The age of chiropractic miracles is not yet done

The age of chiropractic miracles is not yet done

One might be surprised to learn that chiropractic was once said to cure deafness. The creator of chiropractic, D.D. Palmer, claimed that by manipulation of the spine he restored hearing in a deaf man, Harvey Lillard. From that moment on Palmer decided, ipse dixit, that the spine was the key to all disease. Yet despite Palmer’s miraculous first manipulation, in the hundred or so years since, chiropractors the world over have failed utterly to recreate Palmer’s success with the deaf; a failure so stupendously comprehensive and absolute that  this treatment modality should have long ago fallen into ignominy and disuse.

So much for Palmer’s original chiropractic miracle. Most practitioners of chiropractic today tend to steer well clear of making such claims; surely nobody would believe them anymore, not in this enlightened age.

Chiropractic for the World Foundation is a registered Canadian charity “whose vision is pure and simple: to bring the gift of chiropractic to the world.” They have been working in Ghana and are delighted to report that the age of chiropractic miracles is not yet done:

Person regained eyesight. Several threw away their canes. Another canceled his appointment with his doctor. Talk about a good day at the office! 3 out of 3 of our helpers want to become chiropractors to take care of their own people here. We are spreading so much light I’m surprised the sun went down tonight!

I’ll admit that when I first read that I was taken aback. How could a Canadian-educated professional individual so sincerely believe that Palmer’s patented back rub for all ailments actually cured blindness? Even Palmer never tried to sell manure of that odour to the public, although his claiming to cure deafness was certainly a stretch. Yet giddy-in-Ghana reports that the blind can see and the lame can walk. I hope those souls didn’t throw their canes too far out of reach. Nonetheless, if a person really did have their sight restored after a chiropractic manipulation, I’d hope – as indeed would the chiropractic profession – that the clinician involved would at least exert themselves to writing it up as a case study. That would show us skeptics what for, what?

Maybe they mean well, and believe that their help wouldn’t go amiss. Ghana ranks 188th in the world for life expectancy at birth. It has an HIV rate of 1.9%. The risk of major infectious diseases is very high: watch out for diarrhea, hepatatis-A, typhoid, malaria, schistosomiasis, meningococcal meningitis and rabies. These disease risks are manageable with the use of vaccines, public health interventions, and good patient care, and Ghana could certainly benefit from better health resources. It is to that end, one supposes, that, the visiting chiropractors have been offering their help:

We were invited to meet several key government officials, including two medical doctors (Regional Health Directors), and the Minister of Accra, Ghana’s largest city and capital. During all of our communications, whether to patients or to government officials, one thing was consistent – we kept the message of chiropractic very pure and simple! Our message was very well received – people in Ghana are so ready for what we have to offer! They know innately that the body heals itself… that’s why chiropractic make so much sense to them.

It might be helpful to point out at this juncture that an evidence base for the chiropractic treatment of HIV, diarrhea, hepatatis A, typhoid, malaria, schistosomiasis, meningococcal meningitis and rabies does not exist. But this is not about evidence. This is about evangelising the original message of chiropractic, evidence be damned, a century of abject failure of the whole idea of chiropractic be damned. It’s about the idea of innate intelligence of the body that flows through the spine, that can be freed with chiropractic manipulation, that can make the deaf hear, the blind see and the lame walk. Chiropractic rejected the germ theory of medicine from the outset. Instead, the straight chiropractic paradigm allows only that diseases arise from subluxations in the spine, malaria parasite notwithstanding. For heaven’s sake, the existence of the malaria parasite itself should be  evidence enough to abandon chiropractic, and sufficient cause to turn back its adherents at the Ghanaian border.

Yet they say their message was very well received. I’d like to assume the Ghanaians were just being polite, but they really shouldn’t have to listen to this nonsense in the first place. They have enough to do with actually treating malaria without having alt-medicine peddlers try to persuade them how not to treat it. It isn’t the first time. We have seen variants on this story before: Matthias Rath took his vitamin pills to South Africa and convinced the government they had no need for expensive anti-retrovirals to treat HIV. As the head of Médecins Sans Frontières said, “This guy is killing people by luring them with unrecognised treatment without any scientific evidence.” Right now in Ghana, homeopaths have set up a malaria prophylaxis clinic “to help combat the effects of malaria through homeopathic care.” I have nothing but sympathy for their patients. There’s something malodorously colonial about these people, chiropractors, homeopaths and pill peddlers alike, their actions as superficially well-meaning yet utterly pointless as flying four thousand miles just to give a starving child a Bible.

Still, the miracles continue. The chiropractors report that they found evidence of “’the adjustment exchange rate’, that one adjustment in Ghana is worth approximately 10 in Canada or USA.” It’s because the Ghanaians live simpler lives, we are told; “ their bodies are not as polluted, mentally, physically and chemically. Their diets are more natural.” Yes, it’s amazing these people die of anything at all.

I can’t be entirely negative. The Foundation raised enough money from chiropractors and their patients in Canada to establish a children’s school in a village in Ghana, which is a worthy accomplishment. I can’t agree that the world needs more chiropractic, but more access to education is always welcome. I would also welcome it if the homeopaths, chiropractors, and alt-med peddlers would keep their useless nostrums at home where they belong, marginalised in modern medicine and as the placebo of choice for the wealthy worried well.

Homeopathy Awareness Week 2009: Zicam!

Homeopathy Awareness Week 2009: Zicam!

Its homeopathic awareness week!

Were you aware that homeopathic nasal cold remedies can burn out your sense of smell? The FDA wants you to know about it.

Zicam make popular homeopathic products such as nasal sprays. Two of their products, Zicam cold nasal gel and and Zicam cold nasal swabs, were recalled by the FDA this week after they were found to destroy people’s sense of smell.

There is more to homeopathy than the snake oil gambit of diluting a compound so much that not a trace of the original remains. The philosophy of homeopathy is, rather,  The Law of Similars, or ‘like cures like’. If a chemical causes a certain set of symptoms, then treating a disease that produces those symptoms with said chemical will effect a cure.

Hence Zicam, et hinc illae lacrimae.  The homeopathic (active) ingredient in Zicam is Zincum Gluconicum, or zinc gluconate, which was approved by the Homeopathic Pharmacopeia Convention in 1997. It was ‘proven’ to produce cold like symptoms in healthy individuals, and added to the The Homœopathic Pharmacopœia of the United States (HPUS) that year. HPUS dictates the maximum strength that a compound can be for over the counter use, although based on what criteria I know not. For Zinc Gluconicum it is a 1x dilution, that is, one part compound to nine parts water. Zicam actually used a higher dilution, 2x, where the previous dilution is taken and diluted a second time. The final dilution is 1:100. Bear in mind that Avogadro’s limit is not reached until around 24x dilution, and many homeopathic over the counter preparations are diluted beyond that, and you can see Zicam’s mistake: their homeopathic cold remedies actually contained ingredients.

Not only that, the effect of using actual ingredients in Zicam neatly disproves the concept of the Law of Similars and the essential philosophy of homeopathy. Sticking harsh chemicals up your nose, it turns out, has potentially life threatening consequences. It doesn’t cure congestion or sinus pain; it causes sinus pain and the loss of smell.

Why did Zicam do it? Probably because, by labelling an over the counter treatment as homeopathic, they avoided the regulation and safety testing that would be demanded for proper drugs.

Remember, homeopaths, Avogadro’s limit is your friend. Make sure that your treatments contain nothing at all and you will avoid these unpleasant lawsuits.

The FDA can’t regulate a placebo.

The Green Party has a problem

The Green Party has a problem

Specifically, the Green Party of England and Wales has a credibility problem.

The European elections are underway in the UK. Seats for the European Parliament are awarded using a system of proportional representation, rather than the first past the post system that elects members to the House of Commons. As a result, small parties, like the Greens, have a better than usual chance of getting elected.

George Monbiot wrote in the Guardian that voting Green is the only choice if one would like to send a message to the three main parties on climate change.  I suppose there’s a certain amount of merit to that suggestion, although the message sent will be subject to interpretation. Certainly it will be this year, where, in the wake of the expenses scandal, votes will be cast all over the place in protest at the incumbent parties. The ballot box is a poor, blunt instrument for sending political messages. After all, one doesn’t have to complete a questionaire explaining one’s voting intention in order to be able to vote.

Back to the question of credibility. Martin at the Lay Scientist has some useful information. He sent requests to the main parties for their positions on a number of different scientific issues, and the results were, for me – in the case of the Greens – surprising.

Here they are on alternative medicine:

Do you believe that complementary and alternative medicine has a role in public health care, and do you believe it should be subjected to the same regulations as conventional medicine?

Green: Yes, we believe that complementary and alternative medicine has a role in public health care. The Green Party, for example, is in favour of increased funding for research on methods of integrated conventional and holistic treatments for cancer. We want the gradual inclusion of complementary therapies within NHS provision so that patients have access to all available and appropriate treatments. Complementary therapies can often prevent the situation worsening and thus save resources. We would oppose attempts to regulate complementary medicine, except by licensing and review boards made up of representatives of their respective alternative health care fields.

The NHS provides free health care for UK residents, and, more and more, takes an evidence-based approach to its provision; for example, NICE, the National Institute for Health and Clinical Excellence, look at various treatments and consider their costs and benefits. The Green Party want more complementary therapies on the NHS,  but framing it as a matter of patient choice rather misses the point. If something doesn’t work, if there is bugger all evidence for a treatment, the NHS shouldn’t be providing it and NICE shouldn’t be approving it. It’s hard to see how the provision of more alternative medicine is anything other than a step back from the laudable progress being made toward evidence based medicine by the NHS. As for holistic cancer treatments, they ask for more research funding. But again, this misses the point. A lot of holistic / alternative / complementary treatments have been shown over and over again to just be bogus, and don’t need more research. The request for more research monies is yet another attempt to have scientists do the same old studies, over and over again, until they get their sums ‘right’. The NHS doesn’t need to integrate homeopathy, chiropractic, aromatherapy, traditional Chinese medicine, flower remedies or whatever into its conventional treatment algorithms. These treatments have not been shown to work. It isn’t worth it.

They also oppose regulation of complementary medicine, except when said regulation is done by proponents of complementary medicine. But why? Is there any good reason that complementary treatments should be exempted from the same kinds of controls to which conventional  treatments are subject? The only reason that comes to mind is simply that in many cases, complementary treatments don’t need regulating because they don’t do any harm, and they don’t do any harm because they don’t do anything at all. Take homeopathy. A sugar pill that claims to be Oscillococcinum will be chemically indistinguishable from any other homeopathic sugar pill, even one that claims to be something else. All are equally worthless as they do not contain any active ingredient. In fact, in terms of regulation of homeopathy, this is all that is needed: a manufacturer can make no claims for treatment, efficacy or application if their product has not gone through the same regulatory process as any other medication. That would be fair, evidence based and scientifically reasonable. Sadly, this is not currently the case, as homeopathic treatments can make such claims, based on ‘traditional useage’.

In other cases, complementary medicine does cause direct harm. Chiropractic, the invented pseudo-medicine of stressing the spine in the hope of treating back problems or illnesses, can lead to stroke and death, but the profession is not interested in monitoring itself. If there is another treatment modality more in need of regulation, I don’t know it.

The idea, then, that the only regulation complementary medicine should undergo is by members of the self-same health care field is nonsensical. These fields have a vested interest in preserving and expanding their scope of practice, and a demonstrable unwillingness to engage with the evidence, or lack thereof, for what they do. Complementary medicine should be subject to the same scrutiny and regulation as is conventional medicine. To want otherwise, as the Green Party of England and Wales do, is not scientifically credible.

On Genetic modification:

The field of genetics has the potential to improve human health and nutrition, but many people are concerned about the effects of genetic modification both in humans and in agriculture. What is the right policy balance between the benefits of genetic advances and their potential risks?

Green: Genetically modified food presents significant and un-quantified risks to human health and the environment. These outweigh any benefits. We would ban the production or import of any genetically modified food. GM is any food that is genetically modified or includes genetically modified ingredients; from genetically modified animals; or from animals that have been given genetically modified feed. People in Britain need to know what they are eating. As such, any GM food available in this country needs to be clearly labelled as containing genetically modified ingredients or coming from genetically modified sources.

It is politically safe to oppose genetically modified foods in Europe, as public opinion is on side. But opposition – from a political party – should at least make some kind of sense. My question to the Green Party of England and Wales on this is simply: if the risk is significant and unquantified, how the heck do you know it outweighs the benefits? As the amount of land growing GM crops has increased every year, and after more than a decade of growing these things, I think the risk would be at least a little quantified by now.

An explanation:

In comments on Gimpy’s blog,  Aram tells us that “any member [of the Green Party] can propose policy, get a number of seconders and get policy passed democratically at conference. It’s not a party that makes policy top-down, with only a few people having “authority” over potential changes.” That could go a long way to explaining why the Green Party of England and Wales comes across as so flaky on these issues. Sure, its democratic, but as in many things, the mob don’t know jack. Ignoring expertise in favour of popular opinion may not be the best way to formulate policy.

What the Green Party of England and Wales get right:

I have to say, I’m impressed with the willingness of their members to engage with their critics, and they are open to reexamining their policies. See Gimpy’s blog for examples. And it is plausible that if enough critical thinkers joined them, the Green Party’s policies could take a decidedly more rational turn.  Whether it is worthwhile to try and improve a brand that is so much associated with sandal eating, Guardian-wearing, granola haired hippies, rather than joining, say, the Liberal Democrats and improving that, is for the individual to decide.

The final thing I will highlight is their stance on climate change, which is on solid scientific grounds.

On climate change:

How will you use a seat in the European Parliament to tackle climate change and its impact on the UK?

Green: The top priority, and the cheapest, is to reduce demand though cutting waste and improving efficiency, The Green New Deal includes massive investment in insulation. Renewables then have maximum value against a backdrop of reduced demand, rather than as currently only filling the gap in increased demand, which allows fossil fuel use to remain high. Carbon trading can work, but needs to be better co-ordinated with meaningful systems and actions. Exempting major polluters is clearly a nonsense. EU and UK carbon reduction targets need to be deeper and managed more actively.

I agree with all their points here. This proposal should get results fast, and I wish there were another party in the UK with a similar level of committment to combating climate change. Then again, I wish that the Green Party had the level of credibility of one of the other major parties; then policies like this could have a chance of implementation.

Summary

As with most parties, their platform represents the particular ideology or world view of their participating members. Many of the issues that the environmental movement has taken on are well supported by good scientific evidence: acid rain, ozone depletion, climate change, ocean acidification, to name a few. The problem is that the philosophy of the Green movement is only sometimes coincident with the scientific evidence. It is a worldview that looks on conventional farming as bad, disregarding centuries of research and innovation, but sees organic farming, the principles of which were spun from whole cloth by a German mystic, as good. It is a short intellectual step to believing in homeopathy or chiropractic and their principles of sympathetic magic and vitalism. There is a willingness to disregard or ignore the entire discipline of risk assessment in favour of the precautionary principle. It is best to do nothing at all, in case the very worst scenario that they can possibly imagine comes true.

The sad part is that scientists could find a home in a party like the Green Party of England and Wales, as so many ‘Green’ issues first came to public awareness because of the gathered scientific evidence. Indeed, in other countries, Green parties are more reasonable.

George Monbiot suggested that a vote for the Greens would send a message on climate change to the main parties. I would suggest that a vote for the other parties just as clearly sends a message to the Green Party of England and Wales. That message? You are not credible. Getting it right on climate is not good enough.