Chiropractic: A Modern Threat to Canadian Health

A Brief History of Chiropractic

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:

Image retrieved Jan. 2017 from here

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.

Harvey Lillard
Retrieved April 2017 from here.

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:

BJ Hardick Universal Intelligence
Image retrieved Jan. 2017 from here.

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 subluxation did little to impede the proliferation of chiropractic.

Image retrieved Jan. 2017 from here.

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.

While practitioners of unproven techniques often recall the aphorism that an absence of evidence is not evidence of absence, after years of investigation, evidence of absence is precisely what plagues the chiropractic subluxation. The British General Chiropractic Council denounced the subluxation complex in 2010, followed by additional chiropractic institutions in 2015. Despite the fact that there is no evidence or plausible biological mechanism to validate subluxations as the cause of disease, and despite the fact that chiropractors can’t reliably identify subluxations, some chiropractors continue to apply this philosophy in their clinical treatment. Prominent chiropractors in support of evidence-based practice have noted the detriment to public health that is subluxation theory.

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.”

Source: Chiropractic Abuse: An Insider’s Lament, pg 21

Chiropractic Abuse by Preston Long

Reformation

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

B.J. Palmer

With a long history of opposition to vaccination, chiropractors who cling to the ideas of the past put children at risk and endanger public health. If you think that chiropractic in Canada has outgrown its superstitious and unscientific views, you would be wrong. A recent investigation uncovered significant promotion of anti-vaccination propaganda among Manitoba chiropractors, leading to calls for proactive oversight and regulation. Some chiropractors are even ignorant enough to make media statements against vaccination.

“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.”

Source: Dr. B.J. Hardick [Facebook]

B.J. Hardick

Steven-Salzberg-on-Vaccinations
Image retrieved Jan. 2017 from here.

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.”

Source: Dr. B.J. Hardick: A Maximized Living Co-Author explains “Why he died.”  [The Chiropractic Philanthropist]

“I check a ton of kids the day that they’re born.”

Source: Kids Chiropractic Adjustment [YouTube]

B.J. Hardick

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:

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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.

Dr. Harriet Hall Chiro
Retrieved Jan. 2017 from here.

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.”

Source: Kids Chiropractic Adjustment [YouTube]

“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.”

Source: http://drhardick.com/kids-chiropractic

B.J. Hardick

Where are the regulators?

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.”

Source: Interview with Dr. Harriet Hall

Dr. Harriet Hall

The Oil Rush: How Health Canada has Failed to Regulate Deceptive Health Products

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.

Essential oils have been marketed relentlessly and deceptively by multi-level marketing organizations that profit from our modern addiction to wellness. Although Young Living pioneered the business of deceptive essential oil marketing, doTERRA made it a household affliction through their consultants’ insistence that oils could treat anything from asthma to Ebola.

The natural Ebola cure.
The natural Ebola cure. Retrieved Dec. 2017 from: http://4.bp.blogspot.com/-H3OdCWW_0to/VCNtk0PL1LI/AAAAAAAADsM/taC1KjoJLr8/s1600/ebolaoregano.PNG

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:

doTERRA Quick Claims Guide
doTERRA Quick Claims Guide. Retrieved Dec. 2017 from: http://media.doterra.com/us/en/flyers/quick-claims-guide.pdf

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.

doTERRA Compensation plan
doTERRA Compensation plan. Retrieved Dec. 2017 from: https://www.doterra.com/medias/9841222451230.jpg

Of course, it is unlikely that anyone gets to the top of the doTERRA food chain without being a prolific purveyor of pseudoscience.

Ange Peters is not a doctor
Ange Peters is definitely not a doctor. Image retrieved Dec. 2017 from: https://i.ytimg.com/vi/SsGecufx1rw/maxresdefault.jpg

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.

Ange Peters Promotion
Are we all just props in a social media nightmare? Retrieved Dec. 2017 from: https://www.instagram.com/hol_fit/?hl=en

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:

HOL:FIT Wellness :: Getting Started with Oils
HOL:FIT Wellness :: Getting Started with Oils. Retrieved Dec. 2017 from: https://docs.google.com/document/d/1FgogIRFosPDLelanNgY5e5Tql1Ygvxu3BrtBdRmsSpY/edit#

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.

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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.

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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.

Ange Peters Learns from YouTube
At least it was much cheaper than a medical degree. Retrieved Dec. 2017 from: https://www.youtube.com/watch?time_continue=1&v=iXIsRSDPWQA

Peters often claims to be “passionate about educating and empowering women to live 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.

Let’s look at a specific example: doTERRA’s Juniper Berry Essential Oil. On their Approved Claims List, doTERRA permits Canadian representatives to make a number of aromatherapeutic claims:

doTERRA - Juniper Berry
Retreived Dec. 2017 from: http://media.doterra.com/ca-otg/en/flyers/approved-claims-list-ca.pdf

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.

A Primer on Facebook as an Investigative Tool

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):

B.J. Hardick Cancer Killers Flyer
B.J. Hardick Cancer Killers Flyer (Scanned by me in 2016)

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.

Hardick Chiropractic Centre Vaccines
Hardick Chiropractic Centre Vaccines – Retrieved December 2017 from: https://www.facebook.com/search/pages/?q=Hardick%20Chiropractic%20Centre%20vaccine

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.”

View Source - Dr. B.J. Hardick
View Source – Dr. B.J. Hardick. Retrieved Dec. 2017 from: https://www.facebook.com/DrHardick

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:

pageID
pageID. Retrieved Dec. 2017 from: https://www.facebook.com/DrHardick

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.

Intel Techniques
Intel Techniques. Retrieved Dec. 2017 from: https://inteltechniques.com/menu.html

Examining the pages liked by B.J.’s professional account, we see a frightening trend:

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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):

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Perhaps most disturbing is that B.J. likes his own posts:

B.J. Hardick Likes His Own Posts. Retrieved Dec. 2017 from: https://www.facebook.com/DrHardick/

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.

Dragons Invest in Snake Oil

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.

On episode 9 of season 12, Dragons’ Den featured a duo from Collingwood, Ontario pitching a product known as the Neuro Connect. Produced by Greg Phillips (no evident scientific background) and Mark Metus (a chiropractor who practices pseudoscience clinically) through their corporation NeuroReset, the Neuro Connect appears to be nothing more than a set of metal clips.

The Neuro Connect.
The Neuro Connect. Retrieved from: https://neuroreset.ca/product/neuro-connect-lifestyle-set-3-green/ (November 25, 2017)

So how do the inventors justify the $80 price tag? They claim that the product carries “a subtle energy pattern that wakes up the sensory nerve receptors” offering to improve the wearers “balance, control, and strength.” They go as far as to claim that the product offers “immediate improvement in your balance and muscle function.” How does it do this? The inventors claim that an energy field is produced through a phenomenon known as quantum entanglement. Of course, this is not how quantum entanglement works, illustrating that – in addition to not understanding physics – the inventors created a product which almost certainly does not work.

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).

Dragons’ Den’s Michele Romanow falling for a classic gimmick. Retrieved from: http://www.cbc.ca/dragonsden/pitches/neuroreset-inc (Nov. 25, 2017)

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?”

Michele Romano

“Yes.”

Mark Metus

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?”

Jim Treliving

“Absolutely. Every sport has an application with our product, whether it’s hockey, baseball…”

Greg Phillips

“What are the other real-world applications?”

Manjit Minhas

“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.”

Mark Metus

Some Dragons were evidently more critical than others.

Dragons1
Both duped, Michael Wekerle and Manjit Minhas portrayed different levels of skepticism. Retrieved from: http://www.cbc.ca/dragonsden/pitches/neuroreset-inc (Nov. 25, 2017)

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.

A Frightening Thought
A Frightening Thought. Retrieved from: http://www.cbc.ca/dragonsden/pitches/neuroreset-inc (Nov. 25, 2017)

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:

Joe Schwarcz
Joe Schwarcz. Retrieved from: https://www.facebook.com/joeschwarcz (November 25, 2017)

Dr. Terry Polevoy – a veracious health watchdog – was equally critical and suggested appeals to the regulatory bodies:

Dr. Terry Polveoy
Dr. Terry Polevoy. Retrieved from: https://www.facebook.com/pg/NeuroReset-Inc-120010445363940/reviews/ (November 25, 2017)

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:

How the product should be used.
How the product should be used. Image retrived from: https://neuroreset.ca/product/neuro-connect-lifestyle-set-3-green/ (November 25, 2017).

The Chiropractor’s Toy

I’ve been keeping my ear close to the ground on all things chiropractic lately, often coming across strange and unethical practices that are in need of a well-deserved scientific flogging. Most of these I let pass in anticipation of a bigger catch, but there is one practice that I can’t get over how funny it would be if it weren’t so troubling. First, some history.

Chiropractic originated from the father and son team of D.D. Palmer and his younger counterpart B.J. Palmer. Papa Palmer is largely attributed as the inventor of chiropractic, but B.J. Palmer and his unparalleled marketing skills helped make the profession what it is today. A prolific promoter, B.J. was an author, a radio host, and even at one point a circus hand. He was certainly no stranger to gimmicks.

In expanding the diagnostic scope of chiropractic practice, B.J. introduced two devices into the clinic. The first was the x-ray machine, which is often of no use when treating lower back pain and is recommended against by Choosing Wisely Canada. Despite this, they are used widely by chiropractors in the treatment of lower back pain. The second device, was the neurocalometer – a gadget that B.J. fervently advertised and sold. What’s unique about the neurocalometer is that even many chiropractors agree that its introduction and promotion was unethical.

The Neurocalometer
The Neurocalometer [source]
So what is the neurocalometer? It’s a thermometer. No really, it’s basically just a thermometer.

The idea is that chiropractors use temperature as a gauge to measure subluxations – displacements of the vertebrae that impinge on the spinal nerves. They (I should be clear – not all chiropractors) believe that this interference in the nerves causes dissipation of heat to surrounding tissue, allowing them to precisely diagnose subluxations. There’s just one problem: subluxations don’t exist. In fact, a group of chiropractors and researchers found no evidence that they exist or are causally related to any disease process. Despite this, a large number of chiropractors still claim to be able to diagnose and treat the mythical vertebral subluxation.

As you can imagine, since vertebral subluxations don’t exist, there isn’t much hope for the neurocalometer as an effective diagnostic instrument, but it gets worse; even the Canadian Chiropractors Association stated that the “validity and reliability of measurement are highly doubtful.” This makes sense. Even if we granted the existence of subluxations, do nerves create heat when pinched? If nerves create heat when pinched, is it enough to be measured? Is enough heat created to be measured indirectly at the surface of the skin? The answer to all of these questions is an affirmative no.

Regardless, many chiropractors still make use of variants of the neurocalometer at great expense to their credibility. Luckily, crafty chiropractors at least avoid the great expense to their overhead and recognize that neurocalometers are really just overpriced thermometers. So why not just use a cheap ear thermometer instead? They measure surface temperature and are much more widely available. Even though they might not be very reliable, they make up for it by being cheap and easy to come by. You can even pick them up at Toys R Us:

In fact, one local chiropractor uses a similar (if not the exact same) model in a video “demonstrating” its use:

Source: “London, Ontario Newborn Adjustment” Retrieved from: London, Ontario Newborn Adjustment

That’s not to say the thermometer doesn’t work; it certainly is a real thermometer, but what is the chiropractor using it for? Well, in the video posted by his practice to Facebook (which my good friend Dennis forwarded to me), he is using it to diagnose subluxations. On a 2-week-old infant.

I left a comment on the post expressing my concerns. It was promptly removed and I was blocked from the page. After composing the initial draft of this article, I sent it to the Kay Harris Chiropractic & Wellness Center asking if they would respond or at least offer corrections if they found issues. They haven’t responded. Why is it that chiropractors have the audacity to promote such things without the integrity to defend them?

Remember, subluxations are to chiropractors as the tooth fairy is to children; they don’t exist, but still seem to bring in the money. That’s not all; there is no reason to think that chiropractic offers any benefits to children:

I don’t know of any reason to believe that it might be necessary to refer a child to a pediatric chiropractor or to use spinal manipulation on a child prior to onset of adolescence. “Wellness care” in the form of “subluxation correction” is unnecessary and scientifically indefensible, and it places children at risk. 

 -Sam Homola, Chiropractor

Yet here is a chiropractor with an infant in one hand and a thermometer in the other. He claims that treatment for a subluxation is needed for a 0.2 degree differential in temperature. Well not only are ear thermometers not designed for this purpose, but they are not terribly accurate. The thermometer in question has an accuracy of ±0.2°C even though its display resolution is 0.1 °C. It might be surprising to you at this point, but that means that a 0.2 degree differential cannot be reliably measured with this device. Because the accuracy is even worse outside its normal operating range, it’s likely that the device couldn’t even diagnose Harvey Lillard‘s Mother of all Subluxations. That is, if subluxations existed.

Further, according to the manual, “this thermometer is intended for household use only.” So I hope the chiropractor’s practice is at home; I want him to be comfortable when he hears this: what you are doing in this video is entirely useless.

Stay Scientific.

Is McDonald’s Using Deceptive Marketing?

Not too long ago, my good friend Ed stumbled upon something peculiar. He found that McDonald’s had a Canadian website that allowed customers to ask questions to be answered by the corporate offices. That’s not the strange part; in fact, I commend them for attempting a transparency initiative. So what was strange? The questions.

Ed noticed that there were a number of questions that were phrased in a way that didn’t seem quite right. Here is an example:

Strange, but not unheard of. After all, although the site was restricted to Canadian users, our population is certainly linguistically and grammatically diverse. For anyone unfamiliar, the question is in reference to a popular myth that McDonald’s used the registered name of a company named “100% Pure Beef” (or some variant) to deceptively hide the fact that they aren’t serving pure beef (they are). Naturally, McDonald’s answers this question in many forms on the Your Questions website. Actually, it answers the exact same question many times:

Well that’s certainly strange now, isn’t it? Why do so many people want to know precisely “Is 100% pure beef a fact or a company?”

Going through the question asking process is a multi-step endeavor. First, you pose your question. Next, McDonald’s will search for related questions and direct you to those queries instead so that you don’t have to ask a question that has already been answered. Should you choose to proceed, you must then link the McDonald’s Facebook or Twitter API to ask your question so that they may take your location, your name, your profile picture, and who knows what else. They include these details in your post (which I’ve censored in the images), but they abbreviate last names. Even so, I thought that this phenomenon was odd enough to warrant an investigation.

Pulling up Burp, I performed a quick spidering of the site to try and get an idea of all the duplicate questions:

If we go based on their naming convention, then the question in question has been asked 42 times along with an extra “compony” edition. From a cursory look at the architecture of their site, I could also tell that they were using Facebook’s Graph API, so my theory was that they were using participants’ current Facebook pictures. I confirmed this when I began to look up users.

Facebook makes it difficult to contact strangers and for good reason. Nonetheless, I was able to identify a total of 6 individuals who had asked a suspicious looking question (not all were of the above form). I only heard back from two.

The first woman – who I will refer to as Sam – accepted my friend request. Sadly, she didn’t respond to my messages, but I was able to learn the following from her profile.

Well that’s strange. Why would a McDonald’s employee go online to ask their employer a question about an easily debunked myth? Why would Sam phrase it the precise way that several others had? Couldn’t she just read the other answers? In fact, her question was one of the most recent of the form asked.

Of course, this could all just be a string of coincidences. So to increase our sample size, let’s see what’s behind door number 2.

The second individual to get back to me was actually kind enough to respond to my messages. This gentleman – who I will identify as Sammy – asked the following question:

,

My conversation with Sammy was in stark contrast to the phrasing of the question; contrary to what you might think, Sammy is quite literate and paid due respect to grammar in our conversation. So that was strange, but I can give you something stranger than that:

Exactly. Sammy is not only a McDonald’s employee, but he operates a branch. In my conversation with Sammy, he had this to say:

And further:

So how did Sammy end up asking such an ill-phrased question? Why is it tied to his Facebook account? Did a customer hijack his Facebook in order to post that question? That seems far-fetched.

So what is plausible? It’s plausible that McDonald’s employees paired their Facebook accounts with the McDonald’s app. It’s plausible that McDonald’s then submitted fake questions in order to boost the visibility of common concerns that they wanted to address. Posing as independent 3rd parties on corporate sites isn’t unheard of, but it could very well be illegal. That doesn’t answer the mystery of why the obtuse phrasing was chosen for the questions.

I contend that it’s not hard to imagine a committee of executives sitting in a room and pondering how us commoners think only to come up with gibberish, but could this really be the case? I think it’s usually the case that the answer to conspiracy theories is just an explanation that evades proponents on its sheer simplicity. For example, it’s also plausible that some humans really just exist as some sort of hive-mind and all simultaneously asked similar ill-phrased questions. After all:

“is there paint group?”

is there paint group?

Then again, maybe I’m just wasting my time:

Thanks for clearing that up, Sammy. I think everyone can rest easy tonight.