A highly controversial 2018 paper suggesting that too much bent-neck staring at your cell phone could sprout, in the words of one of the authors, a “horn” on the back of your head is — perhaps unsurprisingly — getting corrected.
The article, “Prominent exostosis projecting from the occipital squama more substantial and prevalent in young adult than older age groups,” which appeared in Nature Publishing Group’s Scientific Reports in February 2018, received scads of media coverage earlier this year. The stories initially were alarmist but grew increasingly skeptical as journalists and experts began poking holes in the authors’ claims.
The corrected paper doesn’t completely walk back the association, but it definitely mutes the assertions significantly. For example, the original discussion section included this passage:
Our findings and the literature provide strong evidence that EEOP in the younger population is a result of increased mechanical load at the enthesis of the EOP, which is probably linked to sustained poor posture. We acknowledge factors such as genetic predisposition and inflammation influence enthesophyte growth. However, we hypothesise that the use of modern technologies and hand-held devices, may be primarily responsible for these postures and subsequent development of adaptive robust cranial features in our sample. An important question is what the future holds for the young adult populations in our study, when development of a degenerative process is evident in such an early stage of their lives?
That “strong evidence” now is gone, replaced by:
Clearly, the cross-sectional nature of this retroactive case study means that we are unable to draw direct causal links between EEOP formation and other issues such as poor posture and/or the use of mobile phones and other hand-held modern technologies. We acknowledge factors such as genetic predisposition and inflammation influence enthesophyte growth. Similarly, we acknowledge that most of our data were taken retrospectively from a clinician’s database of lateral cervical radiographs, with many individuals therefore originally seeking clinical advice and/or presenting with mild symptomology. Accordingly, despite our exclusion criteria, care should be taken to avoid over generalising these results to an asymptomatic general population. However, the high numbers of EEOPin the 18-30 age group suggests a potential avenue for prevention intervention through posture improvement education in this cohort.
Another addition to the paper is a new statement about conflicts of interest. Shortly after news outlets picked up on the study, Katherine Ellen Foley at Quartz reported that the first author, David Shahar, failed to disclose his financial interest in the research. Not only did Shahar use patients from his chiropractic clinic — where he treats the fallout of a ‘poor posture epideimic’ — as study subjects, but according to Foley:
Shahar is also the creator of Dr. Posture, an online store that advertises information and products related to forward head posture. One section tells users how to “look and feel your best in three easy steps,” which include watching a video by Shahar, downloading at-home exercises, and sleeping with a Thoracic Pillow, which Shahar has trademarked and sold for $195.
That revelation prompted the Washington Post to amend its coverage of the study less than a week after it published a story:
After publication of this story, concerns were raised about an undisclosed business venture of one of the researchers, who works as a chiropractor. This story has been updated to reflect questions about a possible conflict of interest involving his business. The journal that published the main study in question said it was investigating the concerns. The researchers say they are making minor changes to their paper, but stand by their work.
The disclosure statement for the paper now reads:
David Shahar provides posture related services as a chiropractic clinician and posture related advice and products through drposture.com. Mark Sayers declares no competing interests.
The origin of ‘horns’
Neither the word “horn” nor the word “horns” appeared in the original paper. But Shahar agreed with the characterization by the media. As the Washington Post noted in its June story:
Although the study came out last year, it first drew fresh notice following the recent publication of a BBC story that considers, “How modern life is transforming the human skeleton.” The unusual formations captured the attention of Australian media, and have variously been dubbed “head horns” or “phone bones” or “spikes” or “weird bumps.” Each is a fitting description, Shahar said.
“That is up to anyone’s imagination,” he said. “You may say it looks like a bird’s beak, a horn, a hook.
A spokesperson for Scientific Reports told us:
When we became aware of criticisms of this paper, we carefully investigated the concerns raised following an established process. This further assessment of the manuscript, which took additional information into account, revealed that the methodology and data remained valid. It was determined, however, that the paper should be corrected to more accurately represent the study and the conclusions that could be drawn from it. We have also updated the competing interests statement for the paper.
The journal has had some eye-catching episodes recently, including the retraction of a paper that claimed a homeopathic remedy can treat pain in rats, the removal of a cartoon that appeared to include U.S. President Donald Trump’s face in feces, and mass resignations from its editorial board over concerns about how it handled allegations of plagiarism.
The authors have not responded to a request for comment.
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The entire paper should be pulled. Journals should never allow authors to shill for commercial products in this way, and the “research” on which it was based is reminiscent of Andrew Wakefield’s.