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Wrestling with Sass

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Homeopathy

The case against homeopathy in Bristol

In a recent report by Buzzfeed on NHS funded homeopathic care in the UK, Bristol and London were revealed to be the last two places patients could receive homeopathy from the National Health Service.

Bristol and London are the two hold-outs in the entire UK, after Wirral Clinical Commisioning Group voted to end its funding this month after a public consultation showed overwhelming that the public agreed that homeopathy shouldn’t be funded by the NHS.

You may remember that in October last year, Bristol’s Homeopathic Hospital ceased offering homeopathic services. This was, in part, thanks to Good Thinking Society’s campaign to end all NHS funded homeopathic treatments in the UK. Previously the annual spend at the Homeopathic Hospital exceeded £250,000, but in 2015 the referral rate from doctors decreased meaning the total spend amounted to £32,324. A big drop, but still over 200 patients were referred by their medical doctors to a pseudoscientific center.

Bristol still funds homeopathic treatment though. Since the Homeopathic Hospital closed, the NHS passed the contract onto Portland Centre for Integrative Medicine. The PCIM describes itself as “an employee-owned social enterprise, combining the best of conventional and complementary healthcare”. Offering a mixture of private and public services, this is the place Bristol residents will go if they are offered/ask for homeopathic treatment.

The problem with homeopathy

There is overwhelming evidence that homeopathy is not as affective as conventional medicine. In 2010, a House of Commons report found that homeopathy works no better than a placebo. It also mentioned that principles on which homeopathy is based on, which is diluting agents until there are no molecules left, is “scientifically implausible”.

In fact, a few years ago an event run by the Merseyside Skeptics called the 10:23 challenge sought to prove how useless homeopathic medicine was by publically attempting to overdose on it. I’m happy to say that all participants felt no adverse effects from the challenge, in the fact they felt no effects at all.

So if we accept that homeopathy is unscientific, useless and provides no benefit to anyone. Why is the NHS still funding it, why is Bristol one of the last cities to realise what the rest of the UK clearly realised a long time ago?

The Portland Centre for Integrative Medicine has a very interesting statement on their website, “We are pleased to be able to continue to deliver the NHS Homeopathic Service, which has been part of Bristol’s healthcare for over half a century.” One of the reasons people give for maintaining homeopathy, not just as an NHS funded exercise, but as also a staple in mainstream western society – is that it’s been around for such a long time, it’s not doing any harm?

If something is earth based, plant based, has the words ‘clean’ or ‘natural’ or ‘chemical-free’ doesn’t necessarily make it better than something that isn’t anything of those things.

When I’m taking antibiotics for an infection in my tooth, I’m not sure I care that much about it being ‘natural’ or ‘chemical-free’ – I mostly want to my face to stop feeling like a demon is trying to rip off my jaw. But I can also see someone would opt for something ‘natural, chemical-free, soil based’ if I was feeling mildly anxious and I was concerned about the side of affects of an anti-anxiety or I couldn’t wait to see an NHS counsellor – it’s totally understandable.

The problem lies in that the treatment may make you feel better, but it’s has been proven time and time again that the placebo affect also works. It’s even a page on the NHS website about complementary medicine and the placebo affect. So instead of having acupuncture, or being given lavender balm to rub on your elbows, a sugar pill would have sufficed to take away whatever was ailing you.

Unless it was something that needed real treatment, then you may have prolonged your own suffering or possibly made something minor, into something major. Do you want to take that risk? By taking something that has no reward? The harm comes when you may have opted for something that sounded nicer, rather than undergo treatment that would have helped you in the long run.

Another issue that comes up when people discuss homeopathy and its benefits is that there are lots of structures that legitimise homeopathy. There are lots of practices people don’t consider homeopathy such as acupuncture and chiropractic treatment – even though these are listed as complementary treatments by the NHS. I recently wrote an entire blog about how Chiropractors are legitimised by society, even though there is no robust evidence to prove its effectiveness over conventional treatment. Even though there are structures holding up homeopathy as a legitimate medical option, there is probably double the amount of damning actual evidence to the contrary:

• There are currently no universities that offer homeopathy as a course.

There is no legal regulation of homeopathic practitioners in the UK. This means that anyone can practise as a homeopath, even if they have no qualifications or experience.

• Homeopaths cannot advertise that any of their practices actually treat any medical conditions including social media, websites etc.

So why are we still holding out? Why are still propping up ancient institutions that don’t help people with their conditions, or if they do it’s as affective as a sugar pill? When we discovered the world wasn’t flat, did we persist in funding treatment for those who felt anxious about falling off it?

The simple answer is anecdotal evidence. All my reports, studies and quotes from people far smarter won’t change the opinion of someone whose taken holistic medicine or has seen others taken it and improved. No matter how many times you scream, “correlation doesn’t equal causation” or “the placebo effect is real” – if someone truly believes in something, it will take a lot more than facts an evidence to change their opinion.

And that’s fine; you can believe that sticking needles into your chakra will stop your migraines, or that clicking your neck will somehow stop you back pain. The difference is that I don’t want to pay for it, and Bristol shouldn’t have to pay for your indulgence because that’s really what ‘complementary medicine’ means – it means its not really needed.

 

Your Chiropractor isn’t Helping You

When I was around 14, I went to see a chiropractor.

I had back pain for many reasons. I was very well-endowed when I was a young girl, whilst my frame wasn’t small; I had also developed a bad habit of hunching my shoulders to hide my secret busty shame. The awful school stools we were forced to sit on in science lessons didn’t help this habit. Long story short, by the time I got to the chiropractor I had thrown out my back a few times and was turning into The Hunchback of Whitchurch.

After seeing my chiropractor they had determined that one of my legs was too short, my pelvis was tilted and that due to my hunching over I had caused my own pain and I needed to see them for 6 weeks. 6 weeks at £45 a go, wasn’t cheap but my mother being the saint that she is, agreed to it immediately.

Around week five, my appointment was a bit delayed so I was flipping through some reading material in the waiting room. In the book, it described how chiropractic was at odds with the scientific community since its inception due to its founding principles that the body has an ‘innate intelligence’ and that ‘vertebral subluxation complex’ contributed to the health of internal

Breaking this down a tad, basically it meant that chiropractors thought that by clicking your back it would help the health of internal organs.

“What the fuck?” I thought sitting in my blue hospital gown, this guy isn’t a doctor? I looked around at the plaques on the wall and saw that none of people who worked in the clinic had any medical qualifications, it was then I wondered why I wasn’t getting this done on the NHS? Why were their pictures of spines with Latin words next to them? I mean did these guys even fucking speak Latin? Why did this cost so much? Isn’t back pain the most common problem for most humans? Eh?

An Introduction to Chiropractic

No, you read that right. Chiropractors are awful in lots of ways, having ‘chiropractic’ as their collective term for their discipline is another way they are dickholes.

So what is chiropractic anyway? My knowledge base went as far as an Eddie Izzard routine and the fact that if you vaguely mentioning feeling stiff someone from your office would scream from across the room “GO SEE MY CHIROPRACTOR HE’S GREAT”

To be impartial, I’m going to use the NHS description of what chiropractic technique is. It’s fair and balanced and sums it up nicely without getting into the nitty-gritty.

“According to the General Chiropractic Council (GCC), chiropractic is “a health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health”.

Chiropractors (practitioners of chiropractic) use their hands to treat disorders of the bones, muscles, and joints. Treatments that involve using the hands in this way are called “manual therapies”.

Chiropractors use a range of techniques, with an emphasis on manipulation of the spine.

They may also offer advice on diet, exercise and lifestyle, and rehabilitation programmes that involve exercises to do in your own time. Some chiropractors may also offer other alternative treatments, such as acupuncture.

Chiropractic is part of complementary and alternative medicine (CAM), meaning that it is different from treatments that are part of conventional western medicine.

Some uses of chiropractic treatments are based on ideas and an “evidence base” not recognised by the majority of scientists.”

Simple right? They click your back, tell you your pelvis is wonky and then charge you £45 a visit. This isn’t medical or scientific in any way, it’s based on nothing and they may even offer you more nonsense therapies like acupuncture and the majority of scientists think it’s bollocks based on years and years of research and studies.

Except it isn’t simple. Chiropractors are thought of like physiotherapists or opticians.

However, it’s the equivalent of someone saying, “you can’t see very well anymore? Here I bought you this quartz crystal, wave it at the full moon this Sunday, that’ll be £45, cheers bud.”

Actually, there is a teeny bit of consensus amongst the scientific community about chronic lower back pain can be eased with chiropractic treatment. However, they say it’s on par with doing yoga, stretching generally or taking ibuprofen. You know, that costs 50p not £50.

Risk vs. Benefit

However, it goes even further than that. Chiropractic technique not only is not effective, it also harms patients. If had back pain and wanted to wave a crystal at the moon to fix it, sure, go right ahead, you’re not hurting anyone but your back is probably still going to hurt.

The main tenant of chiropractic is to push joints further than they can be naturally moved, therefore it doesn’t seem crazy that there could be adverse effects to violently popping your joints.

They also claim that it could help headaches, sinus pain and menstrual pain. Which is just…ridiculous.

Wikipedia even states it may be harmful in the opening paragraph on the entry about Chiropractic:

“There is not sufficient data to establish the safety of chiropractic manipulations. The rate of adverse events is unknown as they are under–reported. It is frequently associated with mild to moderate adverse effects, and serious or fatal complications, which can lead to permanent disability or death whose incidence is probably low. There is controversy regarding the degree of risk of vertebral artery dissection, which can lead to stroke and death, from cervical manipulation. Several deaths have been associated with this technique and it has been suggested that the relationship is causative, but this is disputed by many chiropractors who believe it is unproven.”

You can see from this quote that these words have been chosen very, very carefully. The chiropractor community have been quick to dispute the claims that violently pushing someone’s neck could lead to a stroke, cause nobody wants to hear about that right?

If we think chiropractic treatment is harmless, even though we know that it increases a risk of stroke and other ailments. Are we just going ignore when it’s being carried out on babies and practitioners accidently break babies necks? Science Based Medicine is an excellent resource and covered this story back in 2013, Steven Novella host of The Skeptics Guide to the Universe and practicing clinical neurologist at Yale University concluded that chiropractic treatment should be held to the classic ‘risk vs. benefit analysis’ that babies shouldn’t have any chiropractic treatment.

“What evidence we do have suggests that there is not a single legitimate indication for chiropractic manipulation of children or infants, which is sufficient to condemn the practice. There is also evidence of potential harm, and even if rare, any harm resulting from a worthless intervention results in an unfavourable risk vs. benefit.”

Uhm, this looks like a fucking nightmare come to life.

Dr. Steven Novella took a look at the chiropractic industry as whole in a series of posts where he broke down the risks, benefits and science of the modern chiropractic industry. Reading through it you can see that whilst modern chiropractors put on the façade of dropping some of the older, antiquated ideas it was attached to in its inception – they still practice and believe the majority of them.

It’s practices like these that explains why even though seeing a modern chiropractor may hold as much scientific theory as seeing a medium, because there are images of spines with Latin terms on it and a waiting room that smells like a dentist’s office, people are willing to believe they are receiving evidence-based medical treatment.

It also explains why the chiropractic community get a bit ‘scientology-esque’ when the media or journalists question their back-clicking chops.

Chiropractors, media, and science

You may have heard about the 2008 libel case brought against physicist and popular science writer Simon Singh and the Guardian newspaper by the British Chiropractic Association. It was made famous due to it being instance of free speech commentary rather than factual statement – even though Singh’s article was scientifically correct. The article was written to promote Simon Singh and Edzard Ernst’s book Trick or Treatment? Alternative Medicine on Trial, a book that looked at the mainstream holistic movement. The most damning statement and the one contested in court sums up my main point in this article, luckily I’m just some chump and this isn’t the Guardian so I’m unlikely to be sued (calm down Mum).

“You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.” Simon Singh, 2008.

Whilst initially, the court sided with the BCA as the quote ‘happily promotes bogus treatments’ could be construed as fact, rather than opinion but later when this decision was appealed the BCA withdrew their case. It seems that chiropractic organisations have a long history with defending their practice, rather than modernising from the outside in. Eventually, the BCA had to actually withdraw any information on any of their members sites, leaflets etc. that alluded they could cure colic, bed-wetting, ear infections of asthma with chiropractic treatment. One in four chiropractors in the UK were under investigation by the Advertising Standards Authority for false information by the end of debacle.

If chiropractors as an organization are so insecure about their scientific grounding, then why do so many intelligent, sane and scientifically aware people still go to the chiropractor and even defend them?

Talking to People

As you can tell by the 1500 words previous to this, I have some pretty strong opinions on chiropractors. Below is a list for some of those strong opinions, briefly summarized:

Scientific evidence

  • The risk outweighs the benefits of seeing a chiropractor; you are more likely to gain a new injury than fixing a previous one.
  • They claim to be able to cure ailments that they do not have any proof for, extending the suffering and pain of their patients.
  • They are expensive, typically not covered by the NHS and people may end up seeing them for years due to them feeling better after a session and then feeling awful the day after.

However, this doesn’t mean shit when you talk to someone who says seeing a chiropractor helping them. I’ve had this conversation many times “My shoulder hurt and I’ve been seeing a chiropractor for years, it’s the only thing that helps.” Or “My mum had back pain for years and walked out of a chiropractic clinic in perfect help.” This is anecdotal evidence, and if the prevalence of anti-vax, crystals and ghost stories can tell you, it is the most powerful evidence when it comes to influencing people.

What are you supposed to do? Call someone a liar? Tell them they are stupid? No, none of that is helpful and it’s not true. They’ve been deceived by an industry that has been legitimized and validated by lots of respectable people, however, that doesn’t meant that it’s true.

So if anecdotal evidence is what convinces people then here goes:

  • I saw a chiropractor for years and my back never felt better.
  • Yoga, swimming and stretching everyday fixed my constant back pain.
  • When I had bad neck pain and referred pain that was agony for years, I went a physiotherapist once, he fixed it and it was free.
  • I’ve been pain free for one year.

If nothing has convinced you I’ll leave you with this:

Chiropractic treatment has been proven to provide little relief for any of conditions it claims to treat, it actually increases your risk of stroke, paralysis or death and it costs a fucking fortune.

Go see your physio on the NHS, it’s free. Or at least, don’t let them adjust your neck for the love of God.

 

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