these interactions (and practitioners of so-called alternative medicine (SCAM) know even less). It gets worse: there is a deplorable lack of research into this subject. Consequently, the knowledge in this area is woefully inclomplete.
If I am right, all this means that we need to
- do the necessary research as a matter of urgency,
- inform ourselves (this applies to healthcare practitioners as well as consumers)
- communicate the existing knowledge and warn consumers.
Failing to do this – as we now have done for many decades – means putting millions of consumers at risk.
Influenza poses a major health challenge due to its variability, pandemic potential and absence of an effective cure. These fact render prevention crucial. This cross-sectional study aimed to explore the link between influenza vaccination and so-called alternative medicine (SCAM) practices among Palestinian adults, along with factors influencing vaccination rates. It also evaluated participants’ attitudes towards SCAM and beliefs regarding herbal and vitamin use for influenza management.
The study was carried out between 18/02/2024 and 23/04/2024. A self-administered online questionnaire was shared through social media and personal communication. This questionnaire was aimed at all adults aged 18 and above. Both descriptive and regression analyses were performed.
The study included 363 participants, revealing an influenza vaccination rate of only 9%. A significant correlation was found between vaccination status and the use of:
- manipulative therapies,
- body-based methods,
- mind-body medicine.
No significant relationship was noted with herbal remedies or alternative medical systems.
Higher income and better health status were linked to increased vaccination likelihood (P-value<0.05), indicating a need for targeted public health campaigns. Although 63% of participants were familiar with SCAM, 34% had never used it for influenza, highlighting a knowledge gap. Popular natural remedies like Vitamin C, ginger, and honey reflect a trend toward preventive healthcare despite concerns over costs and skepticism about SCAM’s effectiveness.
The authors concluded that vaccine hesitancy is influenced by multiple factors, including context and types of SCAM use. Cultural beliefs and personal health philosophies significantly shape attitudes toward SCAM use and vaccination.
On this blog, we have discussed dozens of papers showing a link between various forms of SCAM and uptake of various form of vaccinations (please use the search fascility, if you want to know the details). We have seen that consumers from all parts of the world are less likely to vaccinate, if they are enthusiastic about SCAM. The reasons for this association, and the role of SCAM practitioners in it seem fairly clear:
- SCAM practitioners tend to advise against vaccination;
- SCAM practitioners tend to claim that their own treatments protect against infections;
- SCAM practitioners tend to stress the risks of vaccinations;
- SCAM practitioners tend to claim that vaccinations are not effective;
- SCAM practitioners tend learn these fallacies during their training;
- SCAM practitioners tend to get bombarded with such messages in their ‘professional’ literature;
- Many consumers believe the nonsense they hear from SCAM practitioners, particularly if they share their anti-establishment/science mind-set.
The damage caused in this way by SCAM practitioners is untold. Is it not time to educate SCAM practitioners properly in order to prevent the damage they do to public health?
This is by far the most frequently asked questions I get when giving lectures or joining discussions about so-called alternative medicine (SCAM). People usually hope for an easy answer with perhaps 2 or 3 reasons that stick out. Sadly, this is not possible: there are many reasons, and their importance varies depending on dozens of circumstances.
Here are 12 options for what I consider to be the main reasons. My list is based on both the published evidence and on my 30 + years of researching SCAM:
1. Dissatisfaction with Conventional Medicine
This is the reason that is often thought to be the most important one. I doubt that this is the case. True, many people turn to alternative medicine due to perceived limitations of conventional treatments, such as ineffective results, long wait times, risk of adverse effects, or high costs. Dissatisfaction with conventional medicine is relevant (and often justified) but it is not usually the main factor.
2. Misinformation
I have grown to be convinced that misinformation should be on top of this list. People are told copious amounts of utter nonsense about SCAM. Misinformation originates from practitioners, journalists, the Internet, social media, friends, relatives, VIPs, manufacturers, and sometimes even from politicians. If people had reliable information about SCAM, not many would use it, I am sure.
3. Holistic and Approach
SCAM practitioners and enthusiasts regularly emphasizes holistic care, addressing physical, emotional, and spiritual health. People seeking SCAM are often drawn to its emphasis on balance, well-being and whole person care. I have often pointed out that this is merely another form of misinformation: any good healthcare is about the whole person, and most of SCAM is far from holistic.
4. Fewer Side Effects
Some believe SCAMs, such as homeopathy or naturopathy, have fewer or less severe side effects compared to pharmaceutical drugs or invasive procedures. This is mostly true but, at the same time, it is based on misinformation. The value of a therapy does not depend on its risks; it depends on whether it generates more benefit than risks. And, as we have discussed ad nauseam on my blog, most SCAMs do not rank highly on this score.
5. Personal Empowerment
SCAM often involves active patient participation, such as lifestyle changes or self-administered interventions. This can make individuals feel more in control of their health. People who feel strongly about such issues should, I think, should be reminded that personal empowerment exists in conventional medicine too – only when it comes to it, for instance, when a physician asks a patient to change her lifestyle, it is often not accepted or even frowned upon.
6. Distrust of Pharmaceutical Industry
Distrust in the pharmaceutical industry or the medical/scientific establishment, often fueled by concerns about profit motives or overmedication, pushes some people towards SCAM. This argument is voiced regularly; it really belongs to the first-listed reason above. The sentiment is a powerful motivator, I am sure. Moreover, it seems to become more and more widespread. Personally, I think a certain level of distrust is healthy. What puzzles me, however, is that distrust is so often completely suspended by enthusiasts when if comes to the SCAM industry.
7. Personalized Care
SCAM practitioners often offer individualized remedies and attention. Many people feel that these are lacking in conventional settings. The argument sounds reasonable; yet, I would urge patients to consider that even a totally individualized nonsense must still result in nonsense and can hardly be preferable to a non-individualized but effective therapy.
9. Affluence
There is plenty of evidence to show that, in the West, it is predominantly wealthy people who try SCAM. This implies that many of us have enough cash in our pockets and therefore don’t mind investing some of it in this or that SCAM. The motto seems akin to ‘keeping up with the Joneses’: if so-and-so can afford to have SCAM sessions, I surely must do the same!
10. Education
Most of the surveys on SCAM use demonstrate that SCAM users tend to be well educated. After many years of looking into these issues, I suspect that they are well-educated alright – but not well enough. They often seem to have a superficial understanding of the issues involved. Yet, sadly their knowledge is not deep enough to realize when they are led up the garden path.
11. Time and empathy
In General, SCAM practitioners offer their patients more time than conventional healthcare providers. Many people therefore consult SCAM practitioners – sometimes even when they are aware that the SCAM therapy they are getting is ineffective. They crave empathy, sympathy, warmth, attention, etc. All of this needs time – time that is unavailable under the conventional healthcare systems. Here we have gone full circle: conventional medicine’s lack of time is one of the factors that contributes strongly to the dissatisfaction listed under No1.
12. Efficacy
You may have noticed that I left the most obvious reason to the last: SCAM is employed because it is effective! As we have seen over and over again on this blog, most SCAMs are not effective or not as effective as we are led to believe. Yet, some people are convinced otherwise. Who is correct, the individual experience or the scientific evidence? I have tried to explain many times why our experience can be seriously misleading. Those who still don’t get it may be well educated but, as I pointed out above, not well enough.
There are, of course, many further reasons why people use SCAM. The whole area, it turns out on closer inspection, is a veritable minefield. Many of the reasons are criticisms of conventional medicine in disguise, and conventional healthcare practitioners could, in my view, improve their clinical routine dramatically, if only they considered them carefully.
Regular readers of this blog will know of my long-standing concerns regarding the trustworthiness of research, particularly when it originates from China. I have addressed these issues many times, e.g.:
- Research misconduct in China: an ever increasing worry
- Increasing concerns about SCAM research originating from China
- Concerning developments in acupuncture research: is there something rotten in the state of China?
- If you cannot argue against your critic, have him jailed (a chilling story from China)
- Data fabrication in China is an ‘open secret’
- Acupuncture versus Sham Acupuncture for Chronic Sciatica – another finding that is too good to be true?
- A TCM mixture improves the prognosis of heart attacks? If it sounds too good to be true, it probably is!
- Beware of Chinese acupuncture trials!
- Acupuncture for pain: plenty of useless papers and very little reliable evidence
- A meta-analysis of Chinese herbal medicine for lowering blood pressure
- JAMA just published another truly awful acupuncture study
- More compelling reasons for distrusting Chinese research papers
- A new acupuncture trial with a positive result – alas, it seems too good to be true
- Acupuncture for the prevention of headache? How to fool (almost) everyone with an RCT
- Acupuncture for male infertility (MI): a story of sloppy research endangering public health
- Reviews of Chinese Herbal Medicine: It’s a process akin to money laundering
- Disgracefully low methodological quality of systematic reviews on acupuncture
Now, some further relevant insights into these issues have emerged. A survey was conducted through a collaboration between international publisher Taylor & Francis and the National Science Library at the Chinese Academy of Sciences (CAS). It involved 1,777 students, researchers, and librarians from China, and revealed significant uncertainty about research and publishing ethics:
- 35.9% of respondents were unsure about the responsibilities involved in article authorship, with master students showing the highest levels of confusion.
- A considerable number of respondents reported engaging in ‘gift authorship’ – either adding an author to a paper or agreeing to be named as an author without meeting proper authorship criteria.
- 31% of respondents reported using services offered by third parties to help with publishing in international journals. A concerning number considered activities typically associated with paper mills acceptable, such as writing parts of a paper or adding authors and citations chosen by the agent.
- Only 55.4% of the survey respondents stated that they had access to any training in ethics and integrity, with an even smaller proportion having formal training.
The study’s authors conclude that researchers at all levels need timely, accessible, and suitable training in research integrity and publishing ethics. This training should include undergraduates and those at institutions responsible for upholding overall integrity standards. Essential topics such as authorship responsibilities and working with ethical third-party manuscript services must be part of mandatory training.
Dr Sabina Alam, Director of Publishing Ethics & Integrity at Taylor & Francis, said: “Our survey findings highlight the urgent need for training for students and researchers at all levels in China, a need we believe is also present for many students and researchers across the world. Without this, the knowledge gaps we’ve found leave researchers susceptible to exploitation by unethical organisations, such as paper mills, and many might unknowingly engage in misconduct. It’s understandable that 80% of those who responded to our survey are concerned about the impact of research integrity issues on the trustworthiness of research publications,” Alam added. “Partnerships between publishers and research institutions will be crucial for tackling global research integrity challenges, including developing and implementing comprehensive training in research integrity and publishing ethics. A key reason for our collaboration with the National Science Library at CAS was to explore important issues, and we believe these results from our Joint Lab demonstrate the benefits of working together in this way.”
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I think I should stress that these data and remarks apply to all types of research. The situation in so-called alternative medicine (SCAM) research is clearly more severe. This, I think, is true worldwide but particularly acute for research originating from China.
Carissa Klundt, a 41 year old mom-of-three from Las Vegas, decided to start treatmentsto fix her sore back. She had attended three appointments with her chiropractor before a substitute practitioner stepped in to perform her spinal adjustments on the fourth. Carissa was immediately concerned when she felt a sharp pain in her neck after the chiropractor performed one particular cracking procedure. She experienced pain after the appointment but initially brushed it off as a ‘strained muscle’. When she began ‘blacking out’, her husband insisted she went to a hospital.
There, doctors confirmed that Carissa had suffered a tear in the inner lining of the vertebral artery – a condition known as a vertebral artery dissection (VAD). Doctors warn chiropractic neck manipulation heightens the risk of otherwise rare VADs. It is estimated that one in 20,000 spinal manipulations results in the condition.
Carissa was rushed to the intensive care unit at a specialist hospital as medics feared the VAD could trigger a stroke. After she was discharged, Carissa had a long road to recovery, facing constant pain, and mobility issues. She didn’t suffer a stroke, but was diagnosed with aphasia, due to reduced blood flow to the brain from the torn artery. The condition impairs a person’s ability to express and understand language, whether spoken, written, or signed.
Adamant her visit to the chiropractor nearly cost her her life, Carissa is warning others to be wary of alternative medicine. Detailing what originally led her to visit a chiropractor, she said: ‘I went to my chiropractor because I’d been having a lot of strain in my chest and my back and a friend had recommended one.
After visiting a chiropractor to help relieve some of her symptoms, Carissa felt a sharp pang of pain in her neck during her fourth session. Carissa said: ‘As soon as it happened, I knew something was wrong. You do hear a crack anyway when you get an adjustment but I knew something had gone wrong. There was a pain in my neck. I got home and felt like I was going to throw up. I had no idea a VAD could even happen. Because I work in health, fitness and wellness, I was active after [the appointment]. I was teaching classes, I went to a salon – I did everything wrong. A few weeks after seeing the chiropractor, I was seeing things and blacking out and my husband said ‘we’re taking you to the ER’.’
After undergoing a CAT scan, doctors told Carissa that she had suffered a VAD and transferred her to an ICU at a specialist hospital. Carissa said: ‘I knew straight away that it was from the chiropractor – that’s where the pain all started from. ‘They said I could’ve had a stroke. If I hadn’t gone to hospital, I would’ve had a stroke. I could’ve so easily died. It traumatized my whole family. For the first month I was pretty much in bed. I was exhausted, sleeping for 17 hours a day. I needed help walking. I was in constant pain.’
Carissa says her life was put on pause after suffering the artery tear and is now spreading awareness of the signs and symptoms of the life-threatening condition. Touching on her health status years on, she concludes: ‘I still have lingering symptoms now – it’s a whole lifestyle change. I’ll never ski again, I’ll never go on a rollercoaster, I’m not teaching classes anymore. There’s still a residual fear of it happening again. I’m doing well now but it’s been a long recovery process. My life was really put on pause. I absolutely regret going to the chiropractor. It’s not about blaming anyone, it’s just about spreading more awareness. I want people to understand what the symptoms are and that this is a life-threatening condition. I never thought anything like this could happen to me. I was healthy, active and deeply in tune with my body.’
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Yes, I know!
Yet another case with insufficient details to draw firm conclusions. My chiro friends will not be happy. This is not evidence!, they will say. And right they are! So, let’s look at some more reliable evidence. Here are 3 recent and relevant abstracts:
- 1st abstract: Vertebral artery dissection (VAD) has been observed in association with chirotherapy of the neck. However, most publications describe only single case reports or a small number of cases. We analyzed data from neurological departments at university hospitals in Germany over a three year period of time of subjects with vertebral artery dissections associated with chiropractic neck manipulation. We conducted a country-wide survey at neurological departments of all medical schools to identify patients with VAD after chirotherapy followed by a standardized questionnaire for each patient. 36 patients (mean age 40 + 11 years) with VAD were identified in 13 neurological departments. Clinical symptoms consistent with VAD started in 55% of patients within 12 hours after neck manipulation. Diagnosis of VAD was established in most cases using digital subtraction angiography (DSA), magnetic resonance angiography (MRA) or duplex sonography. 90% of patients admitted to hospital showed focal neurological deficits and among these 11 % had a reduced level of consciousness. 50% of subjects were discharged after 20 +/- 14 hospital days with focal neurological deficits, 1 patient died and 1 was in a persistent vegetative state. Risk factors associated with artery dissections (e. g. fibromuscular dysplasia) were present in only 25% of subjects. In summary, we describe the clinical pattern of 36 patients with vertebral artery dissections and prior chiropractic neck manipulation.
- 2nd abstract: Background: Vertebral artery dissections (VAD) are a rare but important cause of ischemic stroke, especially in younger patients. Many etiologies have been identified, including MVAs, cervical fractures, falls, physical exercise, and cervical chiropractic manipulation. The goal of this study was to investigate the subgroup of patients who suffered a chiropractor-associated injury and determine how their prognosis compared to other-cause VAD. Methods:We conducted a retrospective chart review of 310 patients with vertebral artery dissections who presented at our institution between January 2004 and December 2018. Variables included demographic data, event characteristics, treatment, radiographic outcomes, and clinical outcomes measured using the modified Rankin Scale.Findings: Overall, 34 out of our 310 patients suffered a chiropractor-associated injury. These patients tended to be younger (p = 0.01), female (p = 0.003), and have fewer comorbidities (p = 0.005) compared to patients with other-cause VADs. The characteristics of the injuries were similar, but chiropractor-associated injuries appeared to be milder at discharge and at follow-up. A higher proportion of the chiropractor-associated group had injuries in the 0–2 mRS range at discharge and at 3 months (p = 0.05, p = 0.04) and no patients suffered severe long-term neurologic consequences or death (0% vs. 9.8%, p = 0.05). However, when a multivariate binomial regression was performed, these effects dissipated and the only independent predictor of a worse injury at discharge was the presence of a cervical spine fracture (p < 0.001). Interpretation: Chiropractor-associated injuries are similar to VADs of other causes, and apparent differences in the severity of the injury are likely due to demographic differences between the two populations.
- 3rd abstract: Purpose: The purpose of this study was to determine the frequency of patients seen at a single institution who were diagnosed with a cervical vessel dissection related to chiropractic neck manipulation. Methods: We identified cases through a retrospective chart review of patients seen between April 2008 and March 2012 who had a diagnosis of cervical artery dissection following a recent chiropractic manipulation. Relevant imaging studies were reviewed by a board-certified neuroradiologist to confirm the findings of a cervical artery dissection and stroke. We conducted telephone interviews to ascertain the presence of residual symptoms in the affected patients. Results: Of the 141 patients with cervical artery dissection, 12 had documented chiropractic neck manipulation prior to the onset of the symptoms that led to medical presentation. The 12 patients had a total of 16 cervical artery dissections. All 12 patients developed symptoms of acute stroke. All strokes were confirmed with magnetic resonance imaging or computerized tomography. We obtained follow-up information on 9 patients, 8 of whom had residual symptoms and one of whom died as a result of his injury. Conclusion: In this case series, 12 patients with newly diagnosed cervical artery dissection(s) had recent chiropractic neck manipulation. Patients who are considering chiropractic cervical manipulation should be informed of the potential risk and be advised to seek immediate medical attention should they develop symptoms.
I hope my chiro friends are happy now.
