Australians deserve no-nonsense regulation of chiropractors

Andrew Arnold, the Melbourne based chiropractor whose manipulation of the spine of a two week old infant was described as “deeply disturbing” by the Victorian health minister is presently refraining from treating anyone under 12 years of age.

The ABC reported just over a week ago that health minister Jenny Mikakos also said in part;

It’s appalling that young children and infants are being exposed to potential harm. That’s why I’ve written to the Chiropractic Board of Australia and AHPRA (the Australian Health Practitioner Regulation Agency) to urge them to take the necessary action. There is nothing at the moment that prevents chiropractors from undertaking these risky practices… The advice that I’ve received is that the risk of undertaking spinal manipulation on small infants far outweighs any perceived benefit.

It’s worth noting that chiropractic treatment in general and the manipulation of infants specifically has a history of drawing harsh criticism from health and medical professionals and penalties from regulators. Fairfax reported in December 2011, Doctors take aim at chiropractors. One wonders at the lack of a cogent response to such serious statements from reputable professionals.

The inclusion of a chiropractic course at Central Queensland University prompted 34 scientists, professors and doctors to note federal government funding “gave their ‘pseudoscience’ credibility”. Fairfax reported that their statement included;

…it was also disturbing that some chiropractors spruiked the adjustment of children’s spines for many potentially serious conditions including fever, colic, allergies, asthma, hearing loss and learning disorders.

…the doctors said they were also concerned about chiropractors being the largest ”professional” group in the anti-vaccination network. [Now named The Australian Vaccination Risks Network]

At the time Australian Chiropractors Association president Lawrence Tassell responded by saying the criticism was ridiculous and misinformed. He further contended chiropractic was “evidence-based, including its use on children for the treatment of conditions such as colic.”

Note: The Australian Chiropractors Association was originally The Chiropractic Association of Australia (CAA). [Wikipedia]

Just colic? Was this an admission that fever, asthma, hearing loss, all allergies and all learning disorders did not benefit from chiropractic despite promotional claims that they did? Even so the question of evidence supporting chiropractic for the treatment of colic (crying) was not as Tassell suggested. Months later a Cochrane review consulted research into that very issue.

Conclusions note;

The studies included in this meta-analysis were generally small and methodologically prone to bias, which makes it impossible to arrive at a definitive conclusion about the effectiveness of manipulative therapies for infantile colic.

…most studies had a high risk of performance bias due to the fact that the assessors (parents) were not blind to who had received the intervention. When combining only those trials with a low risk of such performance bias, the results did not reach statistical significance.

This brings to mind criticism of anti-scientific training and ideological dogma favoured by what John Reggars calls fundamentalists. Reggars is past president of the Chiropractors Registration Board of Victoria and past vice president of the Chiropractic and Osteopathic College of Australasia.

In May 2011 Chiropractic and Manual Therapies published Reggars’ wonderfully honest and revealing article, Chiropractic at the crossroads or are we just going around in circles? Reggars is a firm proponent of evidence based therapy. As such he criticises the vertebral subluxation complex and B.J. Palmer’s notion of “dis-ease”. Consider this gem of a paragraph;

The irony of this fervent belief in the VSC and chiropractic philosophy is that its development was not founded on vitalistic theory but rather as a legal strategy, conjured up by an attorney, in the defence of a chiropractor charged with practicing medicine [7, 32, 33]: “Many in chiropractic never learned the origin of the pseudo-religion or chiropractic philosophy. It was nothing more than a legal tactic used in the Morriubo’s case.”[34], and “B.J. Palmer probably developed his disease theory as a result of the winning strategy used by his attorney Thomas Morris to defend Japanese chiropractor Shegatoro Morijubo in Wisconsin in 1907″[35].

– Author’s citations in place.

Reggars also concluded that the Chiropractic Association of Australia (CAA) abandoned science for fundamentalist ideologies. He observed that their “all-encompassing alternative system of healthcare is both misguided and irrational”.

Readers are handed the reality of what chiropractors genuinely offer;

Chiropractic trade publications and so-called educational seminar promotion material often abound with advertisements of how practitioners can effectively sell the VSC 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 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. […]

And;
For the true believer, the naive practitioner or undergraduate chiropractic student who accepts in good faith the propaganda and pseudoscience peddled by the VSC teachers, mentors and professional organisations, the result is the same, a sense of belonging and an unshakable and unwavering faith in their ideology.

Back in June 2016 Ian Rossborough published a similar video which also drew strong condemnation. The Australian Health Practitioner Regulation Agency (AHPRA) responded by banning him from manipulating the spines of children under six.

It is difficult to watch Andrew Arnold “manipulate” an infant. Yes a baby is distressed and crying. But it’s the manipulation of the parents I also find appalling.

Grabbing the infant’s feet he announces “I’m locking in here”. Really? He lifts the baby offering verbal distractions. “I’m just gunna go upside down for a second… yep and as we go back down just hold his head… Perfect!” Then comes the stick-that-goes-click. Or as chiropractors call it, the Activator. A spring loaded device which delivers an “impulse”. He demonstrates the lowest setting and releases it into what seems to be the right side of the infants cervical spine. Another still image (below) shows Arnold apparently applying the activator to the infants upper cervical spine at the base of the skull.

The application of the activator as seen in the video hurts or distresses the infant immediately and he begins to cry. “…and he’s going to squawk a bit”, Arnold offers as if he planned and expected this all along. Then, he does it again! And guess what? More crying. “Sorry mate” he offers for the parent’s sake. He checks the collar bones “…cause they get a bit crunched up inside”. He checks potential for collar bone crunching by moving the infants hand. “So with this, start to get in the habit of getting a grip here”, and the video finishes with what appears to be reference to the Palmer grasp aka Darwinian reflex.

This reflex in which babies grip fingers develops around three months of age. I do hope Andrew Arnold informed the parents of this. Then again, I hope someone informed Andrew Arnold of this.

There’s little doubt we’re slow to not merely evaluate most chiropractic therapy and indeed most chiropractors as offering nothing more than pseudoscience. That so people many in developed nations believe their demonstrably preposterous claims about treatment is quite surprising. With the amount of pseudoscience and junk medicine accessible online it is little wonder parents will fall for chiropractic claims about treating infants.

Chiropractic clients should be informed that mild to moderate adverse effects are frequently associated with manipulation of the upper spine in adults. Dissection of the vertebral artery and stroke may also occur. [Source]. It’s difficult to imagine more than a very few parents would be comfortable having infants, babies and young children treated if aware of this situation.

A 2008 study found there was very little supporting evidence for the claims chiropractors made regarding pediatric treatment. A 2007 systematic review found that serious adverse effects may be associated with pediatric spinal manipulation. However observation data could not support conclusions on incidence or causation.

It remains firmly demonstrable that evidence to sustain even a fraction of claims made by chiropractors as to how effective pediatric treatment is remains absent. The fact chiropractors themselves have not pursued large scale randomised controlled trials with a vigor akin to that with which they claim an ability to heal is concerning.

I have no doubt there are chiropractors who do strive to follow an evidence based approach to treatment. Yet with some influential chiropractors labelling this approach as out of date in favour of the approach of D.D. Palmer’s 19th century vitalism, they face a struggle to be heard.

As John Reggars noted since the adoption of the fundamentalist approach and application of the vertebral subluxation complex (VSC), chiropractic in Australia has taken a backward step. Chiropractors have abandoned a “scientific and evidence based approach to practice for one founded on ideological dogma”.

Australians are entitled to be protected from expensive, dangerous pseudoscience in the health industry. At present we are faced with regulators who need to develop some rather sharp teeth and make a meal of chiropractic pseudoscience.

 

♣ (4/3/19) NB: Colic may refer to severe abdominal pain caused by an intestinal blockage or gas. Infants are prone to the condition, responding with constant crying. In fact crying is the means by which “colicky” babies are diagnosed. Paediatricians may use the “rule of threes” in diagnosis, particularly items 2-4.

  1. Crying begins at around 3 weeks of age.
  2. Crying for more than 3 hours.
  3. Crying on more than 3 days per week.
  4. Crying this way for more than 3 weeks.

Because crying is what determines infantile colic there is ample disagreement as to the role of intestinal pain or even if colic itself is a myth. Other criticisms involve the convenient use of colic as a diagnosis for excessive crying.

Reading;

Seven Ways to Identify Pseudoscience

Original seven ways – © Relatively Interesting

  • The use of psychobabble – words that sound scientific and professional but are used incorrectly, or in a misleading manner;

Self-help books, folk and pop psychology, and motivational seminars often use psychobabble.  Deepak Chopra is a name that comes to mind at present. Nothing more than a fraud according to Professor Jerry Coyne, one may delight in the Wisdom of Chopra which is a Twitter stream made up of seeming quotes that are randomly generated by words that can be found in his genuine Twitter stream. If anybody breathes prescient life into the words of the late Carl Sagan it is the scoundrel and intellectual mobster Deepak Chopra.

Sagan proffered;

I worry that, especially as the Millennium edges nearer, pseudo-science and superstition will seem year by year more tempting, the siren song of unreason more sonorous and attractive.

  • A substantial reliance on anecdotal evidence;

Without a doubt the alternatives to medicine behemoth would be lost without dramatic tales of self-limiting illnesses merely running their course, or completely false or hugely exaggerated stories of serious, disabling or terminal disease executing an about face due to the power of some wonderful concoction. The frustrating hurdle here for those who promote reason is that almost all work undertaken to convince the patient occurs in their own mind. Scam artists from peddlers of herbs to chiropractors, Baptist religions and indeed even the Catholic Church are swift to take credit if they have been involved.

  • Extraordinary claims in the absence of extraordinary evidence;

From 9/11 being an inside job to images of the apparent exhumation of giant skeletons to alien autopsy videos and shaky vision of UFOs drifting across a grainy background it seems all these and other extraordinary claims have one thing in common. A powerful need to believe in their truth by those that ensure certain – in fact sometimes many – conspiracy theories indeed exist. Now thanks to Netflix we can wander through a range of delightful titles that offer everything from reasonable special effects to WW2 era reports and “experts” convinced our governments expect us to believe the laws of physics have been broken.

  • Claims which cannot be proven false;

Insisting oneself or perhaps a number of people in the world have communicated telepathically at infrequent and random intervals with aliens from a distant star is impossible to disprove on face value. The claimant can continue to insist he/she is unaware of who the other telepathic human recipients are, or when he/she will receive or has received a communication. The communication may be quite benign such as, “Happy Birthday Deepak”.

Ideally the burden of proof should be placed on the party making the claim.

  • Claims that counter established scientific fact;

Often going hand in hand with claims that rely on anecdotal evidence are those that defy scientific fact. Homeopathy stands atop the podium in this regard. Not only is it absolutely certain to not work but it’s adherents may insist on relaying impossible tales – often knowing they are outright lies – to besmear evidence based medicine and promote junk, bogus cures. For example pertussis (or Whooping Cough) is sometimes referred to as “the 100 day cough”. Prominent Australian antivaccinationist Meryl Dorey claimed on national TV both her vaccinated and unvaccinated children “got it”. She treated it homeopathically and “none of us were sick for more than two weeks and it was nothing worse than a bad cough”.

Countering established fact may be said of an enormous number of claims made about pseudoscientific “cures” for many ailments. Some treat energy meridians or “chakras” that don’t actually exist. These involve peddling herbs, acupuncture, acupressure, chiropractic, osteopathy, chanting, cupping, aligning activities with moon cycles, astrology and more.

Without a doubt denial of anthropogenic climate change should be mentioned here and we might again reflect upon to Carl Sagan’s worrying prediction.

  • Absence of adequate peer review;

In 2015 antivaccinationist and science fraud Judy Wilyman, under the auspicies of antivaccinationist and conspiracy sympathiser Dr. Brian Martin, finished her PhD at the University of Wollongong. The controversy surrounding inadequate peer review between 2012 to 2016 and indeed until today is a function of the copious inaccuracies in her thesis. Entitled “A critical analysis of the Australian Government’s rationale for its vaccination policy”, it was an immature an inaccurate antivaccination conspiracy rant. The fact that it was accepted, and indeed accepted with it’s discredited bibliography, indicates a clear absence of adequate peer review.

Tragically this eventuality has emboldened Wilyman to demand respect from academics and to level outrageous personal claims at her critics, rather than attempt to publish respectable material.

  • Claims that are repeated despite being refuted;

Whilst a great deal of the above intellectual repugnance deserves a slice of this pie, the authors at Relatively Interesting have populated it with the anti-vaccination obsession with the globally damaging claim that vaccines cause autism. Originally at a 1998 media conference designed to reassure parents, head author of the now rejected paper Andrew Wakefield proffered the baseless claim that rather than use the MMR trivalent vaccine, parents should consider choosing single shot vaccines. The “vaccines cause autism” claim has not only been shown to be false and cannot be replicated, but it is now well established that Wakefield acted with the sole aim of making tens and probably hundreds of millions of pounds via his plan to establish immuno-analysis laboratories for the new condition he was calling autistic enterocolitis. He also held patents for single shot measles, mumps and rubella vaccines.

A five member General Medical Council panel found Wakefield guilty of over 30 charges including 12 of causing children to endure “clinically unjustified” invasive testing procedures, buying blood at children’s birthday parties and managing four counts of dishonesty. Then, his “continued lack of insight” into his conduct, and consequences thereof, meant that only “total erasure” from the medical register was warranted. Today on the back of countless refutations of Wakefields claims he now pushes the fraudumentary Vaxxed full of false information and complete with the tampered audio of phone conversations.

 

Regrettably today more than in recent years we can benefit from keeping an eye out for these seven markers of pseudo-science.

Del Bigtree misleads his audience over vaccine safety testing

In a second episode dealing with the Lies of Vaxxed published by More Truth © an old standard of the anti-vaccine lobby is subject to facts.

The lie Del Bigtree smothers his uncritical audience with is that, “there is not a safe vaccine out there” presumably because as he continues to lie, “there is not a decent safety study on any of the vaccines”.

Lies of Vaxxed: Episode 2 “Vaccine Safety Testing”

What we learn from the video above is that there are six main stages of vaccine development is the US. Including;

  • Exploratory
  • Pre-clinical
  • Clinical development
  • Regulatory review and approval
  • Manufacturing
  • Quality control

During the exploratory stage scientists focus on identifying an antigen that can prevent a specific disease. Without success during this process development goes nowhere. It cannot continue. Nonetheless, the exploratory stage takes years of diligent laboratory research.

When the exploratory stage yields viable results production continues into the pre-clinical stage. Here progress with tissue or cell-culture preparation involves animal testing. This aspect of the pre-clinical stage will assess the safety, or lack thereof, of any potential vaccine. Another aspect of the pre-clinical stage is assessing the ability of the potential vaccine to stimulate an immune response.

Despite the cost and time invested by this point, the majority of potential vaccines do not satisfy the rigour of the pre-clinical stage. In these cases again development cannot continue.

The diligence of the clinical stage can be seen as a three part process.

  • In the quest to ascertain safety, trial vaccines are tested on a small sample of healthy adults.
  • Vaccines are tested on a sample of several hundred adults.
  • Finally the clinical stage involves testing the vaccine on tens of thousands.

With vaccines being developed for children the clinical stage process continues. The age of test subjects is lowered incrementally until the target age is safely reached.

The final stages of clinical development include randomised and double blind trials. The potential vaccine is tested against a placebo. It takes from six to ten years to complete these safety tests. Whilst medications in the USA are subject to the same intense testing it’s worth noting that sample populations are three times smaller than for vaccine studies.

There are six more stages overseen by the FDA for regulatory review and approval of vaccines. This involves safety inspection of manufacturing facilities by the FDA and even more testing.

Safety monitoring, including phase IV trials, continues indefinitely once a vaccine has been approved. In the USA there is the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink – a nationwide set of linked databases.

I certainly recommend watching this video because it is clear that safety is the primary element in vaccine manufacture. Claims to the contrary by Del Bigtree and the Vaxxed cronies are demonstrable lies. Under present manufacturing guidelines and restrictions most potential vaccines do not reach clinical development. As is clear in this video the reason is safety.

Professional anti-vaccinationists like Bigtree, or any who promote Vaxxed in order to consciously profit from their manufactured controversy, are a malignant force in public health. As such they deserve our derision.

 

♣ Despite this reality, in Australia the self appointed “vaccine experts” from the anti-vaccine lobby such as Meryl Dorey, Judy Wilyman and Tasha David insist no randomised double blind trials or testing against placebo has ever been carried out.

♥ Australians may likely remember from 2010, a significant number of AEFI. Febrile seizures in children aged 6-59 months following administration of CSL’s Trivalent Influenza Vaccine. One chid was ultimately compensated. This event resulted in the FDA inspecting CSL laboratories and outlining five “objectionable conditions”. Australia’s TGA reported at length on the event, the FDA inspection and the process of TGA inspection of CSL manufacturing facilities.

Whilst this was an unwanted, unfortunate event, it is also an example of safety and quality control procedures being firmly implemented.

 

Conspiracy Theorists: obsessed and beyond reason

This morning I was met with the news that a train accident in Hoboken, New Jersey had left one person dead and over 100 injured. It was being described as “the worst NJ transit incident in the recent past”.

Moments later I was pondering what conspiracy theorists would be doing with this information. I didn’t expect much but a visit to Prison Planet – a hive of conspiracy paranoia fathered by Alex Jones – yielded some pickings. Comments lay under opening paragraphs from an NBC New York article. One read:

Yet another “accident” hundreds in serious condition, death toll still rising.

Note the press will not identify the train engineer.

Note how the press wont even identify if train was under control of “PTC” positive train control.

PTC prevents this, unless its tampered with. PTC cannot turn the power “up”, in a train, only “down”. That region was one the 1st in the USA to get PTC. Appears Mr. Obama needs a few days to work a narrative.

The author seemed to be “arguing” that the event was executed deliberately. His over confident assessment of “PTC” train control in that region suggested such an accident was unlikely if not impossible. The press, in his mind, were suppressing two vital facts: the driver’s name and the presence/absence of PTC control. President Obama thus, needed “a few days” to mislead the American public.

As it turned out the driver, engineer Thomas Gallagher had spoken to authorities “within hours” of the accident. He had been rescued from his crushed cabin and is reported to be in a critical condition.

Another commenter had worked it out using exclamation marks. This was no accident. It was the “scum Muslims”. He’s quite likely blown his ten bucks – unless the almost certainly American born descendent of Irish-Americans, has converted to Islam:

Can you say Tabotage / Terrorism !!!!!!!!!!!!!!!!!!! The scum Muslims have struck again. This was no accident !!!!!!!!!!!!!!!!. Ten bucks – the engineer was a Muslim.

Someone had posted Beastie Boys Sabotage clip, which was followed by Beastie boyz are enemy jews. Why do you listen to their music?

By this point someone gleaned the rules, summarising them neatly:

RULES FOR POSTING ABOUT THIS STORY:
1. DO NOT WAIT FOR ANY FACTS ABOUT WHAT REALLY HAPPENED. IT IS IMPORTANT THAT YOU IMMEDIATELY POST WHATEVER MINDLESS CONSPIRACY THEORY YOU CAN THINK OF.
2. BLAME THE JEWS

So why was I pondering what these enemies of reason would be thinking? Recently, I’ve been considering the intractability of conspiracy theorist thinking. Or is that lack of thinking? Either way it (the pondering) is likely a constant for those who value the role of evidence in public health and appreciate the harm caused by opportunists who benefit from peddling fear and confusion.

This week I’d enjoyed a discussion in a clinical setting with a physiotherapist about “vitalistic” chiropractic. Whilst familiar and infuriated with the lack of evidence behind treatment claims, she was fascinated to learn of the anti-vaccine slant in chiropractic.

I’ve been as fascinated as disgusted with the antics of David Thrussell who, as artistic director of the Castlemaine Local and International Film Festival, attempted to bring the rankly deceptive anti-vaccine film Vaxxed to Castlemaine. An outstanding conspiracy theorist and blatant liar, Thrussell has played the victim whilst misleading both the media and sponsors of the film festival.

As always the delightfully unstable Judy Wilyman has been showing off her declining grip on reality. Of late she has chosen to bully the Executive Dean of the Faculty of Science, Medicine and Health at the University of Wollongong and also the Minister for Social Services. Wilyman’s ranting is so far from possessing an evidence base or a cogent stream of argument that it beggars belief. Unless of course, one considers it through the eyes of a conspiracy devotee.

Rob Brotherton (@rob_brotherton) authored Suspicious Minds – The Psychology of Conspiracy Theories. He suggests that to the conspiracy theorist their beliefs are unfalsifiable. There is simply no evidence to prove them wrong. In addition, driven by a need for control – a need which they cannot develop when faced with reality – the likes of Thrussell, Wilyman and Meryl Dorey, develop compensatory control.

The misleading film Vaxxed has given compensatory control to so many who lack control. We may consider Dorey’s misappropriation of funds, Wilyman’s feverish ranting about her superior “research” and Thrussell’s manipulation of others as types of compensatory control also.

Suffering from the insignificance that comes with no control over reality, such conspiracy prone personalities fall victim to proportionality bias. Events they desire to control, but can’t, must have a complicated – indeed powerful – cause. We see this also in their propensity toward other conspiracies.

Between 1/4 to 1/3 of Americans believe 9/11 was the result of some type of conspiracy. Usually the Inside Job theory. Within days of Kennedy being assassinated more than half of Americans believed Lee Harvey Oswald did not act alone. Today, according to Brotherton, “the majority of Americans” believe some type of conspiracy led to the Kennedy assassination.

The audio below is from ABC’s All In The Mind and includes an excellent interview with Rob Brotherton. I certainly recommend it.

  • © ABC All In The Mind

 

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Vaccines and autism: A thorough review of the evidence

The following post is an exceptionally detailed review of the evidence, and scientific consensus, specific to the persistent claim of a link between vaccination and autism.

Those familiar with the integrity of the scientific method and its value in examining this particular issue will be grateful for both the quality and extent of this review.

Use of the seven tiered Hierarchy of Scientific Evidence provides an excellent device by which to gauge the value of evidence, and as such, introduces one to a reliable tool for similar endeavours.

I trust you find the article a valuable resource.

Hierarchy of Scientific Evidence

© thelogicofscience.com

The Logic of Science

One of the most common concerns that people have about vaccines is that they might cause (or exacerbate) autism. This idea is perpetuated by celebrities and innumerable websites, and it has become one of the cornerstone arguments of the anti-vaccine movement, but is there any truth to it? Perhaps unsurprisingly, both sides claim a superiority of evidence. Indeed, you can find numerous websites presenting lists of papers that they claim provide evidence that autism is caused by vaccines (such as “124 research papers supporting the vaccine/autism link“). Conversely, those who support vaccines also have lists of papers which they present as evidence that vaccines do not cause autism (for example, here and here). So which is correct? The internet is full of misinformation on this topic, so I want to cut through that crap and talk about the actual studies themselves rather than simply tossing lists around…

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