Feb 08 2007

Debate with a Chiropractor

Below is a response by a chiropractor to some statements I made in response to their entry on another forum. I include here their statements (in italics) and then my rebuttal. It is, in my experience, fairly representative of the kinds of arguments made by the proponents of unscientific medicine.

If MDs knew much about nutrition, then why would they prescribe drugs for every little symptom? If they knew much about nutrition, then they’d be prescribing diets rich in fruits, vegetables, EFAs, etc. instead of drugs.

This question, like most of the questions here, is loaded with false assumptions. The first question is also a false dichotomy – as if one can either offer nutritional advice or prescribe drugs. How about doing either or both when dictated by the evidence. It also assumes that doctors do not recommend dietary changes. This is patently false.

Why do they prescribe dangerous, worthless drugs for hypertension, such as Coreg, when fruits such as grapes and certain berries work much more safely and at least as effectively?

First, patients with hypertension are often placed upon diets to help regulate their pressure, such as low salt diets. Weight loss and regular exercise are also advised – this is the standard of care. But the question assumes that for all patients grapes and berries will effectively treat hypertension, and there is absolutely no evidence to support this claim. There is copious evidence that the approved anti-hypertensive drugs are safe and effective in reducing blood pressure, and thereby reducing it as a risk factor for vascular disease. Good doctors follow the scientific evidence. The questioner is merely parroting ideology.

If you have a headache, they tell you to take aspirin. Now, where in nutrition does aspirin play a role? Nowhere! The only thing that aspirin does is cover up your headache symptoms! It doesn’t go to the root of the problem. If you have a headache, you ask yourself “what could possible cause a headache?” It’s not an aspirin deficiency. Most likely, you are either deficient in some nutrient or multiple nutrients. You may be dehydrated and you just need to drink more water, like 8 glasses per day. Headaches are a common sign of dehydration.

Again, they make many false and unwarranted assumptions:

1 – All headaches have a curable cause. This is false. Many people have headaches for which there is no cure. For example, migraines often cannot be cured. Some people have migraines because of a specific genetic mutation, most seem to have a genetic predisposition even though a specific cause is unknown.

2 – Doctors only treat symptoms and do not look for underlying causes. The standard evaluation of a patient with a headache is first to look for an underlying cause. This list is quite long, and includes serious disorders like brain tumors, and benign conditions like dehydration, sinusitis, neck arthritis, jaw claudication, and many others. There is a standard workup, including history, exam, and diagnostic tests, designed to rule out any underlying or secondary cause of a headache. Only when this is complete will the diagnosis of a primary headache be made and treatment limited to symptomatic relief.

3 – A primary cause of headache is nutritional deficiency. This is actually a rare cause of headache.

4 – Doctors only use drugs to treat headaches. I actually run a headache clinic so I have some experience in this area. The first approach to treatment is to identify any underlying cause and treat it. The second is to identify any triggers or contributors to the headache and remove them. The most common such trigger is caffeine overuse. There is also a long list of foods that might trigger migraines, and I give the patient the list and tell them to keep track of which ones might be triggers. Sometimes the cause is medication overuse, and this has to be withdrawn. Lack of sleep is another common trigger. If headaches are frequent and severe we then focus on prevention. I often prescribe those nutritional supplements that have been shown to be helpful (specifically in migraine) namely magnesium, vitamin B2, and Coenzyme Q10. Only when warranted do I prescribe medications, and I do this very thoughtfully. There are many medications that have been shown to be very safe and effective in preventing migraines or other headaches. I also instruct patients how to treat their headaches when they do occur. This often includes hydration as well as treatments for the pain, nausea, and muscle stiffness if present.

Admittedly I am a headache expert so my algorithm of treatment is likely more complex and sophisticated than a general practitioner – but none-the-less this is the standard of care and it is a far cry from the caricature presented by the questioner.

Quite possibly, your occiput could be subluxated. Yes, there is such a thing as a subluxation! In case you don’t know, which it seems you don’t…a subluxation means ‘less than a dislocation.’ If one vertebra is twisted on another, that vertebra is subluxated. It’s not some miniscule thing that can’t really be detected, and it’s not imaginary! Some subluxations you can see as plain as day on a radiograph. There are varying degrees of subluxation and they occur quite often not only in human spines, but also in animal spines. A subluxated occiput is a common cause of headaches. Dr. Novella stated that chiropractors do not treat real causes…tell me how fixing the obstruction caused by this subluxated occiput is not getting to the root of the cause!

When doctors use the term subluxation they are referring to a displacement of one bone on the other – a displacement that can be verified by exam or X-ray. Chiropractors, however, use the term to refer to alleged displacements that cannot be verified by X-ray and have no scientific validity. This means that they have not been able to demonstrate with scientific evidence that different examiners will find the same subluxations and that these subluxations correlate to any symptoms or disease.

Further, chiropractic ideology states that these unverifiable subluxations cause nerve blockage. However, they do not cause the known signs and symptoms of nerve blockage, they only block the mysterious and undetectable “innate intelligence” – the life force of chiropractic philosophy.

Incidentally, when headache or other symptoms point to a real problem in the base of the skull or the neck I check it out with an X-ray, or more likely an MRI scan. If there is something there that can be fixed, then we try to fix it. The most common intervention is physical therapy. Surgery is a last resort.

So, given this information, why would a MD tell you to take aspirin? Is it because they really don’t know much about nutrition? Or is it because the nutrition that they do learn has a pharmaceutical bias…that is, don’t tell the patient anything that can harm the sales of Big Pharma!

This is nonsensical conspiracy mongering.

If drugs and surgery work, like in the instance of cancer, then why does the cancer many times come back? The answer: 1)Chemotherapy weakens the immune system so bad,that if the cancer doesn’t kill them, some other disease will. 2) removing cancer surgically doesn’t remove the reason that the cancer is there to begin with! If the patient doesn’t change his or her lifestyle drastically, the cancer will probably come back.

This assumes that lifestyle was the cause of the cancer in the first place. There are lifestyles that can predispose to cancer, but they are risk factors for the appearance of cancer. This does not mean that they prevent the body from fighting the cancer, or that changing the lifestyle will cure the cancer. This is often like closing the barn door after the horse has run away.

Cancer comprises many diseases with many causes. But in common is a mutation in a cell that causes it to be immortal and grow without limits. Once the mutation occurs and it slips past the immune system and the cancer takes root, it’s too late to change the risk factors. Some cancers can be cured with a combination of drugs, surgery, and radiation. Each type of cancer has its own chance of being cured. Few have a 100% chance. No treatment is perfect, and many are limited by their toxicity. The trick is to find a way to kill cancer cells without killing healthy cells.

When there is a cancer recurrence after treatment it is not accurate to say that the cancer “came back.” Rather, it was never entirely gone. The surgery did not remove the entire cancer, and the treatment did not kill every cancer cell. So the remaining cells continue to divide and the cancer grows. This has nothing to do with the failure to make lifestyle changes – it just reflects the fact that our current treatments do not always work adequately to eradicate the cancer. Sometimes we know a treatment will likely not be a cure and the goal is to extend the quantity and quality of life.

Why doesn’t the doctor educate the patient in cancer prevention? Yes, contrary to the ridiculous Merk commercial that’s been running lately, cancer can be prevented, and it’s not a difficult thing to do!!! It can’t, however, be prevented using Medical treatments.

The medical community does promote cancer prevention. It was scientific medicine that has, and continues to, identify the causes of cancer and teach prevention. That’s what the surgeon general warning against tobacco is all about, and the dietary recommendation of the USDA, for example. But to say that preventing cancer is “not a difficult thing to do” is absurd. Cancer is a tough problem and the primary risk factor for cancer is age. This means that as our population ages cancer prevalence is actually going up.

I’m not saying that a chiropractic adjustment will cure any cancer. If that particular cancer is due to diseased tissue caused by obstructed nerve signals which is caused by a subluxation, then it is possible to treat that cancer with chiropractic adjustments.

This statement is demonstrably absurd and wrong. There is absolutely no evidence that a chiropractic subluxation (which don’t exist, remember) causes any cancer, and no evidence that manipulation can treat any cancer. To suggest otherwise on the part of a profession is malfeasance.

However, most cancer is caused by poor lifestyle choices and dietary habits. Proper nutrition and a drastic change in lifestyle both cure and prevent cancer. You’ll never see a conventional medical cure for cancer…ever!!! Cancer is a multi billion dollar industry and finding a cure would put a stop to the billions upon billions of dollars that Big Pharma makes on cancer drugs and treatments. With the technology that we have today, there’s absolutely no excuse for not having cures for cancer, diabetes, AIDS, Herpes, etc. The truth is you’ll never see conventional medical cures for any of these things, so donating to these charities is really a waste of money.

Wow. More malfeasance. Actually, the number one cause of cancer is age. Nutrition can reduce the risks of certain kinds of cancers, but this overall effect is very small. Smoking is probably the number one preventable cause of cancer, and we do need to maintain efforts to minimize it.

Conventional medicine has gotten better and better over the years at treating cancer, and survival has slowly but continuously improved. We have cures for some cancers, and the list will grow in the future. There is ongoing research into many very promising modalities, and I think we will see stunningly effective treatments in the upcoming decades.

The notion that there is a conspiracy not to cure or prevent cancer is nonsense that has been thoroughly debunked. The reason cancer and AIDS have not been cured (although there are effective treatments) is because they are complex medical problems.

Another great example of MDs not knowing much about nutrition is with the imaginary disease called “Acid Reflux.” They like to prescribe antacids which raise the pH of the HCl in the stomach, thinking that it’s the solution. Wait. What’s causing your acid reflux? Must be having too acidic of a pH in your stomach. Wow is that wrong! The real reason is that you aren’t properly digesting your food. Raising the stomach acid to a more basic pH will only cause more indigestion and heart burn and “acid reflux” in the long run. There are several things that you can do that most MDs would never tell you to do: 1) You can change to an Organic diet. This alone cured my ‘acid reflux’ !! If I had a conventional pizza, it wouldn’t matter what I put on it, I’d be paying for it later. If I had an Organic pizza, it didn’t matter what I put on it, I could make it as spicy as I could stand and I wouldn’t get acid reflux. 2) Take a tablespoon of Raw Apple Cider Vinegar before or after each meal. 3) Take digestive enzymes. Your best bet would be to do all 3 things. If you did them honestly, you’d never have acid reflux again, and that’s a fact!

Actually most acid reflux is caused by a bacterial infection with H. pylori, which can now be cured with antibiotics. Some people have a leaky sphincter between their stomach and esophagus. Others simply make too much acid. Others eat things they shouldn’t, like too much caffeine, which relaxes the gastric sphincter. Others have a hiatal hernia, and they should not eat late at night. These are all proven causes of acid reflux. Antacids only play a part in their treatment – they are usually a stop-gap measure, but they are important because recurrent reflux can damage the esophagus and lead to cancer. There is no evidence that an organic diet is helpful, nor digestive enzymes or apple cider.

I find it laughable that your Dr. Novella states that “it is ONLY scientific medicine that has ever identified and treated the real cause of any disease.” So, if someone has scurvy, you’re telling me that they should take ‘scientific medicine’ instead of simply eating an orange? Are you telling me that if a patient presents with an iodic goiter, you are going to send that patient home with a prescription for some drug when they just need to consume more Iodine? I know that an orange couldn’t really be the cure for scurvy and iodine couldn’t really be the cure for an iodic goiter because those are natural cures and we all know that natural cures don’t exist!

The notion that some cures are “natural” is a non-sequitur. It is also a false dichotomy that “scientific medicine” is limited to drugs and surgery. It was science that discovered the role of vitamin C in scurvy and iodine in goiter, and prescribing both is part of scientific medicine.

There’s a reason why you don’t see as many scientific studies on the health benefits of chiropractic. Chiropractic doesn’t have Big Pharma to conduct studies for 200 million dollars a piece. Without Big Pharma conducting its subjective studies on its own drugs and then “donating” hundreds of millions of dollars to the FDA, which, for some reason, then approves these drugs after such a nice donation, then western medicine would be at the same stage as chiropractic. A perfect example of Big Pharma being in bed with the FDA and AMA is the drug Vioxx. That ‘safe and effective’ drug has killed over 100,000 people, yet it the FDA somehow approved it, and MDs for some reason keep on prescribing it.

The FDA is a federal agency, it does not take donations. So this is just a lie. Chiropractors have loads of money. They have no excuse for not testing their own theories and treatments. None. Chiropractic is not where scientific medicine is now because chiropractic is not a scientific profession. They are self-described as philosophy based (at least the straight chiropractors, there are those who at least profess to be scientific, but still lack scientific rigor).

Vioxx is actually a good example of why the system works. The initial studies with the drug did not pick up the increased risk of heart attack. Although the FDA approval process is pretty good overall, it is impossible to catch every effect of a medicine when it is being studied in thousands of patients. When it goes to market it may be taken by millions of patients, and new effects may emerge. This is why the FDA requires after market data collection, and it is not uncommon to withdraw drugs from the market if problems crop up.

It does appear that the company dragged their heels on some of the data with Vioxx, and if this is found to be the case legally they should pay the price. But let’s review what happened. After Vioxx was on the market scientists continued to study its effects. The company supported this research, even though there was no requirement for them to do so. Eventually the data became clear that there was an increase in heart attacks among Vioxx users who were at high risk, and the company withdrew Vioxx from the market. If there were some big Pharma/FDA conspiracy, why would that have happened at all? Wouldn’t they have just kept the whole thing hushed up?

If you compare those 200 million dollar studies conducted by big Pharma to the 2.4 million dollar joint study on chiropractic treatment of sciatica conducted by Northwestern (my school) and Palmer College, it’s easy to see why you don’t see as much scientific evidence, but it’s coming, I can assure you.

We’ve heard this for decades. “The research is coming.” I’m not holding my breath. But if it does, great. I will happily modify any of my opinions based on new research. However, the chiropractic community does not do this. When a major study showed that chiropractic manipulation had no effect on asthma in children, the chiropractic community dutifully ignored the data and continued to treat asthma anyway. When the evidence showed there was a risk to Vioxx, it was pulled from the market.

My question to you is, have you ever gone to a chiropractor? Have you ever talked with someone who has? Haven’t you heard any of the miraculous success stories?

I’ve seen 1st hand and heard a lot of amazing stories of colicing babies that stopped crying immediately after a chiropractic adjustment. My chiropractic philosophy professor told us about a night when he was a young chiropractor and he awoke with a bad feeling. He went to check on his infant son and found that his face was bright blue and he wasn’t breathing. His son was suffering from SIDS, which has no known Medical cause. After quickly inspecting his infant son, he noticed that one of his thoracic vertebrae was out of place (I forget which one specifically). So he adjusted it and his son started breathing immediately!

This is all anecdotal. Anecdotal evidence is worse than worthless, because it leads us to conclusions we wish to be true, not the truth. It is very revealing that he is appealing to anecdotal evidence to make his case.

Nervous obstruction causes all sorts of ailments that medicine can’t explain, which is why they like to label chiropractic physicians as quacks.

Nervous obstruction causes neuropathic symptoms – pain, allodynia, numbness, weakness, autonomic dysfunction, etc. – based upon the nerve obstructed. There are no demonstrable mysterious effects that cannot be explained. This is a chiropractic fiction without empirical evidence.

No matter what any doctor tells you, nature and the human body are infinitely smarter than any scientist.

This is meaningless anti-scientific propaganda. Yes, nature and the human body are complex and we are far from explaining this complexity. But this is true for any practitioner, and it is irrelevant to the real question – how do we know what treatments work and are safe and which ones do not. Both common sense and history tell us that the answer is careful controlled observation, intellectual honesty, accounting for all the evidence, adapting to the evidence, and asking tough questions – in other words, science.

So, it doesn’t make sense to be putting unnatural things into your body. Only the body can cure disease & only the body can heal itself.

The entire notion of “natural” is meaningless. And it is a false premise that only the body can cure disease. To take a simple example, if you have a bacterial infection (even if your immune system is in perfect working condition) it may be too much for your body to fight it off. Antibiotics, however, can kill the bacteria and cure the disease. If you have appendicits and you let nature takes its course, you are likely to die. If you cut out the appendix, you are likely to be cured and to live.

Basically, this statement is just ideology, it is chiropractic propaganda without sense or evidence.

That’s why using drugs is so dangerous, and that’s also why chiropractic, as well as other forms of alternative holistic therapies, such as naturopathy, homeopathy, massage therapy, herbal medicine, acupuncture, etc. have much better success in treating people.

The evidence clearly contradicts this statement. Drugs can be safely and effectively used. Sure, they are powerful and can be misused, but rational pharmacotherapy is highly effective. There is absolutely no evidence to support the claim that naturopathy, homeopathy, or acupuncture can cure anything. Massage therapy may be useful in muscle relaxation. And herbs are drugs – they are just dirty drugs that have not been purified or properly studied.

I apologize for the length of this blog entry, but I think the debate above gives a good flavor for the types of arguments used by the more extreme chiropractors and proponents of alternative medicine in general. It is rife with false assumptions, lies, logical fallacies, appeals to anecdotal evidence, anti-scientific rhetoric, and simple abuses of common sense.

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