Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
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Chiropractors are getting very touchy indeed, all over the world. And no wonder, because their claims are being exposed as baseless as never before, in the wake of their attempts to stifle criticism by legal action..
In March, Shaun Holt appeared on Breakfast TV in New Zealand. Holt has done a lot of good work on TV in debunking some of the preposterous claims made by quacks. See him on YouTube.
This time he talked about chiropractic. Here is the video.
One could argue that he was over generous to chiropractic, especially when talking about their effectiveness in treating low back pain. He said, quite rightly, that chiropractors are no better than physiotherapists at treating low back pain.
But a recent trial suggests that neither are much good. “A randomised controlled trial of spinal manipulative therapy in acute low back pain” (Juni et al., 2009 in the BMJ; see also coverage in Pulse). This trial compared standard care with standard care plus spinal manipulative therapy (SMT). The results were negative, despite the fact that this sort of A + B vs B design is inherently biassed in favour of the treatment (see A trial design that generates only ”positive” results, Ernst & Lee 2008, Postgrad Med J.).
"SMT was performed by a specialist in manual medicine, chiropractice and rheumatology (GH), a specialist in physical medicine (DV) or an osteopath (RvB), all proficient in SMT."
"Conclusions: SMT is unlikely to result in relevant early pain reduction in patients with acute low back pain."
Admittedly, the trial was quite small (104 patients, 52 in each group) so it will need to be confirmed. but the result is entirely in line with what we knew already.
It also adds to the evidence that the recommendation by NICE of SMT by chiropractors constitutes their biggest failure ever to assess evidence properly. If NICE don’t amend this advice soon, they are in danger of damaging their hitherto excellent record.
Despite the moderate tone and accuracy of what Holt said on TV, the New Zealand Chiropractors’ Association made a formal complaint. That is what they like to do, as I learned recently, to my cost. It is so much easier than producing evidence.
Quite absurdly the New Zealand Broadcasting Standards Authority (BSA) has upheld some of the complaints. Their judgement can be read here.
The BSA consists of four people, two lawyers and two journalists. So not a trace of scientific expertise among them. Having people like that judging the claims of chiropractors makes as much sense as having them judged by Mr Justice Eady. They seem to be the sort of people who think that if there is a disagreement, the truth must lie half-way between the opposing views.
One of the BSA members, Tapu Misa, has used her newspaper column to quote approvingly the views of the notorious Dr Mercola web site on flu prevention “Your best defence, it says, is to eat right, get lots of sleep, avoid sugar and stress, load up on garlic, Vitamin D and krill oil”. (Snake oil is said to be good too.) There are some odd attitudes to science in some of her other columns too (e.g. here and here). Not quite the person to be judging the evidence for and against chiropractic, I think.
In fact the TV show in question was more than fair to chiropractors. It adopted the media’s usual interpretation of fair and balanced: equal time for the flat earthers. A Chiropractor was invited to reply to Holt’s piece. Here he is.
The chiropractor, Doug Blackbourn, started very plausibly, though a tendency to omit every third syllable made transcription hard work. He established that if you cut yourself you get better (without any help). He established that nerves run down the spinal cord. So far, so good. But then he quickly moved on to the usual flights of fancy.
"We have two premises. The body heals itself and the nervous system runs the body. Now the nervous system runs the body, travels down through the spinal cord so chiropractic is not based on the belief that, you know, energy flows, it’s based on the fact that your nervous system runs the body and [inaudible] affects the overall health of the body"
This statement is totally vague. It has nothing whatsoever to do with the main question, can chiropractors do anything useful. It is sheer flannel.
We’re seeing people, heck, diabetes. I had a quadriplegic come in one time for adjustment, we’ve got stroke people, we’ve got all sorts of conditions. We’re not treating the condition, We’re allowing, checking the spine to see if there’s any interference there that will slow the body down"
“Interference”? “slowing the body down”? These are utterly meaningless phrases that simply serve to distract from the only question that matters.
"Chiropractice is the most safest [sic] profession to go to to get your spine adjusted"
Hmm I thought it was the only job that uses the word ‘adjustment’.
Worst of all was his response to a question about asthma.
Presenter: "So chiropractors are not out there claiming they will cure asthma for example?". Chiropractor: "No"
This is simply untrue, both in New Zealand and in the UK. For a start, just look at what Blackbourn’s own web site says about asthma.
"The challenge, of course, with allergy and asthma medication is there is no end-point. There is no cure. Asthma and allergies, for the most part, are lifelong conditions requiring lifelong medication. Might there be a better way, an alternative solution?
“Alternative” is the key word. Medical treatment is designed to combat symptoms, and is successful to a certain extent with allergies and asthma. Underlying causes are not addressed, however, and symptoms continue year after year. What else might be done?
Enter chiropractic care. Chiropractic health care, with its unique comprehensive approach, is able to offer positive benefit to a variety of conditions and ailments. In the case of allergies and asthma, these “hypersensitivity conditions” may respond well to therapy designed to normalize the body’s flow of nerve signals. To use a metaphor, chiropractic treatment removes roadblocks to the body’s natural healing abilities. Restoring these imbalances may help reduce such hypersensitivity reactions."
Blackbourn’s web site describes him thus
"As a Doctor of Chiropractic, Dr. Doug Blackbourn . . ."
But the qualifications of “Dr” Blackbourn are B.App.Sc (Chiro) M.N.Z.C.A , the same as those of “Dr” Brian Kelly.
After a performance like this, perhaps someone should submit a complaint to the New Zealand Broadcasting Standards Authority.
After all, I notice that they have dismissed complaints from one chiropractor, Sean Parker, after a TV programme looked at the business practices of his private chiropractic practice, The Spinal Health Foundation. Perhaps the BSA understands business better than it understands science.
Follow-up
Is chiropractic crumbling in New Zealand? The New Zealand College of Chiropractic featured in my editorial in the New Zealand Medical Journal, and in the fallout from that article, It’s principle, “Dr” Brian Kelly (B App Sci (Chiro)) seems to be getting desperate. His college is now canvassing for recruits in Canada. They are promised all the woo.
- Subluxation centered techniques – Gonstead, Toggle Recoil, Thompson, Diversified
- Traditional philosophy featuring vitalism and innate healing – congruent curriculum
Perhaps Canada is a good place to recruit, gven the $500 million class action being brought against chiropractors in Canada, after Sandra Nette became tetraplegic immediately after a chiropractor manipulated her neck, Canadian chiropractors must be looking for somewhere to hide.
Stuff and Nonsense. jdc described this story at the time the complaint was lodged.
Shaun Holt’s own blog follows the action.
New Zealand Doctor covers the story.
Bay of Plenty Times “Bay researcher slams television complaint ruling“
16 Responses to Two lawyers and two journalists squash criticism of chiropractic on TV
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Interesting to note that they didn’t ask him about his “Dr” title too …
Blue Bubble
Good point, I added a bit about “Dr” Blackbourn’s B.App.Sc (Chiro).
The problem, as always, is that presenters don’t know enough about the topic to ask the right questions.
I also checked Doug Blacbourn’s own web site. What he says about asthma there is totally inconsistent with the answer he gave on the TV programme.
There’s a certain irony in the start of that newspaper column accusing “Big Pharma” of making up new ailments, when we’re talking here about a therapy that is based on “an entity that is yet to be shown to exist”.
I thought that the good doctor (the real one) was actually very effective in his presentation, given the audience.
I give him 9 out of 10, and a koala stamp!
(I am from ‘down under’, and fancy that I understand the subtleties and nuances of the antipodean reactions to ANY perceived pronouncements from an apparent ‘authority’)
As for the ‘balance’ piece that followed: this fornicating fibber would make a great party-politician, or perhaps a ‘Human Resources Co-ordination Management Executive’, or whatever the slimy bureaucratic parasites call themselves these days.
Thank you for another superb post.
Re the follow-up: It has to be said that any Canadian chiropractors relocating to New Zealand are likely to feel quite at home with the New Zealand Chiropractors’ Association’s propensity for complaining when any negative publicity about chiropractic appears in the media. For example, when 62 Canadian neurologists publicly highlighted the deadly risks associated with chiropractic neck manipulation, they were subjected to harassment and intimidation by the Canadian Chiropractic Association:
Quote:
“…The College [Alberta College and Association of Chiropractors] went further in its bad faith by chilling and seeking to prevent scientific debate. Through the Canadian Chiropractic Association, its response to the statement of the Canadian neurologists and chiefs of neurology departments of major teaching hospitals in Canada was to individually threaten each and every one of the physicians whose name was associated with the statement with professional disciplinary action, with challenges to their standing and accreditation with hospitals and with legal action on the basis that their warning the Canadian public and governments about the dangers of neck manipulation was defamatory to chiropractic.”
See para 147 here:
Click to access claim.pdf
You have to wonder how much longer chiropractors can get away with their charade.
It’s interesting too how the interview with Dr. Holt ends with words akin to “… but that’s just his opinion”, when the interview with the chiropractor (unless the above is edited) ends with no such qualifier. It’s so frustrating that alternative medicine’s endemic use of litigation has been so effective at putting the press on the back foot. Even in this instance where the interview with the Dr. contained pertenent, intelligent questions, and (I woudl guess from their demeanour) the interviewers weren’t particularly sympathetic to chiropracty, it’s chiropracty that gets given the most credence.
The adjudication from the NZ BSA is a deeply depressing read, forming an eerie sort of Antipodean companion piece to the Singh case. The kind of feeble “evidence” the NZCA are reported as citing could have come straight from the BCA and its discredited “plethora”.
Given that two of the NZ BSA panellists were lawyers it does, as DC says, make one rather nervous about the ability of legal systems to actually assess scientific and medical evidence accurately. Which is yet another argument for NOT having issues of medical and scientific fact (and legitimate public interest) decided in the courts.
It would be interesting to see what would happen if Dr Holt were to repeat the same eminently reasonable things about back-cracking in a NZ newspaper article. One wonders if the NZCA would sue? On the present evidence, I guess they probably would.
There is a good chance NZ laws are similar, to English ones, as they presumably derive, like their parliamentary system, from the English model. In which case, perhaps some concerned NZ MP would like to raise the matter in parliament, assuming they have “parliamentary privilege”? One would think that the question of whether the public are getting taken for a ride, with legal chill being used to silence anyone saying so, was a clear issue of public interest.
I wonder how many Kiwis and Aussies have signed the Singh petition so far?
Oops – for anyone not familiar with “parliamentary privilege, the missing link is:
http://en.wikipedia.org/wiki/Parliamentary_privilege
Great post David.
It was painful listening to the chiro. The tired arguments of real medicine leads to a lot of problems and side effects. Ergo chiropractic works.
I wonder how long it will be before they come up with “cranial manipulation”, since all the nerves in the spine which they love so much originate in the brain anyway.
And the presenters of the show. They set out this “balanced” debate to be biased towards the chiros, but well played to Dr Shaun Holt for speaking up against the chiros.
Slight ridicule in the end: “If it is in the book, it must be right.” These people have no idea of what is right even if it came up and whacked their heads…
I’d not picked up on this judgement, but I blogged about the complaint when it was originally made by the New Zealand Chiropractors’ Association. I noted that (quite aprart from the 2/3 of chiropractors Shaun Holt asked who said they would treat asthma and ear infections) the NZCA website listed asthma and ear infections both on their research page and on their page that tells clients what to expect from chiropractic. I also commented on Shaun Holt’s blog – the post that includes the chiropractic video is here.
Thank you for your work to help evaluate chiropractic medicine and show its weaknesses and false claims. The NZ Chiropractic Assn are always quick to respond, and good healthy public debate allows better understanding and evaluation. Many chiropractic treatments lack sound evidence of efficacy and this should be widely understood. False claims need challenging.
@dbaptista: “I wonder how long it will be before they come up with “cranial manipulation”, since all the nerves in the spine which they love so much originate in the brain anyway.”
The osteopaths are way ahead of you: “cranial osteopathy” was invented back in the 1930s.
[…] Ben Goldacre has a fairly extensive set of links to such work here, as does David Colquhoun on his blog.) And TV1 gave equal time to a chiropractic spokesman, so it’s hard to see how a finding […]
[…] and two journalists squash criticism of chiropractic on TV from David Colquhoun’s blog September 23rd, 2009 This includes a video of Shaun Holt on Breakfast TV: well worth reading & […]
Yeah, Chiropractic treatment is the most powerful natural curing method. I also like this natural method because it, the most viable treatment method than any other treatment method.
http://www.myclevelandchiropractor.com/
@mitchdcba
How I love it when alternative medicine advocates make comments that condemn themeselves more clearly that I ever could.