One of the most ridiculous pieces of "journalism" I have ever come across

Heroin laced cannabis heading to Brighton streets, police fear
8:53am Thursday 13th August 2009

By Naomi Loomes

Dealers are lacing cannabis with highly addictive heroin to get users hooked on the deadly drug.

Secret off-the-record discussions between police and a supplier in London have revealed how recreational drug users are being tricked into becoming addicted to Class A drugs.

Officers fear it could lead to a surge in addicts in Brighton and Hove, which is already known as the drug death capital of England.

They believe cannabis users are becoming accidentally dragged into heroin use.

It follows the discovery that potent, paranoia-inducing cannabis, known as skunk, was being sold in large quantities in Brighton and Hove last year.

Detective Sergeant Hari McCarthy, of Sussex Police, said: "People buy it thinking it’s just very strong weed."

"It’s not being sold as skunk, just good weed, but it’s an easy way to get users hooked on heroin."

She added that dealers mixed various chemicals with cannabis before selling it, including tranquillisers and even urine.

There are believed to be 2,300 heroin addicts in Brighton and Hove.

The revelation was made during an inquest in Brighton into the death of 34-year-old electrician Lee Donlan from a heroin overdose.

Clinical and forensic toxicologist Peter Sharpe confirmed that taking mixtures of drugs was becoming more and more common in Brighton and Hove, in particular the highly dangerous combination known as speedballing.

He said: “There’s a mixture called speedballing – it’s heroin with a bit of cocaine, usually injected into the arm or ankle.

"People like the mixture of heroin and cocaine because the cocaine reduces the low that comes after the heroin."

Okay, lets take the first claim:

"Dealers are lacing cannabis with highly addictive heroin to get users hooked on the deadly drug" - an urban myth that I can remember doing the rounds as far back as the early 1970s.

Let's think this one through: I am a cannabis dealer (I'm not BTW, I'm just pursuing a thought experiment). I start somehow mixing heroin (usually a brown powder) with my cannabis (a brown or black resin or - more likely these days - a green herbal substance). I do this in such a way that my customers don't notice the extra brown powder. Because heroin is quite expensive in relation to the profit I normally make on my cannabis and because I am not telling my customers about the heroin and therefore can't charge for it, I am now selling my cannabis at a loss .... but I have a cunning plan. Providing my customers don't notice that the cannabis I'm selling them has a completely different effect from normal cannabis and keep coming back to me to buy their cannabis for several months, I shall, one day be able to say to them: "Ha! I've been giving you heroin all these months and now you are addicted so you will have to keep buying heroin from me now." Okay, they had been regular customers in order for me to get this far, but this will absolutely ensure their continued customer loyalty .. unless, of course, they beat me to a pulp with my bong and go and buy their heroin elsewhere.

I'm sorry, but this is complete and utter nonsense.

Second claim (part of the first one in fact): "heroin is a deadly drug" - at least I assume this is what the author intended to imply. The claim is worded as though she believes that cannabis is the deadly drug.

Heroin causes constipation. That's about it. It's addictive and street heroin (cf the legal kind that addicts could get if we did not have such crazy drug laws) is full of crap. I suppose that the point being made here is that you can overdose on heroin, but, again, much of the problem here arises from the fact that heroin is traded on the black market and there are therefore no controls on strength and purity. Heroin is certainly not a deadly drug in the sense that tobacco is.

I'm not suggesting anyone takes heroin by the way. It's much better to do something worthwhile with your life.

Third claim: "Dealers mix various chemicals with cannabis before selling it, including tranquillisers and even urine"

Tranquillizers usually come as white pills these days. They are far less readily available than they used to be since it was discovered that they can lead to addiction. They are sold on the black (or "grey" - as it is sometimes called) market in their own right as recreational drugs. But, according to this article, some dealers are crushing them up and mixing the resulting white powder with cannabis. I'm not sure what effect the cannabis smokers (who are presumably too stoned to notice the white powder) are supposed to derive from inhaling the smoke from burning valium and lactose, but I can't imagine it's a very peasant effect.

And as for urine.....

So the dealer urinates over his cannabis supply - which he then has to dry out again. To what end? To increase the weight of the weed with a few milligrams of urea? I think I'd just reach for the oregano and sprinkle a bit of that in.

Claim three: "People like the mixture of heroin and cocaine because the cocaine reduces the low that comes after the heroin."

The effects of heroin wear off after several hours. The effects of cocaine start wearing off after about twenty minutes. Hard to imagine cocaine injected at the same time as heroin would help much with any come-down after the heroin wore off.

The rest of the article (which I've not reproduced) goes on to list the names of various people who have died from drug overdoses and includes some confused nonsense about dosages. The correct information is that the LD50 for heroin is between 1 and 5 mg/kg of body weight.

I suppose that there is an argument that, because we all wish to see (especially young people) taking as few drugs as possible and suffering as little harm as possible, it's perfectly okay to write complete nonsense about drugs. Anything that puts people off! But this argument only holds water if we assume that everyone is as stupid as the author of this article. In fact, most young people will read this sort of thing, and fall about laughing. While this would be the most appropriate response in this case, there is always the danger that other articles on the dangers of drugs (written by people who actually know what they are talking about) will elicit a similar response.

There is growing evidence that cannabis in general (and skunk in particular) may have long term deleterious effect on young people whose brains are still developing. (By the way, the problem with skunk is not really its strength - high strength, leads to less being smoked and therefore less lung damage - but the particular balance of psychoactive compounds it contains; though more research is required on this.)

How on earth are we going to get this genuine science across to young people who have grown up on the diet of tripe provided by newspapers like the Brighton & Hove Argus?

Harry Patch, War, and Human Nature

I caught part of "Any Answers" today (2009-08-08) on Radio 4. They were discussing Harry Patch’s misgivings about war – something which had presumably been discussed in the antecedent edition of "Any Questions" which I did not hear.

The first caller opined that the propensity to engage in war was a fundamental part of human nature and that the hope for a future without war was futile. Other callers took the view that human nature was not like this at all.

I think the first caller, rather than the others, was actually correct (at least partially) in his analysis of human nature; but I think his conclusion was false. I think he was making an mistake analogous to one of the mistakes people make when discussing Richard Dawkin’s "selfish gene".

The warlike disposition of groups of hunter-gathers (ancient and modern) is discussed by (inter alia) Stephen Pinker in his excellent book The Blank Slate. I do not agree with everything Pinker says in this book and I think that he somewhat overstates his case when it comes to his forthright rejection of the notion of the notion of the "noble savage". Nevertheless, I think that Pinker is probably right in concluding that humans almost certainly do have an innate disposition to declare "We are tribe X; tribe Y are over there and they are not tribe X; let’s go and kick the shit out of them all".

Variations on this theme have played out throughout human history and we see examples of this disposition even in modern times: in Rwanda; in the behaviour of the (Gentile) German population during Kristallnacht; in Northern Ireland; in the behaviour of football hooligans; and in many other situations.

The good news is that humans are also capable of deciding that, actually, the members of tribe Y are members of “our” tribe after all; and the communication age has made this easier then ever. Of course we still have vile organizations like the BNP, but most British people today cry as many tears over the TV picture of a dying child, with a different skin colour, on the other side of the world as they do over the TV picture of a dying child, with the same skin colour, in the next county.

It is these considerations (and others) that make the segregation of school children along religious lines so utterly pernicious.

Anyway, back to Harry Patch. Does our innate warlike nature (assuming this is our nature) make war inevitable? Let’s take a recent example: the Iraq War. Did the Brits all work themselves up into frenzy and decide: "Let’s go off and kill the Iraqis, they’re not a bit like us."? Urm, "No!". That’s not how it happened. Tony Blair decided to go to war. Okay, he had the support of the Cabinet, but (so far as one could tell) not one single Cabinet member really thought it was a good idea. Tony Blair then got the support of Parliament but, again, one had the impression that most MPs were thinking about their careers rather than baying for Iraqi blood.

Did Tony then lead his tribe into battle with the other tribe? No; he stayed safely at home and made vacuous speeches on TV.

Did the troops behave like a bunch of hunter gatherers intent on murder and mayhem in the enemy "tribe’s" camp? Well actually, in one or two cases, they may have done. But these really were isolated incidents. By and large, they went off to war because they had been ordered to do so and were not driven by a sense of hatred towards the Iraqi people or by a sense that the Iraqis were "other" and therefore worthless.

We could say the same (concerning the gap between the decision makers and the people going off to do the actually fighting) about almost any large scale modern conflict.

In other words, while it may well be true that humans organized in small groups of hunter gatherers - which have little contact with other groups – are genetically predisposed (because of the way we evolved) to violence in certain circumstances; the notion that the genesis of modern wars is somehow an expression of that propensity is highly questionable.

It is rather like the wrong-headed argument that because genes are (metaphorically) selfish and because human behaviour is (to a large extent) determined by our genetic make-up, humans must be innately selfish.

There are lots of reasons why "selfish" genes lead to altruistic behaviour in humans and there are many reasons why an innate propensity for violence toward "the other" in individual humans does not lead inevitably towards war between nation states.

Perhaps Harry Patch’s vision of a future without war will one day be realized.

Let us hope so.

Using Paypal: A cautionary tale

Executive summary:

1) Paypal is a convenient way of transferring money to people who are not set up to receive credit card payments (eg eBay sellers).

2) Paypal purports to be “safer than using your credit card, but this is highly misleading. For payments over £100 you are protected if you use your credit card by something called “Section 75”. You lose this protection if you pay using Paypal – even if your Paypal account draws from your credit card account. (Paypal does offer some protection on purchases within ebay however).

3) Paypal have poor customer service, are not interested in discussing questions about whether their sellers may be engaged in fraudulent activity, and may unilaterally close a dispute thereby preventing further buyer communication with Paypal or the seller complained about.

4) Paypal state that they do not “tolerate fraud or illegal activities”. Judging by my experience, this claim would appear to be untrue.

Our story:

My wife and daughter bought two pairs (a pair each) of “UGG” boots from http://www.australia-ugg-boots.com/ and paid using Paypal. The domain “australia-ugg-boots.com” is registered in Australia:

Whois Record
Registrant:
Jackie Beament
PO Box 3950
Joondalup, Western Australia 6027
Australia

Domain Name: AUSTRALIA-UGG-BOOTS.COM
Created on: 28-Feb-09
Expires on: 28-Feb-10
Last Updated on: 01-Mar-09

Administrative Contact:
Beament, Jackie
PO Box 3950
Joondalup, Western Australia 6027
Australia
894048411 Fax --

Technical Contact:
Beament, Jackie
PO Box 3950
Joondalup, Western Australia 6027
Australia
894048411 Fax --

Domain servers in listed order:
NS1.AUSTRALIA-UGG-BOOTS.COM
NS2.AUSTRALIA-UGG-BOOTS.COM

And the site makes the following claim:

Australia-Ugg-Boots.com is a family business manufacturing ugg boots here in our home town Melbourne, Australia since 2007. We manufacture high quality sheepskin footwear made from first grade double faced Australian Sheepskin. Australia-Ugg-Boots.com has been successfully wholesaling and retailing to many satisfied customers within Australia and Overseas. Our website was established in 2007 successfully providing customers all over the world with our great product, cheap prices and fast, reliable, friendly customer service.

A complication here (it should perhaps be noted) is that "UGG" is not a protected trade mark in Australia, but it is in the UK and other countries outside Australia.

When we received the boots (we did receive them) the parcel came not from Melbourne but from Shanghai. The boots were perfectly well made, but clearly counterfeit (with counterfeited "UGG" "trademarks" all over them) and lined with synthetic fur rather than sheepskin. The main problem, however, was that both pairs were each a couple of sizes smaller than ordered and than stated on the sewn in labels. Apparently this is one of the features of counterfeit UGG boots – quite why these firms can fake the boots so expertly and yet fail to size them correctly is, to say the least, puzzling. As we have real UGG boots at home we are able to compare like with not-like.

So we raised a dispute on Paypal.

AUSTRALIA-UGG-BOOTS (of China) got straight back and said we could return the boots and get a full refund. Trouble is that this costs rather a lot of money and they take no responsibility if goods are "lost in the post". The Royal Mail will only cover you up to £39 – unless you pay them shed-loads of money first.
Forgive my cynicism and scepticism, but I do not have a great deal of confidence that, if I sent these boots back to Shanghai, I would ever see my boots or my £130 again.

On to Paypal, the "safer" alternative to using your credit card.

It would by an understatement to say that Paypal have been unhelpful. They simply refused to help and then closed the case without consulting me further. This means that I can no longer communicate with them or the seller about this case. More worryingly, Paypal are (it would appear) continuing to trade with this company (which would certainly seem to be committing offences under UK law) and refusing to warn other potential buyers about the pitfalls of buying from the website in question.

As our experience illustrates, the fact that Paypal accepts a seller onto its books is no guarantee (or even indication) that that company is "kosher". In fact, the fact that a company only accepts Paypal and does not accept direct credit card payments may well be an indication that further scrutiny of that company is required before buying from it.

If you make payments over £100 using your credit card– even to companies in China – you enjoy buyer protection. If you use Paypal you lose that protection – it is not "safer" at all.

I shall, in future, use Paypal (if at all) only as a means of last resort to pay for goods and services and I suggest anyone reading this does the same.

My response to a pro chiropractic response to Simon Singh's article

A critique of Simon's article by Richard Lanigan can be found at: chiropracticlive.

I address some of the points Richard Lanigan makes below:


Beware the spinal trap
by Simon Singh

Simon: This is Chiropractic Awareness Week. So let’s be aware. How about some awareness that may prevent harm and help you make truly informed choices? First, you might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that, “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

Richard: If I was going to criticise a health care profession, I would say it was important to have all my facts and provide accurate information. DD Palmer was 15 in 1860, worked as a teacher in the mid 1860s, worked as a bee keeper and small famer in the early 70s. The first mention of DD Palmers involvement in “healing” was in 1885 when he became a magnetic healer. It would seem he was in fact developing “developing his theories” in the 1880s rather 1860s, I suspect Simon Singh has confused DD with Andrew Still who founded Osteopathy and was developing his theories about manipulation in the 1860s.

DD Palmer's hypothesis was that interfering with nerve function would affect optimal well-being, he explained his theory around “displaced vertbrae”. Palmer’s understanding of the effects of spinal manipulation should be viewed in its time (the late 19th century) when surgery had a mortality rate of 76%. I know of no 21st century chiropractor who would explain chiropractic as Palmer did, or a surgeon who would operate in his street clothes without a mask. To define chiropractic along these lines is like defining medicine the way Harold Shipman practised.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

Stranger things have happened. Here we have a news report in 2008 stating a chiropractor restored a mans [sic] sight. I think its fair to say if Palmer had observed Harvey Lillard getting his hearing back he may have thought that he had discover the holy grail of healing. Look at the competition at the time 1895??

Me: Daniel David Palmer was born in 1845 (according to Wikipedia at least) so Richard my be right here and Simon may be wrong. On the other hand, the BCA is not suing Simon for getting his date wrong so I'm not sure how relevant this is. [By the way, "magnetic healing" had nothing to do with magnets and was rather a cross between massage and meridian therapies (according to this source; so Richard's suggestion that Palmer was thinking about magnets rather than manipulation at this stage is misleading.)

As for anecdotal claims that sight or hearing was restored in particular individuals by chiropractic, there is a even a name for this kind of fallacy: The "post hoc ergo propter hoc fallacy."

Simon: 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.

Richard: Whether sceptics want to believe it or not, I have helped children with all these problems. Lets look at “Ear infections” and I will try not to let my “ideas rise above my station”. For many years ear problems have been misdiagnosed by medics and treated ineffectively with grommets and antibiotics.

So what is a clinician to do. Angela Peel White my anatomy tutor at The Anglo European College of Chiropractic was a qualified GP. I never held it against her because she was a brilliant tutor. She told us know the anatomy of the region you are examining. If you look at the inner ear it has “drain” called the eustachian tube. Its narrower at the top, children with small little necks have only a small gradient and the tube does not drain very well. The blockage causes pain due to the discrepancy of the air pressure outside the ear drum and inside. This can also be a problem for inexperienced divers. Who are not able to “equalise” ear pressure as they decent in water.

The biological explanation as to why “manipulation” could help a child with otis media is very similar to how experienced divers equalise when the eustachian tubes are blocked and unable to relieve the pressure on the inner ear as they descend in the water. They crack their TMJ as if blowing rings smoking dope (I am a child of the 60s), this helps open the eustachian tube and equalise the pressure on the ear drum.

There is also a neurological explanation, I will spare the details suffice to say when Professor Ernst or chiropractic sceptics say there is “no biological reason why spinal manipulation should with help ear Infections” the anatomy shows clearly they are talking through their collective arses.

I have four children, young children cannot crack their jaw themselves, the adjustment requires skill and practise, not all chiropractors can do it and that’s a problem when chiropractors enter these clinical trials. I am not an academic, I am just a clinician.

Me: Not quite sure how to respond to this. Yes, "cracking" your jaw can (temporarily) relieve pressure in your inner ear. There are other ways of doing this, and I am not qualified to say whether jaw cracking is the most appropriate strategy for children, but what has this got to do with neurology? Also, what has Richard's claim that he can crack kids' jaws, and some chiropractors can't, got to do with anything? Any sensibly designed clinical trial would address such considerations.

Richard: Then Simon continues to the bit that upset the BCA

Simon: ……..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.

Richard: First I would question whether the BCA leadership is the respectable face of chiropractic. No One would dispute that the “scientific evidence” is weak for these conditions, which account for a very small part of my practice 5% and I probably see more children than most chiropractors. However if we look at Professor Ernsts own “Hierarchy of Evidence” at the bottom there are “case reports” and “observational studies”. Yes the chiropractic evidence is at the bottom of Ernsts pyramid however “not a jot of evidence” would only be accurate statement if Professor Ernst were to remove the bottom of his pyramid. In addition anyone with a limited knowledge of the politics of the chiropractic profession would know that the BCA leadership with rather stick to musculoskeletal pain syndromes and probably puts childhood disorders on their website to prevent more members from leaving the association. If Simon had directed those comments at the UCA or the McTimoney association the BCA leadership would have been leading the applause.

Me: Here we start to get to the heart of the matter. What Richard omits here is the consideration that real medicine is expected to move up the pyramid of evidence.

If a treatment or observation about a certain existing treatment or lifestyle is novel then “case reports” and “observational studies” do constitute a jot of evidence. If, after a hundred years plus of chiropractic, we still only have “case reports” and “observational studies” as evidence and nothing at higher levels in the pyramid (thinking here of the conditions over which Simon is being sued) then it is perfectly reasonable comment for Simon to say that there is not a jot of evidence.

There is, after all, some annecdotal evidence for almost every nutty thing that can be thought of. Are we to conclude that the phrase "not a jot of evidence for X" be banished from the language?

Simon: I can confidently label these treatments as bogus because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst.

Richard: What does that prove? Margaret Thatcher was the first women prime minister we can only pray the second one is better. The chapter on chiropractic in “Trick or Treatment” has only three chiropractic references all by the co-author Professor Ernst which should have set alarm bells ringing in a science journalist with a PhD. To pad out the chiropractic chapter they finish it talking about homeopaths and vaccines. I told Simon I did not believe he had written that chapter and it was all Ernsts [sic] work but he says he did write it.

Me: The fact that Simon has written a book proves nothing, it does, however, suggest that Simon has researched the matter thoroughly and that (given that we know that Simon is a highly respected science journalist) his views and claims are worth investigating.

Simon: Ernst learned chiropractic techniques himself and used them as a doctor.

Richard: I can carve a joint, this does that make me a surgeon? Chiropractors spend five years learning to adjust spinal joints. Simon has not visited the Anglo European College of Chiropractic to see how chiropractors develop their skills and Guardian readers are expected to believe professor Ernst thought himself these “chiropractic techniques” over a few weekends and it would appear he was not very good at it, many failed practitioners end up in academia.

Me: The fact that Edzard Ernst learned chiropractic techniques is interesting background information. As, I suppose, Richard indirectly implies, this is of little ultimate relevance to the question as to whether what Ernst says about the generally efficacy of chiropractic is true.

Simon: This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

Richard: Arthritis is a chronic condition suffered by millions of British people often it has developed because it was not managed properly when it was just a small ache ( Pain killers and anti inflammatory medication to mask a mechanical problem). In May, the National Institute for Clinical Excellence in the UK published its guidelines for the management of Low back pain http://guidance.nice.org.uk/CG88 . What was extraordinary about these guidelines is that they were stating that doctors should no longer offer; Spinal injections, Traction, Lumbar Supports, Ultrasound, Interferential, Laser and should consider a course of spinal manipulation by a chiropractor or an osteopath or acupuncture instead.

In effect NICE is stating that the orthodox methods for treating back pain has not worked and the evidence is suggesting that it would be cost effective for the NHS to pay for complementary treatments like chiropractic and acupuncture in the future.

Me: First of all we are back to back pain here - not the subject of the libel action or of Simon's more derogatory statements concerning chiropractic. Moreover, the argument used here: "There is growing evidence that many accepted medical treatments for chronic back pain don't really work therefore we should replace them with treatments for which there is no real evidence at all" does not really hold a lot of water - even if some people at NICE are using this argument too.

To those who say that there is real evidence, I say: "show me it" - a test which the BCA have spectacularly failed (again talking of the claims which are the subject of their libel action against Simon.

Simon: More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Professor Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

Bearing all of this in mind, I will leave you with one message for Chiropractic Awareness Week – if spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Richard: Which drugs, Viox, Celebrex, statins etc,etc. In 1998 Lazarou et al estimated that 106,000 people die each year from adverse reactions to prescribed medications. Thats [sic] the equivalent of a jumbo jet crash every 2 days and no public enquiry? Professor Ernst has spent the last ten years trying to convince the British and Irish public that chiropractic is more dangerous than medicine.

The tragic story of Laurie Mathiason who suffered a stroke ten years ago while receiving chiropractic treatment in Canada is not convincing “evidence” that chiropractic is dangerous. Every five minutes someone in England will have a stroke(National Audit Office), there are no epidemiological studies that would even hint that this finding has anything to do with chiropractic, yet Professor Ernst goes on repeating his opinion.

I have practised in the same area for almost fifteen years, I adjust the cervical spine of the vast majority of my patients and I don not recognise the “dangerous” practise Simon describes. I have never had a complaint or hurt anyone, occasionally a patient feels worse after the first visit, but thats about it. If patients were having strokes surely I would have heard something and the fact Ernst wont let poor Laurie Mathiason rest in peace because he needs this anecdote to bases the theory on which has created his media profile, dont kid youselfs Professor Ernst is not well known for his research he has become the Jordan of the EBM community, I wonder what David Sackett makes of Ernsts evidence base? The inconsistencies in these arguments by the sceptics are staggering, something happens after a vaccine and its coincidence, anything happens after a chiropractic adjustment and its the chiropractors fault. For a small profession we must be good at hiding our bodies, perhaps thats [sic] where Harold Shipman learned how to kill his patients without anyone noticing.

Me: All medical interventions (both conventional and so called "alternative") have potential risks and benefits. That's why we need to base medical interventions on real evidence. Real evidence is collected when researcher's move up the evidence pyramid cited above. The notion that we can have one kind of evidence to conventional medicine and another "alternative" kind of evidence for "alternative" medicine is simply nonsense.

The real difference between science and woo (in all it's forms) is not that science is all true and woo is all bollocks; the real difference is that (true) scientists (of course individual scientists can be just as irrational as anyone else) constantly revise their ideas and practices in the light of the ever growing body of evidence.

When they found out that Shipman had killed lots of people, the medical profession investigated the evidence that the case provided, concluded that administrative practices had been woefully inadequate, and changed their administrative practices to try and prevent this happening again in the future. Similarly, when the medical profession discovered that Cox-2 inhibitors had an unacceptably high risk for the (far from insubstantial) benefit they were providing, the medical profession changed their practice and stopped prescribing these drugs.

Where are the clinical studies documenting the risks and benefits of chiropractic for infant colic? where are the stories of the chiropractic "profession" changing its treatment of infant colic in response to such clinic studies? Chiropractic just doesn't work like that.

There is some evidence that (non-cracking) massage and manipulation provided by an osteopath, chiropractor, or physiotherapist might help a bit with back pains and aching joints. All the rest is woo!

Simon Singh: Beware the Spinal Trap

Edited version (the "libellous" bit about chiropractic being "bogus" has been removed)of the Simon Singh 2008 Guardian article for which Simon is being personally sued for libel by the British Chiropractic Association (please re-blog):

BEWARE THE SPINAL TRAP

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.

You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial.

Woo in the Telegraph - a response (of sorts)

24 June 2009

Dear Dr [Schroedinger99],

I am writing in response to your email concerning Annabel Croft article, which appeared in the Telegraph.

Your comments have been passed on to our editorial team for their future reference on this topic and I would like to thank you for taking the time and trouble to write to us on this matter. We value your readership and appreciate our readers' comments.

I hope you shall continue to enjoy The Daily Telegraph.

Yours sincerely,

Andy King

hmmm........

Well, let's just say that if I ever hear that someone has died because he/she relied on ingredient-free homoeopathic remedies rather than seeking the medical intervention he/she required, I shall remind Andy King of this email.

Woo in the Telegraph

Someone may die after reading this tosh!

Article about treating ovarian cysts with magic water

Sir
It is grossly irresponsible of the Telegraph to publish an article like this without any accompanying opinion from a genuine health professional.
If people choose to “treat” their hay-fever using “homeopathic medicines” (i.e. “medicines” with no ingredients) that’s fine by me. If people choose to treat their ovarian cysts using “homeopathic medicines”, they could die.
Yours faithfully
Dr Schroedinger99

Footnote to anyone reading this who might be inclined to believe that there is something in homoeopathy:

Let’s take one of the remedies mentioned: Nux Vomica. This is an extract from the Strychnos Nux Vomica tree which contains a number of highly poisonous alkaloids – none of which, to my knowledge, have any useful role in the treatment of hangovers. Fortunately for Annabel Croft, homoeopaths do not supply this extract in its pure form. They dilute it first. They really really dilute it:

As you will find if you follow the http://www.healthroughhomeopathy.com/ link for this article: “Over the counter remedies tend to come in 6c and 30c potencies. A solution labelled as '6c' has been diluted six times at a ratio of one part substance to 99 parts alcohol and water, whereas a solution labelled as '30c' has been diluted 30 times at a ratio of one part substance to 99 parts alcohol and water. 6c potency is typically used for long standing conditions, such as rheumatic pain. 30c potency is typically used for first aid or acute situations, such as the onset of a cold or bruising after a knock or fall.”

What this means is that homeopathic Nux Vomica with a potency of 6c has one part Nux Vomica to 100 to the power 6 parts alcohol and water – eg 1 ml Nux Vomica in 1000000000000 ml of alcohol and water; homeopathic Nux Vomica with a potency of 30c has one part Nux Vomica to 100 to the power 30 parts alcohol and water – eg 1 ml Nux Vomica in 1000000000000000000000000000000000000000000000000000000000000 ml of alcohol and water (which won’t even display on my calculator).

(I hope I've got these figures right, but, hey, I could be out by several million and still make the same point)

This alcohol and water is sprinkled onto pillules (typically containing lactose) and these are then dried – ie the alcohol and water is allowed to evaporate. The pillules can then “be dissolved in warm water” (I am not making this up) which the patient can (presumably) either drink or dilute 1000000000000000000000000000000000000000000000000000000000000 times and begin the whole process again.

Anyone who believes that these remedies could possibly have any effect is, IMHO, in serious need of clinical help.

I suppose, to be fair, I should at least consider the possibility of "water memory":

It has been suggested that one way to explain the alleged efficacy of homoeopathic remedies may be that water somehow "remembers" what used to be in it. There is, in should be noted, no scientific evidence for such a mechanism or for the efficacy of homoeopathic remedies, but I think it is also worth pointing out that the notion of "water memory" is inherently implausible.

For example:

* The tap waster we all drink has had all sorts of things removed from it and would be extremely hazardous if it "remembered" those constituents in the sense suggested by homoeopathy.

* There are (I suppose) chemicals that "remember" other chemicals (in a certain sense) like antibodies; but injecting someone with rabies antibodies will not produce a similar effect to injecting someone with rabies antigens.

* Even if we allowed water to "remember" what had been in it, how are we to explain the transfer of that memory to pills (which may be made of lactose or calcium carbonate or almost anything and which have lost all the water put on them to evaporation) and from the pills back to water?

Who would you rather have move in next door to you?

Sir Trevor McDonald OBE Newsreader & TV presenter

Freema Agyeman BA Actor

Dr Simon Singh Science jounalist & author

Shami Chakrabarti CBE Lawyer & Director of "Liberty"

Stephen Fry BA Jewish homosexual TV presenter, actor & author

Konnie Huq BA “Relaxed Muslim” TV Presenter

OR

Nick Griffin Fat white bog-eyed racist bigot, Holocaust denier & leader of the BNP

Shami Chakrabarti in Bradford

My wife I took my teenage daughter to see Shami Chakrabarti of "Liberty" (formerly the National Council for Civil Liberties) speak at Bradford University last week (2009 June 03).

It was, in many ways, a wonderful experience. The "Great Hall" at Bradford was full to bursting, and it was nice to see that so many people were prepared to drag themselves away from things like Big Brother and Britain's Got Talent (not to mention their computers) to simply listen to someone speak in a hall. Shami was eloquent, entertaining, and self assured. A superb role model for my daughter.

Shami spoke movingly about the battles fought and won over the years, and the battles (e.g. on "rendition" and torture) still playing out today. She reminded us that the European Court of Human rights is not some kind of arm of Brussels's EU bureaucracy that forces us to eat straight bananas (as the Daily Mail might have it) it is the result of a process began, after the horrors of World War II, by Winston Churchill's brain child: The Council of Europe. Sir David Maxwell-Fyfe (who oversaw the drafting of Convention and whose moniker hardly conjures up an image of Johnny Foreigner) said at the time that it was designed to incorporate a traditional civil liberties approach to securing "effective political democracy", from the strongest traditions in the United Kingdom, France and other member states of Europe.

But then Shami said a few words about religion .......

First of all she contrasted states where a single compulsory state religion that permeates all aspects of life (citing Afghanistan under the Taliban and England under the Tudors as examples) with states where religion was more or less outlawed (the French Republic and Soviet Russia) and indicated that her position lay somewhere between these extremes. Fair enough! Shami then went on to suggest that (Professor) Richard Dawkins (who she insisted on referring to as "Mr Dawkins") was an advocate of the Soviet approach to religion and that he denied the contribution of religion to art, culture, and music. This is quite simply false in every respect and a gross calumny against Richard Dawkins.

Shami went on to provide an example of how Liberty had helped forge a righteous path between these two extremes by (for example) championing the case of Sarika Watkins-Singh who wished to wear her kara (Sikh bracelet) to school that had rules against the wearing of any jewellery.

Now, don't get me wrong, I'm not generally against people wearing karas or crosses round their necks or any other symbols and I don't really understand why the school thought it necessary to ban jewellery - other than (perhaps) in the laboratories and on the playing fields - but the judgement in this case (endorsed by Liberty) seems just plain barmy.

The judges ruled that though it was perfectly okay for schools to impose general bans on jewellery, they have to make exceptions for individuals who claim that their jewellery is religious in character. In other words, the judges and Liberty have endorsed the principle of different laws for people of different faiths.

As we have seen in many parts of the world, this is the road to tyranny not the road to liberty.

Writing to the The General Chiropractic Council

Me first:

Dear Sir/Madam

I note that your CoP contains the following entry:

C1.6 may publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority.

As you may be aware, the ASA recently declared in a ruling against Chiropractors “Dr Carl Irwin and Associates” (http://www.asa.org.uk/asa/adjudications/Public/TF_ADJ_46281.htm) that

“We considered that, whilst some of the studies indicated that further research was worth pursuing, in particular in relation to the chiropractic relief of colic, we had not seen robust clinical evidence to support the claim that chiropractic could treat IBS, colic and learning difficulties.

On these points the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness) and 50.1 (Health and Beauty Products and Therapies).”

It has come to my attention that Huddersfield Chiropractic (http://www.huddersfieldchiropractic.co.uk/BCAD02_Babies.asp) make the following claim on their website:

"Birth and early infancy can sometimes be a very difficult and traumatic time for both mother and baby. After the baby's head has engaged, usually during the eighth month of pregnancy, there can be a lot of stress on its head and back as it continues to move within the womb. This stress can increase further during the birth process, particularly if it is prolonged or involves breech presentation or forceps delivery. As the child grows up, and starts to walk, climb and run, the inevitable falls and bumps can affect the still-developing bones of the spine and skull. Once at school, the child carries heavy bags, sits on badly-designed chairs and participates in a variety of sporting activities.
These stresses and injuries can result in the tightening of muscles in the neck or back, so causing the bones of the spine to lose their normal motion or position. This can irritate or put stress onto the nerve roots that branch off the spinal cord to the organs and tissues of the body. In babies and young children this may lead to symptoms including:
• asthma
• colic
• hyperactivity
• bedwetting
instead of treating the symptoms with drugs, or assuming that the child will 'grow out of it', the chiropractor will gently adjust a child's spine to remove the nerve stress and return his/her body to healthy healing."

Unsurprisingly, the cited Danish research is not regarded as "robust clinical evidence" by the ASA - it would seem to fall well short of the standards applied in conventional medical research.

The claim concerning “colic” would seem to be in breach of the ASA Code. While this is not an advertisement in the sense defined by the ASA, Huddersfield are publicizing their practice and would, therefore, appear to be in breach of your code.

Please could you inform me whether you consider Huddersfield’s claims to be appropriate and whether you intend to take action against this company.

Yours faithfully


Dr* Schroedinger99

*non clinical

The first reply - which came straight back:

Dear Dr Schoedinger99,

Thank you for your email of 4 June 2009. With regard to the final sentence of your email, the Investigating Committee of the General Chiropractic Council investigates complaints relating to the fitness to practise of individual chiropractors, rather than complaints against companies or organisations. In this respect please contact us if you wish to make a complaint about a chiropractor or wish to receive a copy of our complaint information pack.

As your email refers in part to a ruling made by the ASA against a chiropractor, I have referred your email to the Chief Executive & Registrar, Margaret Coats, who will provide a separate response to your email.

Yours sincerely

XXXXX
Specialist Officer (Regulation)
General Chiropractic Council

Ths was quickly followed up by another response:

Dear Mr Schoedinger99
Your email of 4 June has been brought to my attention because it refers to the recent ASA adjudication against a chiropractor – Carl Irwin. I thought you might be interested to see that the GCC’s patient information leaflet (copy attached) includes the following statements

Chiropractors mainly treat
• back, neck and shoulder problems
• joint, posture and muscle problems
• leg pain and sciatica
• sports injuries
You may also see an improvement in some types of
• asthma
• headaches, including migraine; and
• infant colic

It’s important to emphasise that the GCC doesn’t claim that chiropractors 'treat' asthma, headaches (including migraine) and infant colic. It is possible that chiropractic care may help to alleviate the symptoms of some of these conditions. Chiropractors are trained in differential diagnosis and should refer any patient for appropriate care from another health professional when necessary. It is important that, where appropriate, there is good co-management of patient care. But the statement about the possibility of improvement has been included on the basis of the currently available evidence.

I'm not sure what level of detail to go into but as you may know there are a number of ways of measuring, or rating, evidence levels. One relevant example is Brønfort G. Efficacy of Manual Therapies of the Spine, Amsterdam: Thesis Publishers, 1997. This study rates the levels of evidence available at the time and provides a measuring tool to do it - I've cut and pasted the 'ratings table' below for your information. If there's anything that's unclear please do get back to me.

The available evidence of the efficacy of the chiropractic contribution to the management of some types of asthma, migraine headache and infant colic is inconclusive (i.e. level D in the measuring tool used by Brønfort).

Further, with regard to some types of asthma:
• Brønfort concluded in 1997 that there is moderate evidence (Level B) that SMT is a non-efficacious therapy for chronic to moderately severe asthma in adults. There was insufficient data (Level D) to draw conclusions about the efficacy of spinal manipulative therapy (SMT) for other respiratory diseases (including childhood asthma)
• In 2001, Brønfort et al ( see c. below) concluded that after three months of combining chiropractic SMT with optimal medical management for childhood asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. The observed improvements were thought unlikely to be as a result of the specific effects of chiropractic SMT alone, but other aspects of the clinical encounter that should not be dismissed readily.

So although some clinical trials had positive results there is insufficient data to make strong statements about efficacy. There is a higher level of available evidence (i.e. level B) with regard to some types of headache (such as tension-type and cervicogenic headache) and there appears to be a clinical advantage, of both SMT and exercises, both of which chiropractors use, compared to placebo and at least equivalence with commonly used therapies.

Other studies which appear to echo the evidence levels outlined in the paragraphs above are:
a. Nielsen NH, Brønfort G, Bendix T. et al 1995. Chronic asthma and chiropractic spinal manipulation: a randomized clinical trial. Clin Exp Allergy Jan;25(1):80-8
b. Balon J, Aker PD et al 1998. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. NEJM 339 (15): 1013-1020
c. Brønfort G , Evans RL, Kubic P, Filkin P 2001. Chronic pediatric asthma and chiropractic spinal manipulation: a prospective clinical series and randomized pilot study. JMPT 24(6):369-77
d. Brønfort G, Nilsson N, Haas M, Evans RL, Goldsmith CH, Assendelft WJJ, Bouter LM. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database of Systematic Reviews 2004, Issue 3 Art. No.: CD001878. DOI: 10.1002/14651858.CD001878.pub2
e. Wiberg JMM, Nordsteen J, Nilsson N. 1999. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomised controlled clinical trial with a blinded observer, JMPT 22 (8): 517-22.
This isn’t an exhaustive list but I do hope that this level of detail is helpful.
Please don't hesitate to contact me if you have any questions.
Yours sincerely
YYYYYY
Chief Executive & Registrar

This all seemed rather irrelevant, so I worte back again:

Dear Ms YYYYYY

Thank you for your email, but I do not feel that you have addressed the complaint I raised.

To summarize:

the GCC’s CoP states that chiropractors “may publicise their practices or permit another person to do so consistent with the law and the guidance issued by the Advertising Standards Authority.”

The ASA have made it clear that it is not acceptable for chiropractors to claim that they can treat infant colic – a judgement which you appear to endorse in your email to me.

Huddersfield Chiropractic claim that they can treat infant colic.

I suggest, therefore, that Huddersfield Chiropractic would seem to be in breach of your CoP and I am requesting that, in view of this, you take action against them.

Yours sincerely

Dr Schroedinger99

I then received a very polite phone call from Ms YYYYYY from which the following emerged:

1) As XXXXX indicated, the Investigating Committee of the General Chiropractic Council investigates complaints relating to the fitness to practise of individual chiropractors - not chiropractic businesses.

2) XXXXX did not pass on my complaint to YYYYY for her to deal with instead. XXXX passed on my complaint so that she could advise me on the sort of evidence the GCC use and how they assess that evidence.

3) If I wish my complaint to be considered, I shall have to resubmit it naming the individual chiropractors who work at the firm I am complaining about.

I note that the GCC seem to be very professional (unlike other "regulators" I have dealt with - e.g PhonepayPlus) and obviously take their role seriously.

I hope this helps others making complaints to the GCC about chiropractors who make bogus claims on their own websites.