Edzard Ernst

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

We have often discussed cupping on this blog, e.g.:

Yes, generally speaking I have been critical about cupping – not because I don’t like it (I even used the treatment as a young clinician many years ago) but because the evidence tells me to. I was glad to see that the authors of a recent article entitled “Utility of Cupping Therapy in Substance Use Disorder: A Novel Approach or a Bizarre Treatment?” offer even more outspoken words about the therapy. Here are their conclusions:

Established treatment modalities for substance use disorder and its withdrawal symptoms include pharmacotherapy and psychotherapy, but their utilization by the general population remains unsatisfactory. Taboos regarding mental health services and concerns about confidentiality are massive obstacles for patients seeking psychiatric help, and alternative forms of medicine may seem more approachable, even with the associated risks. As displayed in this case, cupping therapy is a traditional therapy with no role in treating polyaddiction and withdrawal symptoms, but it unnecessarily exposes individuals to really uncomfortable and often concealed complications such as bruising, and skin and blood infections, especially when carried out by untrained, incompetent individuals. While one can explore these options in addition to seeking professional mental health care, it is imperative to spread awareness about the roles, scientific soundness, and adverse effects of these alternative health practices. The health promotion and education sectors need reforms to educate the general population, especially the rural population in India, about the dangers of iatrogenesis caused by non-evidence-backed treatments. There needs to be an extensive advertisement of only the most effective and scientific treatment options provided by medical professionals, and the risks of overlooking them in favor of traditional cures propagated by unqualified individuals. With all the scientific advancements in the 21st century ranging from artificial intelligence in healthcare, and robotic surgeries, to extensive clinical trials for novel anti-cancer drugs, we cannot allow the propagation of ancient, scientifically unsound techniques that may cause more harm than benefit to patients.

Why, I am sure you ask yourself, are they so critical? The reason lies in the case they report in the same paper:

A 30-year-old man presented to the psychiatric outpatient department with complaints of nervousness, anxiety, a sense of impending doom, irritability, anger outbursts, headache, and reduced sleep and appetite for the last five days. The patient had a history of daily consumption of 5-10 mg of alprazolam tablets, 200-250 mg of codeine syrup, and about five packets of chewable tobacco over the last seven years; this was a pattern of polyaddiction to a benzodiazepine, opiate, and nicotine. The patient had no history of fever, confusion, or hallucinations. On eliciting the past history, the patient revealed that he went to an alternative medicine practitioner after his family persuaded him to seek help for his substance use disorder. After ceasing the consumption of all three substances for three days, he started developing the symptoms with which he presented to our hospital. He was hesitant to talk about his substance use disorder to medical professionals and concerned about confidentiality, and, hence, went to an alternative medicine practitioner whom he deemed approachable. There he was given wet cupping therapy on the head for four days, which involved the use of rubber pumps to create a suction inside the cups placed on his head. After three to five minutes, the cups were removed and small incisions were made on the cupping sites, following which a second suction caused the oozing out of blood from the incision sites on the scalp (Figure 1). But, this did not improve his symptoms, and hence, he stopped going there two days before coming to our tertiary care hospital.

Figure 1: Wet cupping therapy on the head with blood oozing from incision sites<

Figure 1: Wet cupping therapy on the head with blood oozing from incision sites<

On examination, the patient had a pulse rate of 76 beats per minute, blood pressure of 128/78 mm Hg, and respiratory rate of 22 per minute. He was well-oriented to time, place, and person. Systemic examination of the cardiovascular system was unremarkable. He denied any other substance use. The skin over his head had distinct cupping marks but no signs of infection or active bleeding, which are some common complications after cupping therapy (Figure 2). On assessment, the patient had a Clinical Opiate Withdrawal Scale (COWS) score of 13 and a Clinical Institute Withdrawal Assessment (CIWA) scale score of 26.

Figure 2: Cupping marks on the head`

Figure 2: Cupping marks on the head

Later, the patient was admitted to the psychiatric ward to manage the withdrawal symptoms, where we initiated pharmacotherapy. Tablet diazepam (20 mg/day), sodium valproate (800 mg/day), tramadol (200 mg/day), thiamine (300 mg/day), paracetamol (500 mg/day) and intravenous fluids were given to the patient. We counseled the patient regarding substance abuse, its harmful effects, and de-addiction. The patient’s symptoms started to improve, and we continued the treatment for four days and discharged him with a COWS score of 4 and a CIWA score of 2. We intended to reassess him after 14 days, but we lost him to follow-up.

We have discussed the homeopathic obscession with bovine mastitis before. For instance, we have looked at this systematic review which did exactly that. Its authors are highly respected and come from institutions that are not likely to promote bogus claims:

  • Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Canada
  • Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Canada
  • Canadian Bovine Mastitis and Milk Quality Research Network, Canada
  • Canadian Bovine Mastitis and Milk Quality Research Network, Canada
  • Sherbrooke Research and Development Centre, Agriculture and Agri-Food Canada
  • Canadian Bovine Mastitis and Milk Quality Research Network, Canada
  • Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montreal, Canada.

A total of 2,451 manuscripts were first identified and 39 manuscripts corresponding to 41 studies were included. Among these, 22 were clinical trials, 18 were experimental studies, and one was an observational study. The treatments evaluated were conventional anti-inflammatory drugs (n = 14), oxytocin with or without frequent milk out (n = 5), biologics (n = 9), homeopathy (n = 5), botanicals (n = 4), probiotics (n = 2), and other alternative products (n = 2). All trials had at least one unclear or high risk of bias. Most trials (n = 13) did not observe significant differences in clinical or bacteriological cure rates in comparison with negative or positive controls. Few studies evaluated the effect of treatment on milk yield. In general, the power of the different studies was very low, thus precluding conclusions on non-inferiority or non-superiority of the treatments investigated. No evidence-based recommendations could be given for the use of an alternative or non-antimicrobial conventional treatment for clinical mastitis. The authors concluded that homeopathic treatments are not efficient for management of clinical mastitis.

Did this finally stop homeopaths from claiming that their placebos work for mastitis?

I would not count on it!

Will it stop homeopaths to conduct trials of the subject?

No!

Recently a new study has emerged. Its aim was to assess the potential of a novel homeopathic complex medicine in managing bovine mastitis. Twenty-four lactating Holstein cows with mastitis were divided into two groups: the homeopathic complex group received a homeopathic complex daily for 60 days at a dose of 20 g/d; the placebo group received the calcium carbonate vehicle without homeopathic medicines at the same dose and repetition. The main outcome measure was somatic cell count (SCC; cells/mL), with additional outcome measures including milk production (kg/d), milk constituents (percentage of protein, fat, lactose and total milk solids), and serum levels of cortisol, glucose, ammonia and lactic acid. All outcomes were measured at the beginning of the study and after 30 and 60 days. Milk samples were also collected from all animals at the beginning of the study, confirming a high (>0.2) MAR index for isolated bacterial cultures.

Assessment of SCC showed a statistically significant difference favoring the homeopathic complex versus placebo group at day 60. A reduction in serum cortisol levels and an increase in fat, lactose and total milk solids in animals treated with the homeopathic complex at day 60 were also seen. Other outcome measures did not show statistically significant inter-group differences.

The authors from the Paranaense University-Praça Mascarenhas de Moraes, Umuarama, Paraná, Brazil, concluded that the results of this non-randomized, open-label, placebo-controlled trial suggest the potential for a novel homeopathic complex medicine in management of multiple antibiotic-resistant bovine mastitis, thus offering dairy farmers an additional option to antibiotics and making dairy products safer for consumer health and milk production more sustainable.

Here are just some of the most obvious points of concern:

  • The trial was supported by the manufacturer of the homeopathic product, yet the authors declare no conflicts of interest.
  • The exact nature of the product remains unknown to anyone like me who tried to obtain the information by searching the websites of the manufacturer, etc.
  • The trial was non-ramdomized and open label, i.e. wide open to bias, yet the authors do not shy away from drawing firm conclusions.
  • There is no plausible rationale for homeopathy in this (or any other) indication.
  • Homeopathy for animals contradicts the gospel of Hahnemann, its inventor.
  • Overwhelmingly, the evidence fails to show that homeopathy is effective for bovine mastitis.

I do understand that manufacturers smell a lucrative market, but I still think that, for serious veterianarians, scientists, journal editors, etc., the subject should be closed.

The utilization of certain forms of so-called alternative medicine (SCAM) is prevalent among adults. While researchers have extensively studied the factors influencing SCAM use in Western countries, significant barriers to its adoption remain. This paper draws attention to the obstacles faced by individuals in their journey to using SCAM.

Qualitative interviews were conducted with 21 patients who had turned to SCAM for managing a chronic illness/condition and had been chosen through a ‘snowball sampling’ strategy. These in-depth, face-to-face interviews occurred in Miami, USA, during 2014-15. The sampling, data collection, and analysis processes of this study adhered to the principles outlined in Charmaz’s constructivist grounded theory approach.

From the data, three central barriers to SCAM utilization in the US emerged: 1) Financial barriers: A significant portion of SCAM treatments is not covered by insurance, making them cost-prohibitive for many. 2) Skepticism and discouragement: Both conventional medical practitioners and a segment of the public exhibited a noticeable trend towards discouraging SCAM use. 3) Evaluation challenges: Patients expressed difficulty in assessing the efficacy and benefits of various SCAM treatments compared to their costs.

The author concluded that despite the widespread interest in and use of SCAM in the US, numerous barriers hinder its broader integration into mainstream healthcare. These obstacles not only restrict healthcare choices for the general public but also appear to favor a select demographic, potentially based on income and availability of information.

So, 21 individuals chosen via a snowball sampling strategy located in Miami feel that there were obstacles to using SCAM.

No!

These obstacles existed about 10 myears ago.

No!

The obstacles only existed in the imagination of these 21 guys.

No!

The alleged obstacles are hardly relevant and therefore are not truly obstacles.

The only truly relevant obstacle to SCAM-use is the fact that most SCAMs have either not been shown to work, or shown not to work!

Perhaps surprisingly, the author concedes that their study has certain limitations: “This study had some inherent limitations. The sample, while chosen based on theoretical sampling to achieve theoretical saturation, was both small and self-selected. This limits the broad applicability of the findings. Moreover, individuals from lower socio-economic backgrounds were not represented in the sample, which may have overlooked important perspectives on affordable SCAM options. The sample did not offer a detailed exploration of SCAM perceptions across diverse demographic categories, such as social class or ethnicity. It’s also essential to highlight that this research was conducted exclusively in Miami, a city with a significant population of ethnic minorities in the US. This demographic context could have uniquely influenced the feedback from SCAM users.”

If I may, I will another limitation: This study was utter nonsense from its conception to its publication!

You might think that all of this is quite trivial and that I am rather petty. If you look into Medline and realize how many such useless and counter-productive SCAM studies are being published, you might change your mind.

Much of the discussions on this blog are directly or indirectly related to the subject of research integrity. Research integrity refers to the ethical and professional standards that researchers must adhere to while conducting research. It involves conducting research in a way that allows others to have confidence and trust in the methods and findings of the research. Research integrity includes honesty, rigour, transparency, open communication, care and respect for all participants, and accountability. According to the ‘Concordat To Support Research Integrity‘, the core elements of research integrity are:

  1. Honesty in all aspects of research, including in the presentation of research goals, intentions and findings; in reporting on research methods and procedures; in gathering data; in using and acknowledging the work of other researchers; and in conveying valid interpretations and making justifiable claims based on research findings.
  2. Rigour, in line with prevailing disciplinary norms and standards, and in performing research and using appropriate methods; in adhering to an agreed protocol where appropriate; in drawing interpretations and conclusions from the research; and in communicating the results.
  3. Transparency and open communication in declaring potential competing interests in the reporting of research data collection methods; in the analysis and interpretation of data; in making research findings widely available, which includes publishing or otherwise sharing negative or null results to recognise their value as part of the research process; and in presenting the work to other researchers and to the public.
  4. Care and respect for all participants in research, and for the subjects, users and beneficiaries of research, including humans, animals, the environment and cultural objects. Those engaged with research must also show care and respect for the integrity of the research record.
  5. Accountability of funders, employers and researchers to collectively create a research environment in which individuals and organisations are empowered and enabled to own the research process. Those engaged with research must also ensure that individuals and organisations are held to account when behaviour falls short of the standards set by this concordat.

These points apply to all types and aspects of research and to all individuals involved in it. Obviously, they apply also to research of so-called alternative medicine (SCAM). I will therefore briefly discuss each point in respect of SCAM research.

Ad 1

Honesty in research is an important ethical prerequisite. In SCAM, we regularly see that the honesty seems to be in short supply. There are many ways in which lack of honesty shows itself. For me, the most impressive one is when SCAM researchers disclose – as they often do –  that their aim is to demostrate that their assumptions/theories/hypotheses are correct. In such cases, they abuse the tools of science which are not for confirming hypotheses but for testing, i.e. trying to falsifying them. This blog offers plenty of examples for this phenomenon (e.g. here or here)

Ad 2

The lack of rigor in much of SCAM research is legend and has become a constant theme on this blog. How often have we seen useless and unnecessary observational studies or pilot studies on subjects where controlled trials already exist? How often have we lamented over misinterpretation of a study’s findings? How often have we reported research that was ill-conceived from the outset, unable to answer any meaningful research question? My all time favourite examples of drawing a wrong conclusions are from the area of homeopathy, e.g. here and here.

Ad 3

Much of SCAM research is being conducted by SCAM enthusiasts who have no qualitification or experience in research or science. Inevitably, this must lead to bias. Just think of the fact that some countries, e.g. China, or some SCAM journals, or some SCAM researchers (e.g. THE ALTERNATIVE MEDICINE HALL OF FAME) publish as good as no negative findings

Ad 4

Lack of respect for research subjects has many guises. For instance, if clinical trials are being conducted of treatments that are utterly implausible. This, in my view, constitutes an abuse of the willingness of volunteers to make a contribution to research. Another example is the incessant flow of untrustworthy research by SCAM enthusiasts which eventually can only erode the public’s trust in research and is bound to render the essential cooperation of researchers and volunteers more and more problematic.

Ad 5

When I think of accountability, I think yet again of the men and women in my ALTERNATIVE MEDICINE HALL OF FAME. As any of its members ever been held accountable for misleading the public through their pseudo-research? Sadly, the answer, as far as I know, is NO.

We have repeatedly discussed the fraud committed by many chiropractors. A recent article provided further information on this lamentable issue. Here are a few excerpts:

Fraud in US chiropractic care is on the rise. A shocking 82 percent of the chiropractic services billed to Medicare is unallowable, according to a recent audit by the Office of Inspector General. The audit found a lack of effective controls allowed an estimated $358.8 million in taxpayer funds to be improperly billed to Medicare.

Chiropractors engage in fraudulent billing practices in a variety of ways. Sometimes they target environments like nursing homes or substance abuse rehabilitation centers, looking for new patients who may – or may not – require their services.

In one case, a St. Louis-based chiropractor bribed police officers to get access to personal information about individuals who had been in car accidents. The chiropractor then contacted the accident victims and claimed to be from an insurance company or the state to arrange appointments at his practice.

In another case, a Houston-based chiropractor and his medical group settled with the federal government for $2.6 million and were also banned from billing federal programs for 10 years due to their involvement with a fraudulent billing scheme.

Lastly, in 2021, a chiropractor was found guilty of federal criminal charges, including five counts of healthcare fraud. The chiropractor was accused of defrauding health insurers by submitting $2.2 million in billings for chiropractic services that were never provided, office visits that never occurred, false diagnoses, and falsely prescribed medical devices.

Although other medical specialties also have bad actors, certain specific reasons can be identified as to why fraudulent billing and abuse have been increasing among chiropractors. These practitioners have fewer lower-cost codes to bill for, which means they need more patients to boost their earnings. For example, a service may only be billed at $25 or $50, but if this is billed to every patient on every visit, it quickly adds up. Because employers often have limited resources, it’s easy for minor charges to go unnoticed.

According to a 2018 report, the inspector general has conducted numerous evaluations and audits of chiropractic services since 2005 and has identified hundreds of millions of dollars in overpayments for services that did not meet Medicare requirements. The report also noted that the OIG’s investigations and legal actions involving chiropractors have demonstrated that chiropractic services are susceptible to healthcare fraud.

______________

Personally, I am not surprised by such reports. Sure, not all chiropractors committ financial fraud. But arguably ALL chiropractors are dishonest when they tell their patients that their spinal manipulations are effective and safe for a wide range of conditions. To put it bluntly: chiropractic was founded by a crook on a bunch of lies and unethical behavior, therefore, it is hardly surprising that today the profession has a problem with honesty and fraudulent behavior.

 

 

Suzanne Somers, born Suzanne Marie Mahoney on October 16, 1946 in San Bruno, California, was an American actress, author and businesswoman.  Somers has published several best-selling self-help books, such as I’m Too Young for This! and The Natural Hormone Solution to Enjoy Menopause. In 2001, it was reported that she had breast cancer and was opting for so-called alternative medicine (SCAM) to treat it, In particular, she used Iscador, a preparation of mistletoe that we have discissed many times before on this blog, e.g.:

In an interview with Larry King in 2001, Somers revealed that she had been receiving treatment for a year. She also explained that she refused to go through with chemotherapy and instead used SCAM. “I decided to find alternative things to do,” she continued. “Because I have done so much work in my books about hormones, and that hormonal balance is why people gain or lose weight, and, it was my belief that a balanced environment of hormones prevents disease. And the first thing they said to me, we are taking of off all hormones. I said no, I’m going to continue taking my hormones, which is the first thing against the common course…”

Recently, it was reported that Somers has died of cancer aged 76. Earlier this year, Somers said they had “used the best alternative and conventional treatments to combat it [her cancer].” But now, a source close to the star shares that many around her didn’t like it. Somers’ friends tried to convince her to ditch SCAM in favor of chemotherapy. “She was advised by several people to consider the more conventional approach, but she did not listen,” a source close to Somers told the Daily Mail. The source continued, “She has always rejected chemo, so it wasn’t even an option. Her friends and loved ones urged her to reconsider so many times during her cancer battles and at the end.” A statement read. “Her family was gathered to celebrate her 77th birthday on October 16th. Instead, they will celebrate her extraordinary life, and want to thank her millions of fans and followers who loved her dearly.”

Perhaps this sad case is an apt occasion for rephrasing the warning that I posted only a few days ago:

be very cautious about using SCAMs for cancer and seek professional advice, preferably NOT from a SCAM provider.

 

The BBC has a popular program entitled JUST ONE THING presented by Dr, Michael Mosely. In each of these short broadcasts, Mosely presents JUST ONE THING that will make your life more healthy. Whenever I listen to them, I get slightly irritated. Mosely is clearly a very skilled presenter and makes complicated things easy to understand; but for my taste his approach is totally devoid of critical thinking. This is obviously the point of the series and probably one reason for its success. So, maybe it needs to be tolerated – perhaps, but surely not if it seriously misleads the public on important health issues.

The most recent broadcast was entitled EMBRACE THE RAIN and, in my view, it did cross this crucial line. Mosely explained that after it has rained, the air is full of negative ions and these ions are effective against depression. The center piece was his interview with Prof Michael Terman who explained some of his research on the subject, in particular a clinical trial which showed that intensely ionized air was effective against depression. Terman explained that this was more than a placebo effect, that it worked even for serious chronic depressed patients, and that the effect was better than standard treatments.

At no stage was there an even mildly critical question from Mosely. Consequently many depressed patients might now abandon their standard treatments and opt for air ionizers in their homes or walks in the rain which was deemed to be just as effective. In view of the fact that chronic depression, through its suicide risk, can be a life-threatening condition, I find this rather concerning.

My concerns were not exactly alleviated when I did a quick search for the evidence. The most recent review on the subject states that there has been considerable interest in the potential effects of negative air ions (NAIs) on human health and well-being, but the conclusions have been inconsistent and the mechanisms remain unclear. So, why does Terman promote NAIs as though they are the best thing since sliced bread? It took me less than a minute to find a possible answer: he holds a patent for a NEGATIVE ION GENERATOR!

It is laudable of the BBC and Michael Mosely to present aspects of healthcare in a simple, understandable way. Yet, it would be even more laudable, if they did their homework a bit better and, crucially, tried to also educate the public in critical thinking. After all ’embracing the rain’ will not change lives but critical thinking most certainly does!

If you assumed that the best management of a child by chiropractors is not to treat this patient and refer to a proper doctor, think again. This paper was aimed at building upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Its authors composed a best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. They thus syntheized results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process.

The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed the following aspects of the clinical encounter:

  • patient communication, including informed consent;
  • appropriate clinical history, including health habits;
  • appropriate physical examination procedures;
  • red flags/contraindications to chiropractic care and/or spinal manipulation;
  • aspects of chiropractic management of pediatric patients, including infants;
  • modifications of spinal manipulation and other manual procedures for pediatric patients;
  • appropriate referral and comanagement;
  • appropriate health promotion and disease prevention practices.

The authors concluded that this set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.

Whenever I read the term ‘evidence-informed’ I need to giggle. Why not evidence-based? Evidence-informed might mean that chiros are informed that their treatments are useless or even dangerous for children … but, on reflection and taking their own need for earning a living, they subsequently ignore these facts. And sure enough, the authors of the present paper do mention that a Cochrane review concluded that spinal manipulation is not recommended for children under 12, for a number of conditions, or for general wellness … only to then go on and ignore the very fact.

In doing so, the authors issue a string of self-evident platitudes which occasionally border on the irresponsible. For instance, under the heading of ‘primary prevention’, vaccinations are mentioned as the very last item with the following words:

If parents ask for advice or information about childhood vaccinations, explain that they have the right to make their own health decisions. They should be adequately informed about the benefits and risks to both their child and the broader community associated with these decisions. Consider referral to a health professional whose scope of practice includes vaccinations to address patient questions or concerns.

What that really means in practice, I fear, might be summarized like this: If parents ask for advice or information about childhood vaccinations, explain that they are dangerous, and that even D. D. Palmer recognized as early as 1894 that vaccination is ‘…the monstrous delusion … fastened on us by the medical profession, enforced by the state boards, and supported by the mass of unthinking people …’

Altogether, the ‘Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors’ is a thoroughly disreputable document. It was constructed in the way all charlatans tend to construct their consensus documents:

  • convene a few people who are all in favour of a certain motion,
  • discuss the motion,
  • agree with it,
  • write up the process
  • publish your paper in a third class journal,
  • boast that there is a consensus,
  • stress that the motion must thereefore be ethical, correct and valuable.

Do chiropractors know that, using this methodology, the ‘flat earth society’ can easily pass a consensus that the earth is indeed flat?

I am sure they do!

‘The Cult of Chiropractic’ is the title of a video that has just been released. I think it is very good and, if you are interested in the subject at all, I recommend you have a look. You can watch it here:

The Cult of Chiropractic : r/h3h3productions (reddit.com)

The video is not just well-done, it also is fun and informative. I learned a few things from it that I did not yet know. It also brings Simon Singh and myself together after we had not met for several years; and that is always a pleasure!

But back to ‘The Cult of Chiropractic’ and the question whether this assumption is true. Some time ago, I published a post about so-called alternative medicine and cultism. I listed a few questions we should ask ourselves to determine whether chiropractic is a cult. Let me adapt them slightly:

  1. Is chiropractic based on dogma? The answer is yes – think, for instance, of the assumptions that subluxations exist.
  2. Does chiropractic demand acceptance of its dogma or doctrine as truth? For straight chiropractors, the answer is yes.
  3. Is the dogma set forth by a single guru or promulgator? Yes, DD Palmer.
  4. Is chiropractic supposed to cure all ills? For many chiros, the answer is yes.
  5. Is belief used by chiropractors as a substitute for evidence? Yes.
  6. Do chiropractors determine their patients’ lifestyle? Yes.
  7. Do chiros exploit their patients financially? Yes.
  8. Does chiropractors impose rigid rules and regulations? Yes.
  9. Do chiros practice deception? Yes.
  10. Do chiropractors have their own sources of information/propaganda? Yes.
  11. Do chiros cultivate their own lingo? Yes.
  12. Do chiros discourage or inhibit critical thinking? Yes.
  13. Are questions about the values of chiropractic discouraged or forbidden? Yes.
  14. Do the proponents of chiropractic reduce complexities into platitudinous buzz words? Yes
  15. Do chiros assume that health problems are the result of not adhering to the dogma? Yes.
  16. Do chiros instill fear into members who consider leaving? Yes.
  17. Do chiros depict conventional medicine as ineffective or harmful? Yes.
  18. Do chiros ask others to recruit new members to their cult? Yes.

Based on these 18 questions, I conclude that chiropractic is indeed a cult. What about you? Even if you disagree, please have a look at the excellent  video, ‘THE CULT OF CHIROPRACTIC’.

Conspiracy beliefs (CBs) can have substantial consequences on health behaviours by influencing both conventional and non-conventional medicine uptake. They can target powerful groups (i.e. upward CBs) or powerless groups (i.e. downward CBs). Considering their repercussions in oncology, it appears useful to understand how CBs are related to the intentions to use conventional and so-called alternative medicines (SCAM), defined as “medical products and practices that are not part of standard medical care” including practices
such as mind–body therapies, botanicals, energy healing or naturopathic medicine.

This paper includes two pre-registered online correlational studies on a general French population (Study 1 N = 248, recruited on social media Mage = 40.07, SDage = 14.78; 205 women, 41 men and 2 non-binaries; Study 2 N = 313, recruited on social media and Prolific, Mage = 28.91, SDage = 9.60; 154 women, 149 men and 10 non-binaries). the researchers investigated the links between generic and chemotherapy-related CBs and intentions to use conventional or SCAMs. Study 2 consisted of a conceptual replication of Study 1, considering the orientation of CBs.

Generic CBs and chemotherapy-related CBs appear strongly and positively correlated, negatively correlated with intentions to take conventional medicine and positively with intentions to take SCAM. The link between generic CBs and medication intention is fully mediated by chemotherapy-related CBs. When distinguished, upward CBs are a stronger predictor of chemotherapy-related CBs than downward CBs.

The authors concluded that the findings suggest that intentions to use medicine are strongly associated with CBs. This has several important implications for further research and practice, notably on the presence and effects of CBs on medication behaviours in cancer patients.

Sadly, the influence of CBs is not confined to the field of oncology but applies across all diseases and conditions. We have seen and discussed these issues in several previous posts, e.g.:

The most impressive evidence, however, is regularly being provided by some of the people who post comments on this blog. Collectively, this evidence has prompted me to postulate that SCAM itself can be seen as a consiracy theory.

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