In this episode of Life, the Universe & Everything Else, Ashlyn Noble is joined by Gem Newman, Greg Christensen, and Mark Whatman to discuss local and international news of interest to skeptics, including WiFi fears, the link between gay marriage and abortion, hominid fossils, and more! This episode is the first of our new biweekly news round-up shows. You can now expect a new episode every week!
I hope that you’re all enjoying your sundry church services, Humanist gatherings, and/or LUEE podcast-listening-sessions.
You may have noticed a brief interruption in your Life, the Universe & Everything Else podcast service two weeks ago. If so, I apologise! (If not, keep reading anyway. There’s good news at the end of this post!) We’ve changed file hosting services, and while our new service is much cheaper (by roughly an order of magnitude), this meant that we needed to do some behind-the-scenes work to make the transition as smooth as possible while ensuring that everyone still got their podcast fix!
For iTunes users, this is pretty straightforward. Simply go to the Life, the Universe & Everything Else podcast page in iTunes (click on that link then click “View In iTunes”) and hit “Subscribe”. Then you’re all set! If you’re not using iTunes, you’ll have to point your podcatcher to our new feed at http://feeds.feedburner.com/luee. How exactly you do that will vary depending on which service you use, but feel free to comment here if you have any difficulty and we’ll try to help you out!
For those of you who had no trouble with the update, congratulations! For those of you who did experience difficulty, we heartily apologise, and offer you this in consolation: We’re going to make it up to you! Starting this week, we plan to return to a weekly podcast schedule!
Robert Shindler, our former Executive Producer, has moved back to Alberta, leaving the podcast in the able hands of Greg Christensen and Ashlyn Noble (with Leslie and myself helping out, too). Their plan (well, Ashlyn’s plan, really) is to keep the regular biweekly podcast schedule untouched, but to add shows on the off weeks that are dedicated to going over sciency or skeptical news items that might otherwise be missed. This will give us more time for news than we usually have on the show, it’ll free up more time on the non-news-themed weeks to cover our topic, and it’ll give us weekly content again. Huzzah!
You can expect the first news-centric show one week from today!
On Tuesday, I was contacted by a producer with Radio-Canada (the French division of CBC) for an interview. They were putting together a téléjournal (television news) piece about prayer in Winnipeg City Council meetings, and were hoping for comment from the Winnipeg Skeptics. I agreed to speak with them, and also attempted to put them in contact with Jeff Olsson of the Humanists, Atheists, and Agnostics of Manitoba and Robert McGregor of the Winnipeg Secularists (who, I informed them, had put together a petition on precisely this subject).
There were several points that I stressed in the interview, which I’ll summarize here.
First of all, while the Winnipeg Skeptics has no official position with regard to any particular religious claim (except for those that relate to science, such as creationism), the organisation is supportive of secular government over sectarian government.
It is true that Canada doesn’t have a constitutional separation of church and state; indeed, while we have no official religion, our head of state is also the Supreme Governor of the Church of England. That said, the Canadian Charter of Rights and Freedoms guarantees freedom of thought, freedom of conscience, and freedom of religion.
I have no problem with members of City Council praying privately. I would never ask a politician to “check their religion at the door”. But when religious observance is carried out by an elected body that is meant to represent the people, that religious observance is effectively being carried out on behalf of the people. Canada’s government is committed (nominally, at least) to multiculturalism and religious pluralism. It seems to me that, in such a nation, governmental entanglement with religious practice (such as prayer) should be minimized.
Even the most benign, vague, and seemingly inoffensive prayers can be divisive. A simple prayer to “God” may be offensive to a deist, who may not believe in an interventionist god, or to a Hindu, who may believe in many. Members of minority religious or cultural groups may see governmental prayer as another way in which they are marginalized.
As is to be expected, the five-minute discussion that I had with the journalist was cut down to a single soundbite—but one that accurately represented my position—while Robert McGregor was (appropriately) given a more extensive interview. I thought that the finished piece (which is a distinctly Manitoban combination of French and English) was very good, and you can view it here.
Less good was the online article summarizing the téléjournal piece, which identified me as the organiser of the Winnipeg Secularists and seemed generally convinced that Robert and I were the same person. This has since been corrected, but until about an hour ago still listed my name as “Greg”.
If you don’t read French, feel free to have Google translate the article for you. Alternatively, there is a similar article (bereft of any reference to yours truly) on CBC. The usual caveats against reading the comments section apply, of course.
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 http://www.sciencebasedmedicine.org/.
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: http://www.startleddisbelief.com/2010/04/winnipeg-skeptics-presentation.html.) 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.
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.
Richelle McCullough, a medical student at the University of Calgary, argues that physiotherapy is a preferred practice to chiropractic.
“If someone is dealing with lower back pain, physiotherapy is a good option,” said McCullough via email. “They can do spinal manipulations, but more importantly (they) can help you strengthen the supporting muscles to prevent future re-injury.”
Gem Newman of the Winnipeg Skeptics, a local group that has been critical of the chiropractic industry, also advises physiotherapy over chiropractic.
“When examined through the lens of science-based medicine, chiropractic offers little to distinguish itself from physiotherapy,” he explained in an email.
McCullough also believes that chiropractors are unqualified for dealing with behavioural disorders, respiratory illness, rheumatological problems, cardiovascular disease and infections, which they often claim to be capable of treating.
According to Newman, chiropractic is based around a “vitalistic philosophy”. This philosophy purports that the health of a person is related to the flow of innate intelligence, a sort of spiritual energy.
“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,” explained Newman.
Although many chiropractors have abandoned this old theory for a more scientific approach, many still claim the capability to treat several different diseases, including asthma, allergies and infections.
McCullough argues that most chiropractors belong to the latter category, and that those who use a more legitimate scientific approach are in the minority.
“This sort of thinking has led to all sorts of ridiculous claims, from the ability to cure asthma to a treatment for depression,” she said. “If subluxations caused all these health problems, then why do people never suddenly develop allergies or psoriasis after a back injury?”
The following email appeared in my inbox, yesterday.
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.
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.
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.