I’m told that getting Twitter-spammed by the troll Mabus is recognition that I’ve annoyed somebody by commenting about alternative medicine. Is it sad that I feel proud? I ignored him and intend to continue to do so.
It happened in the process of a discussion on Twitter with a chiropractor, @Liam_Mulvany – who I am sure is sincere, for what that’s worth – about the use and value of his chosen ‘therapy’. One thing I commented on during the discussion was that his website testimonials only mentioned back pain and asking if he treated other conditions with chiropractic; he said that he did not. (“I only deal with musculo skeletal probs.” was his tweet, to be exact.) This has resulted in him commenting on an obscure page on my blog. I’ve no problem with that – I’m here to engage, although I expected it to be more with teachers than chiropractors. I’ve replied to it, here. I did however feel that as I’d spent a little while checking my references and laying out my reasoning, just like I tell my kids to do at work, I should put it up as a blog post too.
So here it is.
I like this.
We examine a situation(somebody with back pain), perhaps one we’ve set up ourselves called an experiment(maybe used chiropractic methods on back pain), and collect data(asked the individual “whats changed?”). When we analyse this data,(how many people report an improvement) it tells us if our hypothesis truly describes the real world or not.(does chiropractic work) Either way we can now give a better hypothesis,(a reason as to why chiropractic works) a description of the world that is, in some way,(the best method of treatment) a better match to reality. This process, simple and elegant, has turned into a separate assessment target where we need to teach our kids ‘how science works’, as if it’s separate from all the facts we’ve discovered using it.
For a medical treatment – or anything which claims to treat a health issue – there are two aspects to consider.
1) Does it work? (is it effective, which is not quite the same as does the patient say it helps.)
2) Is it safe?
Together, these two aspects will help qualified medical staff to make a judgement based on the benefit versus the risk. For chiropractic, There is a fair bit of evidence that it is about as effective as other manipulative therapies, such as physiotherapy or, for that matter, osteopathy, for back pain and related conditions. There is, as far as I’m aware, very little evidence to suggest it is at all effective for conditions such as asthma, ear infection or colic. You could argue that claiming – as many chiropractors have done, and for all I know you may have done – to treat these conditions with chiropractic is ‘bogus‘. And it is a matter of record that chiropractors over-use X-rays to ‘diagnose’ mythical subluxations, in direct opposition to NICE Guidelines. Of course, chiropractors generally (and their ‘professional’ association) have shown a rather poor understanding of research to date.
Which brings me nicely to the risk. There is evidence that a small number of ‘adjustments’, as performed by chiropractors, can lead to rather severe consequences, including stroke and death. Now, in medicine, if there is a risk of these kind of irreversible side-effects, we manage the risk. We make sure to try alternative treatments first. We check for sensitivity to drugs, and where necessary have crash-carts and trained personnel on hand. Chiropractors appear to lack the insight into possible consequences, which means they cannot adequately balance a non-zero risk against a benefit which appears minimal.
Talking about looking for evidence, or investigating ‘how’ it works, is an irrelevant distraction. In summary, the researchhas already been done, and like for so many other forms of alternative medicine, the result is the same. It doesn’t work much (if at all), and the risks – which are so rarely made clear to patients – mean it should be avoided if possible.
Are we done now?
I would welcome any useful links, clarifications or suggestions. Please note I feel that data is more inportant that anecdotes. The one point in his comment that I agree with is that it is odd in science teaching to divorce the scientific method from the evidence collected with it and the theories created by it. But then, like most science teachers I know, I don’t separate them. And if Liam’s teachers had made this clearer, perhaps he would find it easier to consider the data rather than the anecdotes and realise that the therapy he practises has significant issues.