teabluesreviews (teabluesreviews) wrote,
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teabluesreviews

BSA vs Dr Shaun Holt: What can experts safely say?

A small article on Stuff.co.nz (http://tinyurl.com/mdv5vp) just caught my attention. Apparently Breakfast regular Dr Shaun Holt is in trouble for panning chiropractic 'medicine'. Holt is an interesting character, he runs a science communication group that discusses recent medical research, and a lot of what he communicates matches the advice and opinions I come across from my GPs, the few medical practitioners I know personally, and among doctors who blog. Holt advocates evidence-based medicine, which is brilliant, although he has a tendency not to scrutinise the research he reports to the public very thoroughly, so that sometimes he says things that are just plain wrong. For example, in a recent edition of Holt's NZ Natural Health Now (http://tinyurl.com/m4oy2a), he cites a meta-analysis of acupuncture research that I had already seen savaged all over the blogosphere (Orac, as usual, being the most vicious: (http://tinyurl.com/crbt33)). So Holt isn't always thorough, but generally he does a good job. He'd do a better job if he did more investigation, but to his credit he does provide links in NZ Natural Health Now, so readers who are curious enough can follow up on his advice with their own supplementary reading.

Chiropractic is a *little* less loopy in its foundations than acupuncture, but it also has disturbingly reductive roots. The modality's founder, Daniel David Palmer, developed a theory that manipulating the spine could solve almost any disease, because the spine connects the brain to the body. No, you didn't read wrong, that really is as stupidly over-simplified as it sounds. In fact, Palmer claimed that the vast majority ('99%') of diseases are caused by displaced vertebrae. Journalist Simon Singh covered all this ground in his famous and controversial article, Beware the Spinal Trap. Singh's article, which I'll link to below, detailed not only the dodgy beginnings of chiropractic, but also the relatively high risks involved in the modern practice:

"In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection."


[source: http://tinyurl.com/m6cgv8]

This article sparked a fascinating response from the British Chiropractic Association. They decided to sue Singh for libel. British libel law is quite, quite mad. The burden of proof is reversed in such cases, and Singh has to prove his innocence rather the BCA proving his guilt. The BCA are under no obligation to demonstrate that their outlandish claims of being able to cure relieve ear infections and other non-spine-related illnesses have any basis in fact. The scientific and journalistic communities responded with a wealth of intelligent disapproving comments and letters:

“England's strict libel laws can deter individuals from speaking out against bad science, even when they have strong evidence for their argument. Simon's campaign deserves the support of everyone who cares about fighting pseudoscience.”
- Professor Richard Wiseman, Professor of the Public Understanding of Psychology, University of Hertfordshire

“This case is critical for all science writers and investigative journalists, for if our skeptical investigations and subsequent opinions can be squelched through the threat of a ruinously expensive lawsuit, then the result will be that misguided quacks and dishonest frauds can simply say and do what they like without recourse, with disastrous results for the public. There is no place for the law to stop critically important investigations into possible fraudulent or unfounded claims. Without the freedom to perform such important investigations, science and journalism take a back seat to anyone with the legal clout to stop us for their own nefarious reasons.”
- Michael Shermer, Scientific American

"Last year I was sued personally, alongside The Guardian, by a German vitamin pill salesman called Matthias Rath. He had moved into South Africa, a country headed by an HIV denialist president, taking out full-page newspaper adverts claiming that antiretroviral medication was a conspiracy from the pharmaceutical industry to kill africans, and vitamin pills were the answer to the Aids epidemic. I was highly critical of these activities. The libel case brought by Rath dragged on for 17 months and ultimately cost £535,000 to defend. This is not an isolated case, and my thoughts are with Simon Singh. It is vitally important that we are able to criticise ideas and practices in medicine: this is how ideas improve, and it is how foolish, dangerous practices are eradicated. The law is wrong."
- Ben Goldacre, Bad Science


[source: http://tinyurl.com/r2bqse]

Now we Kiwis have our own bizarre case of a chiropractic body silencing a critic who is merely giving an evidence based perspective - in other words, a medical perspective. The BSA's decision astounds me. The blogosphere is already reacting with disgust against today's decision. MacDoctor is a doctor, albeit one who lets his Right-wing and occasionally puritanical politics heavily influence his opinions. In this case though, he's a great local expert. Go read his post here: http://www.macdoctor.co.nz/2009/09/24/broadcasting-substandards/

I had planned to write a proper note about this, but I'm suffering insomnia so I'm sleepless and simultaneously exhausted. I can't go on. I might try to rewrite this tomorrow, I have an awful lot more to say.

Here is a link to Holt's (very measured) comments from Breakfast in March.

http://www.youtube.com/watch?v=EUlYH8e3NW8

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