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.

 

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Podcast Episode: What Do Athletic Trainers and Physical Therapists Think About Chiropractors?

 

Timothy Mirtz, DC PhD from the University of South Dakota chatted with me about what athletic trainers and physical therapists think about chiropractors and what can be done to change the interprofessional relationships.

Find it on iTunes by searching for OnTheOtherHand or go here.

This is our first episode with our new sponsor. It’s very cool that a great business sees the value in our podcasts and wants to help us continue to make them.  I would appreciate if you would check out coldlasertherapy.us I’ve used them for years to buy all of my cold laser equipment. They have really fair prices and excellent customer service.  Complete cold laser setup with two pairs of safety goggles for under $1600.  For real!  Plus, listeners to the podcast get $50 off their order by using coupon code: PODCAST

Health Insurance Crisis? Solved.

cone

Don’t panic.  I may have done it.  Yes, your friendly chiroblogger may have accidently solved the national healthcare crisis.  I found an existing health insurance company that provides comprehensive health coverage for under $40 per month.  And this isn’t just some catastophic Roadrunner gets smushed by a falling safe and winds up in traction kind of coverage.  This is really good.  Really, really good.  Just look at these benefits:

Illness – Covered
Injuries & accidents – Covered
Hospitalization – Covered
Surgery – Covered
Hereditary conditions – Covered
Diagnostics – Covered
Prescription medications – Covered
Vaccinations – Covered
Annual Exams – Covered   
Dental Scaling/Polishing  – Covered
 
Wow!  Prescriptions?  Dental cleanings?  They even include some elective surgical procedures.  For forty bucks a month?  There aren’t even any copayments!  I’m awaiting the phone call from Obama any second now.
 
This just may be the ticket the country is waiting for. 
 
Now, there are a couple of exclusions.  There’s always fine print, right?  Okay, the following are not covered: parvo, distemper, kennel cough, heartworms and feline leukemia.  And grooming, bathing and dipping are out too.  Other than that, PurinaCare seems to provide a pretty darn good health insurance for a really reasonable price. 
 
Crazy, right? Dogs and cats get high quality health insurance while their owners are left to be ill.  What’s in it for we, the people?  A lot, according to the North American Pet Health Insurance Association (NAPHIA). 
 
According to recent studies, the NAPHIA figure the health benefits of  pet ownership  include:
  • Reduced risk of cardiovascular disease
  • Higher survival rates from heart attacks
  • Significantly lower use of general practitioner services
  • Reduced risk of asthma and allergic rhinitis in children exposed to pet allergens during the first year of their life
  • Better physical and psychological well-being for seniors
  • Interesting.  These are pretty tangible preventative health benefits.  I may have solved the health insurance situation after all.  I mean, obviously the pet insurance companies won’t cover people.  But if the benefits of pet ownership are so great for health, I might just start instructing my uninsured patients to take two kittens and call me in the morning.  Problem solved.

    Next?

     

    Dr. Brett Kinsler is a chiropractor in Rochester, NY.  He is insured but his cat (favorite hobby = peeing in corners) has no coverage.

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    Blogito Ergo Sum: Skeptical Chiropractor

    Critical_thinking

    I like to use the term “skeptical chiropractor” to describe some aspects of my professional personality.  Lately, I have been asked to further define the phrase.  I’ll try…you let me know what I’ve missed.

    1. Being a skeptical chiropractor means not clinging to a set of beliefs.  I try not to have any set of principles that are not based upon scientific evidence or, lacking that, at least based on rational, logical thought thought and reason.

    2. I am willing to change my thinking as the scientific evidence changes or improves.  If my practice was only based on 100+ year old beliefs, this would not happen.  And while I may be passionate about my convictions, the core is logically founded and I possess enough open-mindedness to alter those cores if and when I am presented with additional, quality evidence. 

    3. I do not take it personally when science changes and challenges my practices.

    4. I question new methods, procedures and products and do not blindly accept information simply because “some expert” says it is so.  Any gurus I subscribe to are those who I respect because of their critical thinking, not simply rote absorption of their sermons.  I begin from a point of doubt and add confidence as supporting information dictates.

    5. I examine new information for bias and attempt to strip that away in looking only at factual information.  I also try whenever possible to remove my own bias in the presentation of information, advice or treatment of patients.

    6. I completely avoid using the term “vertebral subluxation” as it is an entity that is unproven, unscientific, confusing to professionals and patients alike and wrought with controversy.

    I hope this helps shed some light on what it means, in my opinion, to be a skeptical chiropractor.  As for skepticism in general, let me know if you’d like my JFK conspiracy theory, sightings of Bigfoot or an opinion on crop circles.

     

    Dr. Brett L. Kinsler is a skeptical chiropractor in Rochester, NY.

    Read the News Today? Oh Boy.

    hot air news

    News: something frequently full of hot air and worthy of setting on fire.

    “Did you see that thing on the news?” asked my patient of 13 years.

    I was sure I hadn’t since I rarely watch or read news anymore.  I guessed she was talking about the same story that was catching most local people’s attention, “Oh, about the bear who fell out of the tree downtown? Sad, isn’t it?”

    “No, I mean the chiropractic and stroke thing.”

    “Oh!” I said, “Someone just forwarded that to me.  The one where the court decided that the force involved in chiropractic adjustments is nowhere near the force required to injure a healthy vertebral artery, and that if there had been sufficient force to injure the artery, there would have been damage to the surrounding bone?”

    “Is that what that case said?” she asked somewhat confused.

    “Sure.  Not surprisingly, it rides on the coattails of that recent study that showed that the risk of stroke was about the same whether the patient visited a chiropractor or a medical doctor.  They think is has something to do with the fact that people who are soon to have stroke might visit either type of doctor for headache and neck pain first.  At that point, it doesn’t matter if they get cervical manipulation, an Advil or a cheese omelet – they’re going to have a stroke.”

    “Huh.  Well, my husband said there wouldn’t be an article about it if there wasn’t something to it.”

    “Yeah,” I responded, “I just read an article about Bigfoot, the Loch Ness Monster and UFO’s.”

    “People actually fall for that crap!” she exclaimed, “Do you believe that!?!”

    “Yes.  As a matter of fact I do.”

    “My husband just wants me to minimize whatever risks I can,” she said.

    “Okay, great.  You didn’t drive to my office, did you?  Since driving here is way more risky than walking.  Oh, and I hope you didn’t eat any animal products today since your risk of heart disease, cancer and diabetes is dramatically increased.  Oh, and you told me you took an ibuprofen last night.  You do know that increases your risk of gastric ulcer and some cardiovascular problems.  And you do know that living in an urban area, your odds of injury and illness are higher than in a rural area so did your husband put the house up for sale yet?”

    “Uh…can you do something for this headache I have?”

    “When did it start?”

    “About a minute ago.”

     

    Dr. Brett Kinsler blogs as RochesterChiro and is a chiropractor in Rochester, NY.

    Live & Let Live or Sort ’em Out?

    carefulSome of my more outspoken opinions (who, moi?) on topics like decompression and autism have sparked an interesting debate that is being held mostly by private email.  Without naming names and pointing fingers, I would like to hear what you think…

    If a colleague is practicing in a manner that you find objectionable and unethical, what should be your course of action, if any?  Some people are saying that people should be able to practice however they see fit and writing like mine actually harms the practices of others.

    Other folks say that it is the job of honest, ethical chiropractors to weed out the “sick” members of the chiropractic flock in order to advance the heard.

    Yet another sect says that, yes, in fact we should denounce unethical practices but for Pete’s sake, do it quietly.

    Ready for a fun social experiment?  Here is a practical, real world example and I will abide by the most convincing argument.  I was recently given an advertisement of a chiropractor who is basically offering money for referrals of patients.  Illegal?  Probably.  Unethical?  Definitely.  Should be stopped for the benefit of the profession?  Certainly.

    What to do, what to do.careometer

    Choice A: Ignore it and let him go on doing what ever he wants — after all, he’s a fellow chiropractor.

    Choice B: Send Dr. Bribes-a-lot a private note asking him to kindly stop making the profession look bad.

    Choice C: Pass the ad along to the state board and let them handle it.

    What do you think?

    Chiropractic Care: Does the benefit outweigh the risks?

    Are there risks to chiropractic treatment?  Well, some, but most of the adverse events (side effects) that can occur with chiropractic care of the neck and low back are benign and self-limiting.  This means they are mild, do not affect a person’s activities of daily living and typically go away on their own after a few days.  This generally means post-adjustment soreness, nausea, that sort of thing.

    A study recently published in the Journal of Manipulative and Physical Therapeutics (Rubenstein SM. JMPT 2008;31:461-464) asked the question “Do the benefits of chiropractic care outweigh the risks.”  I’ll save you some reading….YES.

    The author examined the minor and occasionally serious events associated with chiropractic care and found that the best evidence suggests that chiropractic care is a useful treatment for patients with low back or neck pain and the risks of serious adverse events should be considered negligible.

    I once heard it described that if you drive more than a mile or so to your chiropractor’s office, the chances of having a serious injury are much greater on your drive to the office than during any time actually spent in the office.  And any link between chiropractic treatment and stroke has not been without flaws.  In fact, a recent study showed that the risk of stroke following a chiropractic visit was equal to the risk of stroke following a medical doctor visit.  It seems that patients who are about to have a stroke tend to self-refer to chiropractors and medical doctors.  Go figure.

    Risks with any treatment shouldn’t be taken lightly but certainly we should use a rational and intelligent approach to them.  As far as chiropractors peforming spinal manipulation, we should keep studying the risks but I believe that no sleep should be lost worrying them.

    More Spinal Decompression Lies You Should Know

    None of my blog articles have caught more attention or been the subject of more flack than when I tell the truth about non-surgical spinal decompression like the VAX-D, DRX-9000 and other pieces of equipment that are similar.  You will recall that I am not against the use of these machines in general — only that the marketing of them is seriously misleading and the practitioners who use them frequently sell patients on long term, prepaid care plans that are highly unethical.  The marketing of non-surgical spinal decompression also frequently falsely claims superiority over other techniques like flexion-distraction — such claims have not been proved.

    As a result of some of the feedback I have received, I came across an article from the journal Chiropractic & Osteopathy titled “Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media?” published in May 2007.

    What’s the bottom line?  Does the decompression hype live up to the claims?  That’s a big, giant, whopping “NOPE!”

    A little more detail, you say?  Okay.  The article examines this “heavily marketed” version of traction therapy that “can cost over $100,000.”  The authors extensively search all the major medical and scientific literature databases to find every scientific research article published on nonsurgical spinal decompression.  It turns out,  there was only 1 randomized controlled trial, 1 clinical trial, 1 case series and 7 other papers.  Each was reviewed individually. 

    The authors concluded that “In general the quality of these studies is questionable.”  And that there was “only limited evidence…available to warrant the routine use of non-surgical spinal decompression, particularly when many other well investigated, less expensive alternatives are available.”

    Gee, that sounds just like what I told you a few months ago.

     Also interesting was that this intervention has never been compared to exercise, spinal manipulation, standard medical care or other less expensive conservative treatment options which have an ample body of research demonstrating efficacy.  How the practitioners can get away with claiming any superiority and not be restrained from doing so is a mystery to me.

    I’m not saying that any chiropractor who has a spinal decompression unit is a crook.  If he or she is charging you the same as a regular visit in order to use the experimental equipment, then that may be fine.  If he or she tries to convince you to pay in advance, sign up for a dozen or two visits or tells you how fantastic the device is compared to other treatments, don’t walk….run away and find another chiropractor.

    Speaking Engagements

    This has been a great year for me with respect to speaking engagements.  I was invited to speak at the American Board of Trial Attorneys’ continuing education program where I taught a section on spinal anatomy for attorneys.  Then, I was invited by the University of Rochester Office of Prehospital Care to teach in their lecture series at fire departments and ambulance corps in two counties.  I completed teaching the ‘Protect Your Back for EMS Workers’ lecture and have just started teaching ‘Ethical Decisions in Prehospital Care’.  The feedback I have been getting is excellent.  It seems that people really appreciate continuing education lectures that are well-prepared and engaging and I am happy to oblige.  I don’t think I would like teaching something I didn’t find interesting.

    I have certainly learned a great deal of respect for all of my prior teachers and university professors as the time it takes to prepare a really good one or two hour lecture is at least 10 fold greater!  Luckily, these lectures are being repeated in various agencies so at least I can recycle the time spent in preparing them.

     

    Dr. Brett Kinsler, chiropractor in Rochester, NY, is available for speaking engagements on a variety of topics in healthcare and emergency medicine.  He can be reached through his website at http://www.RochesterChiro.com

    Chiropractors at the Olympics in Beijing

    Four doctors of chiropractic will join the 62-member U.S. Olympic healthcare team for the 2008 Olympic Games in Beijing, China, to help optimize performance outcomes for many of the 600 U.S. athletes. Since the 1980 Winter Olympic Games in Lake Placid, New York, chiropractors have provided healthcare services to elite performers, and this year chiropractors will assume an even greater role in the integrated healthcare team, which includes medical doctors, massage therapists, and certified athletic trainers.

    Chiropractic fulfills a need, not only by treating injuries but also by aiding in recovery and positively impacting athletic performance.  Chiropractors promote active care and treatment with a commitment to healthy progression and rehabilitation. The role of chiropractors in the U.S. Olympics emphasizes its dedication to promoting optimal individual performance.

    Chiropractors will provide care during practice sessions in the Olympic Village, training facilities as well as during the Olympic events.

    Chiropractic care is particularly valuable for pain management, and offers athletes highly effective solutions for achieving optimal performance without the use of prescription drugs.

    In addition to the four chiropractors who will provide care to the U.S. Olympic athletes, chiropractors from around the world will be joining their respective Olympic teams.  Team chiropractors will be present from Sweden, New Zealand, United Kingdom, Canada, Brazil, and China, among others.

    Dr. Brett L. Kinsler is a chiropractor in Rochester, NY who cares for athletes, both elite and amateur.

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