Manipulation, chiropractic, and the idols of Francis Bacon

Chiropractic has had a colourful history since its invention in the 19th Century.

Chiropractic has had an extraordinary history, but the vehement response of its practitioners to criticisms of its claims is nothing if not human. These unwelcome aspects of human behaviour – a readiness to believe and a violent reaction to well-founded criticism – were recognised and categorised by Francis Bacon 400 years ago.

Chiropractic has been defined as “a system of treating bodily disorders by manipulation of the spine and other parts”.1 The Oxford English Dictionary gives a number of meanings for manipulation, including “The act of operating upon or managing persons or things with dexterity, especially with disparaging implications, unfair management or treatment”. Manipulate, among other meanings, is “to manage by dexterous contrivance or influence, especially to treat unfairly or insidiously for one’s own advantage”.

[Until 1818 English dictionaries gave only one meaning for manipulation: the method of digging for silver ore.]

The practice of chiropractic began in the US in 1885. It is one of a number of strange behaviours and belief systems which have had their origins in that country, including osteopathy, craniosacral manipulation, applied kinesiology, scientology, creationism science, Christian Science, and Mormon beliefs. It was in that country too that homeopathy received its greatest support after its invention in Europe. Why this should have happened is an interesting question. An American friend says that it springs from an overwhelming desire to avoid the perceived errors of Europe with its suppression of religious freedom.

David Daniel Palmer was born in Ontario in 1845, and brought his family to the US where by 1865 they were living in Davenport, Iowa. He was a grocer, and a bee-keeper, and had a deep interest in spiritualism. He practised ‘magnetic healing’ and called himself ‘Doctor’. 2, 3, 4

He later said that the idea of chiropractic came to him as ‘received wisdom’ at a séance in 1885, from a certain Dr. Jim Atkinson, deceased at that time. Shortly after this, on 18 September, 1885, he treated a man who had been deaf for 17 years. He said: “I examined him and found a vertebra racked from its normal position – I racked it into position by using the spinous process as a lever, and soon the man could hear as before.” He went on: “There was nothing crude about this adjustment; it was specific, so much so that no chiropractor has equalled it”.

Palmer called the spinal irregularity he had found a “subluxation”, a term borrowed from orthodox medicine where it means a partial dislocation of a joint. Only chiropractors can find, feel, or see their patients’ abnormalities, which they proceed to correct.

Palmer decided there must be a single cause for all diseases: “I then began a systematic investigation for the cause of all diseases and have been amply rewarded.” He had a friend coin the word ‘chiropractic’ from the Greek ‘cheir’, hand, and ‘praxis’, action. He said that the free flow of the body’s ‘innate intelligence’ (or ‘psychic energy’) to all parts of the body was interrupted by spinal vertebral subluxations, and this was the cause of 95 percent of all illnesses.

He said: “I occupy in chiropractic a similar position to Mrs [Mary Baker] Eddy in Christian Science. Mrs Eddy claimed to receive her ideas from the other world and so do I. I am the fountainhead.”

Palmer was hugely successful. In 1897 he opened the ‘Palmer School of Care’ in Davenport. Admission was by payment of tuition fees and no other qualification. In 1905 it was renamed ‘The Palmer School of Chiropractic’ and it has gone on to occupy a large campus on what is now called Palmer’s Hill, in Davenport.

His son, Bartlett Joshua (‘BJ’), took over the business in 1906, while his father was in prison for practising osteopathy and medicine without a licence. DD and BJ fell out and DD opened a rival school.

By 6 August 1908, the US congress was considering a bill to regulate the practice of chiropractic and to licence chiropractors.

David Daniel Palmer died in 1916 a short while after being run over by BJ in an automobile. The death certificate said ‘typhoid fever’.

Bartlett Joshua Palmer made a fortune, and promoted chiropractic in Canada, Australia, and the United Kingdom. He stressed salesmanship as he taught, and his classrooms were decorated with such slogans as:

“The world is your cow, but you must do the milking”

and

“Early to bed and early to rise, work like hell and advertise”.

BJ marketed a patented machine called the Neurocalometer which he said could detect subluxations, whether or not the patient had symptoms. It is still sold today as the Nervoscope and costs about $US799.

BJ founded a radio station, WOC (Wonders of Chiropractic) in 1924.

In 1926, HJ Jones in Healing by Manipulation stated there were more than 8000 chiropractors in the US and Canada.

BJ died a multimillionaire in 1961.

This story is one of extremely successful entrepreneurship in the best tradition of American showmanship. It has nothing to do with science, and a lot to do with evangelical know-how.

In 2007 there were 19 colleges of chiropractic in the US, two in the UK, at least one in Australia and one in New Zealand.

Repeated examinations of x-rays, MRI scans and autopsy material have failed to show any evidence for existence of the ‘subluxation complex’. The American Association of Chiropractic Colleges states that “the subluxations are evaluated, diagnosed, and managed through the use of chiropractic procedures”.

Because of Palmer’s initial dogma, many chiropractors reject the role of infectious agents in disease and hence deny the value of vaccination.5 Chiropractic neck manipulation is associated with an increased risk of vertebro- basilar vessel damage.6 Chiropractors insist on spine x- rays even when the risk of unnecessary exposure to radiation is raised, and this despite the absence of x- ray changes consistent with a ‘subluxation’.

A careful examination of all the scientific evidence7 has resulted in the conclusion that chiropractic offers some help for low back pain but otherwise has no more effect than that of a placebo for any other complaint.

In 1999 an American chiropractor, Samuel Homola, published Inside Chiropractic: a Patient’s Guide8. He supported manipulation for back pain, but rejected what he described as chiropractic dogma. He confirmed that the chiropractic profession had little tolerance of dissent.

“Its nonsense remains unchallenged by its leaders, and has not been denounced in its journals. Although progress has been made, the profession still has one foot planted lightly in science, and the other firmly rooted in cultism.”

He was labelled a ‘heretic’ by his colleagues.

Some commentators divide chiropractors into ‘straight’ dogmatists and ‘mixers’ who will use some science.

Chiropractors and defense by legal action: the American Medical Association Saga

In the US, doctors encouraged the arrest of chiropractors for practising medicine without a licence. By 1940 it is said that 15,000 prosecutions had been brought. However 80 percent of these had failed, with the United Chiropractors’ Association, encouraged by BJ Palmer, giving financial support to the defendants.

The AMA Committee on Quackery lobbied in 1963 to have chiropractors relegated to a non- medical status. The committee argued that chiropractic should not be recognised by the US Office of Education, citing the lack of scientific evidence, the denial of germ theory, the claim to be able to treat 95 percent of all diseases, and the use of the ‘E- meter’.

In 1976 the Chiropractors’ Association, having become aware of further action planned by the AMA, brought a suit against the association on the grounds that it planned to limit chiropractors’ practice, and this was in breach of anti- trust legislation as it was anti-competitive.

In 1987 the Court found in favour of the chiropractors, and an appeal by the AMA in 1990 failed.

The chiropractors had shifted the issue from science to rights of commercial practice. This was totally in keeping with their history of astute business acumen – and lack of scientific evidence.

The 1978 NZ Royal Commission of Inquiry into Chiropractic

In a context of legal and political mechanisms, the NZ Chiropractors’ Association with its supporters, and the NZ Medical Association and its supporters, battled for and against official recognition of chiropractic as a national health resource, and the access of its practitioners to the rewards from the Accident Compensation scheme.

The chiropractors bolstered their position with hundreds of letters to the commission from satisfied customers, and the NZMA responded by scathing and dismissive comments as to the worth of such letters, and by decrying the lack of science in the practice of chiropractic.

Kevin Dew9 suggests that the result was a negotiated settlement exchanging a proposal by chiropractors to restrict their practice to musculoskeletal conditions, in return for official Government recognition, and the addition of chiropractic to New Zealand’s health resources.

The controversy was resolved without any resolution as to the scientific validity of the claims of chiropractic. It was thought there were only 100 chiropractors in New Zealand at that time.

Recent publications6show that the majority of chiropractors in the English- speaking world continue to make claims for their treatment which extend well beyond the realm of musculo- skeletal disorders.

There were 391 chiropractors advertising in the Yellow Pages in New Zealand in August, 2010.

Simon Singh and the British Chiropractors’ Association

In 2008, Simon Singh and Edzard Ernst published a book called Trick or Treatment.7

On 19 April 2008, Singh wrote an article in The Guardian, pursuing the topic canvassed in the book, that chiropractic was alternative medicine and there was no evidence for any effect except on lower back pain.

“The British Chiropractors’ Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections and prolonged crying even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession, yet it happily promotes bogus treatments”.

The BCA quickly sued him for libel, and on 7 May 2009 the court handed down a verdict in favour of the chiropractors.

Meanwhile in New Zealand

On 25 July 2008, the NZ Medical Journal published a paper by Andrew Gilbey reporting evidence that some chiropractors in NZ were using the title ‘Doctor’ in a manner which could mislead the public. In the same issue an editorial by David Colquhoun appeared, critical of chiropractic, and the qualifications of its practitioners. He wrote:

“For most forms of alternative medicine, including chiropractic and acupuncture the evidence is now in. There is now better reason than ever before to believe that they are mostly elaborate placebos, and at best are no better than conventional treatment.”

In the next issue of the NZMJ the editor published a letter from a lawyer, Paul Radich, representing the NZ Chiropractors’ Association, threatening legal action under the NZ Defamation Act, against the journal, Gilbey, and Colquhoun. The letter demanded apologies from all parties, and outlined the financial penalties for all.10 The tone was intimidatory.

In his comments about the position of the NZMJ as a scientific publication, the editor, Frank Frizelle, invited the chiropractors to an evidence- based debate with these words: “Let’s hear your evidence, not your legal muscle”.

The NZMJ published an invited response from the NZ College of Chiropractic in its next issue11 and I understand there has been no further correspondence from the lawyer (personal communication from the editor, NZMJ, September 2010).

Back to London

A month after the initial court procedure in London, Simon Singh announced his intention to appeal the finding in favour of the BCA.

On 1 April 2010 the Appeal Court handed down its verdict. The Lord Chief Justice of England and Wales, The Master of the Rolls, and Lord Justice Sedley stated that Singh(s comments were not libellous, and that they were matters of opinion backed by evidence. They went on to quote an American judge, Judge Easterbrook, now Chief Justice of the US 7th Circuit Court of Appeals.

In Underwager v Salter 22 Fed.3d 730 (1994):

“Plaintiffs cannot, by simply filing suit and crying ‘character assassination’ silence those who hold divergent views, no matter how adverse those views may be to the plaintiff’s interests. Scientific controversies must be settled by the methods of science, rather than by the methods of litigation. More papers, more discussion, and more satisfactory models – not larger awards of damages – mark the path toward superior understanding of the world around us.”

Back to New Zealand

As it happens, nine days after Singh’s appeal was upheld, Ernst and Gilbey authored a paper in the NZMJ: “Chiropractors’ Claims in the English-speaking World”.5 They examined 200 individual chiropractors’ websites and nine chiropractic association sites in Australia, Canada, New Zealand, the UK and the US. They concluded:

“The majority of chiropractors and their associations in the English-speaking world seem to make claims which are not supported by sound evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.”

On 11 June 2010, Shaun Holt and Andrew Gilbey wrote a letter to the editor of the NZMJ12 drawing attention to the wider public scrutiny of chiropractic claims and nature following the success of Simon Singh’s appeal.

Francis Bacon and his ‘idols’

Francis Bacon (1561-1626) lived at a time when the new empiricism was disturbing the security and comfort taken in accepting the opinions of established authorities. He was a lawyer, a legal theorist, a judge, and a writer. He became Lord Chancellor, but was charged by Parliament with corruption, and having taken bribes from those appearing before him in court. He pleaded guilty and wrote: “I was the justest judge that was in England these fifty years, but it was the justest censure in Parliament these two hundred years.”13

Bacon wrote a series of ‘Axioms’ towards the end of his life. I would like to use some of these to examine aspects of human behaviour that the history of chiropractic reveals. It has been a considerable surprise to me to realise the prescience of this man.

He used the term ‘idols’ to list aspects of human behaviour.

Axiom 41: “The Idols of the Tribe”

These have their foundation in human nature itself.

“For it is a false assertion that the sense of man is the measure of things. On the contrary, all perceptions, as well of the sense as of the mind, are according to the measure of the individual, and not according to the measure of the universe.”

We are all subject to our nature, and seek security and certainty, and believe the evidence of our eyes. If we get better after manipulation, then clearly the manipulation made us better. Emma Young says: “We are causal determinists – we assume that outcomes are caused by preceding events”.14

Axiom 42: “The Idols of the Cave”

These are the idols of the individual man, due to our own peculiar natures, our education, our own experiences, or to reading from authorities we admire. “The spirit of man is in fact a thing variable and full of perturbation”. If we are told by our parents or teachers that someone else is better after manipulation, then we will believe that it is a ‘true’ relationship.

Axiom 43: “The Idols of the Marketplace”

“Formed by the intercourse and association of men with each other. For it is by discourse that men associate, and words are imposed according to the apprehension of the common understanding. The ill and unfit choice of words wonderfully obstructs the understanding. Words plainly force and overrule the understanding, and throw all into confusion and lead men away into numberless empty controversies and idle fancies.”

The choice of the word ‘subluxation’ for example, to describe an undemonstrable change! Or the claim for the existence of ‘psychic energy’. A radio station extolling the “Wonders of Chiropractic” is a wonderful Idol of the marketplace.

To take legal action and gain the publicity which is sure to follow with extensive argument about the meaning of, for example, ‘happily’ has great appeal in the marketplace.

Axiom 44: “The Idols of the Theatre”

“Which have migrated into men’s minds from various dogmas, and the wrong laws of demonstration. All the received systems are but so many stage plays – many more plays of the same kind may yet be composed.”

How well aware of this human trait are all showmen and charlatans. The Palmers, father and son, exploited this behaviour. To claim that new knowledge has come from beyond the grave is wonderful ‘theatre’, full of drama and mystery. To maintain the dogma of the wonderful in the face of evidence to the contrary is so much easier than to examine the evidence.

All these human behaviours can be seen in the history of chiropractic, and in so many other catastrophes such as the anti- vaccination campaign, the Peter Ellis trial, the Cartwright affair, the anti- fluoridation campaign and so on and on.

The history of chiropractic, and the response of chiropractors to criticism about the absence of science in their beliefs, illustrate the profound insights of Francis Bacon about our nature. It is our nature which results in the persistence of the perverse, and which resists the truth.

The responses of those without objective evidence for their personal beliefs often include ad hominem attacks, threat of legal action and financial injury, professional ridicule, and public invective. All these are seen in the chiropractors’ responses.

References

  1. Collins’ Concise Dictionary of the English Language (1988).
  2. Shapiro, R 2009: Suckers: How Alternative Medicine Makes Fools of Us All. Vintage Press, London.
  3. Carroll, RT 2003: The Skeptics’ Dictionary; A Collection of Strange Beliefs, Amazing Deceptions and Dangerous Delusions. John Wiley & Sons, NJ.
  4. Goldacre, B 2008: Bad Science. Fourth Estate, London.
  5. Ernst, E; Gilbey, A 2010: NZMJ, 123(1312) 36-44.
  6. Ernst, E 2007: J. R. Soc. Med. 100(7) 330-338.
  7. Singh, S; Ernst, E. 2008: Trick or Treatment: Alternative Medicine on Trial. Transworld Publishers, London.
  8. Homola, S 1999: Inside Chiropractic: A Patient’s Guide.
  9. Dew, K 2000: Sociology of Health & Illness, 22(3) 310-330.
  10. Editorial, 2008: NZMJ, 121(1279) 16-18.
  11. Roughan, S 2008: NZMJ, 121 (1280)72-74.
  12. Gilbey, A 2010: NZMJ, 123(1316) 126-127.
  13. Hollander, J; Kermode, F 1973: Oxford Anthology of English Literature. OUP, London & New York.
  14. Young, E 2010: New Scientist 2720.

Newsfront

Psychic and TVNZ join forces to profit from child’s disappearance

When Sensing Murder psychic Deb Webber announced on TV One’s Breakfast show that missing Auckland toddler Aisling Symes was in “a ditch, hole” it raised eyebrows all over the place (NZ Herald, 9 October).

Webber was appearing on the show to plug her upcoming nationwide tour – and also the latest series of Sensing Murder, screening on the same channel. Later that day TVNZ journalist Amy Kelley asked the police at a press conference how seriously they would take Webber’s “information”.

TVNZ then approached a friend of the Symes family and subsequently Webber had met them. The state broadcaster seemed to have far too cosy a relationship with the psychic.

TVNZ spokeswoman Andi Brotherston defended the channel’s role, saying, “You know what they are doing? They are being human. They have a family out there that are desperate to find their child.”

Interestingly, Webber’s Sensing Murder co-star Kelvin Cruickshank said at a public show in Hamilton (see p. 16) that his spirits had told him to keep clear of the case, because the family were devout Baptists who didn’t believe in spiritualism.

It is worth remembering that at the time Webber made these comments (less than 48 hours after Aisling’s disappearance) misadventure seemed the most likely explanation. It was only as time went on that the abduction scenario gained favour. When her body was eventually discovered in a concrete stormwater pipe the Waikato Times (13 October) reported Webber had been “proved correct”.

But “ditch” or “hole” covers almost all the likely options – including a shallow grave. Again, the standard psychic’s ploy of making a vague statement which is then misremembered as more accurate than it was, paid dividends.

Hunt on for ‘panther’

A few years back the annual NZ Skeptics conference heard about reports of big cats in the South Island high country. Now someone has built a trap for the mystery beast (Sunday Star-Times, 13 December).

High country farmer David Wightman says he’s never seen the “panther”, but others on his 9500ha Winterslow Station in North Canterbury have, on at least four occasions. “Too many people have seen it to doubt what it is – without actually capturing it and doing a DNA test on it, one can only assume it is a black leopard or black panther.”

Wightman said he planned to use a live goat to lure the panther into the trap. The panther would be unable to harm the goat because it would be in a separate enclosure, but its bleating should be enough to attract the cat. There was no evidence of a large predator attacking free-ranging stock, however.

We should apply the skeptical adage, when you hear hoofbeats in the night, think of horses, not of zebras. Big cats have been reported very widely, and sometimes are reported as brown or grey, suggesting that breeding populations of at least two species are involved. Black leopards (‘panthers’) are rare within their natural range compared to the more common spotted variety, yet no spotted leopards have been sighted roaming free in New Zealand.

Far more likely that the big cats are just that – big cats. Feral domestic cats can grow remarkably large – I once saw one in the Lewis Pass which must have been almost a metre nose to tail – and people are very poor at judging scale at long distances (hmm, maybe that cat wasn’t so big after all!).

Scientology ‘organised fraud’

The church of Scientology has been branded an “organised fraud” by a French court and fined 600,000 euros ($1.2m) for preying financially on vulnerable believers (NZ Herald, 28 October).

Judges in the Paris criminal court ordered the church to pay for adverts carrying its findings to be placed in newspapers around the world. It is believed to be the first time that Scientology has been declared fraudulent by a court in a large, democratic country, although individual scientologists, including its founder L Ron Hubbard, have previously been convicted of fraudulent activities. The Paris decision went further and declared the core claims of Scientology were “fallacious” and designed to “hook” members into paying large amounts of money.

Two French female plaintiffs alleged that, between 1997 and 1999, the Scientology movement persuaded them to pay the equivalent of 21,000 euros and 49,500 euros for treatments to improve their mental and physical health. The two main Scientology bodies in France were put on trial for “systematic use of personality tests of no scientific value… with the sole aim of selling services and products”.

Scientology spokeswoman Agnes Bron said the verdict was the result of an “inquisition of modern times” and that they would appeal.

Science writer wins ruling in libel battle

Brtiish science writer Simon Singh, who is being sued for libel by the British Chiropractic Association, is to fight on after a preliminary judgment against him was opened to appeal (The Guardian, 14 October).

Singh was sued after writing an article in the Guardian criticising the association for supporting members who claim that chiropractic treatments can treat children’s colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying.

Singh described the treatments as “bogus” and criticised the BCA for “happily promoting” them.

In May, Mr Justice Eady in the high court ruled on the meaning of the words, saying they implied the BCA was being deliberately dishonest. Singh was initially refused leave to appeal, but Eady’s interpretation was deemed to be open to argument by Lord Justice Laws, who said Eady had risked swinging the balance of rights too far in favour of the right to reputation and against the right to free expression.

Many scientists and science writers have rallied to Singh’s support, claiming that the freedom of scientific opinion is at stake. “Simon Singh’s battle in this libel case is not only a glaring example of how the law and its interpretation are stifling free expression, it shows how urgent the case for reform has become,” said Jo Glanville, editor of Index on Censorship.

‘Tumour’ thrown at meeting

The hysteria over the Dept of Conservation’s use of brodifacoum to eradicate pests on Rangitoto and Motutapu, reported in last issue’s Newsfront, has continued (NZ Herald, 15 October).

A woman, Donna Bird, was ejected from a 14 October meeting on Auckland’s North Shore after hurling abuse and objects – one of which she claimed was a tumour that had been taken out of her – at DoC speaker Richard Griffiths. The department were “parasites” and “disease mongerers”, she said.

Others at the meeting accused DoC of spreading poison in the gulf, and of being blinded by science. Six dogs died and others became unwell after apparent exposure to tetrodotoxin, a natural marine toxin, on Auckland beaches. Marine organisms, including penguins and dolphins, had also been found dead in the area. Mr Griffiths told the meeting toxicology results ruled out brodifacoum as being responsible. “I’m not sure what else we can say.”

Thief warned of sex change curse

A thief in Auckland may get more than he or she bargained for with a terracotta flower pot taken from a Gulf Harbour home (Rodney Times, 3 December).

The owner says it contains his African witchdoctor grandma’s ashes and is now cursed. In a letter to the Rodney Times, At du Plooy says his grandmother was a sangoma or witchdoctor who died in Africa aged 93. Du Plooy claims to be a medium who keeps in contact with her spirit. While he should be able to trace the pot, through this link, it appears grandma is unfamiliar with the area concerned.

Instead, she has cursed a one kilometre area around the pot with sex-change ions – meaning men may gradually change to women and vice versa. Dumping the contents won’t break the spell, du Plooy says, only its return.

Room for all in discussion group

The nzskeptics Yahoo discussion group has been very busy of late, with December 2009 registering more than 300 new messages – the largest number in the almost five years of the group’s existence. In large measure this has been thanks to contributions from a couple of participants who hold views which I would assume most of our members don’t share.

One of these was a scientologist, the other a chiropractor. Topics discussed ranged beyond the core concerns of these two camps into Chinese medicine, psychiatry, evolution and the nature of the soul.

Although the tone sometimes veered towards exasperation, the debates with one or two exceptions were generally conducted in good spirit, and didn’t degenerate into the flame wars that internet discussions are notorious for. A good thing too – when scientologists and chiropractors make their presence known on the group, it’s a reminder that it is open to anyone who cares to sign up. Skeptics are on public display, and some will judge the society by the way a few individuals behave.

The flurry of activity seems to be dying down again, at least for the time being. Ultimately fatigue sets in, as entrenched positons show no signs of shifting, and one by one people drop out. But discussions like these are still worthwhile. While occasionally frustrating, they serve the function of giving participants the chance to hone their arguments, and to examine issues from perspectives they may not have considered, as well as providing a stimulus to further reading and research. Many more read than actively take part, and derive some pleasure from following the exchanges – although my mailer’s Deleted folder currently has a stack of 32 unread messages with the subject line ‘Chiropractors’. There are only so many hours in a day, after all.

A group where everyone held similar views would get boring very quickly. nzskeptics, for now, is working well, and has become a valuable extension of the society’s activities. Thanks are due to Simon Clendon for getting it up and running and maintaining it.

And Kevin, Justin, and all the other regulars on nzskeptics, your contributions are appreciated too.

Hokum Locum

Another Alternative to Evidence Based Medicine

Vehemence based medicine: The substitution of volume for evidence is an effective technique for brow-beating your more timorous colleagues and for convincing relatives of your ability. New Zealand Medical Journal Vol 113 No 1122 p479

Chiropractic

This pseudoscience is now being advertised on television. In the same way that acupuncture can be easily learned during a one-hour lecture, anyone can learn how to make the spine go “click”. Many lay people have discovered this for themselves. Four or more years of training are unnecessary when a modality has no scientific basis. You only need to learn how to produce a pleasing noise from the spine without harming the patient. Osteopaths extend this effect to include the joints. If you pull firmly on your fingers you get the same effect, often a dramatic crack. Various theories have been proposed for this such as air bubbles, but I have noticed that large joints frequently produce all sorts of noises when they are being examined. When the neck is forcibly manipulated in this way there is a real risk of serious injury to major arteries in the neck. The shearing forces cause a tear in the arterial wall (a “dissection”) and this interruption to the blood supply to the brain can cause a stroke. If you have a sore neck and simply wait for it to get better you are not exposed to this risk. I used to do a lot of spinal manipulation but gave it up because patients started coming back all the time to have their spine “put back in”. I had unwittingly stumbled upon the secret of chiropractic! This became very tiresome and I stopped the practice after giving myself a nasty fright when a patient fainted and I thought I had killed her. Chiropractors talk about “adjustments” and this is the source of their income – adjustments to their bank accounts. Once the patient is convinced of the need for frequent adjustments, the chiropractor has a regular patient for life. For a detailed view of the pseudoscience of chiropractic visit www.quackwatch.com.

For a review of serious adverse effects of chiropractic refer Ernst E. Medical Journal of Australia 2002; 176: 376-380

Good Health

I have forwarded a copy of this publication to the editor. It is an advertising supplement for alternative medicine. Good Health employs a resident naturopath, Lani Lopez, complete with a Kentucky fried medicine qualification – N.D. Dip J. Herb. We learn that Mandy Smith owes everything to a diet rich in pond scum (spirulina aka blue/green algae). Auckland-based readers will be delighted to know that NZQA loans and allowances are available if they wish to obtain such qualifications from Wellpark College of Natural Therapies. Refer www.wellpark.co.nz, although their website was down when I visited. I was particularly taken with an article on joints with metaphors such as “creaking hinges and rusty joints.” My left knee has osteoarthritis and I learned that “essential oils, Clove, Frankincense, and Cajuput oil penetrate deeply into swollen areas and support normal joint articulation.” The only problem with that claim is that human skin is actually impervious to such treatments as it is a very effective barrier. However, I had a biomechanical brainwave. Why not insert grease nipples over troublesome joints and use a modified grease gun to pump the “two main natural ingredients Glucosamine and Chondroitin” directly into the joint? The next time I take the car for an oil change and grease I’ll have my knee done as well, and if that fails there’s always…

Doctor Levine’s Patented Power Knee Strap

There must be plenty of money in this product as it has recently featured in several half-page advertisements. It is claimed the strap provides relief from arthritis and chronic knee pain. The strap costs $24.95 and is designed to sit just beneath the kneecap. Dr Levine is described as a “nationally famous physician and former head of orthopaedic surgery at one of New York’s leading hospitals.” I decided to check these claims and the website of the American Medical Association (www.ama-assn.org) had a search engine by doctor’s name. This confirmed the existence of Dr Jack Levine. The website also had a statement of the ethical standards for the AMA members and it appears that this advertising is a breach of Article 2. I emailed the AMA pointing this out and will report back, assuming they bother to reply. The strap is obviously a placebo. It might work if it was tightly placed around the upper thigh where it could cut off the circulation, compress the nerves and produce a pleasing numbness – a sensation that frequently comes over me when I am confronted with American consumerism.

Slimming the easy way

A 44-year-old woman was referred to hospital with anxiety symptoms, weight loss and hypertension after taking a Chinese herbal remedy for weight loss. Her doctor was obviously suspicious about the composition of this preparation because it had actually worked. These preparations are normally useless. The initial suspicion was that the herbal remedy contained ephedrine (“Ma Huang”), which is a dangerous but commonly used preparation. Gas chromatography revealed, however, that the herbal preparation was adulterated with fenfluramine, a potent and dangerous amphetamine derivative. One can only agree with the author of the report: “stringent regulation of traditional medicines, at least to the standards of conventional practice, is urgently needed”. British Medical Journal Vol 324 16 March 2002 p679

Recovered Memory

This contemptible pseudo-science is still blighting lives all around the world despite being condemned by most authoritative Psychiatric Colleges. Psychologists at the University of Otago have found that children can only explain early childhood events using the language they knew at the time. The researchers are quoted: “If you take our data to their logical conclusion, then one implication would be that we need to express scepticism about very early verbal memories that are recovered during the course of therapy”.

The merciless badgering of self-deluded therapists is a process very similar to “facilitated communication”. This is where the “facilitator” guides a handicapped person’s fingers on a keyboard to produce written communication, which the person is incapable of when unaided. This is of course a complete delusion and we have experimental psychologists to thank for exposing this nonsense which should not be either encouraged nor funded by ACC.

Article Published in US Psychological Science-reported in Sunday Star Times 28 Jul 2002

Hokum Locum

The Women’s Weekly and Other Medical Journals

Dr John Welch goes eyeball to eyeball with the iridologists, and takes a look at some famous faces

Chiropractic Treatment of Infertility

During idle moments I read medical journals such as the Australian Women’s Weekly. In this case the issue was March 1999 and I really must speak to the Librarian about the disgracefully outdated journals currently held by the medical library.

Following extensive investigations for infertility, our reporter consulted Dr Naomi Perry, an Adelaide chiropractor, who “was doing revolutionary work treating women with infertility by manipulating their spines.” The chiropractor discovered that “Concepta” (not her real name) had a spinal curvature (scoliosis). This is hardly surprising since chiropractors diagnose this disorder in 100% of their patients, it being a central tenet of the chiropractic theory of subluxations. After four months of manipulation a pregnancy was confirmed. If the writer had stood on her head for two hours every night , a pregnancy would have eventually occurred since this event is a function of time for most couples.

Gypsies have the greatest success in predicting pregnancy. This is because they have crystal balls and can see it coming.

The White Stuff?

I was disappointed to miss the International Iridiology & Sclerology Conference held recently in Auckland. Iridologists have now discovered new secrets of divination using the sclera (white of the eye). This immediately reminded me of Ken Ring’s demonstration of “reading” elbows, knees or any part of the body for that matter. As far as iridology is concerned it doesn’t matter whether the iris, sclera, eyelid or the nostril are “examined”. Given a gullible customer, iridologists can spout any old rubbish and they will be believed. Nevertheless, there were some inspirational papers: “Pupillary ruff phenomena in the iris” presented by a senior iridology lecturer at the South Pacific College of Natural Therapies, and “Emotional resistance patterns in the sclera” by a US visitor whose qualifications included a ND (doctor of naturopathy) and a PhD from the University of Wakula Springs, the same one attended by Tarzan. The rather alarming claim is made that “it (iridology) is poised to become mainstream within this decade in many countries like NZ”.

Given the composition of the Health Minister’s committee on alternative medicine, this is a distinct and unwelcome possibility.

Health Secrets of Your Face

Each of the five elements which form the basis of acupuncture-earth, fire, water, wood and metal-have a corresponding face shape which tells the analyst about a person’s talents, personality and potential health problems. Kate Winslet sought the help of a facial analyst when she needed to shed 25 kg of weight gained during her pregnancy. For her “wood” face she was told to “prune” back on sugar, wheat and dairy products. The diet worked so well she not only shed some ugly fat but got rid of her husband…

The face is viewed as a map with different areas representing parts of the body. For example, the forehead represents the bladder and the area between the eyes relates to the spleen and gall bladder. Never be tempted therefore, to squeeze any pimples in this area!

Catherine Zeta-Jones has a “metal-type” face that doubtless describes her attraction to Michael Douglas who is certainly “well-metalled”.

New Zealand Woman’s Weekly 15 October 2001

US cancer institute funds trials of complementary therapy

The Gonzalez regime is a program of dietary modification, supplements and “detoxification” using coffee enemas. The supplements include animal glandular extracts, vitamins, trace minerals, papaya and magnesium citrate. Gonzalez has based his treatment on pseudoscience and anecdotal evidence of success has seen US$1.4 million dollars wasted on a formal clinical trial. I predict that the treatment will be a complete failure but this will not deter Dr Gonzalez from continuing to promote this worthless treatment. Neither will this deter gullible individuals from wasting money on this fraud. Rectal coffee could well be dangerous as the following account will demonstrate.

British Medical Journal Vol 320 24 June 2001 p1690

Fatal heart attack from a health food product

A woman collapsed and died soon after drinking a “natural” health drink containing guarana and ginseng. She had a faulty heart valve as well as a history of palpitations and had been warned to avoid caffeine, which is a heart stimulant. Her blood caffeine level was 19mg/L, the equivalent of drinking about 20 cups of coffee. The caffeine concentration in the drink was 60 times greater than levels found in cola drinks. Guarana seeds contain about 5 percent caffeine.

Medical Journal of Australia 174:520-1, 21 May 2001

Dangerous Chinese Medicines

Traditional Chinese medicines are basically placebos and when they do seem to work it is largely due to the illegal insertion of potent western medicines such as steroids. They can also contain mercury and arsenic, as well as toxic herbs and even banned animal species.

An Indonesian man was brought to a Hospital emergency department and was found to be confused due to a low blood sugar. After an injection of glucose he recovered and was able to tell his medical attendants that he was taking a Chinese remedy called “Zhen Qi”. The label on the bottle listed the ingredients as ginseng, pearl, ram’s horn, bark and “frog extract”. Gas chromatography revealed that the mixture also contained glibenclamide, a potent oral hypoglycaemic agent used for treating diabetes!

For once I join with naturopaths, homeopaths and alternative health practitioners everywhere, in condemning this cynical attempt to make sure harmless and ineffective quack remedies actually work by the inclusion of dangerous but effective drugs.

British Medical Journal Vol 323 6 Oct 2001 p702, p770

Hokum Locum

Manipulation of the Colon

Some time ago I remember reading a letter in the Listener from a frustrated doctor who accused the public of being medically illiterate. Sometimes I feel this way myself but it is not a good practice to attack one’s audience. Public education cannot be achieved within the context of traditional ten-minute medical consultations compared with quacks who may spend up to an hour providing mis-information. Drug companies are on record as cynically exploiting a gullible public eg. “…neither government agencies nor industry, including the supplement industry, should be protecting people from their own stupidity”.
Letter to Hoffman-Laroche, quoted in NCAHF Vol 15 No.4

In a letter to Little Treasures, a writer who would probably prefer to remain anonymous claimed that her child’s constipation was cured by chiropractic manipulations because “one leg was slightly longer than the other and the passage to the bowel was obstructed by this”. The anatomical possibilities are intriguing! George Dunea writes a regular letter on the US medical scene for the BMJ and in an article reviewed the current activities of chiropractors in the US. Using aggressive marketing techniques they are claiming to treat an even wider range of self-limiting conditions such as colds and colic. One third of Americans use such unconventional treatments at a cost of $10 billion annually and one third of this cost is borne by public funds or private insurance. Dunea goes on to say: “Alternative treatments have also become popular for pets…one large dog, afraid to sleep because he had been beaten badly as a puppy, was described as taking his first afternoon nap after his spinal cord had been adjusted”.
Realigning the Spine. BMJ Vol 307 p71

An American doctor, posing as a concerned parent, surveyed 100 chiropractors and found that 80% of them would treat middle ear infections with cervical spine “adjustments”. Some 78% also sold vitamin supplements from their offices.
Chiros treating children. NCAHF Vol 16, No.6

Conductive Education

This is a treatment based on the teachings of the Peto Centre. Children suffering from cerebral palsy are treated with an intensive (and expensive) series of exercises aimed at developing alternative neurologic circuits to their paralysed limbs. These treatments have no scientific basis and a government financed controlled trial confirmed that the Peto system gives no better results than conventional treatment. There are frequent public appeals to raise money for this treatment but the money could be put to much better use by organisations such as the Crippled Children’s Society.
BMJ Vol 307 p812

Homeopathic Immunisation

Enough has already been said on the enduring myth of homeopathy. An Australian GP was rebuked for recording a homeopathic-type immunisation in a child’s health records and the Medical Defence Union said that such action makes the GP potentially liable if the child subsequently develops a serious illness such as whooping cough or measles.
NZ Doctor 11/11/93

Psychic Surgery revisited

Shirley MacLaine, the high priestess of new-age (rhymes with sewage) silliness has regained her health and happiness after visiting a Filipino psychic surgeon. In Shirl’s own words: “He inserted his hands into my body and withdrew clots of blood and internal matter of some kind, then withdrew his hands”. In defence of Woman’s Day they did add at the end of the article “Oh Really!”
Woman’s Day 31/8/93

Yin Yang Tiddle I Po

So went the song of the Goons (actually Yin tong..) making about as much sense as an article on Chinese medicine which appeared in NZ Doctor 22/7/93 entitled “Look to natural forces to maintain health”. It is written by a trained veterinarian (Massey 1980) who is now practising as a doctor of Chinese herbal medicine. If that isn’t a paradigm shift I don’t know what is! I would love to know what prompted him to change from scientifically based veterinary practice to this nonsense. The treatment of subclinical diseases is prompted by examination of the tongue and pulse. This is a wonderful scheme because all sorts of diseases can be treated and there is no way of disproving that they ever existed. “Iced food and drinks should be avoided like the plague, as these are discordant with the prevailing Qi of summer and will stress the body”.

In a child with eczema the Chinese diagnosis was “blood deficiency complicated with wind and damp. The prescription was designed to “nourish blood, expel wind, strengthen digestion, remove damp, and cool the emotions”. As I have mentioned before, Chinese herbs sometimes contain unexpected substances. A chronically ill man developed muscle wasting which proved to be due to triamcinolone (a potent steroid) contained in “herbal” tablets. Each “herbal” tablet contained 5.4 milligrams of triamcinolone.
GP Weekly 17/11/93

Japanese Herbal Medicine

Japanese doctors will soon be able to gain a degree in Japanese herbal medicine. Seventy percent of Japanese doctors already prescribe such remedies known as kampoyaku. In response to side-effects of modern drugs and a consumer sense of depersonalisation in western medicine, such remedies are now state funded to the tune of US$1.5 billion and increasing by 15% annually. Kampo is based on 4000-year-old medical texts and diagnosis depends on the skill and intuition of individual doctors. (Where have I heard that before?) Such clinical instincts have already been shown to be weak in Western medicine, eg. “only about 50% of gastroscopies, coronary artery grafts, and carotid endarterectomies could be justified by independent panels of experts”.
Viewpoint, The Lancet Vol 341, p878

It is interesting that the Japanese community sees fit to waste money in this area when they have a chronic shortage of trained anaesthetists, causing Japan to have a maternal mortality (during childbirth) twice as high as the UK. There is also a complete lack of information about crude surgical mortality rates because the large numbers of private hospitals are not required to report their operation numbers.

Their hospitals have also been struck by an epidemic of methicillin resistant staphylococcus aureus (MRSA) due to the widespread overprescribing of antibiotics (BMJ Vol 306, p740). MRSA is a nasty bacterium which becomes prevalent whenever antibiotics are prescribed either inappropriately or excessively. This epidemic occurred because doctors are paid a set price for drugs used, whereas the drug companies supply these at a discounted rate with the doctors pocketing the difference.
New life for old medicine, The Lancet Vol 342, p485; Health Research in Japan, Letter, The Lancet Vol 342 p500

The Cocaine and Guinea-pig Diet

Move over Jenny Craig! An entrepreneurial father and son have set up a weight loss clinic on the shores of Lake Titicaca, Bolivia, at 3810m above sea level. Obese guests are invited to chew a syrupy extract from coca leaves (cocaine in its crudest form!) and if that is not enough they can enjoy having their skin rubbed down with a live guinea pig. These attractions are hoped to restore the flagging tourist industry but it is bad news for the guinea pigs.
Economist August 31st 1992, p36

Generalised Chemical Sensitivity

This is a diagnosis beloved of quacks who validate essentially depressive symptoms that some patients develop after a real or imagined chemical exposure. Glutaraldehyde is a highly effective disinfectant which has good activity against both the hepatitis and HIV viruses, but can cause skin and other sensitivity. A nurse who used this chemical developed baffling symptoms and was seen by a number of specialists who are described as suggesting that “her illness may have had an `emotional’ component”. Note the implied suggestion that an emotional cause is somehow less honorable than a “real” illness.

Her most distressing symptoms were “mood swings, irritability, loss of judgement, poor concentration and short-term memory loss” which are classic depressive symptoms. She is described as being unable to enjoy a lengthy conversation without becoming exhausted. An occupational physician dogmatically stated “There’s no doubt in my mind that the chemical has affected her immune system, leading to a multi-system pathology”. He went on to decry the patient’s “degrading and demeaning experience in failing to have her condition acknowledged by specialists” and “they go away thinking it’s all in their minds”.

Here again is the implication that physical symptoms are either “real” or imaginary. As we know, symptoms are almost always real, but can be produced by anxiety or notional beliefs (somatisation, for example headaches with depression). The result is a person who is now chronically unwell and unemployed and who has received both the wrong treatment and the wrong diagnosis. Exposure to other foods and chemicals now “causes an immediate deterioration in her ability to think clearly”.

This is a classic case of somatisation and is clearly not an occupational disease. This patient’s illness has arisen from the notion that she has somehow been “poisoned” and the availability of compensation completes the process. Doctors who continue to deny the importance of psychological factors paradoxically encourage the abnormal illness behaviour while no doubt sincerely believing that they are acting in the patient’s best interests.

This whole area was briefly reviewed by NCAHF (Vol 16 No. 6) who coined the phrase “environmental anxiety disorder” and quoted research in which immunologic testing did not differentiate patients with chemical sensitivities from controls. Finally NCAHF says “the power of the imagination, operant conditioning, and practitioner influence can reinforce imaginary sensitivities”.
GP Weekly 17 Feb 93

Quackery in the US

The US National Institutes of Health Office (Alternative Medicine) has awarded nearly $1 million in research grants for topics which include: t’ai chi for balance disorders; massage for HIV-exposed babies; dance movement for cystic fibrosis patients; biofeedback for diabetics and acupuncture for depression. I predict that all of these trials will produce glowing reports of improvements, having failed to make any allowance for the placebo effect, natural disease variation and spontaneous improvement.

D is for Dog, and for Doctor

A colouring book for young patients of chiropractors says “A is for alligator and adjustment. B is for bells and for back. C is for caterpillar and for chiropractor. D is for dog and for doctor.” The latter two may have more in common than is apparent at first glance.

It is as much of a surprise to the medical profession to find that their standards of back care are under attack as it would be to a high-rise executive to be attacked through his office window by fighter planes.

The orthopaedic surgeon, secure in his strength and apparently limited in his intellect, seems ill-equipped to withstand the challenges mounted against him from a variey of paramedical platforms. The face of the enemy may be unfamiliar, but the threat to the doctor’s authority is absolutely clear. The battleground is the low back. The opposing forces clash at the point of pain.

The public has little confidence in the medical profession’s ability to diagnose or manage back pain. Recently, on my way to conduct a seminar, I took a taxi from my hotel. The driver, seeing my carousel full of slides, observed I was going to give a lecture. When I responded to his questions that my topic was back pain, he observed I must be a chiropractor.

The medical profession is justifiably under attack because the conventional medical management for back pain is often wrong.

Prolonged bedrest beyond five days is of no proven value, and admitting a patient to hospital merely to sit on him is boring for the physician and makes it difficult for the patient to breathe. Getting high on drugs seems somehow more appropriate on the street than in the clinic. The prescription of modalities, such as traction, to treat a structural spinal abnormality leads to lengthy treatment producing temporary alteration but which ends precisely where it began, with a structural spinal abnormality.

Medicine’s fascination with excessive and even unnecessary investigations proceeds towards one of two unfortunate conclusions.

The patient is told, “The results of your tests were negative. Get lost.”

Or, the surgeon is seduced into operating on an x-ray. When the radiograph, rather than the patient, demands treatment, I recommend that the surgeon content himself with the film, a view box and a pair of scissors.
Faced with this apparent lack of medical success, there is little wonder that many patients seek out alternative treatment, searching for “a backache remedy that works”.
Therapeutic touch is one such alternative. It is a non-invasive therapy utilising “the body’s own electromagnetic field” which assists the client (no longer the patient) to return to “a more balanced state of body, mind and creative spirit”. I suspect the client/patient is not the only one who is being creative.

Polarised Haemoglobin

The Magnetic Four Season Band is typical of the commercially available remedies to relieve backaches. Naturally, since over 80% of backache subsides spontaneously within three months, the Four Season Band comes with a money-back guarantee.

The advertisement also explains the Band’s mode of action to relieve back pain, namely the polarisation of haemoglobin by small magnets. I have no idea what that means, but I feel better already just knowing my haemoglobin has been polarised.

The lack of proof or scientific validity seems no deterrent to the method, and the picture is confused, as it is with so many spurious treatments, by the coincidental subsidence of pain or some unrelated additional benefit.

In the case of the Magnetic Four Season Band, for example, you might use the magnets to attach yourself to the outside of a bus and be allowed to travel for half-fare.

Skull Manipulations

Perhaps striking closer to home is the practice of craniosacral therapy. Instruction in this art form throughout North America generates an annual revenue of more than three million dollars.

The therapy is based on a philosophy expounded in 1908 by an osteopathic student, who felt that since suture lines were visible on the human skull, God had intended there to be movement. The fact that no movement can be demonstrated and that the suture lines commonly fuse over the age of 50 was, and is, considered irrelevant.

Having spent considerable time and money, and having been required to memorise, for example, the over 20 articulations at the base of the skull (none of which move) as potential sources of pathology, it is little wonder that the initiated are reluctant to dismiss the technique as a waste of time.

Furthermore, patients find it comforting to lie in a darkened room, listening to soft music and having their heads massaged. But transient relaxation does not justify a belief in the repetitive expansion and contraction of the skull every five to ten seconds, nor does it establish cranioscaral’s link, as described in one of their texts, with Phillipine psychic surgery.

And I have great difficulty in accepting craniosacral’s “Laws of the Lines of Gravity”, which state:

Man deals with himself in such a manner that his brain becomes more perfect because he arranges his lines of gravity in a different manner from any other creature. Also, the gravity lines pass through his diaphragm, and no animal has this diaphragm-gravity relationship.

I advise patients who wish to have the bones of their skull rearranged to choose their therapist carefully.

Whiplash Worries

Clearly we are on the road to confusion, and it is the patient who may become the accident victim. And what motor vehicle injury is more classic than whiplash?

Every one of us who has ever worked in an Emergency Room has treated this problem, and yet whiplash is not a diagnosis. It describes only a particular mechanism, commonly seen in rear-end collisions, which may lead to a variety of neck injuries.

The pathology after an acceleration-deceleration injury may be as simple as a minor muscle haematoma or as devastating as a cervical fracture with cord damage.

Each is a distinct entity requiring specific treatment, and the diagnosis should reflect the individual conditions — not the common physical cause.

Whiplash to the chiropractor offers a different vista. Gone is the range of diagnoses, to be replaced by the ubiquitous vertebral subluxations. Anatomical reality is replaced with a line drawing where the neck bows like a willow in the wind.

In case of accident, medical attention is not recommended, but the admonition to see a chiropractor follows immediately after advice to remain at the scene of the accident until all information has been collected, and before being instructed to notify your insurance company.

Thorough examination by a chiropractor is presented as a wise precaution to determine the presence or absence of injuries.

As an example, headaches are a current complaint after a whiplash-type injury, and according to matrial supplied by the chiropractor:

Most headaches result from spinal subluxations, in other words, malfunctioning vertebrae. These subluxations cause irritation of the delicate nerves and arteries that supply the head and face area, causing pain. Subluxed neck vertebrae can also interfere with the blood circulation to the brain.

The chiropractor’s adjustment keeps the body free of nerve interference and allows normal blood flow. This allows the body to use its own inherent healing ability to maintain a state of health.

A Blow to the Head

For minor cervicel adjustments, a chiropractor may employ the activator gun. This instrument closely resembles a dental implement which used to be used to pound an artificial crown on a tooth. A spring-loaded plunger is propelled a centimetre or so beyond the end of the barrel.

Patients are told that contact with the skin and subcutaneous tissues creates a subtle pressure wave, sufficient to restore minor subluxations without the discomfort or potential risk of a full adjustment. In Ontario, each trigger pull is worth $10.

Market Forces

In health care, as in any retail business, effective marketing means listening to consumer demands. Giving the client/patient what he or she wants is the name of the game.

When the validity of treatment is not an issue, everything from electric pain management to dietary regulation can have a place in the control of back pain. When you treat a self-limiting condition, easy access, lucid explanations, emotional support and physical contact are powerful weapons.

It should come as little surprise that most sociological studies rank the chiropractor well above the doctor in the ability to control back pain.

And where is the doctor? Has the battle been lost by default? Medical training provides little knowledge or skill to justify the restoration of public confidence.

The modern medical attitude says, “Well, Bob, it looks like a paper cut, but just to be sure, let’s do lots of tests.”

Even the doctor confronted by a patient on whose back clings a large, green monster may be reluctant to make a definite diagnosis.

Although the doctor thinks he has found the trouble, he may refuse to make a commitment until all the investigations are complete, all the while muttering under his breath about the complexity of back pain and the possibility of arthritis or cancer.

D is certainly for Dog, and seems an appropriate mark for the doctor’s attempt at back care.

The fundamentals of patient back education are too often left to junior colleagues without the depth of knowledge necessary to answer questions or the depth of experience necessary to command respect.

A concerned patient requires a clear understanding of the problem, but the lesson in consumer satisfaction so clearly demonstrated by the chiropractor is lost on the physician.

Doctors Gullible Too

Equally quick to criticise the chiropractor for non-scientific methodology, the doctor is equally vulnerable to promotions based on scant medical research — an appeal through showmanship rather than science.

Consider the cold laser. Lasers are high energy light beams which travel in perfectly straight lines. They can be used to signal satellites or to burn holes in bricks. When the energy of the beam is reduced below the combustion point there is no known effect.

Laser surgery relies on the laser’s ability to vapourise tissue. Laser therapy relies on the laser’s unseen ability to increase the energy-containing capacity of the mitochondria within the cell. There is no way to measure this!

Lasers are said to normalise Brownian movement, the random particle movement typified by dust motes in a beam of light. Since random motion is an element of quantum mechanics, and cannot be measured in the living body, there is no way this theory can be tested.

Furthermore, I find it difficult, even in a large scale model, to differentiate between normal random movement and abnormal random movement.

Finally, the laser is heralded as being able to increase the nervous system’s light-carrying capacity, or bioluminascence. This capacity, unknown to the neurophysiologists and anatomists, is well recognised by those who sell medical lasers for $10,000 apiece. Still, lighting up the nervous system has a great deal of appeal.

Having purchased my own expensive equipment, in order to keep up with the clinic across the street, I intend to treat all my joggers so that they can run safely in the dark.

Mind-Body Interaction

The back is an emotional target, and is subject to storng mind-body interaction. Dreaming he is falling, Jerry forgets the well known “always wake up before you land” rule and is flattened like a pancake in his own bed. Here is mind-body interaction in the home.

Six months of inactivity with a bad back, too much beer and too much televisio, and we have the perfect male specimen poised to return to the job. Here is mind-body interaction in the workplace.

Lack of physical stamina limits performance. Strength requires exercise. The willingness to actively participate in the recovery process is a positive mind-body interaction.

Using exercise to control back pain is not a new idea. One manual published in the 1920s pictures the author, complete with bow tie, demonstrating his own routines.

But modern medicine’s love of technology threatens to make even this simple idea unmanageably complex. A bride in her wedding gown standing next to a computerised exercise machine smiles out from a glossy advertisement and exclaims, “Superb! I passed my dorsal stress test. Have you?” I haven’t the faintest idea what she is talking about. I think I prefer the man in the bow tie.

Active, Healthy Machines

Given the choice, of course, many of the doctor’s patients also prefer technology to exercise. One case in point is the passive exercise studio, where you can assure yourself of a healthy, attractive body, painlessly, without perspiration, without the discomfort of strained muscle and bruised joints, and never be out of breath.

The answer, of course, is the machines do all the work. An electric table folds in the middle, helping you with your sit-ups. After a busy day at the clinic, the machines are in great shape.

The same appeal possessed by passive exercise motivates many patients to visit the chiropractor. It is far easier to let something or someone else do the work and take the responsibility than to take charge of your own problems. But chiropractic is not unique in its emphasis on passive techniques. Nor is it alone in its apparent disregard for anatomical considerations.

Manual therapy, performed by a broad spectrum of experts, remains shrouded in folklore and mystery. Thoracic manipulation, as a means of moving the thoracic vertebrae independently, disregards the intervening skin, fat and muscle present in the average living patient.

This same disregard for proven functional anatomy appears in the descriptions of the neurolymphatic reflexes. For example, symptoms of conjunctivitis (an eye complaint) may be treated with pressure on the appropriate reflex location, the upper humerus at the deltoid insertion (arm-shoulder connection).

As surprising as this sounds at first, it is in fact one of the better recognised non-anatomical connections. The next time you meet someone whose eyes are red and bleary from a previous evening’s party, punch her or him sharply over the outer shoulder and watch the eyes fly open. You have just demonstrated a neurolymphatic reflex.

Fallacious anatomy can be used to justify massage or manipulation which brings only temporary pain relief, and yet the patient’s comfort may be enhanced through the erroneous belief that some structural malalignment has been correxted. But when applied in a more sinister fashion, anatomical misinformation can create unwarranted fear and justify the continuation of unnecessary treatment.

Anatomical Misinformation

Dozens of medical conditions are purported to arise because of minor vertebral malalignments. The anatomy seems reasonable, the terms sound familiar, and the medical problems are easily recognised, and yet something is amiss. To accept the diagnosis you must believe. But there are several conflicting belief systems at work in the realm of back pain.

Where better to indoctrinate the true believer than in childhood. Convincing new parents that their infant’s spine requires manipulation to ensure normal growth not only increases current practice, but fosters the child’s lifelong adherence to the principle. “Bring your children for an adjustment. Teach them the benefits of chiropractic.”

Without the knowledge that most back attacks subside spontaneously within 12 weeks, that back pain is a self-limiting condition, and that most back disorders can be controlled through simple measures of self- help, a chiropractic schedule of adjustments outlining intensive care for 13 weeks, reconstructive care for two to two and a half years, and maintenance care for a lifetime seems almost reasonable.

Dependency a Problem

Dependency can be a serious problem, but patients readily accept the idea that their back can somehow be straightened, pressed and cleaned in time for them to pick it up before the shop closes. Passive acquiescence and dependency are the antithesis of active participation and self control.

For those who allow back pain to dominate their lives, the statistics paint an ominous picture. Anyone remaining off work with a bad back for more than six months has only a 50% chance of returning to work on a regular, full-time basis.

Remain off the job for a year, and the chance falls to 25%.

Remain unemployed because of a bad back for two years, and there is virtually no statistical probability that you will ever return to your previous employment in a regular productive capacity.

It is the doctors, far more than the chiropractors, who have been guilty of creating dependency. It is little wonder that many patients will use more than the “apple a day” to keep the doctor away from their backs. The medical profession possesses the potential to eliminate back pain as a major socio-economic problem, but we have yet to demonstrate our understanding of the solution.

Too many meetings, too many publications, and too much time and effort are addressed to the perfect surgical solution while neglecting the simple fundamentals of intelligent and effective back care.

Patients need a simple answer to what can be a simple problem. Most need support, not surgery. They need a platform from which they can achieve their own success.

Joint Responsibility

This is not a popular message. There are too many vested interests and too many strongly held differences of opinion to gain consensus. But whether we like it or not, the battle has been joined and will continue. Both the doctor and the chiropractor have a responsibility to promote better back care.

No longer can the physician place unwarranted emphasis on investigative procedures and invasive therapies.

No longer can the chiropractor hide behind non-diagnoses like “concomitant intervertabral subluxation complexes,” nor report that “the form of treatment given is chiropractic care”.

No longer can the physical therapist be allowed to treat patients solely with modalities possessing no proven therapeutic value, providing temporary pain relief at the risk of long-term dependency.

Dr Hill presented this at a conference of the NZ Society of Physiotherapists.

Once When My Back Was Crook

I was struggling with the vacuum hose to reach an awkward corner of the kitchen.

“What’s wrong? Afraid to bend your back?” my wife asked. I felt a little pain and it didn’t go away. It got worse, seemed to improve for a day, stayed barely tolerable for a week, and then became intense.

It spread, and by the following weekend I was virtually immobile — unable to roll over in bed, racked with unbearable pain every time I moved. I finally phoned Skeptic Barrie Tait, who agreed to see me the next morning. My panic was dictated by an important conference I had to attend on Monday morning in Wellington. Things were looking bleak.

Dr Tait was the soul of courtesy and good-humoured professionalism. He’s the head of Musculoskeletal Medicine at Christchurch Hospital. I bragged about that. People always want to convince everyone — especially themselves — that their doctor is a genius.

Finally, after a gentle, thorough and obviously expert examination, Barrie took the crucial first step on the road to my recovery — he gave my disease a name.

“It’s lumbar dysfunction,” he said with quiet authority. I tried to translate from the Latin and kept coming up with something that seemed to mean “back not working too well.” What could he do for it, I asked eagerly.

“Nothing,” he said. Take pain killers and anti-inflammatories and your back will gradually heal itself. There was no specific medicine or treatment. I should go ahead and walk as much as possible.

Which is what I did. I stopped by the chemist and, by the time I was limping up to Victoria University things were improving. As the hours wore on, my back got better and better, and at home later that evening I was virtually able to turn cartwheels. The pain was gone. After over two weeks of agony, my tortured back was miraculously “cured”.

Over the years, the Skeptics have been relatively unsuccessful in altering the general public credulousness toward alternative medicine. In light of my experience, it’s not hard to see why.

What if Barrie had twirled a pendulum over me, said a mantra, given me chiropractic manipulation, a homeopathic preparation, or analysed my irises? And what if — like most desperate, pain-wracked patients — I’d wanted to believe it?

Barrie would have had a convert for life. The psychological evidence of my spectacular “cure”, coming as it did after weeks of suffering, was overwhelming. Who cares what the Skeptics think about alternative medicine when sufferers are similarly “cured” on a daily basis by chiropractors and other healers?

And it’s not just back pain that has spontaneous remission, but countless other afflictions. This — combined with the fact that people want to believe in their healer, orthodox or quack — means there will always be an army of satisfied customers ready to testify that some placebo cured them after all the marvels of scientific medicine had failed.

Having said all that, and accepting it at a rational level, I still in my heart believe Barrie Tait is a medical genius. I can’t help it. You see, once when my back was crook…