Edzard Ernst

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

Due to the unclear risk level of adverse events (AEs) associated with high-velocity, low-amplitude (HVLA) cervical manipulation, the aim of this study was to extract available information from randomized clinical trials (RCTs) and thereby synthesize the comparative risk of AEs following cervical manipulation to that of various control interventions.

 A systematic literature search was conducted in the PubMed and Cochrane databases. This search included RCTs in which cervical HVLA manipulations were applied and AEs were reported. Two independent reviewers performed the study selection, the methodological quality assessment, and the GRADE approach. Incidence rate ratios (IRR) were calculated. The study quality was assessed by using the risk of bias 2 (RoB-2) tool, and the certainty of evidence was determined by using the GRADE approach.

Fourteen articles were included in the systematic review and meta-analysis. The pooled IRR indicates no statistically significant differences between the manipulation and control groups. All the reported AEs were classified as mild, and none of the AEs reported were serious or moderate.

The authors concluded that HVLA manipulation does not impose an increased risk of mild or moderate AEs compared to various control interventions. However, these results must be interpreted with caution, since RCTs are not appropriate for detecting the rare serious AEs. In addition, future RCTs should follow a standardized protocol for reporting AEs in clinical trials.

I am more than a little puzzled by this paper. To explain why, I best show you our systematic review of a closely related subject:

Objective: To systematically review the reporting of adverse effects in clinical trials of chiropractic manipulation.

Data sources: Six databases were searched from 2000 to July 2011. Randomised clinical trials (RCTs) were considered, if they tested chiropractic manipulations against any control intervention in human patients suffering from any type of clinical condition. The selection of studies, data extraction, and validation were performed independently by two reviewers.

Results: Sixty RCTs had been published. Twenty-nine RCTs did not mention adverse effects at all. Sixteen RCTs reported that no adverse effects had occurred. Complete information on incidence, severity, duration, frequency and method of reporting of adverse effects was included in only one RCT. Conflicts of interests were not mentioned by the majority of authors.

Conclusions: Adverse effects are poorly reported in recent RCTs of chiropractic manipulations.

So, AEs are known to get seriously (and unethically) neglected in RCTs of chiropractic. Therefore, it must be expected that the new review finds only few of them in RCTs. No big deal! But why then conclude that HVLA manipulations do not impose an increased risk? Why do the authors claim that “case reports … do not imply causal relationships”? Why not be honest and simply state that RCTs are an inadequate tool for assessing the risks of spinal manipulation? And why ignore our review which, after all, is highly relevant and was published in a most visible journal? Did they perhaps read it and then decided to ignore it because it would have rendered their whole approach idiotic?

I don’t know the answer to any of these questions. What I do know, however, is that this new review arrives at a utterly misleading and possibly harmful conclusion. It thus is a significant disservice to our need to making progress in this important area.

Astrology is a subject that regularly crops up in the realm of so-called alternative medicine (SCAM). Thus we have dealt with it on several occasions, e.g.:

Many SCAM proponents evidently believe that astrology works.

The question is, does astrology have any value at all in healthcare?

Several recent papers go some way in answering it.

The first paper evaluated the existing research base on correlates of belief in astrology and fortune-telling. the researchers conducted a scoping review to synthesize the available literature base on belief in astrology and to review the evidence for “fortune-telling addiction” using Arksey and O’Malley’s methodological framework. Databases of PubMed, ProQuest, EBSCO, and SCOPUS were searched for relevant studies published in peer-reviewed journals.

The search findings revealed the association of belief in astrology with cognitive, personality, and psychological factors such as thinking style, self-concept verification, and stress. Case studies on “fortune-telling addiction” have conceptualized it as a possible behavioral addiction and have reported symptoms such as distress, cravings, and salience.

The second study examined the relationship between Western zodiac signs and subjective well-being in a nationally representative American sample from the General Social Survey (N = 12,791). Well-being was measured across eight components:

  • general unhappiness,
  • depressive symptoms,
  • psychological distress,
  • work dissatisfaction,
  • financial dissatisfaction,
  • perceived dullness of one’s life,
  • self-rated health,
  • unhappiness with marriage.

Parametric and nonparametric analyses consistently revealed no robust associations between zodiac signs and any of the well-being variables, regardless of whether demographic factors were controlled for. The effect sizes were negligible, accounting for 0.3% or less of the variance in well-being, demonstrating that zodiac signs lack predictive power for well-being outcomes. An additional analysis revealed that astrological signs were no more predictive of than random numbers. Thus, a randomly generated number between 1 and 12 is statistically as predictive of one’s well-being as one’s zodiac sign.

The authors concluded that these findings challenge popular astrological claims about the influence of zodiac signs on well-being and quality of life.

The third paper reports a retrospective, single-center cohort study of 2545 adult patients with confirmed COVID-19 infection presenting to the emergency room over a 14-month period (September 2020 to November 2021). COVID-19 infectivity was determined based on polymerase chain reaction (PCR) testing. Western and Chinese Zodiac signs were designated using date of birth. Both Zodiac signs were evaluated for risk of infection and death.

Mortality rates across the zodiac and astrology signs showed no statistical difference using the 12-sample test for equality of proportions. Coincidentally, the mean age for the deceased was 74.5 years, and it was 53.9 years for those alive, resulting in a difference of 20.6 years. A two-sample t-test confirms that the observed difference of 20.6 years of age between the two groups is statistically significant with a p-value <0.05. The coefficient of the predictor age is statistically significant. The odds ratio estimate of age is 1.06, with the corresponding 95% confidence interval (CI) being (1.048, 1.073). This means that the odds of dying increase by 6% for every additional year.

The authors concluded that there was no statistical significance between Western and Chinese Zodiac signs and mortality or infections. 

So, does astrology have any value in healthcare?

The answer is as simple as it is unsurprising:

No!

Gastroesophageal reflux disease (GERD), also named Gastro-oesophageal reflux disease (GORD), is a common condition characterized by stomach contents flowing into the esophagus, causing distressing symptoms and potential complications. GERD is primarily linked to lower esophageal sphincter dysfunction, and its symptoms can impact quality of life. Treatment options include lifestyle changes, medications, and surgery. Homeopathy is sometimes advocated as an alternative to conventional orally administered drugs for GERD.

This review examined the clinical evaluation of homeopathic treatments for GERD, highlighting their potential role by analysing existing clinical studies. The authors conducted a comprehensive database search for clinical studies RCT, open label, retrospective, perspective, and observational studies on homeopathic treatments for GERD, adhering to inclusion criteria related to homeopathy in GERD treatment.

Six clinical studies were identified:

  • 1 open label study,
  • 3 retrospective studies,
  • 1 prospective study,
  • 1 observational study.

Renu Mittal’s study demonstrated significant symptom improvement and enhanced quality of life with homeopathic
treatment. Dr. Leena Dighe’s study reinforced the effectiveness of homeopathic medicines in GERD, Acid-Peptic Disorder (APD), and irritable bowel syndrome (IBS), while Sitharthan’s retrospective analysis supported the potential of homeopathy for gastrointestinal disorders. A study exploring Robinia pseudoacacia in GERD treatment showed positive results.

The authors conclused that these studies suggest the potential of homeopathic treatments in managing GERD and related gastrointestinal disorders. These findings encourage future studies and applications of homeopathic interventions in GERD management. Further research, including randomized trials, is needed to solidify homeopathy’s role in gastroenterological care.

Does anyone really think that this paper is worth publishing?

Its authors and the editors of the INTERNATIONAL JOURNAL OF HIGH DILUTION RESEARCH evidently do:

  • Parth AphaleDR D Y PATIL VIDYAPEETH PUNE
  • Dharmendra SharmaDr. D.Y. Patil Homoeopathic Medical College & Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India
  • Himanshu ShekharDr. D.Y. Patil Homoeopathic Medical College & Research Centre, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, Maharashtra, India

But I don’t!

Why?

Because none of the primary studies come anywhere near of being reliable evidence.

I think that reviews of this nature drawing such unwarranted conclusions are counter-productive – counter-productive even to those people whose aim it is to promote homeopathy. Nobody with an ounce of critical thinking capacity can take such nonsense seriously. The only possible conclusion that can be drawn from the presented evidence is along the following lines:

This review failed to generate any sound evidence that homeopathy is an effective therapy for GERD.

 

This systematic review and meta-analysis investigated the impact of quality of life (QoL) on mortality risk in patients with esophageal cancer.

A literature search was conducted using the CINAHL, PubMed/MEDLINE, and Scopus databases for articles published from inception to December 2022. Observational studies that examined the association between QoL and mortality risk in patients with esophageal cancer were included. Subgroup analyses were performed for time points of QoL assessment and for types of treatment.

Seven studies were included in the final analysis.

  • Overall, global QoL was significantly associated with mortality risk (hazard ratio 1.02, 95% confidence interval 1.01–1.04; p < 0.00004).
  • Among the QoL subscales of QoL, physical, emotional, role, cognitive, and social QoL were significantly associated with mortality risk.
  • A subgroup analysis by timepoints of QoL assessment demonstrated that pre- and posttreatment global and physical, pretreatment role, and posttreatment cognitive QoL were significantly associated with mortality risk.
  • Moreover, another subgroup analysis by types of treatment demonstrated that the role QoL in patients with surgery, and the global, physical, role, and social QoL in those with other treatments were significantly associated with mortality risk.

The authors concluded that these findings indicate that the assessment of QoL in patients with esophageal cancer before and after treatment not only provides information on patients’ condition at the time of treatment but may also serve as an outcome for predicting life expectancy. Therefore, it is important to conduct regular QoL assessments and take a proactive approach to improve QoL based on the results of these assessments.

Am I missing something here?

Isn’t this rather obvious?

The way this paper is written, some practitioners of so-called alternative medicine (SCAM) might feel that, by improving QoL (for instance, by some fancy aromatherapy, reflexology, etc.), they can significantly better the cancer prognosis.

Patients with a poor prognosis are more seriously ill and therefore have a lowe QoL. Assessing QoL might be a useful marker, but would it not be better to ask why the QoL is in some patients less than in others?

For some time I have had the impression that research into SCAM is on its knees. Specifically, I seemed to notice that less and less of it is getting published in the best journals of conventional medicine. So, today I decided to put my impression to the test.

I went on Medline and serached for ‘COMPLEMENTARY ALTERNATIVE THERAPY + NEJM or Ann Int Med or Lancet or JAMA. This gave me the number of papers each of these four top medical journals published during the last decades. These figures alone seemed to indicate that I was on to something. To get a more reliable overall pivture, I added them up to get the total number of SCAM articles per year published in all four jurnals. As these figures indicated a lot of noise, I grouped them into periods of 4 years.

Here are the results:

  • Number of papers in the four journals published between 1999 and 2002 =115
  • Number of papers in the four journals published between 2003 and 2006 = 44
  • Number of papers in the four journals published between 2007 and 2010 = 20
  • Number of papers in the four journals published between 2011 and 2014 = 23
  • Number of papers in the four journals published between 2015 and 2018 = 38
  • Number of papers in the four journals published between 2019 and 2022 = 36

These figures confirm my suspicion: top medical journals publish far less SCAM articles than they once used to. But how do we interpret this finding?

The way I see it, there are several possible explanations:

  1. The editors are becoming increasingly anti-SCAM.
  2. Less and less SCAM research is of high enough quality to merit publication in a top journal.
  3. Numerous SCAM journals have sprung up which absorb most of the SCAM research but which are largely ignored by the broader medical community.

Personally, I think all of these explanations apply. They are the expression of a phenomenon that I discussed often before: over the years, SCAM has managed to discredit and isolate itself. Thus, it is no longer taken seriously and in danger of becoming a bizarre cult.

I fear that serious healthcare professionals get increasingly irritated by:

  • the embarrassing unreliability of much of SCAM research (as discussed so many times on this blog);
  • the fact that some research group manage to publish nothing but positive results (see my ‘ALTERNATIVE MEDICINE HALL OF FAME);
  • the news that a substantial proportion of SCAM research seems fabricated (see, for instance, here);
  • the fact that too much of SCAM research is of dismal quality (as disclosed regularly on this blog);
  • the fact that many SCAM proponents are unable of (self)critical thinking (as demonstrated regualrly by the comments left on this blog).

If I am correct, this would mean that, in the long-term, one of the biggest enemy of SCAM are the SCAM researchers who, instead of testing hypotheses, abuse science by trying to confirm their hypotheses. As Bert Brecht said: the opposite of good is not evil, but good intentions.

Although the vaccine has many individual and social benefits, ‘Vaccine Hesitancy’ has led to an increase in the number of vaccine-preventable diseases.

The aim of this study is to determine the effect of ideas that cause vaccine hesitancy to comply with traditional medicine practices and drugs and to determine the ratio of parents’ preference for so-called alternative medicine (SCAM).

This study was performed on the parents who refused vaccination in their children under the age of 8 between the years 2017-2022. Parents of the vaccinated children who were matched for age and gender were determined as the control group. Demographic characteristics of families, education levels, compliance ratios for well-child follow-up and pregnancy follow-up, preference ratios for traditional medicine and/or SCAM applications were compared.

A total of 123 families, 61 of whom were vaccine refusal and 62 of the control group, were included in the study. It was determined that the ratio of parents who refuse vaccination have increased in the last five years. The education level was found to be higher in the SCAM group (p=0.019). The most common reasons for vaccine refusal were distrust of the vaccine content (72.1%) and noncompliance with religious beliefs (49.1%). It was also found that the ratios of prophylactic vitamin use and tetanus vaccination of mothers during pregnancy were lower in the SCAM group. While the rate of compliance with vitamin D and iron prophylaxis for infants was lower in the vaccine refusal group, the ratio of preference for SCAM was higher.

The authors conclused that vaccine hesitancy is a complex issue that affects public health, in which many individual, religious, political and sociological factors play a role. As with recent studies, this research shows that the most important reason for vaccine rejection is “lack of trust”. The higher education level in the vaccine refusal group may also be a sign of this distrust. Not only the rejection of the vaccine, but also the lack of use of vitamin drugs seems to be related to lack of trust. This may also cause SCAM methods to be preferred more. These results show that providing trust in vaccination is the biggest step in the fight against vaccine hesitancy.

We have discussed the link between SCAM and vaccination hesitancy many times before, e.g.:

This new study seems to imply that the common denominator of both SCAM use and vaccination hesitancy is distrust, distrust in vaccinations and distrust in conventional medicine. That makes sense at first glance but not when you think about it for only a minute.

I can see why people distrust conventional medicine (to some extend, I do it myself). But why should distrust motivate some people to put their trust into SCAM which is even less trustworthy than conventional medicine. The rational thing for a distrusting person would be to critically assess the evidence and go where the evidence leads him/her. This path cannot possibly lead to SCAM but would lead to the best available evidence-based therapies.

If we consider this carefully, we arrive at the conclusion that not distrust but a degree of irrationality is more likely be the common denominator between SCAM use and vaccination hesitancy.

What do you think?

Yes, I have done it again: another book!

Bizarre Medical Ideas: … and the Strange Men Who Invented Them

In order to let you know what it is all about, allow me to post the intoduction here:

Medicine has always relied on extraordinary innovators. Without them, progress would hardly have been possible, and we might still believe in the four humours and be treated with blood letting, mercury potions, or purging. The history of medicine is therefore to a large extent the history of its pioneers. This book is about some of them. It focusses on the mavericks who separated themselves from the mainstream and invented alternative medicine, healthcare that remained outside conventional medicine.

Few people would deny that differences of opinion are necessary for progress. This is true for healthcare as it is for any other field. Divergent views and legitimate debate have always been important drivers of innovation. Yet, some opinions have been so thoroughly repudiated by evidence as to be considered demonstrably wrong and harmful.

The realm of alternative medicine is full of such opinions. They are personified by men who created therapies based on wishful thinking, fallacious assumptions, and pseudoscience. Many of the alternative modalities – therapies or diagnostic methods – that are today so surprisingly popular have been originated by one single person. This book is about these men. It is an investigation into their lives, ideas, pseudoscience, and achievements and an attempt to find out what motivated each of these individuals to create treatments that are out of line with the known facts.

The book is divided into two parts. The first section sets the scene by establishing what true discoveries in medicine might look like. It offers short biographical sketches of my personal choice of some of my ‘medical icons’. In addition, it provides the necessary background about the field of alternative medicine. The second section is dedicated to the often strange men who invented these bizarre alternative treatments and diagnostic methods. In this section, we discuss in some detail the life and work of these individuals. Moreover, we critically evaluate the evidence for and against each of these modalities. An finally, we attempt to draw some conclusions about the strange men who invented bizarre alternative methods.

Having studied alternative medicine for more than three decades and having published more scientific papers on this subject than anyone else, the individuals behind the extraordinary modalities have intrigued me for many years. By describing these eccentric men, their assumptions, motivations, delusions, and failures, I hope to offer both entertainment as well as information. Furthermore, I aim at promoting my readers’ ability to tell science from pseudoscience and at stimulating their capacity of critical thinking.

Phantom pain (pain felt in an amputated limb) affects the lives of individuals in many ways and can negatively affect the well-being of individuals. Distant Reiki is sometimes used in the management of these problems. But does it work?

This study was conducted to examine the effect of distant Reiki applied to individuals  suffering from phantom pain on:

1) pain level,

2) holistic well-being.

This study was designed as a single group pre-test/post-test comparison. The research was conducted between September 2022 and April 2023 and included 25 individuals with extremity amputations. Distant Reiki was performed for 20 minutes every day for 10 days. Data were collected at the beginning of the study and at the end of the 10th day. The measurements included an Introductory Information Form, the Visual Analog Scale for Pain, and Holistic Well-Being Scale (HWBS).

The results show that there was a significant difference between pre-test and post-test pain levels of the participants (p < .05) and HWBS subscale scores (p < .05). Accordingly, it was determined that after 20-minute distant Reiki sessions for 10 consecutive days, the pain levels of the individuals were significantly reduced and their holistic well-being improved.

The authors concluded that distant Reiki has been found to be easy to administer, inexpensive, non-pharmacological, and appropriate for independent nursing practice to be effective in reducing phantom pain levels and increasing holistic well-being in people with limb amputation.

Yes, I agree that Reiki might have been easy to administer.

I also agree that it is inexpensive and non-pharmacological.

I disagree, however that it is an appropriate therapy for an independent nursing practice.

And I disagree even more that this study shows or even suggests that Reiki is effective.

Why?

You probably kow the reason: this study had no control group. The observed outcomes can have several explanations that are unrelated to Reiki. For instance, the 200 minutes of attention, empathy and encouragement are likely to have generated an impact.

My conclusion: it is high time that researchers, peer-reviewers, editors, etc. stop trying to mislead the public with offensively poor-quality research and false conclusions. Reiki is an utterly implausible therapy for which no sound evidence exist.

In contemporary healthcare, evidence-based practices are fundamental for ensuring optimal patient outcomes and resource allocation. Essential steps for conducting pharmacoeconomic studies in homeopathy involve study design, intervention identification, comparator selection, outcome measures definition, data collection, cost analysis, effectiveness analysis, cost-effectiveness analysis, cost-benefit analysis, sensitivity analysis, reporting, and peer review. While conventional medicine undergoes rigorous pharmacoeconomic evaluations, the field of homeopathy often lacks such scrutiny. However, the importance of pharmacoeconomic studies in homeopathy is increasingly recognized, given its growing integration into modern healthcare systems.

A systematic review was aimed at summarizing the existing economic evaluations of homeopathy. It was conducted by searching electronic databases (PubMed, Scopus, Web of Science) to identify relevant literature using keywords such as “homeopathy,” “pharmacoeconomics,” and “efficacy.” Articles meeting inclusion criteria were assessed for quality using established frameworks like the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Data synthesis was conducted thematically, focusing on study objectives, methodologies, findings, and conclusions.

Ten pharmacoeconomic studies within homeopathy were identified, demonstrating varying degrees of compliance with reporting guidelines. While most studies reported costs comprehensively, some lacked methodological transparency, particularly in analytic methods. Heterogeneity was observed in study designs and outcome measures, reflecting the complexity of economic evaluation in homeopathy. Quality of evidence varied, with some studies exhibiting robust methodologies while others had limitations.

The authors concluded that, based on the review, recommendations include promoting homeopathic clinics, providing policy support, adopting collaborative healthcare models, and leveraging India’s homeopathic resources. Pharmacoeconomic studies in homeopathy are crucial for evaluating its economic implications compared to conventional medicine. While certain studies demonstrated methodological rigor, opportunities exist for enhancing consistency, transparency, and quality in economic evaluations. Addressing these challenges is essential for informing decision-making regarding the economic aspects of homeopathic interventions.

The truth is that there are not many economic studies of homeopathy that are worth the paper they were printed on. One of the most rigorous analysis was published by German pro-homeopathy researcher. This study aimed to provide a long-term cost comparison of patients using additional homeopathic treatment (homeopathy group) with patients using usual care (control group) over an observation period of 33 months.

Health claims data from a large statutory health insurance company were analysed from both the societal perspective (primary outcome) and from the statutory health insurance perspective (secondary outcome). To compare costs between patient groups, homeopathy and control patients were matched in a 1:1 ratio using propensity scores. Predictor variables for the propensity scores included health care costs and both medical and demographic variables. Health care costs were analysed using an analysis of covariance, adjusted for baseline costs, between groups both across diagnoses and for specific diagnoses over a period of 33 months. Specific diagnoses included depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache.

Data from 21,939 patients in the homeopathy group (67.4% females) and 21,861 patients in the control group (67.2% females) were analysed. Health care costs over the 33 months were 12,414 EUR [95% CI 12,022-12,805] in the homeopathy group and 10,428 EUR [95% CI 10,036-10,820] in the control group (p<0.0001). The largest cost differences were attributed to productivity losses (homeopathy: EUR 6,289 [6,118-6,460]; control: EUR 5,498 [5,326-5,670], p<0.0001) and outpatient costs (homeopathy: EUR 1,794 [1,770-1,818]; control: EUR 1,438 [1,414-1,462], p<0.0001). Although the costs of the two groups converged over time, cost differences remained over the full 33 months. For all diagnoses, homeopathy patients generated higher costs than control patients.

The authors concluded that their analysis showed that even when following-up over 33 months, there were still cost differences between groups, with higher costs in the homeopathy group.

SURPRISE, SURPRISE!!!

Homeopathy is not cost-effective.

How could it possibly be? To be cost-effective, a theraapy has to be first of all effective – and that homeopathy is certainly not.

So, why does the avove-cited new paper arrive at a more positive conclusion?

Here are some potential explanations:

The authors of this paper are affiliated to:

  1. PatilTech Hom Research Solution, Maharashtra, India.
  2. Samarth Homeopathic Clinic and Research Center, Maharashtra, India.

The paper was published in the largely unknown, 3rd class Journal of Pharmacoeconomics and Pharmaceutical Management.

Most importantly, the authors aknowledge that many of the primary studies had serious methodological problems. However, this did not stop them from taking their data seriously. As a result, we have here another example of the old and well-known rule of systematic reviews:

RUBBISH IN, RUBBISH OUT!

To answer the question posed in the title of this post:

Is homeopathy cost-effective?

NO

 

 

Terry Power had been registered as a chiropractor since 1988, and as a Chinese medicine practitioner since 2012. In 2020, two female patients (Patient A and Patient B), made separate and unrelated complaints about Power to NSW Police and subsequently to the Health Care Complaints Commission.

Patient A alleged that, during a consultation in May 2020, Power kneaded and squeezed her right breast. Patient B alleged that during a consultation on 14 July 2020, Dr Power inserted two fingers into her vagina. On 27 August 2020, in proceedings conducted under Health Practitioner Regulation National Law (NSW), the Chiropractic and Chinese Medical Council of New South Wales imposed several conditions on Power’s registration including that he must not consult or treat female clients. Subsequently, Power did not practised as a chiropractor, or a Chinese medicine practitioner, since those conditions were imposed.

Power admits inserting his fingers into Patient B’s vagina but denies that he did not do so without “proper and sufficient clinical indications” as alleged by the Commission. In addition, Power denies kneading and squeezing Patient A’s right breast.

In January 2023, following investigation of complaints referred by the Council, the Commission lodged a complaint about Power with the New South Wales Civil and Administrative Tribunal (NCAT). With the leave of the Tribunal, the Commission amended that complaint. In May 2024, NCAT found Power to be guilty of professional misconduct. NCAT will determine the appropriate disciplinary orders at a future hearing.

The statements of Patient B are harrowing:

After being escorted to a treatment room and changing into a hospital gown, Patient B said to Power “I am in a lot of pain due to my chronic pain”. Power then put his hand on Patient B’s pubic bone, which was “right on the pain”, “my legs gave out and I collapsed down. I was in pain” … Power lifted her up to crack her back, a procedure he had undertaken before and with which she was comfortable. Power then instructed her to lie down on her side on the treatment table and began to manipulate her hips. He said that her right hip was “out of place” and then cracked her neck. She was still in pain. Power then said, “you can say no, but how do you feel about an internal?”, to which she replied “if it is going to help then yes”. While standing to her side, Power put on white latex gloves and then inserted two gloved fingers into her vagina. This caused some pain and discomfort. Patient B could feel Power’s fingers pressing on parts of her body inside her vagina, “it hurt like hell and I wanted to scream”. After a minute Power pulled out his fingers. Patient B then asked, “what did you find?”, Power responded by walking over to a skeleton in the treatment room and showing her what he had done. He talked about the muscles and said, “I felt where your ovary was missing. The muscles are really tight around where the ovary was and your uterus”. Power then administered acupuncture above and below her breasts. The entire consultation lasted about an hour. At the end Power said words to the effect “we will see you next time”.

Patient B got dressed and walked out without making another appointment … On 29 July 2020 … when she told the GP “what happened with the chiropractor”, Patient B “broke down in tears and was an emotional wreck”. On return to her grandmother’s house, Patient B collapsed into her mother’s arms and rang the Commission and the Health Board, who instructed her to “make a police report and contact the Health Professional Council”. In conclusion Patient B said: “When I saw Terry Power on the 14th of July 2020, I trusted his professional opinions. When he asked me to consent to him doing an internal on me, I thought at the time this was a normal procedure and l trusted him. My pain is at a stage that I would do anything to have it relieved. At no time during the procedure was another person with Terry.”

__________________________

Was patient B’s right hip was “out of place”?

No.

Is there any justification for a chiropractor to insert two fingers into a patient’s vagina?

No.

Does the question: “you can say no, but how do you feel about an internal?” amount to anything like informed consent?

No.

Is the description “he muscles are really tight around where the ovary was and your uterus” credible?

No.

But this is merely a case report of a chiropractor whom others might classify as a ‘rotten apple’ within their profession. I would, however, point out that such cases are not as rare as we might hope.

A retrospective review of data from the California Board of Chiropractic Examiners, for instance, was aimed at determining categories of offense, experience, and gender of disciplined doctors of chiropractic (DC) in California and compare them with disciplined medical physicians. The authors concluded that the professions differ in the major reasons for disciplinary actions. Two thirds (67%) of the doctors of chiropractic were disciplined for fraud and sexual boundary issues, compared with 59% for negligence and substance misuse for medical physicians. 

And what’s the explanation?

Could it be that chiropractors have no or too little education and training in medical ethics?

 

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