Peanut Butter in the Gas Tank

peanutbuttergastank

People amaze me. Honestly, I am always surprised by many people’s consistent failure to leverage logic in a situation. Here’s an example: A patient had a lumber disc issue three years ago. After seeing several other practitioners, epidural steroid injections and physical therapy all failed to produce desirable results, a friend of the patient suggested he see me. A few properly directed treatments of flexion-distraction and long axis decompression went a long way to quickly dissipate this patient’s disc pain. We were both quite happy with his recovery.

Fast forward to now; three years later. The patient again comes to me with disc pain. When I asked when it began, the patient tells me it started 6 months ago and he went through physical therapy, medications and more injections before returning to me. I was stunned. Chiropractic treatment worked so well for his disc pain in the recent past, why would he not seek my help immediately after a similar flare up?

I equate this form of illogical thinking to putting peanut butter in one’s automobile gas tank. After all, the past hundred times I put gasoline in my car, it ran as it was intended. But this time, I am going to put peanut butter in the tank instead of gasoline hoping for a better result. Huh?

The old adage that people who do what they’ve always done will get what they have always gotten is usually used to illustrate the negative consequences of stagnation. However, if you are satisfied with the results of what you have done in the past, continuing with that same strategy just makes good sense.

 

Brett Kinsler is a chiropractor in Rochester who treats disc injuries in a way that works. If it didn’t work, he would do it a different way. 

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Edzard Ernst, CAM Critic, Talks with Dr. Brett Kinsler on Chiropractic and Bias

Book by Edzard Ernst complementary and alternative medicine

Professor Edzard Ernst, MD, PhD, FRCP, FRCP holds the Laing Chair in Complementary Medicine at the Peninsula Medical School, University of Exeter and is the Editor-in-Chief of two medical journals. He has also been seen as a major public opponent of chiropractic and alternative medicine. He has devoted most of his career to publishing articles that are critical of complementary and alternative medicine….an unbelievable number of papers. Like 1500 or so. He’s been especially critical of chiropractic and, in the opinion of many researchers, has glossed over important research and exaggerated results. To me, what’s most interesting about Ernst is that he claims objectivity and lack of agenda. This podcast asks some tough questions of Prof. Ernst.

You can get the podcast episode on iTunes by searching the podcast section for “On The Other Hand” or you can just click here.

Thanks to this episode’s sponsor: Audible.com, the audiobook company. Get a free audiobook download just by trying their service free for 14 days.

BMJ Writer Discovers Head Up Ass

photo of a kid on the beach with a clenched fist and the caption "I hate sandcastles."

John C. McLachlan is a professor of medical education who wrote an article in the British Medical Journal (BMJ 2010; 341:c6979) called “Integrative medicine and the point of credulity.”  McLachlan proposed that integrative medicine should not be used as a way of smuggling alternative practices into rational medicine by way of lowered standards of critical thinking. He worries that failure to detect an obvious hoax is not an encouraging sign.

The author, upon seeing a request for presenters at an integrative medicine conference in Jerusalem, submits a paper posing as an embryologist who discovered a new version of reflexology. He explains that he has identified a homunculus represented in the human body, over the area of the buttocks. The homunculus being inverted, such that the head is represented in the inferior position.  As with reflexology, the “map” responds to needling, as in acupuncture, and to gentle suction, such as cupping.

He stops short of telling the conference organizers he has discovered a system whereby the head is up the ass and responds to needles.  Funny, right?  Well, after submission of an abstract with some sciency sounding references, the proposal gets accepted for presentation.  The author declines to present and, instead, publishes the correspondence in the BMJ.

Now, I’m all for having a good laugh at the expense of wacko alternative medicine practices but my goal is clear — I want to help clean up the field in order to highlight the people who are actually doing some good, honest, logical research.  I actually have a problem with what Dr. McLachlan has done.  By poking fun from a distance and walking away without letting the conference organizers in on the joke, the author misses a huge opportunity to educate and possibly improve that which he criticizes. It would have been far better if he accepted a slot at the conference and awaited to see if people would point out the errors in his “research” or simply used the platform to show what bad science is.

The only thing that makes him not a 100 percent coward is that he published his story. Someone who asks difficult questions so that when you answer incorrectly you will learn is called a teacher.   To ask difficult questions and then tell your friends how stupid someone is without letting them in on where their error was is called by a different name entirely.

Remember Smith’s article about how parachutes aren’t evidence based? That one is funny and brilliantly illustrates its point. This article, while funny with its head-up-ones-ass ha ha I get it humor, is really only about as funny as watching your kids get their math homework wrong and, instead of helping them, you call all of your friends and laugh at your kids’ ignorance. Nothing was learned. Nothing was improved and we all feel a little bit sick for participating in the joke.

Yes, it was a hoax but science relies on some degree of honesty and trust.  It is impossible for one scientist to be at the apex of all fields and know all that is known from every discipline.  Isn’t that why we have specialists?  Could it be that the scientific committee accepted McLachlan’s proposal simply in order to learn whether or not this revolutionary discovery was plausible or bunk?  Unlikely, but possible.  Today, I would rather lend the benefit of the doubt to the conference organizers rather than the scientific playground bully.

 

Brett L. Kinsler is a chiropractor in Rochester, NY who writes the RochesterChiro blog and produces the podcast On The Other Hand.

 

Chiropractic and Stroke Podcast Interview Posted

The first real episode of the On The Other Hand podcast is now live.  In it, Dr. Stephen Perle discusses the topic of chiropractic and stroke with me.  You can get it through iTunes or from here. I’m interested to know what you think but for clarity I’m going to try to keep podcast comments on the podcast site or on iTunes.

Enjoy.

Contract To Be Fooled

A few days ago, my ten year old forwarded an email to me containing one of those modern electronic chain letters. You know the sort: enter your favorite color, your pet’s name and the month you were born, forward it to 20 people and something magical will happen. Not wanting to miss a skeptical teaching moment, I replied to my daughter’s email asking if she thought there was any truth to this exercise. No, she wrote back, but it’s fun. Smart girl.

I recently wasted ninety minutes of my life watching a movie with no positive qualities whatsoever. Of course, my kids quickly declared it the second funniest movie ever. It was edged out by a YouTube video involving a cat and a magic marker. Well, the movie wasn’t entirely without merit. There was one of those scenes shot on a roller coaster from the perspective of a rider. The dips, the turns, the twists. I love those! Is it real? Of course not. But it’s fun.

But while enduring the mind numbing remainder of my kids’ second funniest film, that roller coaster scene got me thinking. Scenes like that in movies are fun because we have given our permission to be fooled. And simply by doing so, we can experience physiological effects like feeling our stomach drop and our bodies shift to balance on the turns of the coaster track.

Allowing our minds to be tricked can be entertaining and provide a physical manifestation. Just remember that you are doing it in fun. When you get carried away and believe the deception, there are problems.

Brett L. Kinsler, DC is a skeptical chiropractor in Rochester.

I’m With The Band

** SPOILER ALERT **

If you use Power Balance Bands and don’t want to know the truth behind them, do not read further. In fact, this warning goes if you use Power Bands, Balance Bands, Bionic Bands, Silly Bands or you’re just a singer in a rock and roll band. I don’t want to be blamed for bursting your balloon or adding strokes to your croquet game.

** SPOILER ALERT **

I have to tell you something.  I hate the expression I have to tell you something mainly because I know someone who says it all the time and it is usually something like “I’ve got to tell you, I like pens better than pencils” which may be entirely true but is not exactly the type information that was bursting to be brought forth. Had to tell me? HAD to? Okay. Anyhow, that’s not what I had  to tell you.

I do have to tell you that I am in something of a quandary. I have super secret information about Power Balance Bands that I want to tell you about but I am afraid it will be just too much for some people.  Like the fact that I am avoiding the whole Tooth Fairy conversation with my kids. I think it’ll be a bit much and it’s not really hurting them. Well, one kid I know who wanted a new video game and ripped a tooth out of her head so she could make a couple of extra dollars…she should probably be told about the Tooth Fairy and fast.  But I’m not doing it.  See, I’m not sure I want to be the one to lay this heavy news on people. Maybe they’re not ready to hear it. Maybe the Power Balance Strength Bands are giving them that perfect edge in their sport and anything that might spoil that edge isn’t worth it. Maybe I will single-handedly screw up the next world series or world cup or world wrestling federation cage match.

You’re probably thinking I’m going to tell you that these bands are worthless. That sticking a hologram on a piece of plastic and attaching that to your wrist couldn’t possibly affect athletic performance in any reproducible, measurable way. You’re thinking that the very idea that “Power Balance bands are designed to work with your body’s natural energy field” and “the hologram in Power Balance is designed to resonate with and respond to the natural energy field of the body” is downright silly.

And you’re thinking I’m going to tell you they don’t work.

You’re wrong. they do work.

Don’t misunderstand me, these plastic bracelets are the original silly band. They’re bullshit and there is nothing but junk hooey to back them up…along with a bunch of testimonials (insert your own joke about Ekolu Kalama famous stand up paddle surfer here).

But they do work.

How?

I asked my good friend, the world famous neurologist as seen on TV to explain in ten words or less how these plastic energy holographic bands work.

“Alex, I’ll take plastic placebos for 500.”

True. But placebos work.

Remember my post about placebos a while back? https://rochesterchiro.wordpress.com/2008/10/24/one-pill-makes-you-larger-and-one-pill-makes-you-lie/

We discussed the fact that placebos can be helpful to patients but there is no getting around act of lying. Well, the makers of Power Balance Bands are lying. They are telling people why the bands work using made up terms and junk pseudoscience instead of just telling people that they do work. The theory and pretend science is garbage and an embarrassment.

Here’s the bottom line: If you think these things will improve your athletic performance, your math skills or generally make you a better looking person, you are probably right.   But if you for one second believe that a 3-D picture like a hologram can balance out your energy fields, improve your strength or flexibility, or that Mylar material treated with energy waves at specific frequencies resonate and work with your body’s natural energy flow to help enable you to perform at the best of your ability, then please schedule some time with me because I think we need to have the Tooth Fairy conversation as well.

And remember, somewhere, someone has a warehouse full of copper bracelets all the athletes swore by ten years ago. If you are going to use one of those or the Power Bands, remember to wipe off the snake oil first. It interferes with the energy flow.

Dr. Brett L. Kinsler practices both chiropractic and skepticism in Rochester, NY.

Arrgh, Fake Number!

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Do you remember that Seinfeld episode when Elaine admits to giving a fake telephone number to guys she meets but doesn’t want to date? The purpose, of course, is it allows her to avoid a confrontation either at the time of the initial meeting or on the phone later during which she would need to tell the prospective suitor she is not interested.  Instead of dealing with the real issue honestly and head on, she manufacturers a piece of false evidence so she can avoid dealing with the real problem.

The other day I received in the mail something that looked like a new chiropractic research journal. With a traditional medical journal type cover, there was no flash, no pictures, just a listing of the articles inside and their authors. The journal was entitled, “The Industry Compendium of Chiropractic Research” vol 56, no. 9.

Hell, I was impressed. How did I not hear that a new chiropractic journal was started, produced so slickly and mailed to chiropractors who hadn’t even paid for subscriptions? I have also been hearing how difficult and expensive it can be to keep a print journal afloat and how many medical journals are finding it necessary to move to electronic, on-line only versions.

Something wasn’t quite right.

The smaller print on the cover of this “journal” said, “Supplement to Chiropractic Economics,” a trade magazine known for glossy ads and fluffy articles. Everything changes once the Compendium is actually opened. Just about every article, some of which are lacking authors names, all of which are lacking statements of funding support, is followed by an advertisement for the very product discussed in the article.

A topical analgesic does well in a clinical trial, there follows an ad for that analgesic. Next, an article on the efficacy of a nutritional supplement followed by an ad for that nutritional supplement. In all, it was insulting that the word “research” was placed on the cover. Worse yet, there are a lot of people in chiropractic who will mistake this magazine for actual, high-quality research.

There is a significant body of research attributable to the chiropractic profession but there is much more that needs to be accomplished. Currently, there is a lack of financial resources and a shortage of qualified individuals necessary to carry forth the work. The fact that a trade publication, Chiropractic Economics, is interested in advancing the body of research within chiropractic is noble and welcomed. They could make a donation to private researchers, develop an award for research, support fellowships or one of a thousand other ways they could actually advance research within the profession. Like Elaine and her fake phone numbers, Chiro Eco’s fake journal avoids dealing with the problem head on and instead, they produced a fake research journal in the hopes of advancing their vendor’s agendas at the expense of intellectual honesty and impartiality.

Dr. Brett L. Kinsler is a chiropractor in Rochester, NY who had to look up the word compendium and finds it ludicrous it appears on the cover of this catalog.

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Bad Advice

Not so long ago, my office manager asked me to take a phone call.  Someone was asking if we do a certain technique. This was not an uncommon scenario — people call all the time wanting to know if we can do what their doctor in Peoria did.  Many times we can, sometimes we don’t but it never hurts to ask.

This particular person was asking about a chiropractic technique my assistant had not heard of so she punted it to me. My feeling, and the research generally agrees, that most chiropractic techniques get you to the same place.  The old-timers used to say it didn’t matter if you took a bus, car or train — they all get you to about the same place eventually. So, whether someone adjusts your spine with the push of a hand or the thump of an instrument, whether the table moves with the adjustment or lights up like a winning slot machine, most chiropractic techniques can eventually help patients in pain.

However…the techique this person was asking about is, well, bull. Plain and simple. If you saw it done, you would laugh your ass off.  Seriously. Right off. Gone. It’s disproven, silly and so far from the realm of scientific reality it would make Stephen Barrett squeal like a little girl. Of course I took the call.

“Hello Ma’am. Yes, I heard that’s what you were looking for. Oh, I’ve heard of it alright. Oh boy. Well, you do know there is absolutely no scientific evidence supporting that technique, right? No, none. It’s garbage. Huh? Right, so you know it’s a complete waste of your time and money? Okay, well I certainly don’t use that procedure in my office and I really don’t respect anyone who does. I couldn’t possibly. Why?!? Because they are basically criminals; lying to patients and tricking them with pseudoscientific jargon and useless tests that are light years beyond ridiculous.  In fact, anyone who uses that technique would have to be the worst chiropractor in town. What’s that now? Really? You’re kidding me?”

“Ma’am, are you actually asking me to refer you to the crappiest, most dishonest, clinically incompetent doctor I know? Please hold for the number…”

And so it went. Clearly there was a huge disconnect between what this woman wanted to hear and what she needed to hear. I thought I was doing her a favor by smoking her beeline to quackville. Instead, she just wanted the information she wanted in the way she wanted it.

I have a friend who told me he stopped going to his primary care physician since she always gives the same advice.  He once went in for an ankle sprain and he swears she told him to diet and exercise.  He’s the same wiseguy who when she questioned how he was working on his type 2 diabetes, he responded “Positive thinking?”  The problem is that patients frequently don’t want to heed lifestyle changing advice even if that’s what they need to hear the most.

Recently, I was asked for advice on how someone could lower her cholesterol without medications. I told her to try a low-fat, whole foods, plant-based diet. She tried it — for one meal. Then she gave up, citing it as too difficult, and reverted right back to what she was already doing. Six months later she had her blood retested. Shocked! Shocked! that her cholesterol was even higher that it had previously been!  I was again asked for advice on how to lower this skyrocketing cholesterol.

“I am not going to answer this question since you already know my advice,” I said. “If you want some new advice, you really should be asking someone else.”
“Oh, not the vegan thing again,” she sighed, “I was hoping you would tell me something different.”
“Yeah,” I said, “but that is the absolute best advice I have for you. I can give you bad advice. Is that basically what you’d like? Some bad advice? Okay. You should be performing the Mexican Hat Dance during all lunar eclipses in months with a R in their names. That will shoot down those triglycerides like a cartoon anvil falling out of a helicopter. And while you’re at it, smear peanut butter between your toes every night before bed. That will ward off the evil aliens from the planet Cholesterak that inject cholesterol into your blood while you are sleeping.”

I can be chock full o’ bad advice.  Piece of cake. But it’s a metaphor, isn’t it? It’s always a freaking metaphor. I’m chock full of those too.  We know the answers to so many questions in our lives but choose to look the other way. Often, we have the solutions to our health problems but we simply do not want to hear the answers that will actually help. 

How about you? Are you just looking for the advice you want and ignoring what you need?

Is there something you haven’t heard lately?

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Kill a Subluxation

When I had a back injury that first brought me to a chiropractor, my father asked me what the injury was. I told him the doctor said I had an L3-L4 subluxation. No, my father explained, that was just some nonsense the chiropractor made up. What was the real problem? Oh, well it turned out to be a herniated disc — but that was my welcome into the world of chiropractic subluxation.

It may not surprise you to know that for as long as I have been writing this blog, even though there is no topic that is more inherently chiropractic as the subluxation, I have hesitated to address it. Seemingly so integrated into chiropractic history the concept to me is antiquated and unnecessary to modern, evidence informed practices. I have avoided discussing this hotbed of chiropractic silliness due to the lack of good that usually accompanies such a can-opening of any similar collection of worms.

Now, however, thanks to recent statements on the vertebral subluxation complex from the General Chiropractic Council in the UK and the British Chiropractic Association, I have selected to be silent no more. Instead, I have chosen to be paraphrasic. The statement from the General Chiropractic Council (GCC), appears here:

http://www.gcc-uk.org/files/page_file/guidance_on_claims_for_VSC_May_2010.pdf

There is much in there with which to agree and also with the BCA‘s positive reaction to it. I am borrowing heavily from both as I develop my own affirmation:

The chiropractic vertebral subluxation complex is a historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns. This is not to say that chiropractic treatment is not effective and important — but it is not lifesaving. Subluxations are not fatal.

Chiropractors must make sure their own beliefs and values do not prejudice their patients’ care. Furthermore, chiropractors must provide evidence based care, which is clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of the practitioner.

Any advertised claims for chiropractic care need to be based only on the best research of the highest standard. Think this is a no-brainer for everyone? I suggest you see what Bill Esteb over at Patient Media thinks about using evidence in advertising (http://www.patientmedia.com/blog/2010/05/rct_and_the_cult_of_scientism.html) Hint: he thinks it’s stupid.

In light of the absence of supporting evidence I do not support the concept of the vertebral subluxation complex as the cause of disease and serious illness nor am I in favor of teaching vertebral subluxation complex theory to chiropractic students in any other context than historical and theoretical.

I fully support and encourage the inclusion of chiropractic into mainstream healthcare and know that in order to facilitate this integration we need to discard ambiguous terminology and unsubstianted historical concepts. We need to emphasize an evidence-based care model that is easily understood by the other members of the healthcare delivery team.

I feel that chiropractors should refrain from making any reference to vertebral subluxation complex in any media to which their patients or the general public may have access.

Chiropractors are the leaders in non-surgical spine care and there is strong evidence to support the inclusion of chiropractic in musculoskeletal healthcare initiatives. Chiropractors have been shown to possess specific expertise in the assessment, treatment and management of spinal and joint pain and are well-placed to deliver cost-effective services within mainstream healthcare. Let’s not mess it up by speaking another language that other healthcare professionals don’t understand while waving the lunatic flag of our now dead forefathers. There was a reason for the reliance on subluxation dogma in this profession. We needed to prove ourselves separate and distinct from medicine in courts of law. That time is passed. We’ve also given up on that whole flat Earth thing. Get over it and move on.

The GCC and BCA statements are the best thing we’ve gotten from England since Hugh Laurie and perhaps we should all strive to be a little more British.

Dr. Brett L. Kinsler is a skeptical chiropractor in Rochester, NY who is 1/4 British — but is now working on increasing that ratio.

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Spinal Screaming

Scene: Shopping Mall.

Wedged in between the Yogan Frooz (motto: made up Scandinavian words tastën groövi) and the Cell-U-Cessories cart (motto: I’m a bored guy on a stool) one can occasionally spot what is commonly called a chiropractor performing what is commonly called a “spinal screening”. Step right up and you can get your spine checked for problems. No back pain? No problem! These little spine problems are sneaky buggers and have a funny little way of creeping up and kicking your ass. You may not even know you’ve got one until it’s too late. Like appendices that always seem to be removed seconds before they were going to burst (whew, thank God! The size of a grapefruit you say?) these spinal boo-boos can wipe you out! What’s that, Miss? You just had a checkup at your medical doctor’s? Last week? And he didn’t find any spinal problems? Didn’t he? Well, that’s okay – you’ve got to be a chiropractor in order to finds ‘em and fixes ‘em. Here’s my card. We’ll see you at 9:00 am tomorrow. NEXT vict- I mean screening subject!

You might be asked to stand on two modified bathroom scales, one foot on each. Notice how the weight isn’t the same on the two scales? AH HA! Structural imbalance! Or, you might stand against a metal frame with strings going across it and the chiropractor will slide the strings to match up with your shoulders and hips. You step down and AH HA! Those strings aren’t level! Spinal problems! Or perhaps Dr. RightbySears is taking the high tech approach and running a scanning device up and down your spine and them shows you on the computer screen what looks like a bar graph coming out of both sides of your back. Some areas are blue, some yellow and uh oh, you’ve got red ones! You need to come in to my office Monday morning and turn those red things into blue.

Public screenings are an important tool in improving the public health. True, screenings for prostate and breast cancer have taken some hits in the literature but the practices are changing in alignment with the scientific evidence (slowly, but responding). The spinal screenings you see in the mall are not the same as having your blood pressure checked by the volunteer ambulance outside the Stop & Shop. Elevated blood pressure has a clinical correlation with chronic disease and the blood pressure cuff is a proven method of detecting hypertension. The evidence for using two bathroom scales for determining the need for future spine care? Clearly demonstrated in the American Journal of Notsomuch. That fancy scanning thing that produces the sideways colorful bar graphs? Just saw it in last month’s New England Journal of Maybenot. Unproven to be anything other than a marketing gimmicks.

Screening is a public health activity with the aim of detecting disease before symptoms appear. Screening has the potential to save lives and improve quality of life through early diagnosis of serious conditions but can only be ethically used in cases where the screening procedure can actually detect what it proposes to find and the early detection will actually make a difference in the progress of the disease. For example, more than half of seniors have hypertension. One could be accurate half the time waving a magic wand over a group of people over 65 and declaring a diagnosis of high blood pressure in half of them. Accurate? Yes. Ethical? Hardly.

To call these advertising booths ‘screenings’ is a slap in the face to true public health measures. Screenings should identify or prevent a public health concern – not create patients through scare tactics, confusion and deceit.

I have no problem with people marketing their businesses as long as they call it what it is. When I see an ad in the newspaper for a cafe that says it has the world’s best coffee, I’m pretty sure there wasn’t a scientific poll organized to determine it. But it’s different when a doctor does it. It needs to be different.

Setting up a booth in a mall looking for people who will believe what you are selling is not a screening for public service. It’s a store.  And if you sell items or services by lying, then not only is it not a screening but it’s a self-serving  fleecing. These people should have telemarketers for older brothers so they’d have role models to look up to. Run away. All the way to the Gap if you have to.

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