The Architect of Fear

Fraud Andrew Wakefield
Supervillians walk among us

If you’re not familiar with former doctor Andrew Wakefield, here is a quick primer: Mr. Wakefield was (and continues to be) primarily responsible for the widespread misconception that there is a possible link between autism spectrum disorders and vaccination. In 1998, Wakefield published a case series of 12 children where he suggested a link between gastrointestinal disease, autism, and the measles, mumps, and rubella (MMR) vaccine. In addition to the study entirely lacking scientific merit and rigor, investigative journalist and pharmaceutical critic Brian Deer uncovered fraudulent reporting and serious conflicts of interest. Despite all appearances, Wakefield was not an objective researcher, but was funded by a legal team launching a class action lawsuit against MMR manufacturers. In addition, Wakefield had previously applied for a single-jab measles vaccine patent. Wakefield possessed not one, but two serious conflicts of interest where he stood to benefit financially by slanting his research.

Google Vaccines and Autism
The legacy of Wakefield’s misinformation campaign.

In addition to retraction of his original paper from The Lancet, the UK’s General Medical Council revoked his medical license and barred him from practicing medicine. Beyond the fraud and dishonesty, they found that Wakefield acted with “callous disregard for any distress or pain the children [in the study] might suffer.” Despite being one of the worst medical and scientific debacles in modern history, Wakefield used it to his advantage by becoming the ‘expert’ voice of the anti-vaccine movement, enriching himself while deceiving the public at large.

Today, Wakefield has started life anew in Texas where he produces anti-vax conspiracy documentaries and influences gullible celebrities and politicians ranging from Jenny McCarthy – who helped popularized the anti-vax movement in North America – to Donald Trump, who – despite not possessing basic critical reasoning skills – is the current president of the USA.

Trump and Wakefield
How could he be a stable genius if he was vaccinated?

But that’s not all Mr. Wakefield occupies his time with; he also is quite engaged in speaking tours and evidently takes any platform that will host (and presumably pay for) his propaganda. Of course, this has all been written about quite extensively. So what’s left?

What’s left is the big picture. What’s left is Andy Wakefield’s evolution from a medical doctor and researcher to full-time charlatan who profits from fear and paranoia. The progression of Wakefield’s career and scaremongering is worth examining because it illustrates how a lack of moral regard (a callous disregard, if you will) can be used to fuel a movement built on conspiracy and distrust of expertise.

These points are important to emphasize because of how Wakefield is viewed and idolized by his supporters; they see him as a public defender who has been demonized by a vast conspiracy. The foundations of this belief, however, rely on Wakefield’s integrity as a fervent pursuer of truth. Such a characterization of Wakefield couldn’t be further from reality.

Since the initial scare and fallout from Wakefield’s fraudulent paper, a substantial effort has been put into examining the safety of vaccinations and their ingredients, including multi-dose vaccines like the MMR that Wakefield initially raised concerns over. These studies have continued to affirm the safety of existing vaccination schedules and have dismissed links between autism and vaccination. An honest scientist would admit the failure of their pet hypothesis, but Wakefield’s approach has been profoundly different.

Wakefield was recently invited to give a speech on vaccination at the less-than-reputable chiropractic college Life University. Did he give a balanced and comprehensive talk on current state of immunization science? Of course not.

Andy delivered an hour of anti-vax propaganda going as far as claiming that measles might have offered benefits if it continued to infect us. He claimed that vaccination has “destroyed herd immunity.” He claimed that we will experience a “plague” of neurodevelopmental disorders and allergies in children as a result of vaccination. He claimed that vaccines will increasingly fail at protecting us from the contagious diseases they prevent. He even suggested that vaccination may cause the next great extinction.

Andrew Wakefield Extinction
Crazy ol’ Andy “vaccines are causing a mass extinction of humans” Wakefield

It’s important to note how this speech should continue to undermine what little credibility Wakefield has left. In addition to diverging from scientific and medical evidence, Wakefield has evidently changed his stance from “vaccine safety advocate” to “vaccines are bringing the apocalypse.” This is important because Wakefield’s proponents often portray him as someone who is supportive of vaccination generally, but critical of vaccination schedules. This is obviously no longer the case.

Watching his speech, it’s clear where Wakefield’s talents lie; he is a persuasive and captivating speaker who knows precisely how to engage his target audience.

Andrew Wakefield and Chiropractic
😂😂😂😂 Oh, please.

Ironically, the only impending apocalypse from infectious diseases will be a result of anti-vax efforts as measles outbreaks once again plague developed nations and polio reemerges in areas of low vaccination. Wakefield’s advocates need to recognize that his approach has evolved in exactly the way one would expect to capitalize on the anti-vaccine movement. His game isn’t science; it’s fear.

 

 

Chiropractic Pediatrics Vs. Reality (Part I)

No Adjustment Necessary

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.

This is why the response from the CCA was so troubling; their letter ignored the issues at hand and instead defended pediatric practices broadly. Of course, it’s worth remembering that the CCA is not a public health organization and not a regulatory body. Rather, they are an advocacy organization for chiropractors whose mission is for chiropractors to be “an integral part of every Canadian’s healthcare team by 2023.” All I will say in response to that is: won’t somebody please think of the children?

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.

Argumentum ad Chiropractum: A Case Study

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):

ChiroTweet
Why even bother? Retrieved Jan, 2018 from Twitter.

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:

Ghosts
The theatrical version of ghost hunting. Retrieved Jan. 2018 from: Twitter.com

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.

Snowball
Cold, hard logic. Source images retrieved Jan. 2018 from boygeniusreport.files.wordpress.com and img-aws.ehowcdn.com.

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.

Stay logical.

Chiropractors and the Fetus

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.

Breech Baby Position
Breech Position. Retrieved Dec. 2017 from: https://en.wikipedia.org/wiki/File:Breechpre.jpg

In a 2009 article published in Canadian Chiropractor, CMCC graduate John Minardi promotes what is known as The Webster Technique – a technique “specifically designed to detect and correct for pelvic subluxations that occur in a pregnant patient.” Of course, we know that’s bullshit because subluxations don’t exist, but what does he claim is the purpose of this approach? To “improve birth outcome,” naturally.

Luckily, CMCC graduates are often more scientific than their US-educated counterparts. They may not all understand science, but they at least understand the importance of science. In his article, Minardi (who teaches the technique) cites a single paper supporting the approach: “The Webster Technique in a 28 Year Old Woman with Breech Presentation & Subluxation“.

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.

So exactly how pervasive is this unsubstantiated technique in the business of chiropractic? Every word in this sentence links to a London, Ontario Chiropractor advertising Webster’s Technique. Good job, none of you. Of course, there is no firm data because there is no oversight of unscientific chiropractors in Ontario, but – based on 29 chiropractors identified online in London offering the technique and using data from the CCO – at least 21% of chiropractors in London sell this bit of pseudoscience.

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:

B.J. Hardick Webster
Retrieved Dec. 2017, from: https://www.youtube.com/watch?v=XP4VceZsZgI

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.

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

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.