A most annoying non-sequitur logical fallacy, is the allusion to large or seemingly large numbers of adherents as proof something is genuine.
Whenever a pseudoscientist tries to hypnotise me with big numbers I’m reminded of Tony Ferguson and his scam weight loss programme sold in pharmacies. Following a scathing Choice review which included extra demerits for pushing it onto children, Ferguson declared, “600,000 People Can’t be Wrong but Choice Magazine can’t get it right with weight loss investigation!” And yes, if you remember the first part as his sales pitch itself you’re correct. 600,000 people can’t be wrong.
Well, 600,000 people were quite wrong if they were to all argue Ferguson’s magic shakes worked. That’s probably the first problem with this trick. Those figures come from signups and undoubtedly, in this case, the vast majority of that 600,000 had given no feedback and probably tried a number of fads before and since. To cut to the chase it’s a jump from sample size to claims of efficacy without bothering to do or document any science in between. We have no idea how many persisted, lost weight, kept it off or indeed ended up worse off.
Presently fundamentalist chiropractors are defending their hanky panky with the claim that 215,000 people across Australia visit a chiropractor every week. We don’t know how many are first time visitors, how many were unsatisfied, how many show no improvement, how many were injured, disabled or worse and so on. All it tells us is that 215,000 people per week visit these touchy feely agents of cosmic cockypop as part of their foray into alternatives to medicine. It also causes me quite some concern.
In removing insurance cover for the practice of neck manipulation (as reported by the World Chiropractic Alliance), popular US health insurer Kaiser Permanente revised their policy of coverage for chirpractic manipulation to read:
Chiropractic manipulation of the cervical spine is associated with vertebral artery dissection and stroke. The incidence is estimated at 1.3-5 events per 100,000 manipulations. Given the paucity of data related to beneficial effects of chiropractic manipulation of the cervical spine and the real potential for catastrophic adverse events, it was decided to exclude chiropractic manipulation of the cervical spine from coverage.
Now I shan’t apply the same logical fallacy and insist that at least 2.6 Aussies per week, or 10 per month, are at risk of “vertebral artery dissection and stroke”, because I have no idea how many are being, well, abused in this way. I also don’t know how accurate that figure is. I am quite sure however were I to put this to Chiropractors Association of Australia president Lawrence Tassell, he would quite rightly reveal the flaws in my reasoning.
He may even repeat the erroneous view of his immediate predecessor, Simon Floreani that the risk is 1 in 5.85 million (see Lateline video below). Quite a difference, and a figure described as “totally inaccurate” by Professor Roy Beran who published Serious complications with neck manipulation and informed consent in the MJA (2001) including deaths, stroke and other injuries from chiropractic neck manipulation.
His paper was:
…initially knocked back because it was so common knowledge and so frequent that the journal didn’t want to publish it
So all being fair the CAA are welcome to keep promoting their 215,000 patients per week visiting chiropractors, so long as we all accept the very same sales pitch should include Ten Vertebral Artery Dissections and Stroke per month.
Yet a concern of current critics increasingly involves the practice of paediatric chiropractic. Fundamentalists are taking it up in droves and at most appear to offer a light touch in a “clinical setting” to babies, gradually increasing the scope of manipulation with age. Of course the waving of hands over a small baby is an absolute scam. A goldmine given that we know trials have shown no visible effect. Chiropractors have invented “irritable baby syndrome” to revive what used to be called colic which ultimately emerged as an irritable baby, and no actual disorder at all.
Now their unproven rituals and adjustments of invisible subluxations are blessed with claims of “curing” or treating psychological conditions, improving immunity, croup, allergies, wheezing, pertussis, influenza, poor posture, stomachache, hearing loss, headaches, asthma, bedwetting, bronchitis, learning disorders, arthritis…. Soon I won’t even blink if ESP or Cosmic Consciousness makes it onto the list.
That’s only part of it. The level of mumbo jumbo that defies even basic science is close to frightening. Moderate infant complications are ramped to frightening levels as “deficits” are grossly misrepresented, paediatricians mocked and normal motor skill expression deemed a “neurological delay”. The claim that spinal adjustments improve total awareness because “all senses pass through the spinal column” is news to my ears… and eyes, and smell, and taste and vestibular balance.
Studies show that in blind trials, if parents believe the baby is being treated, they report improvement whether treatment took place or not. If told no treatment took place when in fact it did, parents report no improvement in their baby.
It may be expensive woo now but sooner or later, the USA trend of manipulating children’s necks will pick up pace in Australia. John Reggars (in the Today Tonight video), past president of the Chiropractors Registration Board of Victoria and present vice president of the Chiropractic and Osteopathic College of Australasia insists there is no evidence.
A read of Jeremy Youngblood’s death certificate gives insight into what those who stroke and die from vertebral tears brought on by cervical manipulation go through. It is doubly tragic given the view of Kaiser Permanente that there is a “paucity of data related to beneficial effects” in the first place.
In a case report review of serious adverse effects following cervical manipulation published by Edward Ernst in the eMJA in 2002 there is only one death amongst the multiple adverse outcomes. In this case it is a three month old baby and the practitioner is the sole physiotherapist listed. A physiotherapist practising Vojta Therapy which is in fact paediatric physiotherapy. The adverse event was:
Bleeding into adventitia of both vertebral arteries causing ischaemia of caudal brainstem with subarachnoid haemorrhage [and] death
The crucial point here is that regardless of profession, spinal manipulation of all types has been shown to carry significant risks. In 2001 Stevinson and Ernst published Risks Associated With Spinal Manipulation in the American Journal of Medicine, and note in the abstract:
Data from prospective studies suggest that minor, transient adverse events occur in approximately half of all patients receiving spinal manipulation. The most common serious adverse events are vertebrobasilar accidents, disk herniation, and cauda equina syndrome. Estimates of the incidence of serious complications range from 1 per 2 million manipulations to 1 per 400,000. Given the popularity of spinal manipulation, its safety requires rigorous investigation.
In fact according to this RCT published in the Lancet there is no difference between manipulation or placebo when it comes to recovery from low back pain. Physiotherapists confident in spinal manipulation carried out the trial. As Chris Maher says in the Lateline video below recovery rates were almost “exactly the same”. So basically, there’s good evidence to suggest a 50% chance of sustaining an injury to any part of the spine undergoing a procedure not shown to be any more effective than placebo, when the low back is involved. Serious complications and death apply to manipulation of the neck. There is no evidence supporting application of the latter.
As reported by John Dwyer, Emeritus professor Uni NSW, the literature contains 700 cases of adverse reactions in children following chiropractic adjustments. Given the danger of all spinal manipulation, the copious numbers of adverse effects from vertebral manipulation and the inherent danger of paediatric manipulation, chiropractic faces an uphill battle in the eyes of evidence based treatment.
Added to this however, is the rapid rise of the fundamentalists, who I prefer to call the Mystic Chiropractors. Their disillusioned appreciation of conventional medicine and aversion to supporting it is nicely summed up by Lawrence Tassell on the topic of vaccination. From Adelaide Now:
He also dismisses suggestions chiropractors are anti-immunisation.
“We don’t recommend for or against vaccination; we simply say it’s a choice factor,” he says.
Which is of course, the anti-vaccination cover. Who would choose to risk their child’s life when availed of all the evidence? Yet when fed misinformation and outmoded fear mongering vaccination may seem like a “choice factor”. Chiropractors are misleadingly allowed to use the title “doctor”. They still make up the bulk of the “professional” members of the Australian Vaccination Network. In 2009 Floreani and Tassell’s CAA had a grand aim:
To achieve a fundamental paradigm shift in healthcare direction where chiropractic is recognised as the most effective and cost efficient health regime of first choice that is readily accessible to all people
Reggars claims the “all-encompassing alternative system of healthcare is both misguided and irrational”. He’s exposed the money angle informing us:
Chiropractic trade publications and so-called educational seminar promotion material often abound with advertisements of how practitioners can effectively sell the vertebral subluxation complex to an ignorant public. Phrases such as ‘double your income’, ‘attract new patients’ and ‘keep your patients longer in care’, are common enticements for chiropractors to attend technique and practice management seminars.
Selling such concepts as lifetime chiropractic care, the use of contracts of care, the misuse of diagnostic equipment such as thermography and surface electromyography and the X-raying of every new patient, all contribute to our poor reputation, public distrust and official complaints.
This video by the Council on Chiropractic Practice refers to, “the Dark Side of the profession… keeping the imprisoned impulse captive… and [it's] innate potential chained”. What’s it mean? Those who reject the made up notion of “subluxation” are the dark side and as the video states the “right to treat it” is under attack. Sound familiar? It seems the theme of having a right to apply demonstrably dangerous beliefs and practices at the expense of genuine medical intervention is “a right”.
What’s insane about chiropractic is that it’s assumed everyone needs treatment. Their impulse is “imprisoned” along with it’s “innate potential”. The only result of pursuing this potential offered by the “science that makes everyone well and happy” is certain loss of money and a definite risk of injury, disability or death. Palmer’s 18th century superstitious and unprovable “God given energy flows” are today’s “very principles this profession was founded on”.
In The Age yesterday it was reported in Doctors take aim at chiropractors:
CHIROPRACTORS are peddling shonky treatments that could be dangerous for people, including babies and children, a group of high-profile doctors says.
In an extraordinary attack, 34 professors, doctors and scientists issued a statement yesterday calling for more policing of chiropractors’ false claims and said the federal government should not fund chiropractic courses at Australian universities because it gave their ”pseudoscience” credibility.
The group, which includes the president of the Australian Medical Association, Dr Steve Hambleton, and head of public health at Monash University Professor John McNeil, said although some chiropractic treatments had an evidence base, claims it could cure 95 per cent of ailments was nonsense. [...]
In a letter to Central Queensland University protesting against its recent inclusion of a chiropractic course, the doctors said they were also concerned about chiropractors being the largest ”professional” group in the anti-vaccination network.
One of the signatories, Professor of Neurophysiology at Flinders University Marcello Costa, said universities running such courses were encouraging the spread of quackery, misusing public money and delaying effective treatments for people who falsely believed chiropractors could cure their illnesses.
Exactly why these cosmic cuddlers assume they have a right to bring about a shift in the direction of healthcare that is overflowing with pseudoscience and risk, so they can profit, is well beyond my ethics tolerance threshold. Added to the defensive battle posture they have taken up against the “attack”, that is in reality a request for proper evidence on the magic of subluxation, a distinct malignancy is in the air.
Chiropractors aren’t treating you. You’re treating them to a free ride at risk to yourselves and your loved ones.
Today Tonight December 7th 2011
Lateline July 9th 2009