On May 8th, Sharon Kirkey published an article in the National Post on the dubious offerings of chiropractors who manipulate children and infants. The article was respectful of responsible chiropractors and instead focused on bogus pediatric claims outside the domain of musculoskeletal conditions. In the worst cases, I have encountered chiropractors who believe that they can use spinal manipulation to treat mental illness, infectious diseases, and even cancer in children. Despite being a regulated health profession, these claims continue nearly unabated on websites, social media, and other advertising mediums, putting the health of Canadians at great risk. I have taken it upon myself to report these practices in my spare time, but I simply do not have enough time to take on every unethical practice.
Following the publication of Kirkey’s piece, the National Post published a response from the Canadian Chiropractic Association’s (CCA) Chair, chiropractor David Peeace. The CCA is generally considered to be among the voices for progressive and evidence-based chiropractic in Canada. How progressive are they? Well, they have accepted vaccination as an effective public health measure outside the scope of chiropractic practice. You might think that is a pretty low bar for a national organization representing health professionals, but it’s a standard that even some chiropractic regulators have failed to meet.
While pediatrician Dr. Clay Jones wrote a response to the CCA’s letter at Science-Based Medicine, I wrote my own response which I forwarded to the National Post editors. Since it seems evident at this point that they will not be publishing my response, I will post it here. Enjoy.
Chiropractic Pediatrics Not All It’s Cracked Up to Be
In response to criticism of pediatric practices that “border on the fraudulent,” Canada’s largest chiropractic advocacy organization responded in a fashion that one would expect from politicians rather than registered health professionals; the response ignored the pseudoscientific elephant in the room and mounted a defense of indefensible practices.
While there may be a role for chiropractors to manage musculoskeletal (MSK) conditions in adolescents and children (although not well established in the literature), this was not the issue addressed in Sharon Kirkley’s original piece, which narrowed in on “outlandish” claims that mislead the public on serious medical conditions outside of the scope and expertise of chiropractors. The piece also addressed erroneous claims that “birth trauma” to the spine is a common concern that parents should address with chiropractic care.
Despite claims of “successful outcomes,” there is no credible evidence suggesting that spinal manipulation is indicated for any infantile condition. Though the risk of serious adverse events may be low, unnecessary procedures with no demonstrated benefits and documented risks have no place in our healthcare ecosystem. An additional risk exists with young children who may present with MSK complaints that arise from serious underlying causes, requiring appropriate medical evaluation beyond the scope of chiropractic care.
Unfortunately, unsubstantiated pediatric practices and the deceptive advertising that comes with them are commonplace in Canada. Although the precise prevalence is unknown (neither chiropractic advocacy organizations nor regulators seem to keep track), their existence is no secret to anyone with a web browser.
A small proportion of these chiropractors belong to the International Chiropractic Pediatric Association (ICPA), which boasts almost 600 Canadian members. The ICPA’s mission includes the claim to “improve the health of children,” yet they have propelled anti-vaccination ideas and act as a publication venue for papers of questionable quality, highlighting additional affronts to both public health and science.
These are not just my opinions. Earlier this year, the Canadian Paediatric Society reaffirmed their position on chiropractic, raising concerns regarding lack of evidence, lack of training, misleading vaccination advice, overuse of x-rays, and potential side effects. While I have observed many members of the chiropractic profession lambast the medical profession, at least the Canadian Medical Association is forthcoming about the skeletons in their closet and is actively engaged in public health efforts, including confrontation of the opioid crisis.
To avoid instigating a #notallchiropractors movement, it’s worth acknowledging that the profession has made progress in recent years. Indeed, public health experts are increasingly willing to extend an olive branch to the chiropractic community in recognition of the responsible and knowledgeable practitioners who look after the musculoskeletal health of Canadians. The terms, however, are non-negotiable: it is time to drop the pseudoscience.
Firstly, who is the source? The website is branded with the “Awareness Act” moniker, but there is no indication that this is a legitimate organization or that it is affiliated with anything other than its own pseudo-brand. There is no about page, no mission statement, no contact information other than a Gmail address offered on the DMCA page, and no single person brave enough to take personal responsibility for this monstrosity. They do, however, have some pretty dank conspiracies:
As we know from the title, the article claims The Lancet (a medical journal) classified fluoride as a neurotoxin. That would be a strange thing for a journal to do. Why the article was written recently when they reference an issue of The Lancet Neurology from 4 years ago is another oddity, but it is clear that they were biased from the onset: “people are hoping that by bringing awareness to this that somehow we can get sodium fluoride removed from the world’s water supply.” It’s almost as if they already found their conclusion and are merely victims of confirmation bias.
Of course, it is no mystery that fluoride can be harmful in high enough doses. This is true of anything. If there is one thing alternative health and conspiracy theory communities continuously fail to grasp, it’s that the dose makes the poison. I doubt anti-fluoride activists are as careful to avoid equally harmless natural toxins found in produce.
As with all things, the benefits must be weighed against the harms. When it comes to public health, this requires careful cost-benefit analysis drawing on years of complex scientific evidence. In the case of fluoride, the evidence tells us that there are public health and financial benefits to maintaining an optimal level of fluoride. I say optimal because there are consequences from a high dose, but – despite what you might hear from dubious internet sources – overly high fluoride intake is more likely to occur from natural fluoride sources than from carefully controlled municipal systems.
Regarding the paper cited in The Lancet, it’s worth pointing out that – despite the Awareness Act article being published less than a month ago – the link in article is a dead end.
When searching for the original study, I came across this article on Snopes, which debunks the very article I set out to address in this post. Since they were so thorough, I will only conclude by pointing to a recent study examining fluoride neurotoxicity in mice. What did they find? Absolutely no evidence of neurotoxicity, strengthening the growing body of evidence indicating that fluoridated water is both safe and effective.
So what should concern you? Certainly the increasing risk of being misinformed on social media. Unfortunately – despite their best intentions – it’s likely that we all have friends and family who pose a risk by sharing misinformed health information. While it would be nice if everyone took a bit more personal responsibility ensuring they aren’t putting anyone at risk, it’s hard to blame them when even health professional endanger public health with falsehoods.
Want to make a fool of yourself? Commit a logical fallacy. Want to make a bigger fool of yourself? Incorrectly employ a logical fallacy. Indeed, if there is anything more detested on the internet than the incorrect answer to a question (see Cunningham’s Law), it’s incorrectly qualifying a statement as fallacious. While there is a term for grammar mistakes that are made in the correction of grammar, no such equivalent exists for fallacies generally (as far as I can tell).
Some time ago, I wrote an article criticizing a chiropractor for not understanding basic science and using a diagnostic technique that would constitute health fraud if he wasn’t just ignorant. In essence, the tool (an ear thermometer) has legitimate uses, but it was used in an invalid capacity to infer the existence of a biological construct that is – as far as modern science can tell – purely mythical. This is the chiropractic subluxation.
In my first draft, I had the gall to compare the practice to ghost hunting. For reference, ghost hunters employ a range of legitimate measurement tools in the pursuit and quantification of the paranormal. Just like with the chiropractor, they use legitimate tools inappropriately to infer the existence of something that probably doesn’t exist. Just like the chiropractor, they evidently believe that their tools infer the existence of unproven entities. Quite apropos, non?
I ended up removing the ghost analogy in an early draft (I largely felt that it was unnecessary filler, as I often do with my attempts at comedy). Nonetheless, was it a fair comparison? Not according to your friendly twitter chiropractor (a different chiropractor than from the article):
Because the response was to my article, I first thought this must mean that the friendly twitter chiropractor was served some form of internet cache of an old version of my draft. I surmised that his internet provider must provide a robust caching service to save all that sweet bandwidth that would otherwise be lost to logical fallacy cheat-sheet queries. As with Cunningham’s law, it’s worth remembering the old adage: the internet never forgets.
Then again – in this case – the internet did forget and it turned out that I’m just not that original; another contributor made the same connection I first did:
Did we commit a logical fallacy in this analogy? Let’s unpack.
A reductio ad absurdum is actually not a fallacy. In fact, it’s a valid and essential logical tool for either proving or disproving a statement based on the inevitable conclusions that must be made by following the statement to logical extremes. If I say – for example – that the more I roll a ball of snow, the bigger it will get, one can dismiss the truth of the statement on the grounds that a ball of snow cannot get bigger than all of the snow on the planet. This extreme example proves that at some point, I will no longer be able to make the ball bigger with more rolling.
While a reductio ad absurdum is not a fallacy itself, the argument can be used fallaciously. If – for example – I claimed in my article that the scientifically-confused chiropractor must believe that only an ear thermometer is required to diagnose any disease because he used it in this one case, that would be a fallacious argument. It is not, however, a reductio ad absurdum fallacy – such a thing does not exist. Rather, this would be a straw man fallacy, which involves the misrepresentation of the initial premise. Indeed, incorrect use of reductio ad absurdum arguments often result in straw man or slippery slope fallacies. Instead, when illustrating why spinal thermography with an ear thermometer is an invalid practice, comparison to ghost hunting is employed as a comedic device to illustrate the palpable silliness of grown adults hunting for things that likely do not exist.
This would be an opportune time for a deprecating remark about the quality of chiropractic education, but I would hate to provoke twitter warriors with logical fallacy keyboard macros to wrongfully conflate my assertion with an ad hominem. Then again, I love a good rant.
The CBC recently published a story promoting a urine-based test to determine the sex of a fetus during pregnancy. Although the article claims the kit has an 80-92% accuracy based on three studies, no citation was provided and there was clearly no assessment of the quality of these studies (if they exist). While this should have been the focus of controversy surrounding the article, a controversy was instead manufactured surrounding the name of the product: GenderSense.
Rather than relying on a qualified OB-GYN to discuss the nature of this sort of testing, the author interviewed a sociology professor from Wilfred Laurier. While the professor pointed out the issues in conflating gender as a social construct and sex as a biological trait (and I mean – come on – it’s not 2012, people), there was no discussion contextualizing the product medically. When is sex normally determined via ultrasound? How does this time frame and accuracy compare with the proposed product? How will this knowledge empower the consumer to make decisions going forward? Perhaps the company could have avoided this distraction by naming the product SexSense. Then again, that name sounds more like something you’d see in your spam folder rather than a pharmacy.
Like most journalists, I don’t know a damn thing about reproductive health. Unlike many journalists, however, I am concerned with the accuracy of scientific and medical claims. So, time to learn a thing or two.
First, we should establish why sex determination is important. The most obvious answers are for social reasons: preparing psychologically, shopping, religious reasons, and even just plain curiosity. While we can debate the validity of these reasons and their potential consequences, there are also good medical indications. There are numerous sex-linked disorders that a fetus could be predisposed to, either necessitating prompt medical intervention, or potentially forming part of an informed decision in the choice to terminate a pregnancy. The ethical considerations are vast and there is no way I’m touching those. So, how do we determine sex?
How accurate are these measures? The answer is: it depends on how far along the pregnancy is. Obviously it would be great to know at the time of conception, but the unfortunate reality is that we don’t live in a world where techniques like Chinese Astrology are anything more than chain email content or Reader’s Digest filler. Instead, we have to wait for the expression of traits that our science-based tools actually measure.
Cell-free fetal DNA testing is a bit more interesting. This is fetal DNA circulating in maternal blood that is sampled with a blood test. The obvious limitation is the requirement for enough fetal DNA to be in circulation, which most certainly is not the case at the moment of conception. A recent review indicated that the test was unreliable if performed before 7 weeks of gestation. Interestingly, the authors also concluded that urine testing for cell-free fetal DNA was unreliable. Is any urine testing reliable?
Scouring the literature, there were no conclusive studies that supported any form of urine testing for sex determination. Despite this, many products south of the border have made bold claims regarding the efficacy of their urine tests. Experts appear to conclude that these test are entirely bogus.
Does GenderSense have anything better to offer? The purported studies might have the answer, but I won’t hold my breath for their release. After all – as with IntelliGender – GenderSense’s founder Remy Warren does not possess any formal scientific or medical training. Business as usual.
Because the product does not claim to treat a medical condition or make a diagnosis, Health Canada has announced that it will not pursue regulating the device. They make a fair point, but who is to regulate the science of this pseudo-medical product? What happens if parents rely on this information to make medical decisions? Regardless of the implications of knowing the sex of a fetus, the implications of making the wrong assumption could be dire.
It would have been nice if these issues were raised by the CBC. Then again, if it weren’t for bad science reporting, I wouldn’t be learning so much about fetuses.
Thanks to Dr. Terry Polevoy for his investigative work and commitment to Canadian health issues. Remy Warren was contacted prior to the release of this article, but I have not yet received a response.
While chiropractic care for infants has generated substantial controversy (and rightly so), there has been little criticism regarding chiropractic prenatal care. Back pain is, of course, common during pregnancy, but – although it is reasonably safe – there isn’t good evidence that chiropractic care can be effective during pregnancy. Chiropractic care for back pain, however, isn’t the most egregious service chiropractors offer pregnant women. What is? Chiropractic care for breech presentation of the fetus.
Breech positioning occurs when a fetus is positioned bottom-first, rather than the common presentation of head-first. It’s not particularly common and the best course of action is generally to perform a caesarean section. As caesareans are not without side-effects, it’s understandable that expectant mothers would like to pursue alternatives. Enter, chiropractic.
The paper is exactly what it sounds like; it’s a case study that followed an individual woman with breech presentation who received chiropractic care in the form of Webster’s technique. Her follow-up indicated that the fetus re-positioned to the vertex (head-down) position. The study concluded – based on this alone – that Webster’s technique should be offered to all patients instead of a caesarian section. This is an interesting conclusion considering that spontaneous correction occurs in the majority of cases regardless. This study portrays mastery only of regression to the mean and should be cast adrift with the multitude of chiropractic case studies making unsubstantiated claims.
One of the most prolific chiropractors offering the technique is London’s own B.J. Hardick (recently suspended for illegal blood tests). His YouTube video describes a 32-week pregnancy adjustment that he seems rather confident in:
If this is a claim of 100% efficacy, disclosure of the supporting data would certainly be interesting. Regardless, practitioners who claim Webster’s technique is effective at turning breech fetuses have put themselves in a precarious position; a well-defined clinical trial with objective measures of outcome would be easy to run at a low cost and possibly low risk. Yet – after decades of promotion – all we have are useless case studies and useless surveys.
As it stands, the promotion and practice of Webster’s technique as a remedy for breech presentation is quite possibly patient abuse, yet offerings like these appear to be endemic to chiropractic in Ontario. A little bit of reservation from chiropractors offering unsubstantiated techniques would be great. Widespread adoption of a culture that respects and understands science would be even better.
No more than a year ago, my preconception of chiropractic was probably similar to that of most Canadians; I assumed that chiropractors were doctors who specialized in back pain as it relates to the spine and musculoskeletal system. As I began to research chiropractic – dissecting both modern practice and historical origins – I found that this simplistic understanding did not account for the wide variety of diagnostic and treatment paradigms that practitioners adhere to. While many chiropractors are experts in the domains of pain and function in relation to the musculoskeletal system and spine, there are many chiropractors who purport treatment of nearly all medical ailments. These chiropractors hold on to age-old beliefs that are steeped in a spiritual mysticism and vitalism.
The invention of chiropractic is attributed to D.D. Palmer. Palmer was originally a magnetic healer who appropriated the osteopathic technique of joint manipulation. He further appropriated the medical term “subluxation” to refer to what he thought were misaligned vertebrae. Positing that these misalignments impinge on nervous tissue which control healing forces within the body, Palmer implicated subluxations as the root cause for all manner of disease. In his book The Science, Art and Philosophy of Chiropractic, he claimed:
D.D. Palmer’s practice of chiropractic may never have gained the following it has today if it weren’t for the mythologizing of a particular extraordinary deed. In 1895 – examining the back of the hearing impaired Harvey Lillard – Palmer claimed to have discovered a bony protrusion. By performing a manual adjustment of the offending vertebrae, Palmer was credited with restoring Lillard’s hearing.
Although the incident is often said to be instrumental to the proliferation of chiropractic, treatment of the deaf is not something found within the scope of modern chiropractic. In fact, no chiropractor has performed the procedure successfully under controlled conditions. The challenge of repeating this chiropractic miracle is likely attributable to the anatomy of hearing (something we now more clearly understand); the auditory nerves reside exclusively within the skull and at no point travel down the spine. To put it bluntly: chiropractic cannot heal the deaf.
As chiropractic first expanded, some practitioners incorporated radical religious and philosophical beliefs. The adoption of religious symbolism and ideology was – in part – a ploy by Palmer to protect chiropractors from prosecution for practicing medicine without a license. Although much of Palmer’s writings were contradictory and far from concise, his philosophy generally describes a Universal Intelligence (God) that manifests as an Innate healing power channeled through the nervous system and spine.
In essence, Palmer’s principles of chiropractic assert that subluxations result in interference between the Innate vitalistic force and the body by compressing the nerves, causing disease. When chiropractors perform adjustments on patients, they claim to be completing the body’s connection with Innate, allowing it to perform its healing ability. It is this practice that led chiropractors to coin the notion of, “connecting man the physical with man the spiritual,” which is often expressed as turning people’s power on.
Of course, no one would believe these things in this modern age would they? Actually, London’s own celebrity chiropractor B.J. Hardick evidently subscribes to a very similar worldview:
While many current practices today developed from mythologies of the past, chiropractic is unique for retaining much of its philosophical and religious heritage. It’s not uncommon today to hear chiropractors reference Innate or subluxations within their practice. Although the term subluxation does have an appropriate medical use, chiropractors have manipulated it to fit their own design. The lack of substantiation for vertebral subluxationdid little to impede the proliferation of chiropractic.
If subluxations are a valid source of concern, we should be able to identify them, illustrate their causal link to disease, and demonstrate that their treatment has a positive effect on specific disease processes and patient symptoms. In 2009, a group of chiropractic researchers examined the evidence relating to subluxations and found “no supportive evidence . . . for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions.” Some chiropractors took issue with the findings, but none put forward a substantive critique. Indeed, when suggesting a novel scientific paradigm, the burden of proof rests on those who make extraordinary claims.
In his book Chiropractic Abuse: An Insider’s Lament, chiropractor Preston Long details how the chiropractic profession is plagued by unscientific beliefs that have persisted in spite of their clash with modern scientific and medical knowledge:
“I am a chiropractor. I do not say this with pride. My profession is full of men and women who exaggerate what they can do and provide unnecessary and sometimes dangerous services to their patients. Most chiropractors are not bad people, but far too many embrace cult-like beliefs.”
Today, a contentious rift exists within the chiropractic community. There even exists terminology to demarcate between those clinging to the ideas of the past and those who incorporate novel techniques: straights (often self-described as principled) are those who follow the classical Palmer doctrine whereas mixers are those who incorporate other techniques including modern scientific understanding of disease processes (although mixers sometimes pursue equally suspect health practices). This leaves us with two different chiropractic philosophies. The former (the straights) generally believe that subluxations are the root cause of most disease and that a lifetime of spinal adjustments is essential for maintaining proper health. The latter (the mixers) apply spinal manipulation therapy to relieve musculoskeletal pain and generally work with patients to improve mobility and function.
So if the subluxation is a mythical concept, what benefits do chiropractors offer? A 2011 Cochrane review examined the use of combined chiropractic interventions for what chiropractors are most known for: treatment of lower back pain. While they found evidence that “chiropractic interventions slightly improved pain and disability in the short term and pain in the medium term for acute/subacute” lower back pain, they concluded that “there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with [lower-back pain] when compared to other interventions.” Follow up research examining spinal manipulation therapy reached a similar conclusion in 2013.
In addition to lower back pain, there is some evidence indicating that spinal manipulation may aid migraines, as well as neck pain. While the evidence is weak, this may be a result of biomechanical variability among patients, causing some patients to respond well to treatment but not others. After all, many patients swear by chiropractic; while recent Gallup polls illustrated that the American public finds physical therapy generally more effective and safer than chiropractic for neck and back pain, chiropractic care did rank higher than all other interventions. Indeed, many patients are satisfied with their chiropractic care. Despite the mixed evidence, there may be a future for spinal manipulation therapy in treating some pain and disability. If chiropractors can help curtail the opioid crisis as they purport, then their deployment in conservative musculoskeletal care is welcomed.
Unfortunately, a significant impediment to healthcare integration is the division within the chiropractic community. Chiropractic’s historical baggage has led to disparate professional identities, causing criticism from the medical community, particularly among orthopedic surgeons. It’s not hard to see why. Many chiropractors make outlandish and unsubstantiated claims regarding treatment of conditions unrelated to the musculoskeletal system. While evidence-based practitioners generally offer manipulations with the intent of mobilizing joints, those in the straight community claim to precisely adjust misaligned vertebrae and restore them to their proper positions. These claims are dismissed even by chiropractic researchers, yet many practitioners still offer these unscientific services.
A Legacy of Anti-Science
Subluxation-based chiropractic is a treatment in search of a disease. Unlike most medical research which seeks to evaluate novel treatments and diagnostic techniques, chiropractic research is still trying to vindicate an age-old approach to health. This led the American Medical Association to label chiropractic an “Unscientific Cult” as early as 1969. In response, chiropractors sued. Though the AMA lost in an antitrust suit (not by scientific merit), the war continues to this day and chiropractors have still not demonstrated the existence of the subluxation.
In contrast to health practices like physiotherapy or massage, subluxation-based chiropractors are particularly vocal in their opposition to the medical system. A likely explanation – aside from the obvious history – is that physiotherapy, massage, and even modern chiropractic are exclusively complementary to medical practices. Quite distinctly, subluxation-oriented chiropractors often find themselves in competition with the medical system; after all, subluxation-based chiropractors consider their treatment to remedy the cause of most afflictions (despite the lack of evidence). A simple Google search involving the term ‘chiropractic’ and any disease will produce unsavory results. Even chiropractic’s patriarch D.D. Palmer spent time in jail for practicing medicine without a license.
Perhaps the most repugnant philosophical stance that remains pervasive in the chiropractic world is the fervent opposition to vaccination. While scientists and public health experts unanimously recognize vaccination as an effective approach to prevent disease with little risk, the topic remains a contentious issue within the world of chiropractic. D.D. Palmer’s son, B.J. Palmer – the great promoter of chiropractic – is largely responsible.
“The idea of poisoning healthy people with vaccine virus . . . is irrational. People make a great ado if exposed to a contagious disease, but they submit to being inoculated with rotten pus, which, if it takes, is warranted to give them a disease.”
Source: B.J. Palmer’s The Science of Chiropractic: Its Principles & Adjustments
“My parents chose to opt me out of the routine vaccination schedule many years before the world was paying attention to mercury toxicity, Autism, studies, or anything else … My parents wanted me to develop my immune system naturally, without interference.”
Anti-vaccination beliefs aren’t the only risk posed to children by chiropractors. One area in particular where chiropractic has received extensive criticism from the medical community is in the domain of pediatrics. Many chiropractors in Ontario and abroad have made outlandish claims with regards to chiropractic treatment for infants and children. While there are documented consequences from chiropractors working on infants, precise rates of complication are unknown – likely a consequence of poor adverse event documentation and reporting.
“There’s nothing that I love more than seeing a kid jumping up on the table . . . make sure they’re subluxation free and whether it ever elicits a symptomatic change in that child or not, just being able to know that we’ve turned on the power.”
B.J. Hardick is a prominent example of a chiropractor promoting treatments for infants and children. The following images were all scraped from his professional Facebook page:
The absurdity of chiropractors treating infants is only eclipsed by what they claim they are treating; many chiropractors advocate for treatment of children with ear infections, asthma, colic, and other non-musculoskeletal conditions. It’s important to note that the vast majority of conditions that chiropractors treat in children are self-limiting – they tend to resolve spontaneously. A prominent example is colic, for which there is no evidence supporting chiropractic treatment.
In Canada, the problem is pervasive enough that the Canadian Pediatric Society released a position paper: “Chiropractic care for children: Controversies and issues”. The original position was posted in 2002 and reaffirmed in 2016. When examining the scientific evidence, they found that there was no evidence for chiropractic to treat any pediatric disorder. Instead, they found that chiropractors put children at risk by spreading misinformation regarding immunization and by attempting to treat acute pediatric conditions that instead need serious medical treatment. These weren’t the only risks identified. The authors noted that “parents should be made aware that there is a lack of substantiated evidence for the theory of subluxated vertebrae as the causality for illness in children, and x-rays taken for this purpose expose the child to unnecessary radiation.” In fact, chiropractors often overuse x-rays. Even for lower back pain, Choosing Wisely Canada recommends against x-rays partly because it has not been shown to improve management of symptoms. Naturally, misuse of X-ray technology has a long history in chiropractic. B.J. Hardick himself claims that it’s dangerous to adjust without x-rays and has showcased x-rays of children in his YouTube videos.
In a further affront (conscious or otherwise) to public health, many chiropractors attribute risk of subluxation to how the baby is delivered (here is a prime example). Not only are they doing a disservice to public health, but they are unnecessarily shaming mothers about their personal choices regarding the birth process.
“The more natural the delivery, the less interference, the fewer interventions medically that are necessary, the less trauma to the skull . . . I had a baby last week where unfortunately based on the way the baby was presented, they had to turn the baby manually inside the mom and then pull the baby out. So the baby’s neck was definitely subluxated.”
“One fact we do know, however, is that the first subluxation usually happens in the birth canal because of the normal trauma associated with vaginal deliveries. Even babies delivered by C-section are subject to birth trauma and vertebral subluxation. This is why it is absolutely critical for parents to bring their babies to their chiropractor as soon after birth as possible. This will ensure that their child’s nervous system is functioning at full capacity, which will provide the framework for a long life of health and vitality.”
In 1991, chiropractors became authorized to use the title ‘doctor’ under the Chiropractic Act. This privilege has been used irresponsibly by chiropractors nation-wide when making public statements on medical concerns unrelated to musculoskeletal issues. When the public is likely to conflate the use of the title ‘doctor’ with ‘medical doctor’, it is irresponsible to apply the title in the context of non-musculoskeletal medical advice; this is especially true when practitioners are disseminating misleading information.
The College of Chiropractors of Ontario is the self-regulating body for chiropractic in Ontario. As authorized in the Chiropractic Act, the chiropractic scope of practice is as follows:
The practice of chiropractic is the assessment of conditions related to the spine, nervous system and joints and the diagnosis, prevention and treatment, primarily by adjustment, of,
(a) dysfunctions or disorders arising from the structures or functions of the spine and the effects of those dysfunctions or disorders on the nervous system; and
(b) dysfunctions or disorders arising from the structures or functions of the joints.
The problem is that the application and enforcement of this scope is open to broad interpretation. If you subscribe to the classical subluxation philosophy and believe that spinal adjustments channel the healing power of Innate through the body, what could possibly be considered outside of a chiropractor’s scope of practice?
How pervasive is the belief among practitioners that chiropractic can effectively treat a wide range of medical conditions unrelated to the spine? Unfortunately, it is not known. No regulatory body surveys and disseminates this information and existing literature on the topic is unreliable at best. A recent survey of Canadian chiropractors indicated that large proportions of chiropractors in clinical practice use entirely unsubstantiated diagnostic and treatment techniques (for example, 22% claimed to prescribe homeopathy – a treatment that isn’t only unproven but implausible).
Ultimately, the regulatory body has not enforced evidence-based practices, resulting in a vast number of chiropractors who sell useless, even dangerous treatments. My article regarding the Byron-based chiropractor who uses a cheap ear thermometer to diagnose subluxations is a prime example of a chiropractor running a successful business in spite of either having no idea what he is doing, or consciously conning his patients. It’s worth repeating: where are the regulators?
Unfortunately, patients seeking responsible chiropractic care must be extra diligent in screening their care provider. My advice would be to take time to examine the chiropractor’s website. Do they make absurd claims regarding non-MSK conditions? Do they treat infants? Do they treat subluxations? Do they offer long-term treatment/payment plans? Do they advertise testimonials regarding conditions outside of the scope of chiropractic? Do they perform x-rays on every patient? If the answer is yes to any of these, you’re very likely dealing with a quack.
“Good chiropractors are essentially physical therapists who specialize in the spine. Spinal manipulation is an effective option for mechanical low back pain, but physical therapists and some doctors also use that treatment. Some chiropractors want to be primary care providers and treat a variety of non-MSK diseases, but they are not trained to do that. Many chiropractors subscribe to outright quackery like applied kinesiology; and only half of them support vaccination. A medical subluxation is a partial dislocation of a joint that is readily visible on x-ray; the “chiropractic subluxation” is a myth and does not show on x-ray. And chiropractic can be dangerous: stroke is a rare but devastating complication of neck manipulations.”
My former roommate was an early adopter of essential oils. Using a diffuser (ultrasonic humidifier) to spread fragrances house-wide, I would come home to aromas of peppermint, orange, and lavender instead of the familiar musty scent baked into our basement apartment. Sold on the efficacy of essential oils in reinvigorating stagnant air, I too became a user. In a rational world, this is where the story would end. Unfortunately, we do not live in a rational world.
Essential oils have taken upper middle class suburbia (and by extension Instagram) by storm. Social media platforms – once the refuge of dank memes and animal pictures – are now home to the blurred line between people’s personal lives and their multi-level marketing schemes. What’s particularly frightening, however, is how quickly each exciting new business opportunity has become the path to true health and wellness.
If you believe everything you read, you might think that essential oils are here to cure cancer, solve world hunger, reverse climate change, and ultimately prevent the impending heat death of the universe. You might think that essential oils have been divinely bestowed on us to empower stay-at-home parents to become entrepreneurs and health gurus while simultaneously enriching themselves, their communities, and the world around them. You would be wrong, but I can’t blame you.
In reality, essential oils have not been demonstrated to be particularly effective at preventing or treating any disease or condition. It wasn’t long before both the EPA and the FDA took action against this blatant pseudoscience, prompting doTERRA to go on the defensive. Now, rather than instructing their consultants to make unsubstantiated health claims that are illegal, doTERRA provides guidelines for consultants that employ semantics to avoid those pesky science-based regulators:
Of course, there isn’t even good evidence that essential oils satisfy any of the “Structure-Function Claims,” but the mildness of the claims are enough to appease the FDA. As unfortunate as it is for public health, however, doTERRA advocates are not mild people.
In London, we are home to Canada’s first Presidential Diamond doTERRA representative: Ange Peters. In their not-at-all-a-pyramid-scheme compensation plan, the honor of Presidential Diamond is bestowed only on those who have climbed to the top and profited from those below.
Of course, it is unlikely that anyone gets to the top of the doTERRA food chain without being a prolific purveyor of pseudoscience.
Although Peters claims to guide women to true HEALTH, her social media is not filled with responsible health advice. Instead, her media is a window into a world where self-promotion, product marketing, unsubstantiated health claims, and even her personal life have become intertwined into a caricature of the social media takeover by advertisers.
But I digress; what troubles me more than the content of my social media feed is the content of Peters’ advertising. The sheer magnitude of misleading medical claims that appear on Peters’ various platforms is staggering. Her own “Getting Started with Oils” guide provides a compendium of medical recommendations for essential oil, which can be accessed by clicking the prominently displayed “Health Concerns” graphic:
In this encyclopedia of serious medical conditions, various criticisms are levied against effective medical treatments. Instead, specific essential oil “Protocols” are offered for every affliction you can think of. Of course, none of them are proven to work in any capacity, hence the inclusion of the Quack Miranda Warning. In many cases, these “treatments” likely do more harm than good.
Although the domain of this site is registered to doTERRA, the content was taken offline some time ago, presumably in response to the crackdown by the FDA. I find it troubling that Peters went to the trouble to link to an archive of the site. I’m further troubled by the vast assortment of dubious health advice Peters offers when promoting her products and services.
The vitamin and mineral comment likely stems from a landmark 2004 study (and similar studies) that saw a small reduction in some nutrients among cultivated crops, likely attributable to changes in soil composition and changes in cultivated varieties. It’s a worrying trend and certainly something to keep an eye on, but to say we need to eat five times the food today for the same vitamin and mineral intake is nothing short of ignorant. The claim grossly overstates the reduction and doesn’t identify which foods or even which nutrients in those foods are impacted. Further, do these changes even impact our health in any capacity? I get the impression that Peters hasn’t read the primary scientific literature.
Peters often claims to be “passionate abouteducating and empowering women tolive their best life through natural solutions”. In reality, Peters is empowering her audience to take big risks with their health and their finances. Unfortunately, doTERRA has laid the foundation for Peters and other like-minded practitioners to prosper unabated while organizations like Health Canada have been complicit and ineffective in preventing false health claims. Whether a result of incompetence or ignorance, Health Canada – the organization mandated to protect the public from dangerous and ineffective health products – has failed.
In what is certainly an effort to find a balance between consumer demand and public health, Health Canada allows for the registration of Natural Health Products – products which are supposed to be screened to ensure they are “safe, effective and of high quality.” The problem, however, is that a vast number of registered products have literally no scientific evidence supporting the claims they are permitted to make. So how did they come to be registered?
In place of scientific evidence, Health Canada will accept “Tradition Use Claims“. So if someone once used an ingredient, made up a claim about it, and then wrote it in a pharmacopoeia, products using this ingredient can register as natural health products and make the same claims – true or not. This is an ongoing failure of Health Canada that the CBC frequently illuminates. It’s the same flaw doTERRA has exploited.
Here’s the problem: Health Canada’s monograph for juniper essential oil doesn’t contain a single scientific or clinical study supporting its use for anything. Nonetheless, the oil is a registered natural health product, citing juniperus communis as a medicinal ingredient – a compound that also lacks scientific evidence from Health Canada for oral use.
A lack of regulatory controls on health products can have serious consequences. Not everyone is privileged enough with time and resources to conduct a thorough review of health claims. When essential oil companies boast that their products are registered natural health products, it lends legitimacy to the outlandish claims, emboldening proponents to believe that they were right all along about every mystical claim attributed to what is simply an aroma. As a result, listening to doTERRA advocates is like listening to a child talking about all the things Santa’s elves can do. Health Canada needs to be the one to tell her that Santa isn’t real.
I should be clear that I don’t believe Ange Peters acts maliciously. Although I wouldn’t say her business is innocent of profiteering, I get the sense that she feels her beliefs are vindicated. After all, she has amassed an audience of happy and healthy followers. Every successful customer is not just a business win, but a philosophical win. These are the people who I worry about the most.
When one of her clients asks “Does terrazyme help fight against disease?” and Peters answers“Yes,” it condemns her audience to spend time and money chasing supplements that have no clinical evidence for preventing disease. Some may seek these products in place of legitimate medical care, but as it stands, doTERRA is not a medical company and essential oils are not medicine.
Despite not living up to their hype, I don’t hold anything against essential oils. In fact, I still use them nightly in my diffuser. Why? They smell nice and I enjoy it. What I won’t do is purchase from unethical companies like Young Living and doTERRA that have profited from misleading health claims and a predatory business model.
Facebook does not care about your privacy. They aren’t alone; we pay to use all manner of application and platform with our privacy. It’s the price of free. However, I suspect many of us would be more selective with our personal information if we really knew the scope of intrusion. While options are given to users under the guise of Privacy Controls, these are not much more than wool over the eyes. To really understand what’s exposed, you have to think and act like an investigator.
The field of Open Source Intelligence (OSINT) is a passion of mine that focuses on the tools and techniques to uncover information of a target over the internet. Because it’s only peripherally related to the theme of this blog, I’ll take you through the motions using a health-related target who I honed my skills on: chiropractor B.J. Hardick.
I first learned about B.J. through a flyer distributed around town (London, Ontario):
The book is a dreadful amalgamation of dangerous and ineffective alt-med practices that goes as far as recommending chiropractic spinal manipulation as cancer treatment. The book was advertised as a sort of manual that recommends dubious techniques used by chiropractor Charles Majors who was diagnosed with multiple myeloma. Although B.J. claimed that Majors cured himself using techniques presented in the book, the tragic irony is that Majors passed away earlier this year. This is a story for another post, however.
So how does this tie in to Facebook privacy? The public presence of alt-med gurus is very different than typical medical professionals. Success is less about providing sound evidence-based care, and more about relentless promotion through social media. In many situations, such social media accounts are identified as professional extensions of practitioners’ clinical practices, which means that sharing silly memes comparing vaccines to events like the holocaust may very well be in the purview of regulatory discipline. So let’s dig in.
B.J. Hardick is evidently tied to three Facebook accounts: his personal page, his professional page, and his clinic’s page. His personal page is obviously out of scope for this investigation and his clinical page is certainly within scope. While his professional page isn’t explicitly linked to his clinical practice, he shares health and medical information and uses the title of Doctor, which is a regulated title in Canada. Hence, this page is in scope.
The simplest approach to investigations on Facebook is Facebook’s own search. It’s actually rather powerful.
A simple search reveals that the Hardick Chiropractic Centre account has directly disseminated anti-vaccine propaganda that still remains available despite recent warnings to B.J. from the College of Chiropractors of Ontario. Not impressed? Alright, let’s go deeper.
Every Facebook page or account is associated with a numerical ID. Using these IDs, we can make use of Facebook’s graph API, which opens up a vast arsenal of creeping – err – investigating possibilities. Facebook hides these IDs within the source of each page. To view the source (in Chrome), simply right click a page and select “View Source.”
Don’t fret at the incoming wall of code; all we need to do here is search for a single item. If you’re on someone’s personal profile, you want to find the value of profileid. Simply hit Ctrl+F and type in profileid. If, as in this case, you’re not on a personal page but a professional page, you’ll want to find the value of pageid, which appears as follows in this example:
This number is our ticket to the wealth of information we can extract from Facebook. You now have two options. You can learn how Facebook’s Graph API works, or you can use any number of pre-built tools to generate searches for you. Simple, but effective is graph.tips. However, Michael Bazzell’s Intel Techniques has become a household name in the OSINT world due to its comprehensive search tools. Navigate to the Facebook page and you’ll find a form for a Facebook User Number. This is where you place the pageid or profileid value. Click Populate All and you will see a plethora of options. Click Go on any of these and the website will direct you to Facebook with the appropriate search URL.
Examining the pages liked by B.J.’s professional account, we see a frightening trend:
Photos posted, liked, and commented on also portray at least a modest disregard for science and public health (even Health Canada has issued an alert regarding mammography):
Perhaps most disturbing is that B.J. likes his own posts:
What has the world come to?
As our personal and professional lives slowly become entangled in the web of social media, it’s worth taking some time to explore what is revealed about us. I encourage readers to use these tools on their own accounts. Take back your privacy.
I like to believe that we are tending towards a market where a lack of science sense is a lack of business sense. In the domain of medicine, history illuminates the progress of evidence-based practices, taking us from medieval blood letting to the modern clinic guided by the pursuit of truth: science. In 2017, can investments in blatantly implausible and scientifically unsound products still yield a return? The CBC’s Dragons’ Den put that to the test.
Despite such blatant flaws, the Dragons failed to uphold the standards of critical appraisal viewers have come to love. While it’s unreasonable to think that they could perform a thorough examination of a product’s scientific merits on air, I would have thought that the Dragons would at least not be susceptible to simple magic tricks. That’s right, magic tricks. Based on the segment that aired, the Dragons were convinced of the technology’s efficacy all from a technique commonly used to promote the pseudoscience of applied kinesiology.
The technique is less of a demonstration of the product in action and more of an exploration of the frailties and shortcomings of human psychology. The classic technique involves pushing down on a patient’s arm in two separate trials. The first trial is a test of the patient’s baseline strength when the practitioner pushes on their outstretched arm. The second test requires the patient to hold an item purported to weaken or strengthen them before the practitioner pushes their arm. The patient will very likely notice a difference between tests, but it’s not a result of some vitalistic energy force. Rather, it’s a result of the power of suggestion and the practitioner’s influence (remember, the one making the bold claims is also the one providing the force).
Ultimately, the test is unscientific and doesn’t possess the most basic requirement of patient and practitioner blinding. In essence, it’s a magic trick, which isn’t surprising considering it’s coming from a chiropractor who uses wands. I wonder what investment I could muster from the Dragons with a hat that makes rabbits disappear.
If magic clips don’t interest you, the duo also offers an entirely implausible spray:
“You can spray me and make me more athletic?”
Allowing this uncritical promotion is nothing short of irresponsible. The show trespassed on reprehensible when the duo took the opportunity to pitch further unsubstantiated claims to the Dragons and their audience.
“You’re hitting the [golf ball] straighter?”
“Absolutely. Every sport has an application with our product, whether it’s hockey, baseball…”
“What are the other real-world applications?”
“Well healthcare for sure. And the elderly for sure. My mother, she says ‘I just feel like I’m going to fall over, but when I put the device on, I never feel like I’m going to fall over‘ because it helps regulate her balance.”
Some Dragons were evidently more critical than others.
Manjit offered $100,000 for 30% of the company, but five other Dragons jumped on the deal to usurp her. I’m not naive enough to believe that televised deals are real, but – if this one goes through – I hope for the sake of public health and consumer protection that the Dragons lose out.
I’m not the only person appalled at this lapse in skeptical thinking. Dr. Joe Schwarcz – Director of McGill’s Office for Science and Society – had his own criticism for the show and its guests:
Dr. Terry Polevoy – a veracious health watchdog – was equally critical and suggested appeals to the regulatory bodies:
Even the Reddit Skeptic community had many users calling the product a blatant scam. I can, at least, think of one use for these magic clips: