Put the Lyme in the quackonut

A few years ago the British Medical Journal conducted a reader poll to find the fifteen most important advances, discoveries or breakthroughs in medicine since the magazine was founded in 1840. Here is the list:

• Anaesthesia
• Antibiotics
• Chlorpromazine
• Computer use
• Discovery of DNA structure
• Evidence Based Medicine
• Germ Theory
• Imaging
• Immunology
• Oral Rehydration Therapy
• The contraceptive pill
• Risks of smoking
• Sanitation
• Tissue culture
• Vaccines

Alternative medicine supporters were horrified at the list, because not only did it contradict much of quackery by including germ theory and antibiotics, admit to the reality of mental illness by including the first anti-psychotic drug, highlight the value of evidence and recognise the value of vaccines, but one of altmed's most demonised villains (Louis Pasteur) was associated with two of the things in the list.

The best thing that supporters of alternatives to medicine came up with for advances in the last century and a half was chiropractic. While chiropractic has been demonstrated to have some benefit for the treatment of lower back pain, its efficacy seems to be no different to taking a couple of ibuprofen tablets or simply resting in bed without any medication. In layman's terms, this means that, for that condition anyway, chiropractic is an expensive theatrical placebo.

There has been a lot of talk recently about the claims that chiropractors make about the conditions that they can treat. They like to call themselves "Dr" and wear white coats, and even have an official, government sanctioned Chiropractic Board of Australia with its "gov.au" website address in the same way that real doctors have the Medical Board of Australia. The CBA periodically issues decrees about how and what chiropractors can advertise and the claims that they can make for treating certain diseases. The most recent set of rules is very similar to the ones that were issued in 2013 and which have been almost totally ignored ever since. Specifically, chiropractors are not allowed to claim that they can treat anything for which there is no evidence of a benefit from chiropractic. This includes the standard claims on many websites that chiropractic is useful for treating many childhood conditions such as colic, asthma, ADHD, … . A friend of mine recently spent an afternoon looking at the websites of Australian chiropractors and gave up when he found the 69th example of claims which are in total contradiction to the CBA's guidelines. Significantly, he did not find one site in his Google search that complied with the regulations.

As well as the CBA, there are two professional associations of chiropractors in Australia. The Chiropractors Association of Australia claims membership that includes more than half the members in the profession. The CAA's board and spokespeople seem to be dominated by vaccine deniers, believers in the mythical subluxations in the spine, and promoters of the value of paediatric chiropractic. They pay lip service to the CBA's recommendations (and they are only recommendations, because there appears to be no action taken against people who break the rules) but in reality it's just business as usual as it has been for the last 150 years. A smaller organisation called Chiropractic Australia has been formed in an attempt to put chiropractic on some sort of scientific basis, but a similar organisation in the United States (the National Association for Chiropractic Medicine) folded after a few years due to indifference and even hostility from the majority of members of the profession. I predict the same will happen here. At a recent seminar on the advertising of therapeutic goods I spoke to a representative of Chiropractic Australia and within five minutes he used the tu quoque logical fallacy (doctors can't cure everything either) and denied that the word "allopathic" was derogatory almost immediately after using it to disparage the medical profession. This did nothing to raise any optimism I may have had that any reform of chiropractic is possible.

If chiropractors can't treat real diseases and conditions maybe they could turn their sights on things that don't really exist. The current disease du jour in the alternative medicine world is Lyme disease. This is caused by the bacteria Borrelia burgdorferi carried by ticks indigenous to the north-east corner of the United States. No evidence of any ticks carrying this bacteria have ever been found in Australia, but that has not stopped a thriving industry in testing for and treating "chronic" Lyme disease. I put the scare quotes around the word chronic because Lyme disease is cured by a short course of antibiotics so it does not fit the definition of chronic. The point of view of chiropractic, however, is that everything requires a long and expensive course of treatment.

And are there chiropractors in Australia offering treatment for Lyme disease? What a silly question.

Pretend doctors treating a pretend disease. How appropriate is that?

This article was published as the Naked Skeptic column in the June 2016 edition of Australasian Science