Adventures in Chiropractic: Part 3, the talk, contd
You can find parts 1 and 2 here and here.
Cracking Backs
It's because the language is so very careful. He is not saying "chiropractic cures IBS", he's just saying that they've found that patients report their IBS getting better following chiropractic. It's correlation, not causation. It also skirts around the Guidance on Advertising to the Public by the GCC, which states,
The conditions chiropractors are allowed to advertise as being within their treatment remit are all musculoskeletal. IBS is outside that remit so if he said he could treat it he would be in violation of the guidance, but he doesn't say he can treat it. He just says that patients have got better from IBS while he's been treating them, if we think it's because it's the treatment that's our inference, not his.
Cracking Backs
We left the last post having had an "explanation" of the nervous system and how it relates to chiropractic treatment. We begin this post with the chiropractor explaining why patients get their backs "cracked".
The chiropractor explains that the cracking - the noise - is just gas being released from the spine in the same way as we hear a noise when we crack our knuckles. His job is to "find where those misalignments are so that when [he cracks your back] the rest of the body can sort itself out" and the healing process can begin. He gives an example of sciatica, which he says is due to "too much pressure building up in the lower back". The cure is to take pressure off that area so that "the brain can send the information to the right areas".
Okay. The conflation and misinformation is coming thick and fast now but we can do this. So, the noise from cracking the knuckles or the back is indeed from gas and is indeed harmless. There's a fantastic Ig Nobel prize that was awarded to Donald Unger who cracked the knuckles on his left hand every day for 60 years while leaving his right hand untouched to see if it had any impact on his hand health. It didn't. So score one for our chiropractor. However, if cracking joints doesn't do anything other than release air, how does it help the body to "sort itself out"? What does this have to do with the misalignments? It's really difficult to pinpoint a mechanism of action. The example of sciatica seems to include a misunderstanding of both the cause and the treatment for this condition. Sciatica can be caused by various different things. A herniated disc is the most common cause but trauma, tumours and even pregnancy have been linked to its expression. Unfortunately for sufferers, including my poor sister, consistently effective treatments are unknown: even pain medication has poor evidence for efficacy. Of course, this means that desperate patients find themselves falling into the hands of alternative practitioners who claim to be able to fix problems conventional medicine cannot. The A&E doctor told my sister it was most likely there was inflammation around the nerve that was trapping it and causing pain, so reducing that inflammation with anti-inflammatories was the suggested course of action. In that regard, the chiropractor's cure of removing the pressure makes sense, but his proposed method of healing - cracking her back - and the mechanism of healing in that this removal allows the brain to send information to the right areas are both misleading.
Careful Now
The talk has been very chatty and it's possible to excuse some of the lack of clarity on the fact it is fairly informal. There's no powerpoint presentation, not even any cue-cards. It's just a guy speaking to a few people after a long day in the office. But then he says things like "these nerves control a lot of our organs, so if you've got any issue with organs, for example reflux or IBS or headaches... we've seen patients improve in those areas". These patients aren't coming in for these issues, they come in for back problems but "see these other benefits" following their treatment. And it makes me think that this is all much more calculated than it first appears. Why?, you may ask. Let me explain.
It's because the language is so very careful. He is not saying "chiropractic cures IBS", he's just saying that they've found that patients report their IBS getting better following chiropractic. It's correlation, not causation. It also skirts around the Guidance on Advertising to the Public by the GCC, which states,
 |
| Advertising treatment of conditions CAP [the Committee on Advertising Practice] accepts chiropractic treatment can treat, p6-7 of the Guidance on Advertising to the Public by the General Chiropractic Council. |
The conditions chiropractors are allowed to advertise as being within their treatment remit are all musculoskeletal. IBS is outside that remit so if he said he could treat it he would be in violation of the guidance, but he doesn't say he can treat it. He just says that patients have got better from IBS while he's been treating them, if we think it's because it's the treatment that's our inference, not his.
Chiropractors Don't Fix You, They Help Your Body Fix Itself
He ends this section of the talk by summarising what his job as a chiropractor entails: "Our job is to find where these subluxations are so that we can get your body working better". He goes on to say that he's not really solving a patient's pain. he's just removing the blockage which allows the body to do the rest. We get another example, this time of breaking an arm. He informs us that the doctor doesn't fix the break, they will just immobilise it while the brain fixes it by sending "information down to your neck, down to your arm and tell your bones to physically fuse back together" and that if there's a blockage in your neck that can delay the healing process.
I keep running into the problem of knowing enough to know this isn't right, while not knowing enough to explain exactly where it's wrong. Part of it comes back to the problem that we haven't been given a good explanation of what the nervous system is. The way he talks about it makes me think about The Numskulls, little cartoon creatures who control the body from the brain. I have this image of a little person running down a nerve to a broken bone with a note in hand saying "fuse back together you silly bone" and then scurrying back when his job is done. In reality a complex process involving blood cells, the immune system and stem cells, stimulated by hormones from the brain and, yes, signals from the autonomic nervous system, cause new bone to grow between the fracture and eventually, hopefully, join the two ends of the break back together. The implication that it's just the nerves sending signals is so reductive as to be practically meaningless.
Treating Newborns
Treating Newborns
The next part of the talk is, for me, the most horrifying and left me feeling incredibly uncomfortable. We are given another patient anecdote, this time about a six-week old girl who had been suffering from constipation for two weeks. He "checked her spine" and a week later the constipation has passed. Babies are, he tells us, "easy to do" because their spines are so "fresh" as they don't have a build up of stress.
The chiropractor goes on to compare his services to that of a dentist. A child will see a dentist all their life starting from when their teeth emerge and in the same way children should routinely see chiropractors. The average age someone sees a chiropractor for the first time is 47. If you went to the dentist for the first time at 47 it would be very hard for the dentist to fix everything and it's the same for chiropractors and why they can only get some people "so far". The older you are the harder it is to get you completely fixed. On hearing this one patient exclaims "I should have come here years ago!".
Why was this the most horrifying section to me? Well, it's because we're talking about treatment on the people with no ability to consent and for whom there is little evidence that the treatment will be of benefit. While there have been no known deaths from chiropractic care of infants, a review of the literature found seven serious adverse events in patients aged under 18 and in one case a 4-month old was given chiropractic manipulation which resulted in quadriplegia. That same review found 604 mild to moderate adverse events. Now, any treatment is going to have side effects. Just taking an aspirin leaves you vulnerable to indigestion and bleeding. But we have to weigh up the risks and benefits. Taking an aspirin may give you indigestion but should get rid of your headache. Chiropractic may give you a headache but at least it will... er, fail to "provide a clinically meaningful difference for pain or disability in people with [lower back pain] when compared to other interventions", according to the Cochrane Review published in 2010.
There are other problems when it comes to chiropractic care of infants. The first is that it's really expensive! The Sun (I know, but it's surprisingly decent reporting) found chiropractors charging up to £125 per session to treat babies. 'But what price can you put on your child's health?', I hear you ask. None, as long as that price is for something that works. A lot of infant chiropractic is focused on infant-specific problems (unsurprisingly), such as colic, yet claiming these problems can be treated with chiropractic is not allowed by the Advertising Standards Authority. Their guidance specifically says that chiropractors cannot claim to be able to help with colic,
In fact, chiropractors are not allowed to claim they can treat problems specific to babies at all,
This isn't the ASA just being party-poopers, they are an "an evidence-based regulator" that regularly reviews its standards to incorporate changes in evidence. Arguably the ASA is not strict enough with the amount of evidence required to substantiate a claim, but it does mean that if they say there isn't evidence, you know they really mean it. That they have said chiropractors can't claim to be able to treat infant-specific conditions tells you just how poor the evidence is of their ability to do so.
The other major problem with this is that while a lot of this feels like it's playing on the worried well, the first-time parents for whom every cry is a sign their child is in pain and close to death rather than just being a contrary little sod, there are times when babies are legitimately ill. And if parents take their baby to the chiropractor rather than a real doctor, then treatment may be delayed. Chiropractors are not GPs, they aren't trained to identify anything outside their musculoskeletal remit and relying on them to do so is a bad idea.
Associated with this, a significant minority of chiropractors are anti-vaccine. A survey of chiropractors from across Europe found that a significant minority held an "unorthodox" view of vaccines (namely that they either don't work or are dangerous), while a survey of Canadian chiropractic students found that while anti-vaccine stances were in a minority, they become more prevalent in the later years of training. As vaccine-preventable diseases are on the rise due to scaremongering about the (incredibly low) risks of adverse reactions to vaccines, it is vital that people in authority do not contribute to this scaremongering.
Before I move on I want to go back to that constipated baby. I don't have kids and never will, and they remain an unopened and rather scary book to me. But a bit of googling suggests that constipation is pretty common in babies - 15% get it before their first birthday. However, babies also don't poo that often, a few times a week and less if they're getting exclusively breast milk, which could easily be misinterpreted as constipation by nervous first-time parents. Most constipation clears up within a few weeks and bowel movements get more regular after about 6 weeks of age, which is right around the age the chiropractor said things started getting better for his patient. So, did chiropractic clear up the baby's constipation? Or was it just the baby's guts sorting themselves out over the first few weeks of independent life? I know which option I'd put my money on.
The Three Ts: Trauma
We are seamlessly led into the final section of the talk: the three Ts. These are trauma, thoughts and toxins. We begin with trauma and are asked when we experience our first trauma. "Childbirth", one person points out, helpfully guided to this answer by all the hints that had been dropped in the preceding section. He uses yet another patient anecdote, this time a very personal one as it's about his own child. He tells us that when they were 10 minutes old he checked them out because "if you think about where these [subluxations] come from is a couple of different places and trauma tends to be one of them".
"It's actually called 'birth trauma', isn't it", he informs us. It's the first time our spines are "under pressure" after spending nine months in a ball, and being born puts a lot of "stress" on the spine. If that's not checked then over time it can lead to problems. He reassures us that babies are resilient and most can cope with this but for some it causes problems such as constipation and people "don't put two and two together" that maybe the messages aren't getting through to the bowel from the nervous system.
He then moves on to trauma in childhood and later in life, trips and falls and other accidents which we don't consider because we think that "because trauma happened a number of years ago it's not going to affect us". He said that people who had accidents years or even decades ago might not think that they could still be having an impact, but it's all trauma. He then says that even though you didn't feel pain at the time you think you've "got away with it" and are fine, but the damage can be seen on x-rays even if they feel nothing.
You may be thinking that if you've not had any accidents or falls in your life you're safe, but no. People still have back problems and they can still be explained as trauma: sitting at a desk for decades will "put some sort of pressure through your spine". Not only that but "every time you move your body it's going to put pressure on it", you are constantly having "micro-traumas" slowly causing problems in the background until a straw breaks the camel's back.
Oh boy, how to tackle all of this? We have birth trauma, injuries and 'wear and tear' to cover. Let's take these one at a time. Birth trauma. This is a phrase I've heard but normally in the context of the trauma to the mother, not to the baby. The birth trauma the chiropractor appears to be referring to is more normally referred to a birth injury and is more common in developing countries but still occurs in about 2% of live births in the USA. I say "appears to" because I don't think that's what he's really referring to at all. The way he was talking I got the strong impression that he considered being born to be inherently traumatic. Maybe he's been watching too much of The Simpsons.
The chiropractor goes on to compare his services to that of a dentist. A child will see a dentist all their life starting from when their teeth emerge and in the same way children should routinely see chiropractors. The average age someone sees a chiropractor for the first time is 47. If you went to the dentist for the first time at 47 it would be very hard for the dentist to fix everything and it's the same for chiropractors and why they can only get some people "so far". The older you are the harder it is to get you completely fixed. On hearing this one patient exclaims "I should have come here years ago!".
Why was this the most horrifying section to me? Well, it's because we're talking about treatment on the people with no ability to consent and for whom there is little evidence that the treatment will be of benefit. While there have been no known deaths from chiropractic care of infants, a review of the literature found seven serious adverse events in patients aged under 18 and in one case a 4-month old was given chiropractic manipulation which resulted in quadriplegia. That same review found 604 mild to moderate adverse events. Now, any treatment is going to have side effects. Just taking an aspirin leaves you vulnerable to indigestion and bleeding. But we have to weigh up the risks and benefits. Taking an aspirin may give you indigestion but should get rid of your headache. Chiropractic may give you a headache but at least it will... er, fail to "provide a clinically meaningful difference for pain or disability in people with [lower back pain] when compared to other interventions", according to the Cochrane Review published in 2010.
There are other problems when it comes to chiropractic care of infants. The first is that it's really expensive! The Sun (I know, but it's surprisingly decent reporting) found chiropractors charging up to £125 per session to treat babies. 'But what price can you put on your child's health?', I hear you ask. None, as long as that price is for something that works. A lot of infant chiropractic is focused on infant-specific problems (unsurprisingly), such as colic, yet claiming these problems can be treated with chiropractic is not allowed by the Advertising Standards Authority. Their guidance specifically says that chiropractors cannot claim to be able to help with colic,
 |
| ASA guidance, p18 [my emphasis] |
 | ||
| ASA guidance, p8 [my emphasis] |
This isn't the ASA just being party-poopers, they are an "an evidence-based regulator" that regularly reviews its standards to incorporate changes in evidence. Arguably the ASA is not strict enough with the amount of evidence required to substantiate a claim, but it does mean that if they say there isn't evidence, you know they really mean it. That they have said chiropractors can't claim to be able to treat infant-specific conditions tells you just how poor the evidence is of their ability to do so.
The other major problem with this is that while a lot of this feels like it's playing on the worried well, the first-time parents for whom every cry is a sign their child is in pain and close to death rather than just being a contrary little sod, there are times when babies are legitimately ill. And if parents take their baby to the chiropractor rather than a real doctor, then treatment may be delayed. Chiropractors are not GPs, they aren't trained to identify anything outside their musculoskeletal remit and relying on them to do so is a bad idea.
Associated with this, a significant minority of chiropractors are anti-vaccine. A survey of chiropractors from across Europe found that a significant minority held an "unorthodox" view of vaccines (namely that they either don't work or are dangerous), while a survey of Canadian chiropractic students found that while anti-vaccine stances were in a minority, they become more prevalent in the later years of training. As vaccine-preventable diseases are on the rise due to scaremongering about the (incredibly low) risks of adverse reactions to vaccines, it is vital that people in authority do not contribute to this scaremongering.
Before I move on I want to go back to that constipated baby. I don't have kids and never will, and they remain an unopened and rather scary book to me. But a bit of googling suggests that constipation is pretty common in babies - 15% get it before their first birthday. However, babies also don't poo that often, a few times a week and less if they're getting exclusively breast milk, which could easily be misinterpreted as constipation by nervous first-time parents. Most constipation clears up within a few weeks and bowel movements get more regular after about 6 weeks of age, which is right around the age the chiropractor said things started getting better for his patient. So, did chiropractic clear up the baby's constipation? Or was it just the baby's guts sorting themselves out over the first few weeks of independent life? I know which option I'd put my money on.
The Three Ts: Trauma
We are seamlessly led into the final section of the talk: the three Ts. These are trauma, thoughts and toxins. We begin with trauma and are asked when we experience our first trauma. "Childbirth", one person points out, helpfully guided to this answer by all the hints that had been dropped in the preceding section. He uses yet another patient anecdote, this time a very personal one as it's about his own child. He tells us that when they were 10 minutes old he checked them out because "if you think about where these [subluxations] come from is a couple of different places and trauma tends to be one of them".
"It's actually called 'birth trauma', isn't it", he informs us. It's the first time our spines are "under pressure" after spending nine months in a ball, and being born puts a lot of "stress" on the spine. If that's not checked then over time it can lead to problems. He reassures us that babies are resilient and most can cope with this but for some it causes problems such as constipation and people "don't put two and two together" that maybe the messages aren't getting through to the bowel from the nervous system.
He then moves on to trauma in childhood and later in life, trips and falls and other accidents which we don't consider because we think that "because trauma happened a number of years ago it's not going to affect us". He said that people who had accidents years or even decades ago might not think that they could still be having an impact, but it's all trauma. He then says that even though you didn't feel pain at the time you think you've "got away with it" and are fine, but the damage can be seen on x-rays even if they feel nothing.
You may be thinking that if you've not had any accidents or falls in your life you're safe, but no. People still have back problems and they can still be explained as trauma: sitting at a desk for decades will "put some sort of pressure through your spine". Not only that but "every time you move your body it's going to put pressure on it", you are constantly having "micro-traumas" slowly causing problems in the background until a straw breaks the camel's back.
Oh boy, how to tackle all of this? We have birth trauma, injuries and 'wear and tear' to cover. Let's take these one at a time. Birth trauma. This is a phrase I've heard but normally in the context of the trauma to the mother, not to the baby. The birth trauma the chiropractor appears to be referring to is more normally referred to a birth injury and is more common in developing countries but still occurs in about 2% of live births in the USA. I say "appears to" because I don't think that's what he's really referring to at all. The way he was talking I got the strong impression that he considered being born to be inherently traumatic. Maybe he's been watching too much of The Simpsons.
No-one can avoid being born so if it is inherently traumatic then that means we all have these traumas that have been building up and need treatment. The idea of being healthy doesn't seem to be possible under this hypothesis. It's also worth putting this in the context of the ASA guidance. They say that,
There is definitely some serious skirting of the guidelines here.
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| ASA guidance on birth trauma |
There is definitely some serious skirting of the guidelines here.
The discussion about physical injuries puzzled me. On the one hand he seemed to be saying that if you had accidents they could result in permanent injuries, which seems pretty uncontroversial. On the other he seemed to be saying that "near misses" could still leave impacts on the body that we aren't aware of until much later. Now, I appreciate that it is possible to have a very minor injury which, through being ignored or missed can lead to more serious problems down the line but this doesn't appear to be what he's implying. I got the impression he was saying you could have no injury yet still have impacts later on. Which seems nonsensical to be honest.
The final source of trauma can, I think, be summarised as "being alive". The human body is a real mess. We evolved from four-legged ancestors and it shows. There's a reason back problems are so incredibly prevalent in humans - our backs weren't 'designed' to be vertical. This means that pressure is applied where it shouldn't and it gets stressed. Chiropractors are just over-extrapolating from this to assume this means the back is the source of all problems in the body.
The Three Ts: Thoughts
Thoughts, aka 'mental stress'. "This is harder to control because it normally comes from elsewhere, not necessarily from you". It comes from family, friends, work and so on. People are surprised that stress can cause problems in their spine, but stress can "change the chemicals in your body" which means the brain sends different information, and people can "carry stress in their shoulders". Patients who have flare-ups of their condition often find it's due to stress which makes the body go "haywire".
So, there's not too much for this one. I get the impression this chiropractor doesn't really like talking about mental health, which probably isn't a bad thing given how far outside his expertise it is. But thinking back to how uninquisitive he was about my depression diagnosis and now, how brief and superficial his discussion on the mental aspects of health was, I really got the feeling he felt very out of his depth here. While I was grateful he recognised the social aspects of mental health, rather than the increasingly prevalent "self help" approach that says you can just change the way you think and who cares if you have a zero-hours contract and can't afford to put the heating on, just think positive and everything will be better, the idea it is all external seemed to be based on a misunderstanding of mental health issues. I do wonder what people he talks to that they are surprised that stress can cause physical problems. Being stressed and being tense are practically synonymous for goodness sake!
The Three Ts: Toxins
Toxins are "what you put into your body". Eating only McDonalds is bad for you. Even eating a lot of sugar is bad for you - "if you're in a lot of pain, sugar can actually give you more pain... sugar is more addictive than cocaine... it reacts on the brain more than cocaine". While diet isn't his area of expertise and therefore not something he's going to focus on he wants us to know that our diet can impact our spine. He lets us know that if we have a boozy weekend he can tell - there's no hiding from your chiropractor! - your tone and the tightness will give you away. That's not to say that you can't ever have a drink or a piece of cake but we have to be balanced.
This again was a short section but there was the usual mix of really obvious and really dodgy. Who knew that eating only McDonalds was bad for you?! Just about everyone by now. Though it may not as bad as you might have thought given Morgan Spurlock's hit documentary Super Size Me. The sugar claims are harder to fact-check, partly because the science is still being done. At the moment I think we can say that sugar is a factor in inflammation, but,
It is important to remember that inflammation is unlikely to be caused by sugar alone. Other factors like stress, medication, smoking and excess fat intake can also lead to inflammation.
As for the claim that it is as addictive as cocaine, again, the jury is still out. From what I can see sugar can be addictive but only under certain unrealistic circumstances, and the studies have only been done in rats so far.
The stuff about knowing when you've been drinking, while it sounds superficially impressive, doesn't seem that much of a surprise when you think about it. We're all pretty good at recognising when our colleagues come into work after a heavy night's drinking. As we get older we take longer to recover and if the average age of first seeing a chiropractor is 47 then the majority of their patients will be a couple of decades, at least, away from their heady youth of drinking 'til the early hours then heading to work or to lectures without difficulty.
The Sales Pitch
"Where does the chiropractic come in?" Surely if we control all this we'll be fine and won't need to see a chiropractor? If we could eradicate the three Ts then we'd all be great but unfortunately it's just not possible. That's not the way life works. "Because of these three things, your spine will always come out of position, which is why we've got to constantly keep on top of it". When you're fixed you can't stop coming, you just come less. We get the dentist analogy again - you don't stop brushing your teeth because you don't have pain - and in the same way a chiropractor is someone you should see regularly throughout your life.
He says that arthritis comes from a build up of pressure on the spine which leads to problems with signals getting through. Chiropractors think this is why people are more prone to falls as they get older - the signal isn't getting through to the feet as well as it should due to the number of blockages. They can't reverse arthritis but they can try to slow it down. "We're all going to get arthritis.... it just depends how fast you get it". He says he's had patients in their 50s with worse spines than some in their 70s "because they haven't looked after themselves".
He wraps up by addressing the "myths" of chiropractic - who should see them and how long for. "We believe here that everyone should have it, and they should have it forever... because these systems are so important". He reassures us that he's not saying we have to come in twice a week for the rest of our life, it's about getting us to a point where it can be managed. And children, grandchildren, get them in to get checked as it's easier to look after a healthy spine than try and fix it. The talk has been to try and enable us to make an "informed decision" about whether chiropractic is right for us. If it's not what we're looking for, that's fine, but "the door is always open". And with that the talk ends.
The dentist analogy really annoyed me. I go to my dentist once a year or so, for a check-up. Most of the time the check-up finds my teeth are fine and no further treatment is needed. If it is, that treatment is scheduled, performed and then we're back to annual check-ups unless an emergency arises, which happens very rarely. Similar thing with the optician - I go annually for check-ups, and get new glasses if my prescription has changed and leave it at that unless I have problems with either my frames or my vision. I haven't had anyone say that you need to attend frequent regular appointments for the rest of your life, and if they had I'd be seriously worried about the health of my body. Yet that is what he is proposing. If we don't get regular manipulation then our spines will fall out of place and we'll have all manner of problems. I know I said the spine was badly evolved but that's really taking the piss.
The arthritis claims also really annoyed me - I'd definitely gone from bemusement to anger by this stage. I've not listened to so much rubbish since I sat through a talk by a creationist. To say that arthritis is caused by pressure in the spine is to admit you know nothing about arthritis. Osteoarthritis is caused by a loss of the protective cartilage around joints while rheumatoid arthritis is an autoimmune disease where you body attacks the cells that line joints. You can get arthritis in the spine but it's not restricted to the spine and it's certainly not 'caused' by the spine. Arthritis is very common, affecting nearly 9 million people in the UK, but it doesn't affect everyone, you're more likely to get it as you get older and women are more susceptible than men. There were women attending the talk who, I suspect, had arthritis and to hear them being told that it was just pressure on their spine made me want to shout "oh no it isn't!". The thought that these women could be contemplating getting chiropractic for their arthritis made me very angry.
The throw-away comment about falls in elderly people being due to blockages of signals to the feet betrayed his lack of understanding of geriatric medicine. According to experts, falls are more common in elderly people due to three main factors:
The throw-away comment about falls in elderly people being due to blockages of signals to the feet betrayed his lack of understanding of geriatric medicine. According to experts, falls are more common in elderly people due to three main factors:
balance problems and muscle weakness
poor vision
a long-term health condition, such as heart disease, dementia or low blood pressure (hypotension), which can lead to dizziness and a brief loss of consciousness
Conclusions
I'm pretty sure that reading the two posts on this talk will take as long, if not longer, than I spent listening to it that evening just over a week ago. There was so much to deconstruct and there's still more that could be said. Sitting through the talk was an exercise in self-control but I'm very glad I sat silently as I think that he would have been more guarded if I started asking questions and while I feel I did a disservice to the people sitting there by not questioning anything, I know that I do badly trying to debate with someone on the fly, and given how much time it's taken me to critique his claims I know I'd only come off looking like an idiot with a grudge and possibly push those people even more into using chiropractic.
The main thing I realised from the talk, and from trying to dissect it, is how much a veneer of science there is, and how poorly the chiropractor seemed to understand the systems he was explaining. I don't think anyone with even a passing scientific understanding of the nervous system would have explained it in the way he did. I briefly learned about the mechanics of it in my undergraduate degree many years ago - axons and ganglia and activation potentials and gated channels and so on. It's far too much for a general talk but I didn't get the impression that he was really aware of any of this stuff - the way different parts of the nervous system were conflated and the generic references to "pressure" on nerves, it all felt very non-technical and not in a way that made me think he was just trying to tailor the talk to his audience.
I found the reliance on anecdote and patient stories concerning, not just from a "if you had proper evidence for this you'd be using it" point of view but also due to privacy concerns. Is he going to be using me or my sister in future stories? Who knows? The way he kept inferring that traditional medicine and the NHS either didn't know about things like preventative healthcare and the importance of a healthy diet, or just didn't care really bothered me. I'm a massive fan of the NHS and while I know it's under pressures - deliberate pressures by a government who would love to privatise it - the implication that it's not really cut out for looking after people in the modern world and that we need to turn elsewhere for our healthcare needs seemed to be encouraging the view that the NHS is expendable, a view I cannot support. The reason chiropractic isn't available across most of the NHS is that it isn't cost effective. It's not some giant conspiracy, it's just that the NHS doesn't cover "complementary and alternative medicines" for which there are no evidence - as Tim Minchin said,
"By definition", I begin,
"Alternative Medicine", I continue,
"Has either not been proved to work, or been proved not to work.
Do you know what they call 'alternative medicine' that's been proved to work?
Medicine."Tim Minchin, Storm
I tried to go to the talk with an open mind, but over the course of the half hour it slammed firmly closed. The chiropractor was nice and friendly and engaging but he was scaremongering and telling half-truths and full lies and he was doing so out of a genuine desire to help people receive a treatment he thought had helped him when he was younger. And after a week of thinking about it I still don't know if that's better or worse than knowingly giving people bogus treatments.
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