Third Annual Cross Canada Skeptical Smackdown

The Cross Canada Skeptical Smackdown is back… and this year more cities are participating than ever before!

The Cross Canada Skeptical Smackdown is a British-style pub quiz that occurs every year on or around Pi-Day (the fourteenth of March) in multiple locations across Canada, with local and national bragging rights at stake. Teams of four(-ish) will compete in a series of five rounds of questions to see whose knowledge of all things skeptical will reign supreme!

If you want to participate, form a team of up to four players and come down to the closest event near you. And if you don’t have a team, don’t worry about it! Single players will be placed into new or existing teams upon arrival. If you decide to come down, I will personally guarantee you’ll have a great time!

Our event in Winnipeg will be held at the Norwood Hotel (112 Marion Street) on 14 March 2012 at 7:00 pm. You can RSVP at our Meetup site, or you can just show up!

But if you’re not in Winnipeg, you can attend one of the four other events across Canada this year.

City Venue Date Time
Niagara Region Mahtay Café TBA TBA
Ottawa Foolish Chicken 14 March 2012 TBA
Vancouver Billy Bishop Legion 14 March 2012 7:30
Winnipeg Norwood Hotel 14 March 2012 7:00

Participation is free!

The champion team for the past two years running is missing a core member. Come on out and give it your best. Have fun, and maybe walk away as the new national skeptical champion!

For more information on the other locations across Canada, this post will be updated as information becomes available. You can also email for more info.

TEDxManitoba Favourites

All of the talks from TEDxManitoba have been uploaded and are now available for your viewing pleasure!

First, the obligatory self-promotion. As the Sirius Cybernetics Nutrimatic Drink Dispenser might put it: Share and enjoy!

Remember: The “Like” button is your friend! The full text (along with references and annotations) can be found here!

Now that that’s done with, here are a few of my favourite TEDxManitoba talks, in no particular order. The event itself was amazing, the speakers were awesome, and I got useful ideas out of every single talk, whether I agreed with the core premise or not. So watch them all!

But if you don’t have time to watch them all, at least watch these ones!

Robert J. Sawyer: To Live Forever – or Die Trying

TJ Dawe: An Experiment in Collective Intelligence

Kale Bonham: Bridging Cultures Through Community Provoked Art

Matt Henderson: Teaching Ourselves to Last Forever

Hazel Borys: Confessions of a Former Sprawl Addict

Brad Tyler-West: Opposites Distract

Curiosity Didn’t Kill the Cat

This is a talk that I gave at TEDxManitoba on 9 February 2012. Below the video you can find the full text of the talk, with annotations and sources provided. Cross-posted from Startled Disbelief.

As a kid, I loved playing Monopoly. I was great at it, too! I was very nearly unbeatable.

I remember one game, looking down at the board and wondering how I was ever going to win. My mother had just pulled a $500 bill out from where she’d hid it between the couch cushions, my stepfather’s hotels were crowding two sides of the board, and my houses on Mediterranean and Baltic just weren’t paying off. How could this be? I thought to myself. I’m a smart kid. I’m great at Monopoly! But the odds were stacked against me, and the situation seemed impossible.

But that’s what made me such a great Monopoly player, I guess. Somehow, I’d always pull out a win in the end. Thinking back, I don’t remember losing a single game!

At some point, we all need to come to terms with the fact that maybe things didn’t happen quite the way we remember them. As humans, we’re just not that great at telling what’s true from what we want to be true. Let’s be frank: I was ten. I probably sucked at Monopoly. But I remember being awesome.

As Yale neurologist Dr. Steven Novella notes, “Our memories are not an accurate recording of the past. They are constructed from imperfect perception filtered through our beliefs and biases… Our memories serve more to support our beliefs rather than inform them.”[Reference 1]

We’re not great observers, we humans, and we tend to pay much more attention to data that confirm our preconceived notions than to details that don’t fit our theories. We have a marked tendency to remember the hits and forget the misses; presumably why people like Sylvia Browne and John Edward remain so popular.

It’s for this reason that independent confirmation is one of the cornerstones of science.

I’m not a scientist, but I do think of myself as a “science cheerleader”. And science needs cheerleaders, for a couple of reasons.

First, because it’s important for everyone to have a basic scientific understanding. Professor Art Hobson put it this way: “the most crucial decisions [in industrialized nations] concern science and technology, and in democracies, citizens decide.”[Reference 2]

The second reason that science needs cheerleaders is that it is so oft maligned. Scientific skepticism is often portrayed as cold, unfeeling; antithetical to compassion or human emotion. Those with a penchant for whimsical nostalgia stubbornly insist that life was better and that times were simpler before science got all muddled up in society.[Note 1]

Could it be that they’re right?

Science is the quest to understand ourselves, our universe, and our place in it. Science is curious by nature, for its goal is to figure out what’s really true—but for that reason, science must also be skeptical. It insists that we shouldn’t simply take claims at face value, but instead we should proportion our belief in a proposition to the evidence supporting it.

A series of studies conducted in the 1980s found that roughly 80% of people consider themselves above average drivers.[Reference 3][Reference 4] A 1987 study of Australian workers found that only 1% of them rated their workplace performance as below average.[Reference 5] Unless I badly misremember how numbers are meant to work, it seems to me that something very near to half of them are mistaken.

The way that we see the world is coloured by many things, our own egos foremost among them. Perhaps when it comes to Monopoly games we can be forgiven if we see ourselves through rose-coloured glasses. Concern may become warranted when our callous assumption that we outperform our contemporaries affects the quality of our work or the safety of our driving.

But what about when it really counts? What if your child is sick? There are clearly many cases where we simply cannot afford to let our petty biases influence the way we see the world. And that’s where science comes in.

While it’s true that public support for science has remained generally high over the last several decades, and scientific literacy has been increasing more-or-less steadily, there have been some troubling developments in the popular media and in culture at large.[Note 2]

The image of the “mad scientist” is deeply ingrained in our culture, and probably dates to Mary Shelley’s celebrated Frankenstein, in which the relentless pursuit of knowledge leads inexorably to unspeakable horrors. This idea is not a new one. Anti-science messages have been with us for hundreds of years.

Here’s the problem: science is seen by many as unnatural, inaccessible, or even sinister. Scientists are widely regarded as arrogant, superior, or closed-minded.

What’s the common thread here? Aside from being totally awesome, that is. Any guesses?

As unbelievable as it might seem, all of these stories are riddled with anti-science or anti-reason messages. Even in science fiction, the genre that inspired so many of the technologies and conveniences that we take for granted today, it is common to see science portrayed as sinister and destructive.

In Star Trek, a series that celebrates human ingenuity, Spock is set up as a straw man, his much lauded Vulcan logic inevitably knocked down by Kirk’s emotionally driven human pluck. When it comes time to choose between thinking with your head and thinking with your heart, the message is clear: human emotion wins every time.[Note 3]

In Jurassic Park, the audience is shown the consequence of scientists “playing God”. As in Frankenstein, disaster is the inevitable result of scientific excess.

In Lost, John Locke constantly admonishes the other characters to have faith, that they are all on the island for some mysterious purpose. And, because it’s a fictional story, it turns out that he’s right.

Oh, and then there was that episode of The X-Files that showed faith in the supernatural triumphing over the skeptic… Which one was that again…? Oh, right: all of them. Don’t get me wrong: I loved The X-Files, but seriously—it was always a monster? Every time?

And even Scooby-Doo, a longtime favourite among skeptics of the paranormal, isn’t blameless. Recent adaptations are much more likely to feature real monsters than grumpy old groundskeepers who would have gotten away with it, too, if it weren’t for those meddling kids!

But perhaps the most egregious example of anti-science rhetoric in popular fiction is found in Ronald Moore’s 2003 reimagining of Battlestar Galactica.

While dramatically enjoyable, the emphasis of faith over reason was a thread that wound its way through the entire series. What’s worse, the final episodes first hinted then proclaimed that in a society that embraces science and technology, a technologically driven holocaust is inevitable. This has all happened before, we are told, and it will all happen again.

The series culminates (spoiler alert) with the entire human race abandoning all technology in favour of founding a nomadic hunter-gatherer society. Science fiction becomes luddite fantasy—famine, disease, and the concomitant contraction of the human lifespan be damned.

This message is getting through to the public, loud and clear. A 2001 NSF survey found that 50 percent of Americans believe “We depend too much on science and not enough on faith”.[Reference 6] I find this distressing.

From The Terminator to The Matrix to 28 Days Later, the idea that science will lead to some sort of technopocalypse is ubiquitous these days. And after all, why not? Isn’t there a grain of truth to the idea?

Perhaps you might rightly scoff at Ben Stein’s contention in the pseudo-documentary Expelled that the science of evolution led to the Nazi holocaust…[Note 4]

…but what say you when the horrors of Hiroshima and Nagasaki are laid at scientists’ feet? Who can help but shiver upon hearing Oppenheimer’s words? “I am become Death, destroyer of worlds.” How can we answer such a charge?

In the Garden of Eden, Adam and Eve were forbidden the knowledge of good and evil, but their curiosity got the better of them. According to this story, it was our thirst for knowledge that led to the fall.

Curiosity, we’re told, is what killed the cat.

Knowledge can, of course, be used for good or for ill. Scientists invented the bomb—but it was politicians who called for it, taxpayers who funded it, and the military who saw it deployed. If you want to lay death and destruction solely at the feet of scientists, I don’t think that you’re playing fair.[Note 5]

“Curiosity killed the cat.” How unjust!

That we should be incurious is perhaps the single most damaging message that our children receive from popular culture. Curiosity is one of the greatest assets that we as a species possess. It fuels free inquiry! It fuels innovation! Without nurturing our curiosity we risk retarding our progress as a civilisation.

Knowledge is not evil, nor is the pursuit of it. Knowledge of the way this wondrous world really works equips us to better our own situation and that of every other living being with whom we share this planet.

“Curiosity killed the cat.” You would be hard pressed to find an idiom that irritates me more.

You want to know what probably didn’t kill the cat? Diabetes, hyperthyroidism, intestinal parasites! For every cat killed by curiosity, I would wager that there are hundreds who have been saved by veterinary practices unknown a century ago.

Curiosity cured the cat!

Norman Borlaug, the father of the Green Revolution, is credited with saving one billion people from starvation. We have indoor plumbing and flush toilets, and hand-washing, and the germ theory of disease, all of which save countless lives every day. These victories aren’t just victories for science; they are victories for humanity. Science wins this fight.

As for the arrogance and closed-mindedness of scientists: I find this charge frankly startling, for in the process of skeptical inquiry I see the most amazing intellectual humility. The success of the scientific endeavour requires us to admit to our human foibles and failings, our petty biases and conceits. It is only in accounting for these human weaknesses that we make progress. Science is rooted in curiosity, and one cannot be curious without being humble. To wonder how something works, first you must admit that you don’t know.

So if science is so successful in improving our lives, why does science still have such an image problem? Why do people fail to understand that science isn’t the enemy of nature, but merely the study of it?

It probably isn’t news to you that the media has a huge effect on how we think and behave. That’s what advertising is all about, after all, and study after study shows that it works, even when we think that it doesn’t.

In The Demon-Haunted World: Science as a Candle in the Dark, Carl Sagan laments that “Scepticism does not sell well. A bright and curious person who relies entirely on popular culture to be informed about something like Atlantis is hundreds or thousands of times more likely to come upon a fable treated uncritically than a sober and balanced assessment.”[Reference 7]

In a culture so steeped in irrationality, a culture that prizes faith over evidence, it can be difficult to make progress in promoting science. Right now, the greatest obstacle to the public understanding of science is the way it’s presented in the media.

So what if our stories had skeptical, pro-science messages? What if they encouraged the audience to think critically, rather than just nodding along? What if the heroes of our stories weren’t those who simply fought for what they believed in, but those who had the courage to ask themselves why it was that they believed it?

We have the power to reignite the public passion for learning new things. We need to teach everyone (everyone) what science is, at its core. That may sound daunting, but it’s really a very simple idea: Beliefs should be supported by good evidence.

None of us are perfect, and so if we’re serious about figuring out what’s really true we need to understand our own biases and apply a basic skepticism to all claims to knowledge. We need to avoid the temptation to look only for the evidence that confirms what we already believe. Or, as Randall Munroe put it, “You don’t use science to show that you’re right, you use science to become right.”[Reference 8]

And we already have allies in the popular media.

On the front lines, I see novelists like the excellent Robert Sawyer (from whom you heard only a moment ago) and the unbelievably popular J.K. Rowling.

Sawyer is famous for stories that show rationalism triumphing over superstition. In the Harry Potter series, Rowling provides an excellent role-model in Hermione Granger, whose success is due not to some innate talent, but to hard work and a willingness to question popular wisdom.

There are musicians like George Hrab and the inimitable Tim Minchin who encourage us to be skeptical of extraordinary claims. Sara Mayhew infuses her manga with a love of science. Randall Munroe and Zach Weiner pen comics that make us laugh and make us think. We have Bill Nye and Neil deGrasse Tyson working to communicate science to people of all ages. Adam Savage, Jaimie Hyneman, and rest of the gang at MythBusters remind us how exciting it can be to figure out what’s really true.

At this point, you might be wondering what you can do to help.

Be curious. Question everything. Prize learning over simply knowing, because even things that we think we know can turn out to be wrong. As Carl Sagan said, “it is far better to grasp the Universe as it really is than to persist in delusion, however satisfying and reassuring.”[Reference 9]

With everything that science has done for us, it deserves our support. So when you hear someone complain that science is arrogant, closed-minded, or dangerous: speak up. Because you know better.


[1] Steven Novella, “More Evidence Our Memory Stinks”,

[2] Art Hobson, “Physics literacy, energy and the environment”,

[3] Ola Svenson, “Are we all less risky and more skillful than our fellow drivers?”,

[4] Iain A. McCormick, Frank H. Walkey, Dianne E. Green, “Comparative perceptions of driver ability – a confirmation and expansion”,

[5] Bruce Headey, Alex Wearing, “The Sense of Relative Superiority – Central to Well-Being”,

[6] National Science Board, Science and Engineering Indicators 2002, “Science and Technology: Public Attitudes and Public Understanding”,

[7] Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark, page 9

[8] Randall Munroe, xkcd, “Science Valentine”, (image alt text)

[9] Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark, page 16


[1] They set science and rationalism here and they set mystery and compassion there and demand that you choose between them, even though such a choice makes no sense. Science is no more a cold, unfeeling monstrosity than is a screwdriver or a pair of spectacles. Science is a tool that helps us overcome some of our inherent limitations. And yet, the idea that life was somehow better, humbler, and more existentially satisfying in some misty, bygone age is pervasive in our society.

[2] In our culture, the scientifically illiterate can get on by saying that they’re just not “science people”. Basic scientific literacy is very important, but ScienceDaily reports that in North America it sits around 30%. It’s perfectly acceptable in our culture for a person to be scientifically illiterate, but just imagine what it would be like to have a similar attitude toward those who can’t read or write.

[3] To learn more about the Straw Vulcan, I refer you to the TVTropes page that coined the term. I also highly recommend Julia Galef’s talk from Skepticon 4, The Straw Vulcan.

[4] For more about the absurdity that is Expelled: No Intelligence Allowed, I refer you to Expelled Exposed, a site created and maintained by the National Center for Science Education. This site cheerfully exposes the anti-science propaganda behind this so-called documentary, while managing at the same time to be an enjoyable read! I doff my proverbial hat to Eugenie Scott and the rest of the folks at the NCSE for their tireless work in combating creationism masquerading as science.

[5] Neil deGrasse Tyson expressed this sentiment well. “Scientists don’t lead marching armies!” he said. “Scientists don’t invade other nations! Yes, we had scientists who invented the bomb, but somebody had to pay for the bomb, and that was taxpayers, that was war bonds. There was a political action that called for it. But everyone blames the scientists! … At the end of the day, a discovery itself is not ‘moral’, it’s the application of it that has to pass that test.” (This quotation is taken from an interview with Neil deGrasse Tyson at Montclair Kimberley Academy. The interivew was conducted by a rare out-of-character Stephen Colbert, and is fantastic. You can watch it here.)

The Winnipeg Free Press Investigates Sports Bracelets

In today’s Winnipeg Free Press you’ll find an article entitled Wrist management: Can trendy sports bracelets actually improve your game or are they glorified rubber bands? In it, you’ll find a satisfying investigative report by Carolin Vesely on the subject of Power Balance and similar sports bracelets.

Photo by Bill Ebbesen (Creative Commons Attribution-Share Alike 3.0 Unported)

I’ll excerpt some of the good bits here, but please read the article if you’re at all curious about the claims being made.

“That sounds like gibberish to me,” [University of Manitoba kinesiology professor Todd] Duhamel says. Biofields can be measured, but “we don’t know what everybody’s biofield should be; there’s no ‘normal’ biofield frequency” where we can say, ‘Oh, you’re at 47.7 hertz and therefore you’re out of whack because you should be 49 hertz.”

Wearing a watch or ring made of metal will also influence your electrical field, he says, but any ions or other electricity or radiation emitted would only penetrate to a depth of one or two skin cell layers. And it doesn’t make sense, says Duhamel, that something worn on the wrist would affect how your legs work.

“I’d love to see scientific evidence. The fact that they’re making claims about strength and balance but not making an actual health claim would tell me that they have no evidence that it actually affects the human body in any real, meaningful way.”

Renny says iRenew should have results of its latest clinical studies on the website by the end of February. The tab marked “research” currently opens to an empty page, save for a photo of a muscled, braceleted young man hooked up to machines while running on a treadmill.

One of the main marketing tools used by the bracelet companies is a balance test. The test subject is asked to stand on one leg and hold his or her arms straight out to the side. The tester then pushes down on the arm on the same side as the raised leg until the subject falls off balance. The subject then puts on the bracelet and repeats the test — without toppling over.

Gem Newman, founder of the Winnipeg Skeptics, has an explanation.

“It’s a trick sometimes called applied kinesiology,” he says. “The first time when they’re pressing down on your arm, they’re pulling very slightly away from your body. It’s imperceptible to the subject, but they’re pulling you off balance.
“However when they put the wristband on your arm or in your hand, they’ll pull down on your arm again but slightly toward your body.”

Members of his group exposed the “trickery” for visitors at this year’s Red River Ex, where they happened to have their booth near a vendor of Energy Balance bracelets.

Anyone can test this out for themselves at home with a friend, says Newman.

“I’ll usually do it with my magic iPhone.”

When she was writing the article, Carolin Vesely contacted me about some of the claims these hucksters were making. I gave her a brief overview of some of the tricks they use to convince people that their balance or flexibility is improved, and tried to put her in touch with Richard Saunders of the Australian Skeptics. Unfortunately, the time difference apparently made it difficult to conduct a telephone interview, so you’re stuck with me, instead.

For those interested, here’s some news coverage from Australia that, while being rife with false balance and anecdote, does conduct a miniature blinded trial:

Because the claim isn’t addressed in the video, I feel the need to point out that in the segment where flexibility is being tested by having a “skeptical” reporter twist at the waist, it’s common for the subject to be able to twist around more fully on the second attempt than on the first, regardless of whether they’re wearing a rubber band.

Credit where credit is due: Richard Saunders and the rest of the Australian Skeptics deserve high praise for the work that they’ve done combating the vigorous nonsense promoted by Power Balance and their imitators, so I’ll give Richard the last word. Here he is demonstrating exactly how this so-called “applied kinesiology” trick works. It’s easy to do, and I highly recommend trying it out for yourself!

SkeptiCamp Winnipeg 2011: The Videos, Part 3

SkeptiCamp Winnipeg 2011: The Videos, Part 1
SkeptiCamp Winnipeg 2011: The Videos, Part 2

SkeptiCamp is an open conference celebrating science and critical thinking. For more information please visit

Scientific Spirituality

Dr. Ali Ashtari obtained his Bachelors and Masters degrees in Electrical Engineering from Sharif University of Technology in Tehran, Iran, and his Ph.D. in Electrical and Computer Engineering from the University of Manitoba. He currently holds a post doctoral fellowship at the University of Manitoba. He describes himself as a “militant atheist”, and has recently developed an interest in meditation and the scientific study of spirituality.

Science & Media: A Love Story

Richelle McCullough is a medical student at the University of Calgary and is graduating with a Masters degree in Physiology from the University of Manitoba this spring. She blogs at Subspecies and for the Winnipeg Skeptics, and is proud that she is frequently trolled by people who think that the Sun revolves around the Earth.

Realities and Myths About Sex Work

Anlina Sheng is a freelance graphic and web designer, a feminist, and a sex-workers’ rights advocate.

How to Change Minds

Mike Innes is former born-again Christian, and is now a passionate activist for skepticism and equality. He is the father of two boys, and he spends much of his time building more computers than he knows what to do with. The text of this presentation is also available on the Winnipeg Skeptics blog.

SkeptiCamp Winnipeg 2011: The Videos, Part 2

SkeptiCamp Winnipeg 2011: The Videos, Part 1
SkeptiCamp Winnipeg 2011: The Videos, Part 3

SkeptiCamp is an open conference celebrating science and critical thinking. For more information please visit

Polyamory and Mononormative Assumptions

Anlina Sheng is a freelance graphic and web designer, a feminist, and a polyamory activist. For more information about polyamory in Winnipeg, visit

Perpetual Motion and Free Energy… Science or Pseudoscience?

Javier Hernandez-Melgar is a student at the University of Manitoba, pursuing a joint honours degree in math and physics.

Evaluating Rational and Emotional Arguments

Brendan Curran-Johnson is a software developer, unrepentant geek, and incorrigible satirist.

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”.