Monday, February 6, 2012

Sidney Crosby and Quackopractic, Part 2

In case you missed it yesterday, repeat after me: there is only one "system" of medicine, the one based on scientific research via double-blind studies conducted by bona fide peer-reviewed scientists at multiple locations.  One body of knowledge that supports the medical professions we ultimately depend on: physicians, dentists, nurses, dental hygienists, emergency medical personnel, lab technicians, and physiotherapists, etc.  In Alberta chiropractic was de-insured in 2009 by the Alberta Government.  We now continue with the case of young hockey great Sidney Crosby, Dr. Steven Novella completing his indictment of so-called "chiropractic neurology": "It should be noted that neurological symptoms are often especially vulnerable to placebo effects. Many symptoms, like vertigo, or “fogginess” are highly subjective. There is also a well-established “cheerleader” effect – if you take anyone with chronic neurological symptoms (such as chronic deficits from a stroke) and then give them any intervention, they will perform better. Just getting patients off the couch and moving will have some effect. Careful research is necessary to separate the specific effects of an intervention from the non-specific effects of motivation, mood, activity, and also just time. The brain can heal itself to some degree, and after an injury there can be an improvement for even years afterward. Some symptoms are also susceptible to conditioning. Vertigo is perhaps the best example of this. At present the most effective treatment for chronic vertigo (a subjective sense of movement, such as spinning) is vestibular therapy – physical therapy designed to condition the patient to the symptoms, to diminish them over time. It is therefore possible that some chiropractic neurology interventions are simply providing this known mechanism. For example, here is a description of Carrick’s treatment of Hockey player, Crosby: Carrick then signals to restart the gyroscope—with one difference. This time Crosby will be turned upside-down while he is also spun around. He hasn’t experienced this dual action yet. The door clangs shut. Above it, a stack of red, yellow and green lights shines while 10 high-pitched beeps signal the gyroscope is about to start. Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding! This is a very dramatic treatment, sure to impress the naive. It follows a common philosophy in dubious neurological treatments – the notion that you can “rebuild the brain” by stimulating it. While it is true that activity and simulation are better than no activity and stimulation, it does not follow that simply increasing stimulation will increase the brain’s plasticity or recovery (a simplistic more-is-better philosophy). That basic notion was researched and discarded decades ago, for example with specific reference to psychomotor patterning treatments. Chiropractic neurology is an excellent example of exactly why we need science-based practices. Without a grounding in objective evidence there does not appear to be any limit to the degree that beliefs systems can be led astray. Any treatment can deceptively seem to work, and humans are very good at backfilling in justifications and explanations for phenomena that do not even exist. Left to our own devices we will tend to develop elaborate, but entirely fictitious, belief systems. We figured out centuries ago, however, that systematic methods of controlling variables, controlling for bias, and rigorous statistical analysis can compensate for such human foibles. Until chiropractic neurology (and similar practices) avail themselves of such methods there is no reason to take their claims seriously." (emphasis added)  Look, there are competents and incompetents in every profession, and in today's health care system every patient must be their own advocate.  Keep searching until you find the MD that you are confident in, Sidney, but give up the black magic of chiropractic neurology!