Episode #32: Not doomsday (twice), FTL neutrinos and chiropractic

The 32nd episode of Consilience is out! You can download the mp3 here (32mb) and the file’s page on Archive.org is here.

The first black woman in space

Teaching Angela to Appreciate History

Mae Carol Jemison was born on October 17th, 1956, and she was the first black woman in space. She went up on STS-47 in 1992 as a mission specialist.

Updates

Despite silly claims to the contrary, Comet Elenin was never going to kill us all. It’s now gone past its closest approach to earth (in pieces) having done… nothing (to earth, at least).

Harold Camping is back in the news… Remember how the world didn’t come to an end as predicted on May 21 this year? It’s again not going to come to an end on October 21st.

News

South Africa is planning a third satellite (after the partial success of SumbandilaSat).

A stunningly intact dinosaur has been found in Germany. (That silly Pravda article).

There is a hoax email doing the roads claiming that an attached video shows a killer whale taking a man as he walks in the surf. It is a hoax, and the video is actually (an admittedly baffling) advertisement.

The claim that neutrinos travel faster than the speed of light may be refuted by relativity itself. (Though see this for a criticism of this proposed explanation).

The Daily Maverick had a chiropractic FAIL in its First Thing newsletter on October 17th. Chiropractic isn’t a mainstream medical speciality, but dangerous nonsense. And despite the Chiropractic Association of SA claims about lower back pain, chiropractic doesn’t actually work for that condition.

Apparently, the South African Football Association hired a sangoma to magic a win for Bafana Bafana (SA’s soccer team) against France during the 2010 World Cup. Now this sangoma says he’s not been paid his R90 000 (~US$11,000) and that Bafana won’t win any games until he gets his money.

Links of the Week

Angela: a decision tree/flowchart guide to NPR’s Top 100 sci-fi and fantasy books.
Mike: a profile of E.O. Wilson in The Atlantic.
Owen: Skeptoid.com, a brilliant podcast hosted by Brian Dunning.

Quote

“You can’t convince a believer of anything; for their belief is not based on evidence, it’s based on a deep seated need to believe.” ~ Carl Sagan, Contact.

Announcements

Pretoria SiTP on October 22nd.
Visit to Maropeng on October 29th.
http://www.archive.org/download/ConsilienceEpisode32/Consilience32.mp3

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About Michael Meadon

Michael Meadon is a graduate student in cognitive science at the University of KwaZulu Natal in Durban, South Africa. When he's not procrastinating online or propitiating his wife, he investigates the effects of rapid & unreflective facial judgments on political elections. He expects to graduate any decade now. When he was an innocent undergrad Michael studied Politics, Philosophy & Economics at the University of Cape Town. Unfortunately, he had to find out for himself that "social" and "science" often don't go so well together.
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4 Responses to Episode #32: Not doomsday (twice), FTL neutrinos and chiropractic

  1. Trevor Davel says:

    “chiropractic doesn’t actually work for that condition”. Really? Is that really what you understood from the Cochrane review?

    Let me refresh your memory: “High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain. Determining cost-effectiveness of care has high priority.” Also “No serious complications were observed with SMT.”

    And in plain English: the manipulation and mobilisation of spinal joints – approaches used by Chiropractors, Physiotherapists, Orthopedics, and (in the US and Europe) GPs – is no better and no worse that other recognised therapies for pain control. The appropriate way to choose between these options is cost.

    In the Authors’ own words in their plain language summary: “In summary, SMT appears to be no better or worse than other existing therapies for patients with chronic low-back pain.”

    But you: “chiropractic doesn’t actually work for that condition”.

    Now perhaps you were thinking that SMT means chiropractic, or that “other interventions” or “other existing therapies” means placebo. Then your conclusion may have been justified based in an incorrect understanding (and you should try to do better). But as it stands you misinterpreted a systematic review that provides strong support for the effectiveness of SMT (including chiropractic) as saying “chiropractic doesn’t actually work for that condition”. That’s not skeptical. That’s True Belief.

  2. If you listened to the podcast, you’d understand that our discussion was quite a bit more nuanced than the quick summary of “chiropractic doesn’t actually work for that condition”. We even said specifically that nothing seems to work for lower-back pain.

    Also, before leaving a comment like this, it’s usually a good idea at least to read the abstract of the study you’re referring to. Had you done so, you’d have noticed the following sentence: “In general, there is high quality evidence that SMT has a small, statistically significant but not clinically relevant, short-term effect on pain relief (MD: -4.16, 95% CI -6.97 to -1.36) and functional status (SMD: -0.22, 95% CI -0.36 to -0.07) compared to other interventions.” And compare the money-shot from another Cochrane review: “Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school.”

  3. Trevor Davel says:

    Sorry, but I don’t have 1 hour to listen to a Podcast. I had assumed the blog provided a reasonably accurate summary. In the podcast you may make the (debatable) point that nothing works for lower-back pain, but in the blog you specifically call out chiropractic as not working. Why not single out pharmaceuticals or GPs, which (by your contention) don’t work either?

    Had you read my comment you would have recognised in it quotes from the review’s abstract. But an ad hominem is so much easier that actually making an argument. Especially when you provide two quotes that substantiate my argument, and refute yours.

    But let’s work from the abstracts (with which I am quite familiar). The earlier review (Assendelft et al) says “For patients with acute low-back pain, spinal manipulative therapy was superior only to sham therapy”, and the plain language summary (since I don’t have access to the full paper right now to find the relevant quote) “This review of 39 trials found that spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham (fake) therapy and therapies already known to be unhelpful.” So the first significant finding of this review is that SMT is better than a sham therapy according to a clinically-relevant measure.

    And in your comment you claim: ” We even said specifically that nothing seems to work for lower-back pain.” Sorry, wrong, according to the abstract you cite.

    Next, from Assendelft et al: “Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low-back pain were similar.” And from Rubinstein et al: “High quality evidence suggests that there is no clinically relevant difference between SMT and other interventions for reducing pain and improving function in patients with chronic low-back pain.”. And for kicks we’ll add in the sentence you quoted from Rubinstein et al: “In general, there is high quality evidence that SMT has a small, statistically significant but not clinically relevant, short-term effect on pain relief (MD: -4.16, 95% CI -6.97 to -1.36) and functional status (SMD: -0.22, 95% CI -0.36 to -0.07) compared to other interventions.”

    So, having established that SMT is better than sham therapy, we now have Assendelft telling us that SMT is not better than other therapies, and Rubinstein telling us that SMT is neither better nor worse than other therapies (except for short-term pain relief where it is slightly better, but that’s not relevant).

    So your two contentions so far are that “chiropractic doesn’t actually work for (lower back pain)” and that “nothing seems to work for lower-back pain.” Both of which are utterly refuted by the articles you cite.

    Moreover if “nothing seems to work for lower-back pain” then you’re claiming that the evidence-based medical guidelines for treatment of chronic and acute lower-back pain (e.g. http://www.backpaineurope.org/web/files/WG1_Guidelines.pdf) are a sham. Strangely the medical fraternity seems to disagree with your interpretation.

  4. Trevor Davel says:

    Okay, I’ve wasted my time with the relevant part of the Podcast. Where to begin?

    You set up by trashing chiropractic in general based on the fact that it was founded by a kook who believed in vitalism and subluxations. In other news psychology was founded by Freud, and there are still psychologists who practice psychoanalysis (specifically, as opposed to using an eclectic evidence-based approach). So clearly psychology is a sham. We may have progressed from herbalism to drugs based on microbiology and chemistry, but there are GPs who knowingly prescribe drugs as placebo treatments (e.g. antibiotics for flu, http://www.sciencedaily.com/releases/2008/10/081023195216.htm).

    If your gold standard is “evidence-based medicine”, then that must apply to current practice irrespective of what the discipline calls itself. A GP prescribing a placebo is no more or less of a kook in that respect than a homeopath. Medicine – even some CAM – improves with time and research. Chiropractic techniques are being tested in randomised controlled trials, published in peer-reviewed medical (not chiropractic) journals, and subject to systematic reviews by respected organisations. Is that is a valid evidence-based approach for “western” medicine, then it’s valid for chiropractic.

    The first central point of your argument is this discussion: “manipulative spinal therapy doesn’t actually work for lower back pain, at least not better than anything else. Because essentially I think the conclusion is like nothing works, for chronic lower back –” “Lower back pain is really really difficult to treat, that something –” “As I understand it its basically a defect of the model so humans haven’t quite adapted fully to bipedalism so lower back pain is just par for the course, its one of the side-effects of owning a human body”

    Um, no. The Cochrane reviews make it clear that SMT is more effective than sham therapy, so _something_ works for chronic lower back pain; or, at least, two systematic reviews of peer-reviewed randomised control trials say so, if you’re willing to accept that as evidence. Some searching of Pubmed will also show that analgesics and surgery can be effective for chronic lower back pain, as can posture correction and exercise.

    You then discuss the Ernst paper, which considers adverse effects of manipulation. So here we have some evidence of serious problems arising from SMT. First, this problem is associated with SMT, not just chiropractic — of the 32 cases cited 10 involved health-care professionals other than chiros (including an Orthopedic surgeon and a GP). Second, you offer no context in which to assess these cases in relative to other therapies, for example the adverse effects of long-term use of analgesics, complications arising from surgery, effects of slow mobilisation, etc.

    The lack of context is especially relevant when you reach your third point: “always take a cost-benefit approach to this kind of analysis. The problem with chiropractic is that the benefits are minimal to non-existant when compared to something that is a lot more mainstream and a lot more scientifically supported like physiotherapy.”

    What? Let’s go back to Rubinstein et al which says “SMT is known as a ‘hands-on’ treatment of the spine, which includes both manipulation and mobilisation. In manual mobilisations, the therapist moves the patient’s spine within their range of motion. They use slow, passive movements, starting with a small range and gradually increasing to a larger range of motion. Manipulation is a passive technique where the therapist applies a specifically directed manual impulse, or thrust, to a joint, at or near the end of the passive (or physiological) range of motion … Treatment was delivered by a variety of practitioners, including chiropractors, manual therapists and osteopaths”.

    Since the chiro history in your Podcast sounded a lot like the Wikipedia entry, I’ll provide some relevant links: http://en.wikipedia.org/wiki/Manual_therapy, http://en.wikipedia.org/wiki/Physiotherapy and http://en.wikipedia.org/wiki/Spinal_manipulative_therapy.

    Have you worked it out yet? The Cochrane reviews cover SMT, which includes practices used by chiros, physiotherapists, and others (in many US states GPs perform SMT). To be more clear we could look at “Spinal manipulation for low-back pain: a treatment package agreed to by the UK chiropractic, osteopathy and physiotherapy professional associations.” (http://www.ncbi.nlm.nih.gov/pubmed/12635637) in particular the sentence “Early in the design of the trial, it was acknowledged that the spinal manipulation treatment regimes provided by practitioners from the three professions shared more similarities than differences”. Psysiotherapists practice SMT, got it?

    So here’s a systematic review saying that manipulation and mobilisation (both practiced by chiros and physios) are no better and no worse than other therapies, but you say “The problem with chiropractic is that the benefits are minimal to non-existant when compared to something that is a lot more mainstream and a lot more scientifically supported like physiotherapy.” Perhaps we have a language problem here. Let’s say we have two red balls A and B. Would you say that the redness of A is minimal to non-existant when compared to the redness of B? Becasue the Cochrane reviews say that the benefit of SMT is indistinguishable from the benefit of other therapies. And again, this scientific evidence applies to BOTH chiro and physio. Either they are both scientifically valid (for this treatment), or they both aren’t. Pick one.

    Being a skeptic means following the evidence. The problem here is that you have a preconceived notion that all of chiropractic is bullshit, and you choose to interpret research to support that conclusion, even when the research says exactly the opposite. You completely missed the fact that physiotherapists and GPs practice SMT, and you ignored the fact that all therapies have associated advese effects. Here’s the science saying “Hey, if you have lower back pain, what a chiro or physio can do is just as good as your GP or drugs or any other recognised therapy”, and you stick your fingers in your ears and go “La, la, la, not listening, chiro is bollocks”.

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