The Dangerous Truth Behind Cooked Food

Brevity is not one of my strengths. For this reason, what often begins as a minor correction or a response to a question in the comments section often becomes its own blog post (the character limits imposed by various blogging platforms also plays a role).

This is a follow-up to a post from several months ago, in which I discuss the shortcomings of an article from the hilarious The Not-So-Dangerous Truth Behind Microwaves. Here, I respond to some criticism that I received.

This blog is no more an authority than the ones you mocked.


Seriously, that’s great! I’m just some beardy dude who likes science and occasionally has the opportunity to do science, but my specialty is in artificial intelligence (although recently I’ve been helping out with research in robotics and psychology). I make no claim to either authority (something that’s pretty much worthless in matters of science) or expertise (something that’s a little more relevant) in this (or any) subject. I’m trying to instill in people an appreciation for science and critical thinking generally. If you think that I want people to consider me an authority on matters scientific in any domain, either I’m not getting a properly skeptical message across (certainly debatable) or you’re not paying attention.

Firstly, lets define “harmful”: carcinogens are harmful…


…as well as, destroying phytonutrients that the body needs to sustain itself and strengthen defenses.

I do not grant that the reduction of phytochemicals in food is harmful. Stipulating that the compounds in question are healthful, it does not stand to reason that reducing the phytochemical content of a given food is harmful unless it is also established that the subject has a deficiency.

To illustrate by example: I would not consider a carton of pasteurized orange juice to be “harmful” (although its high sugar content may be problemmatic for some), despite the fact that the pasteurization process destroys much of the vitamin C content in the juice (and not all manufacterers add supplemental vitamin C to their juices)—unless, of course, the person consuming the product were deficient in vitamin C and counting on the orange juice in this regard.

Returning to the point about carcinogenicity, I’ll remind the commenter that many common methods of cooking are implicated as cancer-causing, to some degree or other, including pan-frying, grilling, or barbecuing meat (source), smoking meats, roasting coffee beans, or even cooking with vegetable oils (source), or simply heating carbohydrate-rich food by means other than boiling (source).

This is complicated by the fact that several foods contain both compounds found to be carcinogenic and anticarcinogenic compounds.

What’s worse, these phenomena are much better established both epidemeologically and from a basic science standpoint than the carcinogenicity of some microwaved foods. So why the outcry over microwaves? If I had to hazard a guess, I’d say it’s because they’re scary and new and complicated, and people tend to distrust things that they don’t understand. Luckily, I’m under no obligation to hazard such a guess, so I won’t.

Name the evidence that would be good enough to convince you there is “proof”?

The word “proof” is in scare quotes, as though to imply I’m asking for proof. I’m not. Science doesn’t deal in “proofs”: it deals in evidence, and no level of evidence constitutes “proof” in any sense but the colloquial.

But here’s what I think would qualify as good evidence that microwaved foods are harmfully carcinogenic (for example): Replicable (and replicated), peer-reviewed studies establishing from a basic science standpoint that carcinogenic compounds are formed in foods heated or cooked in microwave ovens (and that these compounds are not formed in foods heated by other conventional methods), followed by epidemiological studies showing both statistically and clinically significant correlations between microwave use and cancer incidence.

That’s a lot to ask for, of course, but I’d be happy to give my provisional assent to the proposition if it looks like a consensus is forming in the literature. It would also help if the IARC recognised microwaved foodstuffs as even potentially carcinogenic (Group 2B); but, as it stands, microwaved foods don’t even make the list of things that the IARC can’t rule out.

Is it possible that some foods are less nutritious when microwaved? Of course! I’d say that it’s likely! But the same could be said for boiling, for frying, or for just about any other method of cooking, depending on the food.

Is it possible that some foods are carcinogenic when microwaved? Again, of course! But let’s look at the specifics, and let’s not forget (while we make sweeping generalizations), that the same is also already well established for many popular methods of cooking.

Do these admissions run contrary to my previous article on the safety of microwaves? Hardly. Even if it were (somehow) conclusively “proven” that microwaved food was harmful, that would not make the article I was critiquing “true” in any meaningful sense!

As I’ve said several times now, my problem with the original article had nothing to do with its conclusions and everything to do with the fact that it put ideology first and evidence second. It was horrendously sourced, made sweeping generalizations, got the basic science wrong, and cited as sources sites that were (to put it very mildly) disreputable and dishonest.

The Not-So-Dangerous Truth Behind Microwaves

I received the following message the other day from a close friend of mine.


I saw this and for a moment was terrified until I remembered that I’m friends with YOU and therefore a much more rational person than I might otherwise be just by sheer proximity. Regardless, please remind me again that microwaves aren’t destroying my baby and various loved ones.

The link she provided was The Dangerous Truth Behind Microwaves by Mike Barrett of Ah, EMF scare-mongering. It’s been too long, old friend!

I didn’t have much planned for the next few minutes (aside from playing some Super Meat Boy), so I dove right in.

The article is, as you might expect, riddled with misinformation. That misinformation, however, is crammed cheek-by-jowl with accurate statements, leading me to suspect that the author is guilty only of sloppy research, and readily accepted claims from both scientific and unscientific sources—with perhaps a modicum of cherry-picking thrown in. (This is borne out upon an examination of his source list, but we’ll get to that later.)

How Microwaves Work

Let’s start with the author’s description of the process by which microwave ovens heat food:

In order for something to heat in a microwave oven, water must be present within the substance. If water is not present, heating will not occur and it would remain cool. The reason for this is that water molecules within the food vibrate at an incredible speed, creating molecular friction which is responsible for the heating of the food. The structure of the water molecules are torn apart and vigorously deformed. This is much different than any other method of cooking, as other methods such as convection ovens heat up food by transferring heat convectionally from the outside inward.

This description is almost correct, but is guilty of much hyperbole. First of all, it is not true that, lacking water, heating will not occur. What we’re talking about is dielectric heating. While it’s true that dielectric heating works best on water or substances containing water, it will also work on fats, sugars, and anything that contains electric dipoles.

Second, while stating that “the structure of the water molecules are torn apart and vigorously deformed” sounds scary, I’ve been unable to find any evidence that this occurs, and it’s unclear what the dangers would be even if it did. While the molecules certainly do increase in kinetic energy (they move), the author seems to be suggesting that the molecular bonds are actually broken, which would cause the water to decompose into its component hydrogen and oxygen, as occurs in electrolysis. This is a fairly incredible claim that I’ve been unable to substantiate.

The Dangers of Radiation

The author admits that microwaves are not a form of ionizing radiation, although he stresses that non-ionizing radiation can still effect physical alterations. Sure! Like cooking stuff! He then says:

Other forms of ionizing radiation are visible light, ultraviolet and infrared waves, and waves emitted from televisions, cell phones, and electric blankets.

This is completely false. These are forms of non-ionizing radiation. While it is certainly possible that this was simply a typo, it remains irresponsible misinformation.

And then the real absurdity begins:

Although we’ve conducted study after study concluding that no amount of radiation is safe, we don’t really know what all of this means in the long term.

I’m not even sure the author knows what he means, here. He seems to be conflating all forms of radiation, and then stating that the body of scientific literature on the subject concludes that there is no safe amount of any form of radiation.

Of course some amount of radiation is safe! If there were no radiation, we would be blind and we would freeze to death! Just lumping all spectra of electromagnetic radiation together is eggregious, irresponsible nonsense.

The author claims that “Tissues directly exposed to microwaves are subject to the same deformities molecules go through”. This is very misleading.

Sure, microwave radiation can cause burns: that’s why microwave ovens have doors on them specifically designed to block microwave radiation. You don’t want to bathe your hand in high intensity microwaves for the same reason that you don’t want to stick it in a campfire: it’ll burn.

Now you might be worrying that your microwave door could be broken or cracked, and you’re being exposed to dangerous invisible microwaves without your knowledge! Well, stop fretting. If this were happening, you’d know it pretty quickly, because the microwaves would literally be cooking your flesh, and that’s something that we humans tend to notice.

Remember: microwaves are non-ionizing. They don’t cause cancer: they cause heat.

“Microwave Sickness”

The author of the article then provides a laundry-list of nonspecific symptoms that he attributes to so-called “microwave sickness”:

  • Impaired cognition
  • Nausea
  • Vision problems
  • Depression and irritability
  • Weakened immune system
  • Headaches
  • Dizziness
  • Insomnia and/or sleep disturbances
  • Frequent urination and extreme thirst

Sound familiar?

This so-called “microwave sickness” is just a repackaging of electrosensitivity syndrome, a discredited (and probably psychogenic) disorder that has been shown in controlled trials to no correlation (let alone a causal relationship) to EMF exposure.

Here’s the list of symptoms attributed to electrosensitivity:

  • Fatigue and mental impairment
  • Poor memory and reduced concentration
  • Headache
  • Altered sleep pattern
  • Skin rash

And here are some of the (many, many) symptoms linked to so-called adrenal fatigue:

  • Excessive fatigue and exhaustion, chronic fatigue
  • Sleep disturbance, insomnia
  • Sensitivity to light
  • Difficulty concentrating, brain fog
  • Low immune function
  • Low blood pressure
  • Sensitivity to cold or frequent influenza
  • Anxiety, irritability, or depression
  • Reduced memory

Dr. Steven Novella calls these “the common symptoms of life”. Talking about this purported adrenal fatigue, Dr. Novella notes:

Some of these people may have a real underlying disease, and can get distracted from pursuing a proper diagnosis by the offer of a simple fake one. Many people need lifestyle adjustments, and that is where they should focus their efforts – not on magic supplements to treat nonexistent syndromes.

And finally, just for fun, here are the purported symptoms of being attacked by a psychic vampire:

  • Leaky or diminishing aura
  • Dizziness
  • Loss of energy
  • Muscle tension
  • Mental confusion
  • Headaches
  • Chronic fatigue
  • Sleep disturbances
  • Irritability
  • Depressed mood
  • Physical illness

I’m convinced.

And while we’re on the subject…

It’s true that mobile phones, WiFi, etc. use radio waves in the microwave spectrum, but they are hilariously low-intensity. One of the ways that you can tell is that even the tiny bit of radiation that leaks out of a microwave oven is enough to interfere with wireless router traffic: and, as I said earlier, that’s obviously not enough to do any damage.

Cell phones and WiFi, and their related impact on health, are heavily scrutinized, and there is no strong or even middling evidence linking these devices to health problems such as cancer. There are a small number of studies by a few fringe researchers which have failed reproduction by the scientific community. Many of these experiments have startling methodological flaws. Dr. Steven Novella has a great summary of some new research on the subject here.

Also worth noting: any case or covering that purports to block the EMF emitted by cell phones, laptops, etc. (and such devices are popular!) will fall into one of two categories: (1) it won’t do anything; or (2) it will work, and your cell phone/WiFi will immediately stop working, because its signal is blocked.

So… keep that in mind.

The Nazi Connection

And this is where the author of this article really jumps the shark:

Microwaves were first invented by the Nazis in order to provide a method of cooking for their troops during World War II.

Godwin always makes me laugh. Also, I can find no evidence that microwaves were invented by the Nazis, and substantial evidence to the contrary.

The Sources

The author of this article has obviously taken no care in choosing his sources, which all seem to share strong (and fairly transparent) ideological convictions that bias them against good science. They are also uniformly hilarious.

Here are the websites linked to in the “Sources” section at the bottom of the article:

  • Relfe: “Valuable natural health, mind, spirit, financial and other information unifying the whole, rather than just educating a part of the whole.” The main page contains multiple embedded Alex Jones videos, which describe in detail exactly how the government and the scientific establishment are trying to kill you.
  • The Library of Halexandria: “Halexandria is a Synthesis of new physics, sacred geometry, ancient and modern history, multiple universes & realities, consciousness, the Ha Qabala and ORME, extraterrestrials, corporate rule and politics, law, order and entropy, trial by jury, astronomy, monetary policy, scientific anomalies, religion and spirituality, and a whole host of other subjects ranging from astrology and astrophysics to superstrings and sonoluminesence to biblical and geologic histories to numerology, the Tarot, and creating your own reality.” Need I say more?
  • Lita Lee: The website of “nutritionist” (and Ph.D. chemist) Lita Lee. She would love to sell you all sorts of herbal concoctions, so why not mosey on over?
  • Global Healing Center: An online pharmacy! Except it only seems to stock those shady end-cap items that cause pharmacists to hang their heads in embarrassment, saying “We don’t decide what to stock, it comes from corporate.” Lots of cleanses and detoxifying foot pads!
  • Natural Society: This site seems to be the evil twin of Skeptic North.

And here is a list of the peer-reviewed literature cited by the author:

That is all.

Yes, being a skeptic is fulfilling. Really!

The following is a guest post from Jeffrey Olsson, former Anglican priest and current president of the Humanist Association of Manitoba. Jeff can be found at the Leave Faith Behind blog, and his book is available on Amazon.

Here, Jeff responds to some criticism that his last post received from David Driedger. Before you read on, I recommend reading Jeff’s previous post, Top Ten Reasons Why Being a Skeptic is Fulfilling, and Mr. Driedger’s response to it, A skeptical rant.

Why should it surprise anyone that a skeptic can be happy and fulfilled, let alone that there would be more than ten reasons why skeptics are happy? Hell, I only chose the top ten reasons because I didn’t want to bore anyone by blathering on with the zillions of others. It should also come as no surprise to anyone that people of any different belief set or culture can be fulfilled and happy, well adjusted and socially connected. After all, Skeptics are real people, not the simple caricature that others would demand we are. We have hopes and dreams, families and friends. All of which are totally common to most of mankind. Why would you find it a surprise that skeptics would talk about this? Why would you call it “unhealthy”?

The blog post was not meant to be prescriptive, and it is not. Skeptics do not operate by edict as you apparently do. We think things through and decide if we disagree or not. The post merely recognizes what modern skeptics all over the world are saying. The top ten blog post was written by a skeptic for skeptics. The only surprise to me was that a liberal Christian popped in for a chat. So let’s chat.

Anyone can criticize the modern skeptical movement, we make mistakes and are open to correction, but I highly suggest any critic attend a conference, seminar or venue where skeptics meet. Sit and listen to the rhetoric, logic, values (hopes and dreams) and you will quickly see that we are indeed a happy group of people. If you lack evidence that skeptics are fulfilled by their endeavor look to the size of the recent national and regional conferences in Europe, Canada, USA and Australia and ask yourself “Why do they return in increasing numbers year after year?” The answer is obvious, “Because it’s fun!” (Can I get a skeptical AMEN!)

Now, let me directly answer a few of your concerns.

You wrote: “Okay I will grant the how we got here but who we are and how to improve our lot, really?”

What we are: We are an evolved species. An overwhelming accumulation of evidence shows how we got here; right from the big bang through to evolution, (as you seem to agree) but it also shows who we are in the context of what we are. I’ll explain further.

There is no tangible evidence for dualism, so answering who we are must be possible by looking to the empirical evidence that comes from the sciences of neuropsychology, sociology, evolutionary psychology, biology and anthropology, to name a few. There is no need for supernatural claims to answer that question. For example, we already know that various human cultures differ greatly but further evidence shows us there are many common factors that make us who we are, including our all too human abilities/traits such as, moral reasoning, empathy, logic, extraversion/introversion, sociability, disposition and neuroticism, humour, and anger. I assert that “who we are” must be definable in the context of a material existence. To define who humans are using a supernatural framework is to exceed the evidence available at this time. J. Anderson Thomson defined this well when he said “We are risen apes, not fallen angels.” If you doubt science has already defined who we are you need only look to the reams of evidence available at any secular university in the western world.

To improve our lot: Skepticism, and in particular, applied and theoretical scientific skepticism, has done more to improve our lot in this world than any other undertaking known to man, including all religions combined. Next time you have an infectious disease I suggest you drop the pretense and admit that you already know to visit a doctor who practices western medicine. If you car won’t start you already know to have it towed to a shop that uses modern diagnostic tools and methods. (neither rolling the bones nor prayer will make it start). All of this scientific knowledge comes from those giants who stood before us and dared to dream about better ways of doing things and better ways of living.

Here are just a few of the greatest scientific advances that have made it possible to live as long and as well as we now do: The germ theory of disease transmission, disease vector epidemiology, nutrition, potable water, penicillin, x-rays, rocket science, evolution and much more. Studies show that when asked, parents display an overwhelming consensus, and will tell you that they hope their children have a safe healthy and long life. Science has shown it is uniquely qualified to achieve that goal. Therefore hope is a term that now has a secular meaning. For many people, skeptics included, we cannot imagine a better world without science and technology in it. Four centuries of the enlightenment through skeptical inquiry have paid off big time.

You also asked, “How does a willingness to change make anyone better? There is simply no relationship here.” I know many skeptics who have renounced their former dislike/hatred of homosexuals because they now find it possible to doubt the writings of Saint Paul and because of the overwhelming scientific evidence that shows homosexuals are just like the rest of us, and not like criminals and murderers as St. Paul says. I also know many non skeptics who change their diet when evidence is presented showing that they should be getting more of this or that in their diet. Willingness to change ones beliefs (and habits) when presented with contrary evidence is a virtue. Yes, I said it is a virtue. Nowhere in religion have I found an edict that states, “question everything” or “learn and adapt” or “plan, do, check, act”.

With regard to my “laughable” description of a skeptic cheering when the truth is discovered. I remember working with a team of colleagues performing tests on a synchronous governing system for many long nights while we were trying to restore it to service. We were confounded by its inability to control the speed of the machine it was connected to. When we went back to the office we looked at our drawings and each of us developed a hypothesis of why it would not work and then defined the tests we would use determine the fault. When one of my colleagues finally took her turn to run a test she removed and replaced a linkage that transmitted a signal from a compensating dashpot that we later discovered had been installed upside down. The unit immediately began to do its job. Everyone cheered. The only comments made by ALL of those whose hypotheses were proven wrong were, “Mark the lever so we will never have this problem again”, “Update the manuals”. No one else cared that their hypotheses were wrong, they only cared that they now knew the truth. (A one degree difference on the angle of the linkage would upset the whole machine.) We made sure we documented both the symptoms and the solution and moved on to solve other issues with that system.

And so it is with most skeptics who are applying the scientific method in a whole variety of ways. These are people who are trying to make a difference in some way. When someone comes along and finds a solution we all cheer, because we are often working towards a common solution with a group of others.

Please, laugh at that if it pleases you. Go ahead.

Regarding your reference to “strands of Pentecostalism” I consider such a silly statement ill tempered.

Perhaps you were having a bad day when you wrote your response.

Potent Nonsense

Cross-posted from Startled Disbelief.

Pseudoscience has teamed up with erectile dysfunction to wipe several species of rhinoceros off the face of the earth.

A dead Javan rhinoceros. Public domain image courtesy of Wikipedia.

From the Telegraph:

The International Union for Conservation of Nature, which publishes an annual ‘red list’ of endangered species, said the Western Black Rhino could soon be joined by the Northern White Rhino of central Africa which is “possibly extinct” and the Javan Rhino which is “probably extinct.” Though overall numbers of black and white rhinos have increased, the three subspecies are particularly vulnerable owing to a lack of political will in their habitats and poachers who target their valuable horns which are used in Asian medicine.

When this article first appeared, I linked to it on Facebook, with the title, “Fuck you, Traditional Chinese Medicine.”

An acquaintance from my dinner theatre days (with whom I’ve always been on friendly terms) took umbrage. What follows is a transcript of the short discussion that ensued.

Brandi: The sad part is, western medicine and antibiotics kill and harm ALOT more animals than chinese medicine will ever do. And to add to that, western medicine also kills human beings. Just a way of looking at the other side of things!

Gem: Good to know where you stand on the whole real medicine versus fake medicine thing.

Brandi: Lol my comment was not meant to be offensive or opinionated but rather to shine a light on the subject. Facebook is tough for that!! I do not agree with senseless killings. People could argue for days about what medicine is real and what medicine is fake but the key is education and as I mentioned, there are certainly outs to allopathic medicine as much as anything else. I always say, you bring me your research and I’ll do the same! Only then can one really get into it;)

Gem: Bring you what research? I don’t do medical research, and I’m not qualified to evaluate it. Luckily, we have physicians and medical researchers whose expertise lies in just those areas. I’m certainly always interested in learning more about so-called “alternative” medical practices, [but] citing a positive study or two is unlikely to persuade me of efficacy, because cherry-picking is rampant in the alt-med community and I understand what a p-value is and I recognise that we expect the occasional false-positive. Not only that, but alt-med studies tend to be poorly blinded and controlled. I suggest that if you’re interested in learning more about science-based medicine, you visit

The fact that you use the absurd and discredited term “allopathic” to describe modern scientific medicine illustrates your biases on the subject. This pejorative term was coined by arch-quack Samuel Hahnemann to distinguish the (in many ways prescientific) medicine of his day from his new (and absurd) “homeopathy”. (For more on the subject of homeopathy, feel free to read this: Hahneman asserted that allopathic interventions were those that treated the symptoms, rather than the cause, of the disease. Most science-based medical treatments today do not conform to this definition, because they either seek to prevent illness or they remove the cause of an illness by acting on the etiology of disease.

Occasionally, remedies that were once labelled “alternative” are integrated into science-based medicine—but this should happen only after a large body of medical research has demonstrated that the intervention is effective to a reasonable degree of certainty. And it’s always important to consider each study in the context of the entire body of the medical literature. To quote the wonderful comedian/musician Tim Minchin, “By definition … alternative medicine … has either not been proved to work, or has been proved not to work. You know what they call alternative medicine that’s been proved to work? Medicine.”

Brandi: Lol clearly you have decided to take this much further than it needs to go:) There are plenty of scientific studies to support every field of medicine. I understand how to read them and I can tell you by the abstract alone whether it’s even worth reading the entire study, or if it’s a waste of time:) It’s nice to see you take an interest in the subject as well, hopefully you didn’t need to fork out the thousands of dollars that I did for the education:) I would like to say that using words like “absurd” to color what I have said, clearly states you are not up for the open minded discussion that I was after. I’m always interested in facts and any science to back them up, however I’ve also learned that it’s really not about a cold competition when there are so many things to learn on all sides. I’m sorry to have sparked such a battle, that was not my intention, clearly it’s not something you take lightly. Nor do I:) So let’s leave it here? If we ever run into each other I think the topic would make for some good conversation!!! Hope you are doing well and kudos on the Clue (party?) that was awesome! Was that for Halloween? And who’s idea was it? Good stuff!!!!

Scott: ‎”western Medicine” aka scientifically-shown-to-work-medicine is backed my empiracal evidence. If Chinese medicine doesn’t kill people directly it’s probably because it doesn’t actually do anything, so it would kill people directly in the fact that whatever health issue the person has isnt actually being treated.

Scott: Either a treatment has.

Gem: I’m not being “closed-minded” or dogmatic about this, Brandi. I will gladly change my mind about any given intervention when large, reproducible, randomized, well-controlled studies can consistently demonstrate efficacy. That’s called being intellectually honest.

And if you don’t consider homeopathy absurd, I would wager that either (a) you don’t know anything about it or (b) you have some sort of vested interest in it. It is mathematically hilarious and the body of the medical literature demonstrates that it works no better than placebo.

Gem: Brandi seems to have deleted all of her comments. Interesting.

You’ll note that I ignored her offer to move the discussion on to a more friendly subject, which I’d imagine was what prompted her to stop responding and delete all of her comments. And fair enough; she doesn’t owe me a response! But I think that this is a very important subject, and I was unwilling to be derailed.

Scott later pointed out to me that not only does she work at a health food store (that’s fine, I suppose), she’s also attending the Canadian School of Natural Nutrition. As I’m married to a Registered Dietitian (you know, one of those science-based nutritional experts) and I’m a nutritionist myself (not that that means anything) I find quack colleges such as these distasteful.

And yes, in case you’re wondering, that’s the same Scott who blogs for the Winnipeg Skeptics and who co-hosts our new podcast, Life, the Universe, and Everything Else (Facebook, iTunes).

Luckily, I still had the comment thread open on one of my other computers when Brandi deleted her comments, so the discussion is preserved here, in case there’s anything to be learned from it.

The bottom line is that these animals almost certainly would not be dead if it weren’t for the idiotic notion that rhino horns (and other phallic objects) can aid those suffering from erectile dysfunction. Even if it were true (it’s not!), it would still be horribly unethical to kill these animals for their horns.

The Token Skeptics Strike Again!

The following email appeared in my inbox, yesterday.

Hi Gem,

University of Winnipeg’s newspaper The Uniter is putting together a piece on the legitimacy of chiropractic. As critics of alternate medicine, we would love to speak to a member of the Winnipeg Skeptics on the topic.

The interview can be done over the phone or via email. Unfortunately, I will be leaving town Thursday morning so the interview would have to be done tomorrow evening at the very latest.

Please let me know if someone is available to talk.

Chris Hunter, The Uniter

I’ve discussed chiropractic before; several times, in fact. This is also not the first time that the Winnipeg Skeptics have been invited to comment on a story by the Uniter: Ashlyn and I were interviewed last year for a piece about Winnipeg’s Creation Museum. (I was initially displeased with that piece, but upon further reflection I understand the constraints under which the author was working.)

I put Chris in contact with Richelle McCullough, a medical student who has extensive biomedical research experience. Chris also asked us both to answer a few questions, and we obliged him.

Elementi di anatomia, by Francesco Bertinatti and Mecco Leone. Public domain image courtesy of Wikimedia Commons.

Do medical professionals (doctors) ever tell their patients to visit chiropractors?

Richelle: Referrals are up to the individual physician and I’m sure it happens. Certainly, most insurance companies require a physician’s prescription in order to reimburse expenses, so I would guess that many referrals happen by patient request.

Gem: I’m sure that many do. When it comes to so-called “alternative” medicine, many physicians are what Dr. Steven Novella calls “shruggies”: they are unaware of or disinterested in any alternative modality that does not directly affect their area of expertise. Many doctors also (erroneously) assume that while alternative medicine is mostly ineffective, it is also harmless.

From a medical standpoint, is there any reason to see a chiropractor?

Richelle: There are no good studies that definitively show any benefit to chiropractic above that which is already included in medical sciences, and it’s usually worse.The only thing that chiropractic appears to help is lower back pain. A meta-analysis of all the high quality trials assessing chiropractic for lower back pain was published earlier this year in Spine, and it concluded that chiropractic seemed to be as good as physiotherapy for the treatment of lower back pain, but neither were particularly effective. The paper included studies published in the British Medical Journal and the New England Journal of Medicine – big journals with rigorous standards. Pain is subjective and particularly prone to things like regression to the mean and the placebo effect. Nobody really knows how to effectively treat back pain, and I suspect that even the benefits seen with physiotherapy and chiropractic would disappear given more rigorous controls for medical attention and patient belief that the treatment will help.

Of course, there are many sects of chiropractors, and those who base their treatments on scientific thinking are in the minority. Chiropractic work is founded on vitalistic concepts and the assumption that the alignment of the spine somehow alters the flow of unmeasurable “energy” from the brain to the periphery. This sort of thinking has lead to all sorts of ridiculous claims, from the ability to cure asthma to a treatment for depression. We now know what causes asthma, and it has nothing to do with your spinal alignment. If “subluxations” caused all these health problems, then why do people never suddenly develop allergies or psoriasis after a back injury? Chiropractic treatment for things that have nothing to do with your spine might have short term benefits due to the placebo effect, but ultimately do nothing to treat the underlying disease.

It is ironic that CAM practitioners so often accuse medicine of not treating the root of the problems, and yet advocate spinal manipulation for things like stomach ulcers, which have a demonstrable bacterial cause that can only be effectively treated by a regimen of antibiotics. It’s also interesting to note that they claim to treat very subjective diseases with a natural history of an ebb and flow of symptoms. Some days, asthma may be worse than others, and a paper published in the New England Journal of Medicine earlier this month demonstrated that although any treatment which involved seeing a practitioner made the patients feel better, only drug administration actually improved their ability to breathe. Making the patient feel better is an important part of medicine, but needs to be combined with demonstrable, quantitative improvement of the underlying illness as well. Chiropractic might fulfill the first goal, but certainly not the second outside of the natural ebb and flow of the illness.

Gem: Perhaps, but I’m not convinced.

Chiropractic began as a vitalistic philosophy which posited that health is related to the flow of a spiritual energy called “innate intelligence”. While this energy has never been demonstrated to exist, the founder of chiropractic claimed that interruptions or disturbances in its flow (called “vertebral subluxations”) were the root of all disease. While some chiropractors (sometimes called “reforms”) have moved beyond subluxation theory and take an evidence-based approach dealing primarily with back pain, many chiropractors still claim to treat a host of diseases for which there is no evidence that chiropractic is effective, and considerable evidence that it is not. (Examples include asthma, allergies, and even infections.)

It’s safe to say that if your complaint is not musculoskeletal in nature, chiropractic is likely to be useless. Recent systematic reviews have shown that evidence for chiropractic efficacy for lower back pain is equivocal at best. Of course, all such conclusions are provisional and subject to revision should the state of the evidence change.

Are there serious risks associated with neck adjustments or other chiropractic treatments?

Richelle: There have been several high profile cases in which individuals have died or had strokes after neck manipulation, including a class action lawsuit out of Edmonton after a woman was paralyzed. The arteries which run along the vertebrae in the neck can be dramatically kinked, or even torn during something as simple as turning your head too rapidly, let alone during a sudden jerk from a chiropractor. Risks range from sudden death to stroke up to a few days later, when the clot becomes dislodged and travels to the brain. It’s unlikely that this is a case of mere correlation, since a 2001 study by Rothwell and others found that people under 45 presenting to the hospital with stroke were five times more likely than controls to have seen a chiropractor within the week. It certainly seems to be a very real risk.

There’s also the risk of misinformation. For example, many chiropractors actively promote anti-vaccine sentiments under the guise of informing their patients, instead encouraging them to use chiropractic to “boost their immune system.” The lack of information being spread about vaccines in recent years has resulted in new outbreaks of measles, rubella, and other completely preventable diseases. There’s currently a measles outbreak going on in Minnesota, and unvaccinated two toddlers are in critical condition. Side effects from vaccines are extraordinarily rare, and the consequences of an outbreak can be devastating, even lethal. There is no such thing as boosting the immune system – it’s a completely meaningless phrase with no basis in physiology or biochemistry. Vaccines work by preparing the body to deal with a very specific kind of invader. No amount of non-specific “immune boosting” is going to protect you against any specific pathogen. Even if chiropractic work increased the general activity of the immune system, that is typically not a good thing, leading to things like allergies and auto-immune diseases, which can also apparently be treated with chiropractic work. So which is it – does chiropractic work increase or decrease the activity of the immune system?

Many chiropractors also take multiple x-rays of their patients over the course of treatment, sometimes several a year. Although physicians routinely use x-rays as well, they are used in a way which takes into account the diagnostic benefit with the risks of radiation. Some chiropractors take x-rays of all their patients on their first visit as a policy – whether such a thing is necessary or not! Subluxations cannot be reliably identified by x-ray between chiropractors, so it’s an unreliable test and therefore exposes patients to unnecessary radiation. If you have ever been concerned about radiation doses from body scanners in airports, you should also be concerned about radiation from chiropractic x-rays.

Finally, there’s the use of spinal manipulation on children. There’s no excuse for doing this, as their bones are not fully formed, especially in infants, who are mostly flexible cartilage, which does not need manipulation. Since children do not have lower back pain, there is no demonstrable benefit for the use of spinal manipulation in children, which means any potential side effect pushes the risk-benefit scale well into “this is a really bad idea” territory.

Gem: Very serious complications have been associated with cervical spinal manipulation, but these are fairly rare.

Keep in mind, however, that it’s not only the risk that we’re concerned with: it’s looking at the balance between risk and benefit. All medical interventions carry risks, and it’s important to make an informed decision while understanding the probable outcome. I am not convinced that the benefits of chiropractic manipulation outweigh the risks.

Acupuncture, for example, has been demonstrated to be no more effective than poking the patient with toothpicks. However, this placebo is actually preferable to “real” acupuncture, because it does not carry the risk of infection.

Why are patients not made aware of risks associated with neck adjustments?

Richelle: One of my biggest issues with “alternative” medicine is the lack of informed consent provided to individuals. I believe strongly that people have the right to choose their treatment, but informed consent implies that you not only understand the benefits of your treatment course, but also the risks, how it works, and what other alternatives there are to consider. Do chiropractors ever explain that physiotherapy is equally effective in clinical trials as chiropractic for lower back pain, and holds fewer risks? Do they ever explain to their patients that they can only expect a mild decrease in the severity of their back pain, especially over the long term? Do they explain that there is not any agreement within chiropractic on what a spinal subluxation is, since there is no way to measure it? And do they ever tell them, when offering spinal manipulation for the treatment of non-muscle-skeletal issues, that it has never been demonstrated to be effective in a randomized, controlled clinical trial? The good ones, perhaps, but this is certainly not in the majority.

Chiropractors are there to sell their services. Your family doctor gets paid whether you go home with or without a prescription – if you leave a chiropractor’s office without an adjustment, they’ve lost out on money for that visit, and all the potential subsequent visits. As the standards of chiropractors are self-determined, it says a lot that few chiropractors are willing to stand up for the rights of the patient.

Gem: That’s a question that is probably best addressed to a chiropractor.

Are there alternative options to chiropractors? Other types of professionals that deal with the problems a chiropractor might deal with?

Richelle: If someone is dealing with lower back pain, physiotherapy is a good option. They can do spinal manipulation when medical necessary, but more importantly, can help you strengthen the supporting muscles to prevent future re-injury. There’s not a lot of improvement that someone can expect with any treatment for lower back pain, but at least a physiotherapist can provide guidance to help it from getting worse.

As for the myriad of other problems that some chiropractics claim to be able to treat, people should talk to their family doctor. Chiropractors are not qualified to deal with behavioural disorders, respiratory illness, rheumatological problems, cardiovascular disease, infections, or other medical problems. People should be sure that they learn what their science-based treatment options are and fully understand them before they decide not to use them.

Gem: When examined through the lens of science-based medicine, chiropractic offers little to distinguish itself from physiotherapy. For short to medium term relief of muscular pain, therapeutic massage also has a good track record.

When dealing with a medical complaint, a visit to a real, honest to goodness medical doctor is always a good first step. He or she may then refer you to an appropriate specialist.

In general, what are some changes that need to take place within the chiropractic community for it to become a safer, better form of alternate medicine?

Richelle: Chiropractors need to become their own worst critics. It is only through the process of rigorous peer-review that chiropractors can purge the pseudo-science from their midst. This will require throwing out the vitalistic concepts of “innate intelligence” and subluxations, and examining the premises of chiropractic in the context of modern science. They need to be open to being wrong, and willing to follow where the research leads them. They need to strictly enforce the use of informed consent, and hand out punishment to those who take advantage of patients. If chiropractors used good science as the basis for their treatments, they would quickly find themselves not in the realm of “alternative medicine,” but of simply, medicine. Sadly, that day has not yet come.

Gem: First of all, it’s important to note that “alternative medicine” is not really a useful classification. It’s a catch-all term for any medical modality that suffers from a dearth of evidence. As comedian/musician Tim Minchin said, “You know what they call alternative medicine that’s been proved to work? Medicine.”

Obviously, I’m no expert, but the first thing that I’d like to see from chiropractic is a standard of care. Chiropractic needs to embrace a science-based approach to treatment that takes into account both evidence and plausibility.

Most importantly of all, the reform needs to start from within. This can’t be us versus them: chiropractors who embrace science-based medicine need to be vocal in their criticism of the pseudoscience practised by their peers.

Anything else you would like to add?

Richelle: There is nothing “alternative” about chiropractic, because that adjective implies that is equally valid as the science-based practices in medicine. When something has been definitively demonstrated to be effective as compared to an appropriate placebo and the current standard of care, it becomes part of medicine. There is no alternative medicine: just medicine that works, and medicine that does not or has not been proven yet. The parts of chiropractic that fall into the latter category are not being excluded from medicine because there is some overarching dogma. They’re being excluded because they promote pre-scientific thinking, they encourage dangerous behaviours like refusal of vaccines, and they don’t work better than a placebo for the majority of treatments.

Gem: When evaluating any claim, it’s important to be aware of your own biases. Recognise that you are not an impartial observer, and that your personal experience does not constitute scientific evidence. We can all easily be fooled by confirmation bias, regression to the mean, and other effects that increase the chances we will perceive a benefit where none exists. Fortunately, science can equip us to better assess the state of the evidence as impartially as we can.

If you have some time, I also highly recommend reading Sam Homola’s article The Image of Chiropractic: Consensus Based on Belief on Science-Based Medicine. Dr. Homola is a “retired chiropractor turned skeptic”, and provided a good overview of the subject, along with recommendations on finding a good, science-based chiropractor.

Addendum (6 September 2011): The Uniter article has gone live: “The great chiropractic debate”.