I Speak of Dreams

On the Danger of Neck (Cervical) Adjustments by Chiropractors

Comment on Steve Novella's post at Science-Based Medicine, by a practicing MD physician:

Science-Based Medicine » Chiropractic Neurology.

Re: neck cracking, the most recent surveys of chiropractors, as I recall, show some 2/3 or 3/4 of them using high velocity neck cracking, which is considered dangerous among ER physicians, neurologists, and neurosurgeons. 

Anyone with more than a passive knowledge of the anatomy understands the vulnerability of the vertebral arteries where they exit the safety of the bone in C-2 and twist around to enter the foramen magnum. That is exactly where one would expect the  artery to be torn by a sudden twist of the neck and that is exactly where the arteriograms demonstrate the artery dissection to occur. 

As to [the] claims that this is done with patients on their side, all the videos I see when I Google chiropractic neck manipulation are by chiropractors with the patient either supine or seated and the practitioner above the patient. The attempt to elicit an audible “pop” when nitrogen gas exits soluble form and becomes a bubble, so the patient is impressed that something important (a bone out of place, perhaps going back into place?) has taken place, has real dangers. 

As one who has spoken to the mother of a dead young girl whose neck was cracked by a chiropractor over 150 times as treatment for a tailbone pain, and who started having seizures immediately after the final manipulation while on the examining table…I understand the dangers and advise all patients to “never let them touch your neck.” I have also spoken to surviving patients in wheelchairs who were never to walk again after chiropractic neck manipulation for low back pain, and patients who needed craniotomy to treat the stroke which occurred immediately following neck cracking for shoulder pain treatment. 

I know the official chiropractic position is that the neck cracking is safe, but that is not the position of the medical practitioners who deal with strokes and their sequelae.

Mainstream Media Aiding and Abetting Quackery and Pseudoscience: Burzynski Edition

Why did the idea that autism is somehow caused by vaccination spread so widely?  One reason is that the mainstream media, especially in the UK, ballyhooed this mistaken notion.  The best  introduction to the media's complicity is in Seth Mnookin's The Panic Virus  (you can also find his blog at PLOS-One The Panic Virus)

This time around, the issue is a pseudoscientific treatment for cancer, and the media's complicity.  On November 20, 2011, the UK newspaper "The Observer" published a credulous and  heart-strings-tugging article about a little girl with terminal cancer and her treatment by a US center, The Burzynski Clinic, offering an expensive cancer "treatment" that is almost certainly ineffective.

One UK reader responded.  The Observer edited his response to remove their own responsibility and to recast the tone of the article:

I have had the Observer delivered each Sunday for some forty years and therefore feel entitled to describe myself as a loyal reader. ^but I was concerned to see the article entitled , ‘The worst year of my life: cancer has my family in its grip’ in the 20th November edition. ^ "As stars came out to help little Billie, my cynicism melted away" (Focus).

It is entirely appropriate for you to raise awareness of the dilemmas faced by the families of young children suffering from life-threatening conditions such as Billie Bainbridge. What concerns me is the way in which the article appears to give uncritical support to the treatment offered by the Burzynski Clinic. There is much evidence to suggest that this clinic operates on the fringes of medical practice and does little more than offer false hope at a high price. A look at the Cancer Research UK website would have confirmed this. I fear that the consequences of this article will be to raise unrealistic expectations in other cancer sufferers and their families and line the pockets of charlatans. I look to the Observer to provide balanced and informed articles. I hope therefore, that a future edition of the paper will address the issues I have raised.

A PR Flack for Cancer Quack Attempts to Bully Skeptic Bloggers. Ridicule Ensues

Added Tuesday November 29, 2011: Masterful summary of the issues and supporting blog posts from Josephine Jones

Added Sunday, November 27, 2011:  Why do I care about Burzynski and Marc A. Stephens' attack on Andy Lewis?  Two reasons:

1. Offering false hope to a person with cancer is wrong.  Offering false hope to parents of a child with terminal cancer for any price is evil.  Enriching yourself to the tune of upwards of  $300,000 per victim intensifies the evil.
   
2. Using the threat of litigation to silence criticism of science is wrong.

The short version of the story: Andy Lewis (@LeCanardNoir) is a UK blogger at Quackometer who is particularly tough on pseudoscience and medical fraud. 

There's a US cancer "researcher" by the name of  Stanislaw Burzynski, whose theories have been a cause of concern since at least 1998 (more detail here and here and here).  Burzynski has been able to continue to offer his approach through the ruse of redefing  his treatments as "clinical trials".  Participants in the trials have to pay to enroll, at a huge price tag ($200,000 plus travel expenses).

There's a four-year-old girl in the UK who has a rare, inoperable, and fatal form of brain cancer.  Her parents got wind of  Burzynski's promises of cure, and a fund-raising campaign was launched, to get the girl to the US to enroll in the "trials".  

On November 21, 2011, Andy Lewis published a blog post, The False Hope of the Burzynski Clinic, in which he discussed the current UK case.

The Observer should not have published an article that was so uncritical of such a questionable treatment. ... Such articles will encourage others to go down this misguided path. You may argue that such a treatment gives the family hope, even if it is not effective. It may do. But it looks as if this will be a false hope – and false hopes rob people of real choices. ... There are undoubtedly many ways that £200,000 could help them, but putting a little girl through dubious, risky and unpleasant treatment, that is exceedingly unlikely to help,  is not one of them.....

Peter Kay is right to raise money for this family. And good luck to him. But it would be a dreadful wrong for this money to end up in the hands of someone whose actions cannot be distinguished from mere exploitation of the desperate. That money could make a big difference to this family. It could allow both mother and daughter to be looked after in comfort, without worrying about mortgages or jobs. It will allow them to be together. It will not perform miracles. And nor will it make the pain go away. But such a simple gift will indeed be an act against cynicism and false hope.

The following day, Lewis recieved the first of a series of nasty, threatening, unprofessional emails threatening legal action unless Lewis removed the post referenced above.  The emails were sent by one Marc A. Stephens, who does not appear to be registered as an attorney in Texas.  

It wasn't Stephens (who also uses the 'nym MAS ) first threat to a blogger.

The best response to bullying is to confront the bully (Posts specifically on the threat to Andy Lewis. I will be updating this silently.  For all posts -- that is, those on both threats to bloggers and Burzynski's quackery and pseudoscience -- see Josephine Jones's list at Stanislaw, Streisand, and Spartacus)

More more more update, 11/28/2011: It turns out that Marc A. Stephens had also threatened Rhys Morgan of Bleachgate fame.  Stephens picked the wrong Welsh boyo to pick on -- Morgan's faced down worse, and has doughty friends as well. See Rhys's post at #30 for the juicy details, and Andy Lewis's at #31.

1. The Twenty-First Floor:  Burzynski Clinic Issues Legal Threats Against Bloggers
2. Doubtful Newsblog Burzynski Clinic Issues Legal Threats Against Bloggers
3. Orac Knows at Respectful Insolence A P.R. flack from the Burzynski Clinic threatens a skeptical blogger
4. Guy Chapman's Blahg: The Burzynski Clinic
5. Cubick's Rube: Evidence? Burzynski Don't Need No Stinkin' Evidence
6. Josephine Jones: Controversy surrounding Burzynski’s ‘pioneering’ cancer therapy should be reported in newspapers 
7. Josephine Jones: Stanislaw, Streisand, and Spartacus
8. Stuff and Nonsense: Burzynski Clinic Threatens Blogger
9. Anarchic Teapot at Short and Spiky: Ducks Are Nothing But Trouble
10. Peter Lipson at White Coat Underground: Is the Burzynski Clinic Threatening Critics?
11. Kylie Sturgiss at Token Skeptic: On the Burzynski Clinic Issuing Legal Threats
12. Richer Ramblings Burzynski Clinic Quackery
13. David Colquhoun at DC's Improbable Science The Cruelty of the Burzynski Clinic Must Be Stopped
14. Peter Bowditch at Millenium Project November 25, 2011: More threatening emails from Marc A Stephens, with images 
15. Bob Blaskiewicz at Skeptical Humanities Stanislaw Burzynski's Public Record
16. Beatis at Anaximperator Is Marc Stephens Really a Burzynski Representative?
17. Die Ausrufer (in German, read in Google Translation) Ein Blogger, Krebs, und Radiohead
18. Zeno at Zeno's Blog: Big Business in Texas
19. Mr. Bojangles at EsoWatch (in German, read in Google Translation) LETZTE WARNUNG: Denken Sie an Frau und Kind, enfernen Sie den Blogeintrag 
20. Richard Wilson's Blog: Bloggers React as Leading Quackbuster Threatened with Libel over Exposé of Charlatan Cancer Claims
21. Kevin Bradshaw I Blog Every Day I am Spartacus (allegedly) #Burzynski 
22. Dean Steadman commenting at Quackwatch Helping Steer Other Families Away from Burzynski
23. David Allen Green at Jack of Kent Some Libel Silliness
24. Eddy Cara at The Demon Haunted World Merchant of Hope
25. The Jobbing Doctor at The Jobbing Doctor Quack, Quack
26. Todd W. at Harpocrates Speaks May As Well Try to Stop A Storm
27. Cullen at SkepticCullen Who the Hell Does Marc Stephens Think He Is?
28. PZ Myers at Pharyngula, FreeThought edition: Burzynski Clinic: The Domain of Scoundrels and Quacks and ScienceBlogs edition: Burzynski Clinic: The Domain of Scoundrels and Quacks
29. Rhys Morgan Rhys's Blog at Threats from the Burzynski Clinic
30. Le Canard Noir at Quackometer Burzynski Clinic Threatens 17-year-old Blogger
31. Anarchic Teapot at Short and Spiky Do Burzynski and Dodgy Behavior Go Hand in Hand?
32. Steven Novella at Neurologica The Burzynski Clinic--Another Crank Tries to Intimidate a Blogger and SkepticBlog edition The Burzynski Clinic--Another Crank Tries to Intimidate a Blogger
33. Cory Doctorow at Boing Boing Representative of the Burzynski Clinic Sends Aggressive Legal Threats to Skeptics Who Question "Antineoplaston" Cancer Therapy
34. WriterJames at Cubik's Rube The Burzynski Continuation
35. Sceptical Letter at Sceptical Letter Writer: Dr. Burzynski's Crooked Antineoplastons
36. Skeptical Nurse at Rants of a Skeptical Nurse Stanislaw Burzynski And the Great Peptide Cancer Debate
37. Dave Gamble at Skeptical Science Burzynski Clinic's Quackery
38. Ewan at The Corvid's Fall Threats from The Burzynski Clinic: This Quack Cure for Cancer Needs to End
39. Sense About Science Statement on Libel Threats to Critics of the Burzynski Clinic
40. SkeptiCat at SkeptiCat Up Both of Yours Marc Stephens and Stanislaw Burzynski
41. Phil Plait at Bad Astronomy "Alternative" Cancer Clinic Threatens High School Blogger
42. Craig Malisow at Hair Balls (Houston Press Blog) Burzynski Fanatic Threatens Bloggers 'Round the World
43. Martin Robbins at Google+ Burzynski Lawyer Distances Clinic From Threats to Bloggers
44. Bock at Bock the Robber Burzynski Supporter Threatens 17 year old Blogger
45. Kylie Sturgess at Token Skeptic Won't Shut up about #Burzynski? Photograph a TEENAGER'S House to Silence Them
46. Mark Jones at Good Grief, Linus Bloggers Bullied by Burzynski
47. André at Thinking is Real: Burzynski and Streisand: Still Dancing
48. Crispian Jago at Science, Reason and Critical Thinking  Skeptic Park 4 Featuring Rhys Morgan
49. Josephine Jones at Josephine Jones: Master List of Blog Posts
50. Ian Sample at the Guardian The Schoolboy Blogger Who Took on A US Clinic
51. Scott Gavura at Science-Based Pharmacy Burzynski Clinic, Meet the Streisand Effect

Different kind of update: read this story from Karl S., about his wife's  follicular lymphoma (a type of cancer), and her treatment at the Burzynski Clinic: 

Instead of watchful waiting, "we" decided to try Burzynski's antineoplastons, mainly because we talked to patients who said it helped them. Some said they were cured. Burzynski also said he could cure Joanne. A non-toxic therapy that can cure! How could we not try that? Which illustrates my second deficit: I did not understand that testimonials are not evidence. 

A second reason we chose Burzynski, it was one of the alternative protocols listed as potentially useful by Dr. Ralph Moss, PhD, in a personalized Moss report we purchased.  It's worth noting that Dr. Moss's background and degree was not in medicine....

The event that began to slowly awaken me was Joanne's medical crisis. The necessity to treat with CHOP to deal with fast progression in 1997. Joanne's brain was in a fog from 10 months on the 24-hour pump infusion of Buryzinski's peptides (which smelled like urine). Although she had a 30% response* at one point (or was it?), the lymphoma began to progress rapidly and was now bulky. New nodes were appearing almost daily. When "we" finally went off study, the gallium scan lit up like a Christmas tree. I recall that the liver involvement scared me the most....

Thankfully, CHOP therapy put the lymphoma into remission, even at this advanced stage. Clearly, without effective standard medicine she would have died...

I wonder how many stories there are like Joanne's...with a worse outcome: that is, unnecessary suffering and death, because families chose Buryzinski's quackery over science-based medicine.

image source http://upload.wikimedia.org/wikipedia/commons/b/bc/WPA_quack_poster.jpg

More different kind of update: David Gorski, MD, examines Burzynski's pseudoscience & quack medicine in depth at Science-Based Medicine.

Seven Days Till Cthulhu Day (Winter Edition)

Last year somebody lamented the late notice--not enough time to send out cards

If the image at left means nothing to you, you didn't read enough in your youth.

December 2 is Cthulhu Day.. I was a day late in 2003.

If you need to catch up, a dry but detailed set of Cthulhu FAQs can be read here

Otherwise see the push to teach the controversy

"'In his house at R'lyeh dead Cthulhu waits dreaming.' Do not disturb Him, or you will doom us all!"

It's true. Tremble. But it's funnier with Professor Blue Smush DinoBaby. And I thought Cthulhu was first nominated for the presidency in 2008. I was totally wrong. It was 1996.

Passive Aggressive Thanksgiving

Finslippy started it last year but but it went on. And on. We should start it again...The twitter hashtag is  #passiveaggressivethanksgiving.

Feel free to recycle.

• RT @finslippy: Thanks for calling me, finally. I guess you don't call your mother on Thanksgiving Morning anymore? #passiveaggressivethanksgiving
• RT @finslippy The only way I know anything about you is through your blog. #passiveaggressivethanksgiving -- that's my dad
• RT @randonb: No, no, the food didn't make me sick; I was just throwing up to get the taste of the food out of my mouth. #passiveaggressivethanksgiving
• RT @SarahThyre: Welllll, it appears the turkey's not the only thing stewing in its own juices. #passiveaggressivethanksgiving
• RT @LadyKatieBond: "Do you want me to get this done or to listen to every little thing you say?" #passiveaggressivethanksgiving
• RT @JRehling: Does Thanksgiving feel special to people like you who eat this much every day? #PassiveAggressiveThanksgiving

On the assertion that science is a religion

Orac (a physician-researcher) on the difference between science and religion, and rebutting the anti-science fallacy that science is just like religion:

HIV/AIDS denialism versus science : Respectful Insolence.

Ah, yes, the comparison of science to religion and scientists and physicians to priests! ... I've read it on so many anti-science websites and blogs that I long ago lost count, and it's a common misconception (or outright lie) that frequently needs to be refuted. Religion, after all, requires belief in things that, by its adherents' own admission, can't be proven; indeed, religion is all about strong (or even absolute) belief without evidence. This is in marked contrast to science, which is all about tentative, provisional belief only after there is adequate evidence. More importantly, science is about subjecting those tentative beliefs based on evidence to further testing and overthrowing the ones that can't stand up to that testing. The difference between science and religion couldn't be more stark.

Spanking in the USA: A sad state of affairs and why spanking is never ok. - Child Psychology and Parenting Blog: Child-Psych.org

In the background, Dr. Phil is replaying the video of the Texas judge beating his child.  I want to direct you to an editorial from Nestor Lopez Duran:

Spanking in the USA: A sad state of affairs and why spanking is never ok. - Child Psychology and Parenting Blog: Child-Psych.org.

Yes, the American Academy of Pediatrics unequivocally recommends against the use of aggression as a discipline method. Why? Because the research on physical punishment is clear: it is unnecessary and is associated with a long list of NEGATIVE consequences. For example, although proponents of “spanking” argue that if you don’t spank, the child will not learn to behave properly, the research actually suggests the opposite.

Logical Inference Error

A comment by Composer99

"Misinformed consent" rears its ugly head in Pediatrics : Respectful Insolence.

You seem to be making a very standard logical inference error which we see time and again on the part of apologists for quackery CAM: 

Premise #1: Big Pharma is tainted (lawsuits, demonstrated corruption, thalidomide, whatever turns your crank) 

Premise #2: ????? (maybe a miracle occurs?)

Conclusion: Quackery CAM works. 

As you can see, unless the second premise can be filled in with acceptable evidence, the conclusion simply does not follow from the first premise.

One in Six Children with A Developmental Disability?

Several months ago, a commenter at Respectful Insolence, was wringing her hands over "one in six American children are now considered developmentally disabled", and was implying the high number was new and was caused by vaccination.

"Developmentally Disabled" sounds horrible and scary, doesn't it? Like a child who will never learn, or never live independently in adulthood?

The facts are otherwise.

The source of the "one in six" is a paper in Pediatrics, Boyle et al. (2011) Trends in the Prevalence of Developmental Disabilities in US Children, 1997–2008 Pediatrics. 2011 Jun;127(6):1034-42. Epub 2011 May 23. doi: 10.1542/peds.2010-2989)

From the abstract (emphases added):

Participants and Methods:We used data on children aged 3 to 17 years from the 1997–2008 National Health Interview Surveys, which are ongoing nationally representative samples of US households. Parent-reported diagnoses of the following were included: attention deficit hyperactivity disorder; intellectual disability; cerebral palsy; autism; seizures; stuttering or stammering; moderate to profound hearing loss; blindness; learning disorders; and/or other developmental delays.

Screening for and remediating learning disorders are my areas of expertise. I would say the one in six figure (16.6%) is possibly low. Dyslexia is classed as a developmental disability. Some dyslexia experts put the actual prevalence rate at up to 20%.

It would be a great day for children in America if all students were screened for dyslexia at the end of kindergarten, so that appropriate remediation could begin immediately. Of course, instituting such a course of action would mean a rise in both incidence and prevalence. What a terrible thing! Not.

The change in incidence and rise in prevalence of autism has been widely discussed previously (for starters, see Steven Novella at Neurologica).

The incidence and prevalence of ADHD are well, contentious. The prevalence rates vary from about 6% to over 15% on a state-by-state basis. As the CDC notes:

...because of the evolution of the case definition and differences in how the case definition is operationalized, there is disagreement as to prevalence and precise characteristics of children with the disorder.

Due to the lack of a single, consistent, and standard research protocol for case identification, variable and disparate findings have been noted in the literature.

What's the take-away message here? For Kelly, lara, and others who use the "one in six" headline as a prompt for fears of vaccines, I fear it won't do much. Evidence-resistant ideologies don't change much in response to facts...

For everyone else, when you see the "one in six" figure, now you know what it refers to, and now you know why it isn't a fearful figure.

Flooded El Salvador Needs Your Help

My daughter Allison is in El Salvador with Santa Clara University's study-abroad program, Casa de la Solidaridad.

In October, a persistent tropical depression caused wide-spread flooding and destruction -- it's now being called "The Deluge of 2011".  Damage was especially severe in the Lempa River Delta where it flows into the Pacific Ocean, but the need for disaster relief is intense throughout El Salvador.

One of the people Al is involved with is Juan Velasco of the El Salvador education NGO, Programa Velasco, which is recognized by the IRS as a 510(c)3 charity. I have investigated Programa Velasco and it is well-run and worthy of support, so you can sent relief funds to El Salvador for Programa Velasco's use by going to PayPal and donating what you can.

The Programa Velasco has a page indicating needs with some photos

• Urgent Necessities: Vitamins, Ibuprofen, antibiotics (amoxicillin) and other products to cure and prevent skin infections
• Important Necessities: powdered milk (mostly for children), bottled drinking water, canned food (especially with protein), underwear, boots, shoes.
• Other Necessities: bleach, soap, mosquito netting (preventing mosquito borne illnesses- dengue, malaria, etc).

As always in natural disasters, it's better to send money rather than material goods that have to be shipped, organized at the destination, and transported to areas of need.  Just go to PayPal and donate what you can.

Other reputable NGOs providing services in El Salvador include Voices on the Border,  SHARE El Salvador, Eco-VIVA, the Evangelical Lutheran Church Disaster Relief, and US-El Salvador Sister Cities.

There are other English-language blogs on the Deluge of 2011 and the need for international disaster relief.  An American named Tim has made several mission trips to El Salvador and maintains a blog, Tim in El Salvador.  One of his posts commented on the urgent water issues:

The availability of healthy water continues to be a serious challenge for El Salvador, and the Deluge of 2011 has only made it worse.   According to a story in La Prensa Grafica, the Ministry of Health reports that  10,186 wells were destroyed or contaminated by the flooding.   In addition, some 28,862 latrines were damaged in the flooding.   These damages to the water and sanitation infrastructure of the country create additional risks for disease.

You can see the degree of flooding at this Facebook album

Voices from El Salvador on the destruction: http://voiceselsalvador.wordpress.com/2011/10/17/worse-than-hurricane-mitch-complete-destruction/