Swine Poop - Swine Flu & Chiropractic II

Image by Gonzalo Fernández via Flickr

To quote President Reagan "there you go again". Once again a high profile chiropractor is there suggesting in a press release that chiropractic spinal manipulation is part of a reasonable flu prevention strategy. See my previous blog entry on Swine Flu & Chiropractic.

I know I could sit back and wait for the blogosphere of chiropractic critics to appropriately lampoon this press release. But then they would imply the entire chiropractic profession believes this but I won't be painted with that same paint brush.

I'll put it in the simplest language possible. This idea that "nerve interference" somehow leads one to be vulnerable to infection is swine poop. And the idea that one needs to see a chiropractor to make sure that there is no "nerve interference" so that one's children's immune systems will function at their best is swine poop, too.

As Max Planck wrote in 1936:

An important scientific innovation rarely makes its way rapidly winning over and converting its opponents; it rarely happens that Saul becomes Paul. What does happen is that its opponents gradually die out and that the growing generation is familiarized with the idea from the beginning.

Unfortunately, when it comes to chiropractic the opponents of rational thought and the scientific method within chiropractic seem to reproduce er proselytize before they die out. Thus, this pseudo-religious thinking persists within chiropractic medicine. Exposing this pseudo-religious thinking does not appear to force it underground. (1, 2) It seems that the Internet has allowed this form of lunacy to flourish as much as any other form of C.R.A.P. (convoluted reasoning anti-intellectual pomposity)

The most insidious part of this press release is that the writer has a legitimate degree in public health, an MPH. This might give the laity the belief that this is a legitimate idea. Likewise, one of those cited in the press release has an impressive sounding title as president of an organization with an impressive name. None of this provides any evidence that the press release actually presents valid information about the importance of the subluxation.

The fact that the CDC is cited also gives the illusion that this press release has some scientific merit. It only shows that the writer knows how to package this swine poop so it looks good. Or as was used so often in the last US presidential election, he's put lipstick on a pig. The central premise, go to a chiropractor so he/she can remove the subluxation which causes nerve interference which leads to a poorly functioning immune system is still swine poop.

Obviously the writer of the press release is intelligent. But as I noted in an earlier blog ideological immunity is not the domain of the unintelligent.

Now of course the author of the press release might posit that it is I who have the ideological immunity and just can't see the profound value to one's immune function by removing the ubiquitous nerve interfering subluxation. He might be right. Sometimes people with deviant thoughts are right: think the long road to that Drs. Marshall and Warren traveled before the role of H pylori in duodenal and gastric ulcers and stomach cancer was acknowledged.

However, as Carl Sagan wrote in Broca's Brain:

I believe that the extraordinary should certainly be pursued. But extraordinary claims require extraordinary evidence.

Clearly the idea that subluxations cause nerve interference which then reduces the effectiveness of the immune system is an extraordinary claim and it requires extraordinary evidence. I think as with any rational scientist I am willing to be shown to be wrong in my assessment and change my thinking. The growth of scientific knowledge is made by shattering the previous truths. BUT one won't shatter the current state of scientific evidence exclusively with the pronouncements or press releases of a self-professed expert. Show me the beef er the research that subluxations cause nerve interference and that it reduces the effectiveness of the immune system. Since we wrote our paper on the subluxation (3) I've not seen any evidence yet that our assessment was wrong.

Please prove us wrong by providing extraordinary level of scientific evidence (heck how about any valid scientific evidence). I'll tell you if those who believe this swine poop think that the first author on our paper, the late Dr. Joe Keating would be rolling in his grave if the evidence was presented, I'm here to assure you that I know he'd be cheering. Because Joe and the rest of the authors are basically saying put up or shut up. Please put up or shut up!

SMP

1. Mirtz TA. UNIVERSAL INTELLIGENCE: A Theological Entity in Conflict with Lutheran Theology. J Chiropr Humanit. 1999;9(1). free full text here
2. Mirtz TA. The question of theology for chiropractic: A theological study of chiropractic's prime tenets. J Chiropr Humanit. 2001;10(1). free full text here
3. Keating JC, Jr., Charlton KH, Grod JP, Perle SM, Sikorski D, Winterstein JF. Subluxation: dogma or science? Chiropr Osteopat. 2005 Aug 10;13:17. free full text here

Ye Of Little Faith - In Chiropractic That Is

My last blog entry Swine Flu & Chiropractic is stirring up a hornets nest. Of course you wouldn't know that by looking at my blog because no one has posted any comments, so far. I have received quite a few emails. All of the emails sent to me directly by the person commenting have been complimentary.

I haven't yet received any anonymous hate mail, such as when my colleague Randy Ferrance, DC, MD and I co-authored one of my ethics columns for Dynamic Chiropractic on vaccinations, entitled What's Good for the Goose Is ... Ethics and Vaccinations. (BTW I think we would write this differently now due to a change in the evidence on stroke and chiropractic.)

That column resulted in such an outpouring of venom directed at Dr. Ferrance and me that I wrote a column about Argumentum Ad Hominem (ad hom for short) - which is to attack the person not their argument. For some reason, I do not completely understand, many people in my profession will resort to ad hom rather than find the flaws in an argument they think is wrong. To quote from my Dynamic Chiropractic article: "This is the most feeble reply one can make and generally reflects poorly upon the person who does it. Those who are not biased see this as having no probative value in the argument, and it signals that the person using that reply has no valid counterpoint and is not acting professionally."

Lack of Faith

Some think that my last blog entry shows I lack "faith" in chiropractic. Well clearly I do lack faith in chiropractic, just as I lack faith in medicine, physics, mathematics...

I think that faith is not an appropriate word to describe ones association with ones profession. No one would ask a mathematician, "do you have faith in math?" However, one might ask a member of the clergy do you have faith in your religion. This is because one is obligated to have faith in a religion. There is no other method for one to accept the tenets of a religion, as there is no method to determine the validity or lack of validity of those tenets. Faith is a belief that does not rest on logical proof or material evidence.

I do have faith in the epistemology (a subset of philosophy) inherent in science (i.e., skepticism, empiricism and determinism). Science is an epistemological theory about how one acquires knowledge and cannot be validated using the scientific method. Using science to validate science is a tautology. Thus one must have faith that science is a good method to discover how things function. So far it has worked out pretty well. You are reading this because of thousands of scientific discoveries that ultimately lead to blogging (not sure this is science's best day).

Chiropractic is a health care science and thus starting with my faith in science, I am forced not to have faith in chiropractic but to conclude, based on the available science that chiropractic is or is not a useful method for the care and prevention of human illnesses or maladies.

Given the above, I have found evidence that I find to be compelling to make me conclude that chiropractic is an extremely valuable method for the care and prevention of human illnesses or maladies. I will not blindly have faith in chiropractic or anything else, I will question it constantly, that I believe is my job as an academic.

Narrow view of chiropractic

One chiropractors suggested that my blog entry shows that I have a narrow view of chiropractic and that I implied we should stick to headaches, low back and neck pain. I wrote:

There is a growing body of good scientific evidence that spinal manipulation can be an effective treatment method for neck pain, headaches and low back pain.

Tell me where does it say that we should "stick to headaches, low back and neck pain"? It doesn't. It says that there is a growing body of good scientific evidence on three conditions. That's all. I didn't mention any others.

If one wants to see a good review of what evidence there is take a look at the Council on Chiropractic Guidelines and Practice Parameters (CCGPP)'s web site. One could also look at the Cochrane Collaboration and search for manipulation or chiropractic. Then there are some conditions that there is a complete lack of evidence. Such as preventing the flu.

As you can see from my long list of quotes on this blog, I am a fan of quotes. Two from Carl Sagan are illuminating in this regard.

"Absence of evidence is not evidence of absence"
- "The Dragons of Eden"

This one is often cited by members of my profession about those things we have no evidence for. For example using chiropractic care to prevent or treat swine flu. While this is true I think what is also important is another quote from Sagan:

"I believe that the extraordinary should certainly be pursued. But extraordinary claims require extraordinary evidence"
- " Broca's Brain"

The claim that spinal manipulation will improve immune function to the extent that it can be used to prevent or help treat the flu is clearly an extraordinary claim. I absolutely believe that it should be researched, just it is not my area of research interest. Some might say why not no harm. Well that is true as long as the public isn't lead to believe that this is a validated treatment. Until the evidence is found, we, the chiropractic profession, have to stop making the claim that chiropractic care will help prevent or treat the flu, which is what the blogger I was responding to wrote. He said that one of the "Sure-fire Strategies to help you and your family respond to the threat of the flu" is chiropractic.

As I wrote before it only serves to marginalize our profession by making us look like we are unscientific.

What I Was Taught In School

Another comment was about how a doctor wanted to believe what he was taught in chiropractic school about an adjustment improving immune function. As I tell my students often do not believe what I tell you. Go to the scientific literature yourself and find the evidence. And if you find that the evidence shows. I would be happy to eat my words that an adjustment will help prevent the flu so show me the scientific evidence.

CDC

One comment about my blog entry was that I suggested that people look at the CDC's web site for advice about the swine flu. The problem with that is supposed to be that "the first thing that website site [CDC's] says is to get the flu vaccine to prevent the flu. We all know that the flu shot is a shot in the dark and far from an exact science"

The problem with this statement is that the CDC does not recommend a flu vaccine for the H1N1 but for seasonal flu. In fact, they say that there isn't a vaccine for the H1N1 flu. Here is what they recommend:

1. Avoid close contact - Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
2. Stay home when you are sick - If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.
3. Cover your mouth and nose - Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
4. Clean your hands - Washing your hands often will help protect you from germs.
5. Avoid touching your eyes, nose or mouth - Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.
6. Practice other good health habits - Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

I know that no chiropractor would have a problem with these recommendations. What does this tell us with the complaint about my suggesting use the CDC for information. It tells us that the person who was criticizing me never even clicked on the links to the CDC to see what the CDC actually recommended. Just as they inferred I had a narrow view of chiropractic, without reading carefully what I wrote, they assumed that the CDC would recommend the flu shot.

As I wrote in the swine flu blog: "Overstating what we know only serves to decrease our credibility." In this case making pronouncements that, all easily available evidence, refutes doesn't do great things for ones credibility either.

SMP

Swine Flu & Chiropractic

I recently saw a blog that suggests that the second best of the "Sure-fire Strategies to help you and your family respond to the threat of the flu." is chiropractic. Now don't get me wrong, I'd love to be able to say with a straight face and the research to back it up that going to see a chiropractor would help you prevent or even get better from the swine flu, er I mean Influenza A(H1N1) (surely we don't want to insult swines). But honestly I think it is intellectually dishonest and a public disservice to imply that a chiropractor has unique therapeutic tools that will help prevent or treat the flu.

Let's look at the argument in favor of chiropractic as part of how ones family should "respond to the threat of the flu."

Supposedly Ronald W. Pero, Ph.D. performed one of the most important studies that showed the positive effect chiropractic care has on immune function and general health. First the link in the blog leads to an article about the 1917-8 flu epidemic. I'd like to see the original data rather than the owner of that web sites excerpts. Nevertheless it might be true that chiropractic care was better than medical care for the flu in 1917-8. There is a world of difference in the field of medicine between then and now. I hate to say it but I do not think there has been an equally large increase in the effectiveness of an adjustment. In fact I think most traditionalists in my profession would suggest it was as good as it was going to get way back when and we've only screwed stuff up since then.

I searched the National Library of Medicine's online database search system, PubMed to find any published paper by Dr. Pero on chiropractic. I can't find it. Here is that search. Here is another search of just what R Pero published. I read the title of all 183 papers and none appear to be about chiropractic. If anyone can find me the paper, rather than an article in a chiropractic newspaper talking about the research I really would be grateful to find the paper and read it.

Next the blogger discusses a study done at the National College of Chiropractic (now National Health Sciences University) by their then research director, Patricia Brennan. Brennan’s study, if anyone actually reads it, is not really about immune function. It was an attempt to find a physiological marker of active manipulation. The intent was to see if they could differentiate between a sham and real manipulation.

Lots of folks want to use this study to show how chiropractic improves immune function. What is stated: “phagocytic respiratory burst of polymorphonuclear neutrophils (PMN) and monocytes were enhanced in adults that had been adjusted by chiropractors.” is true. So to the true believer in the unlimited wonders of the adjustment this is “proof” that an adjustment improves immune function. Unfortunately, one cannot conclude this from that study. First of all the subjects were healthy normal individuals. We do not know if the response will happen to those who are ill. Maybe when one is ill the response is blunted or eliminated because the PMN’s are already “enhanced” by the need to fight an infection. Conversely, it is possible that the response is enhanced even to a greater degree in the person fighting an infection. We just do not know. Also the response was transient; it was found at 15 minutes but dissipated by 30 minutes after the manipulation. The true believer’s response would be, "so adjust the patient every 15 minutes." That seems logical, except we don’t know if the response is repeatable or if it fatigues. And again it could be more profound as it is repeated, we don’t know. Also we do not know if the increased phagocytic respiratory burst will actually work in any appreciable way to make one better able to defend against an infection or to help the individual get better faster or have reduced effects of the infection that one might have.

The blogger mentions a study done at Life Chiropractic University. There is no such educational institution in the US. The name of the institution is Life University which was Life Chiropractic College. For some reason there are a lot of people who make this mistake. If one googles "life chiropractic university" one finds many chiropractors web pages say they graduated from there. I suggest they take a look at their diplomas.

Regarding this study, I can not comment about any specifics, I haven't read the paper. My only comment is that good research requires replication and if the best we can do is a paper in a defunct journal that is more than 10 years old...

The blog goes on to say that chiropractic improves "And chiropractic care improves the function of the nerve [sic] system through improving the movement of the spinal bones that encase and protect the spinal cord." This is an interesting theory that has been espoused by some in my profession for years. I am aware of no valid research that supports this statement. There is a growing body of good scientific evidence that spinal manipulation can be an effective treatment method for neck pain, headaches and low back pain. Overstating what we know only serves to decrease our credibility.

For information on prevention and treatment of influenza A(H1N1) (swine flu) see the CDC or CDC's flu pandemic web site or MedLine Plus (great consumer oriented health information). Hopefully your chiropractor will recommend these sources of information rather then suggesting that a sure-fire strategy is getting a chiropractic adjustment.

SMP