$545 million wasn't enough for chiropractors. Now they're lobbying Congress for much more.

Medicare currently wastes more than $545 million a year on chiropractors, as I revealed in an article last year. Wasteful as this is, it's not enough for chiropractors, who have successfully lobbied to have two Congressmen propose a new bill, HR3654, that will require Medicare to pay chiropractors for the full range of services that real doctors offer.

The American Chiropractic Association is practically rubbing its (metaphorical) hands together with glee. As they proudly point out, this endorsement of quackery is bipartisan: the bill is sponsored by two New York Congressman, Democrat Brian Higgins and Republican Tom Reed.

The idea of having chiropractors function as regular physicians is very troubling. Chiropractors do not receive proper medical training: they get their Doctor of Chiropractic (D.C.) degrees from one of a very small number of special chiropractic schools, which do not provide the full medical training that real medical schools do. Their curriculum also includes a heavy dose of pseudoscience, especially the training around subluxations.

For a detailed discussion of why chiropractors are not competent to be family physicians, I recommend this article by an experienced physician, Dr. Harriett Hall, titled "Chiropractors as family doctors? No way!" Dr. Hall goes into considerable detail explain why many of the medical practices of chiropractors are non-standard, not evidence-based, and possibly harmful. Or see this lengthy takedown of chiropractic subluxations by Sam Homola, a former chiropractor.

Many chiropractors are also anti-vaccine, unfortunately, as documented just two weeks ago in this article by attorney Jann Bellamy. Among other things, Bellamy points out that a major chiropractic conference this fall will feature a keynote talk by anti-vaccine activist Robert Kennedy Jr. (about whom I've written before).

Even more alarming, as I've explained before, is that chiropractic neck manipulation has been shown to carry a small but real risk of stroke, because it can create a tear in your vertebral arteries. For example, this report from 2016 documented a case of cerebral hemorrhage apparently caused by chiropractic manipulation. The patient in that case was a 75-year-old woman, which puts her squarely in the class of patients eligible for Medicare.

And to those chiropractors who've read this far: I'm sorry that you were hoodwinked into spending 3-4 years in a chiropractic school, paying nearly $200,000 in tuition and fees, with the promise that you'd be a legitimate medical professional. You were scammed, and I'm sorry about that. And I understand that most (perhaps all) chiropractors want to help their patients. The problem is, the training offered by chiropractic colleges is far short of a proper medical degree.

If the chiropractors' lobbying association get its way, this $545 million (annually) in wasted Medicare dollars will soon become a far higher amount–to the detriment of patients. The bill will allow chiropractors to bill Medicare for pretty much any service that a bona fide physician offers.

It's also worth noting that in 2018, Medicare's Inspector General issued a report titled "Medicare needs better controls to prevent waste, fraud, and abuse related to chiropractic services," which revealed that almost half of Medicare spending on chiropractic care from 2010-2015, between $257 million and $304 million per year, was likely wasted or fraudulent. One wouldn't think this is a time to expand Medicare's coverage of chiropractic.

Congress, don't be fooled by arguments that this proposed new law will lower medical costs, or give patients what they need: it won't. Instead, it will dramatically increase the amount of funds wasted on ineffective treatments. The U.S. does need a better health care system, but this bill would be a big step in the wrong direction.

The federal government is wasting over half a billion dollars a year on chiropractic and osteopathic manipulation

A book on the abuses of chiropractic,
written by a former chiropractor

Here's a quick way for the U.S. government to save over half a billion dollars. Stop paying for coverage of medical procedures that have little or no evidence to support them.

The Centers for Medicare and Medicaid Services (CMS) now releases annual reports of how much it spends, broken down according to the procedures. Their latest data, for the year 2015, reveals that Medicare spent $564,165,721 on pseudoscientific medical practices.

I'm talking about chiropractic and osteopathic manipulation. These are similar but distinct belief systems, both involving bones, and both with little high-quality evidence to back them up. Most people think that chiropractors' spinal "adjustments" can relieve pain from injured or aching backs. It turns out that it's just an elaborate placebo: a back rub at home is likely to work just as well. And that home treatment is probably safer–I'll get to that below.

Osteopathic manipulative therapy (OMT) was invented out of whole cloth in the mid-19th century by Andrew Still. Still believed that every part of the body was linked by a mysterious "myofascial continuity" and that manipulating it could treat a vast range of aches, pains, and other ailments. Most of this is not true. (There is some evidence that OMT can be beneficial in carefully selected cases of lower back pain, but the evidence is quite thin (see this review), and the CMS codes don't distinguish different uses of OMT.)

Osteopathic manipulation is what Larry Nassar, the now-convicted sexual predator, claimed he was doing to the hundreds of young girls whom he molested over the years when he was a sports doctor at Michigan State University and a doctor for the U.S. Olympic gymnastics team. (Osteopathic physicians, which is what Nassar was, generally practice real medicine, and I don't mean to suggest that any of them endorse Nassar's awful abuses. However, OMT is a relic of their pseudoscientific past, and Medicare should not be covering it.)

Chiropractic is no better than OMT. It was invented by D.D. Palmer in the 1890s, around the same time that Andrew Still was concocting OMT.  Palmer mistakenly believed that misalignments of the spine, which he called subluxations, caused a vast range of health problems, even infectious diseases. As retired chiropractor Samuel Homola has written,

there is "no evidence at all to support chiropractic subluxation theory," 

but thanks to clever marketing, chiropractors have convinced millions of people to see them on a regular basis. (See chirobase.org for much, much more.)

Even more alarming is that chiropractic adjustments carry a small but frightening risk of causing a stroke, as a result of tearing the vertebral artery, as I've written about before. In fact, the American Heart Association issued a warning in 2014 that "neck manipulation may be associated with stroke". Not surprisingly, the chiropractors association strenuously denied this, but the evidence speaks otherwise. Indeed, a 2015 study that I described when it appeared showed that Medicare patients–the same cohort whom we are paying half a billion dollars a year to provide chiropractic treatments–suffered a significantly higher risk of stroke after seeing a chiropractor than those who instead saw a real doctor.

And a 2003 study in the journal Neurology show an equally alarming increased risk of stroke due to tears in the vertebral artery after chiropractic in younger patients. The lead author of that study, Dr. Wade Smith, warned that

"physicians and patients should be aware of spinal manipulation therapy as a rare but potentially causal factor in stroke."

[Update: note that a 2016 study, in the journal Cureus, found that the link between chiropractic neck manipulation and arterial dissection was not causal; i.e., that chiropractic did not appear to cause arterial tears. However, concerns remain, as demonstrated in this 2017 case report of cerebral hemorrhage following chiropractic activator treatment.]

The 2015 numbers from the Centers for Medicare and Medicaid Services show that the vast majority of the wasted funds, $545 million, went to chiropractic treatments, with another $19 million going to osteopathic manipulation. Neither amount is justified by scientific evidence.

Let's stop wasting our money on procedures that don't help, and may harm, Medicare patients. If we want to help patients, let's insist that Medicare spend our money on real medicine.

NIH distorts report showing risk of stroke after chiropractic

Why would an NIH center try to mislead the public about a newly published study that it funded? Last month NIH’s alternative medicine center, NCCIH, highlighted one of its studies with this headline: “Low risk of stroke after chiropractic spinal manipulation in older patients with neck pain, study finds.” 

This sounds reassuring, unless you read the study. It turns out that the risk of stroke was 10% higher in patients who saw a chiropractor compared to those who saw a regular doctor. Yet NIH wants us to believe that the study found no serious risk.

Why ask this question? Because earlier studies showed a small but frightening risk of stroke in younger people (45 and below) after chiropractic, caused by dissection of the vertebral artery. Strokes caused by a tear in this artery are extremely rare, but even a tiny possibility of a fatal stroke after a chiropractic manipulation is alarming. As Forbes writer Larry Husten reported last August, the American Heart Association and the American Stroke Association issued a statement warning that chiropractic neck adjustments might cause strokes. The AHA stated:

• "Manipulating the neck has been associated with cervical dissection, a type of arterial tear that can lead to stroke.
• Although a direct cause-and-effect link has not been established between neck manipulation and the risk of stroke, healthcare providers should inform patients of the association before they undergo neck manipulation."

I’ve written about this as well, both at Forbes and in The Atlantic Monthly. The risk is small but the consequences can be extremely serious.

So what's in this new study? The study, led by chiropractor James Whedon at Dartmouth College, was a large-scale survey of Medicare claims involving people aged 66 to 99. Its aim was to answer this question: "what is the probability of stroke following chiropractic spinal manipulation, as compared to a control group of subjects evaluated for neck pain by a primary care physician?" Key findings from the study included these (all from Table 2):

                     Hazard ratio for stroke at 30 days

All patients         1.10 (10% increase)

Patients aged 75-79  1.93 (93% increase)

Patients aged 80-84  2.50 (2.5 times more likely)

Patients over 85     3.59 (over 3.5 times more likely)

This looks bad: for all patients, the risk of stroke was 10% higher if they'd seen a chiropractor versus a regular doctor. In the older patients, the risk of stroke after 30 days was 1.9 to 3.6 times higher than for patients aged 66-69. (All four of these results were reported as statistically significant.) Yet the conclusions of the study–and the NIH press release–make no mention of these findings. The study itself concludes only that 

“Among Medicare B beneficiaries aged 66 to 99 years with neck pain, incidence of vertebrobasilar stroke was extremely low. Small differences in risk between patients who saw a chiropractor and those who saw a primary care physician are probably not clinically significant.”

Talk about spin! The study provides no support for the dismissive statement that the increase in risk of stroke after chiropractic is "not clinically significant"; it seems they are trying to downplay their own finding of a statistically significant increase in risk. The NIH’s press release is just as bad: it merely parrots the study's conclusions, opening with the statement that “cervical spine manipulation is unlikely to cause a stroke,” and never mentioning the statistically significant 10% increase in risk or that the study was led by a chiropractor.

Despite the misleading press release, this new study adds to the evidence that chiropractic carries an increased risk of stroke, especially for older patients. As the American Heart Association recommends, patients should be informed of this risk before submitting themselves to a possibly dangerous neck manipulation. And NIH press officers should read the study before issuing a press release.

Medicare data reveals that U.S. wastes half a billion dollars per year on chiropractic

Hold on, you're about to get "adjusted."

Ten days ago, the federal government released a huge data set detailing how it spent $77 billion in Medicare funds in 2012 to over 880,000 health care providers. The release of this data is part of a new transparency effort by the government, which many of us applaud.

The data reveal some troubling things.

Most news organizations focused on who the biggest beneficiaries are: the New York Times described how just 100 doctors received $610 million. A Washington Post story focused on the top 10 Medicare billers, including one ophthalmologist in Florida who was paid $20 million by Medicare, mostly to cover Lucentis, a drug for macular degeneration. The Post pointed out that Medicare would have saved over $10 million if that doctor used Avastin, which is equally effective. “Medicare pays a doctor more for injecting the more expensive drug,” the Post pointed out.

But until now, no one has pointed out another, far more egregious waste revealed by the Medicare data: we are spending a huge amount of money on the highly dubious practice known as chiropractic.

To be precise, the 2012 Medicare data reveals that in 2012, Medicare paid $496 million for chiropractic.

This is a stunning amount. It dwarfs the funding that NIH wastes on alternative medicine through NCCAM, which is itself an egregious waste of money.

Chiropractors are not medical doctors. They primarily treat back pain, but they claim to treat a wide range of other conditions, which some of them believe are related to mis-alignments of the spine, called subluxations. This belief has no scientific basis. Nevertheless, chiropractors have succeeded in convincing the government to cover their treatments through Medicare.  

Now we know how successful they have been: half a billion dollars a year spent “adjusting” the spines of patients, all funded by Medicare.

(And they have recently been lobbying furiously, as I wrote last summer, to force private health care providers to cover chiropractic and other alternative practices under Obamacare.)

But wait, you might ask, don’t chiropractors provide pain relief? And don’t they have medical degrees? Well, on the second question, the answer is that they have special Doctor of Chiropractic (D.C.) degrees, which are given out by just 15 special chiropractic colleges in the U.S. The entire field was invented out of thin air by D.D. Palmer in 1895, and later popularized by his son. In his book-length expose Chiropractic Abuse: An Insider's Lament, chiropractor Preston Long lists "20 things most chiropractors won't tell you," including

1. "Chiropractic theory and practice are not based on ... knowledge related to health, disease, and health care. 
2. Many chiropractors promise too much.
3. Our education is vastly inferior to that of medical doctors."

These are just the first three: you can see the full list in a review of Long's book by physician Harriet Hall, or read the book itself.

Sam Homola, a retired chiropractor, summarized his concerns about chiropractic in an article at Science-Based Medicine. Homola concluded that 

“There is no credible evidence to support the use of spinal manipulation for anything other than uncomplicated mechanical-type back pain and … no evidence at all to support chiropractic subluxation theory.”

Perhaps most alarming, especially given that Medicare is paying for millions of treatments per year, is that chiropractic manipulation can cause a stroke, by causing a tear in a major artery running through the neck. As reported recently in the Journal of Neurosurgery:

“Chiropractic manipulation of the cervical spine can produce dissections ... of the vertebral and carotid arteries. These injuries can be severe, requiring endovascular stenting and cranial surgery. In this patient series, a significant percentage (31%, 4/13) of patients were left permanently disabled or died as a result of their arterial injuries.” [Albuquerque et al., J. Neurosurg 2011 115(6):1197-1205]

If this weren’t enough to cause concern, many chiropractors are also anti-vaccine, a problem that is apparently serious enough that some chiropractors themselves have spoken out against the anti-vaxxers in their own ranks.

Over a century ago, D.D. Palmer believed, mistakenly, that he cured a man’s deafness by manipulating his neck. His son built Palmer’s beliefs into a profitable business, but neither of them would have dreamed that the U.S. government would one day spend half a billion dollars per year on chiropractic manipulations. 

If we want to start controlling the cost of Medicare, here’s an easy first step: stop covering chiropractic. We will save $496 million a year, and people’s health will improve.

Alternative medicine quacks show their greedy side

Congress is on holiday this month, but the lobbyists are baiting their hooks, planning their strategies for how to get more money for themselves.

A growing lobby is Complementary and Alternative Medicine (CAM) providers, who have discovered a new opportunity to extract even more money from patients than they do already. They want the government to force insurance providers to pay for quack treatments, regardless of whether or not the treatments work. Any attempt to require evidence, they argue, amounts to discrimination.

Discrimination? Yes! We must not allow the government to exclude health care providers just because those providers don't cure anything.  The CAMmers argument boils down to this: we have patients who want our services.  The patients like us. In some cases, thanks to lobbying at the state level, we even have state-approved licenses. Therefore insurance companies must pay for our services.

Neat.

To be specific, the CAMmers are lobbying furiously to try to protect a special clause in the Affordable Care Act (Obamacare) that promises them a fertile new ground for making money from vulnerable patients.

The strategy is simple: require the government to fund any treatment that a patient wants, and dress this up as "patient choice."  Then if insurance companies resist paying for ineffective treatments, accuse them of discriminating against the poor, hapless "integrative medicine" providers.

Thus through a diabolical twist of illogic, if Obamacare doesn't cover homeopathy, or naturopathy, or acupuncture, or magnetic energy healing, or any other so-called alternative therapy, it's discrimination.

The mind boggles.

Why is this an issue now?  Because, unbeknownst to most people outside the Washington beltway, two pro-CAM lobbying groups slipped a clause into the ACA, section 2706, that attempts to force insurance providers to cover a wide range of quack practices.  This section requires that insurers

"shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider's license or certification under applicable state law."

Sounds harmless, right?  Well, no.  This language was added to the ACA by Senator Tom Harkin, after heavy lobbying by the American Chiropractic Association and the Integrative Healthcare Policy Consortium.  In fact, it is virtually certain that lobbyists wrote the section, and Harkin simply inserted it into the law. The IHPC is a lobbying group dedicated to obtaining more government money for homeopathy, naturopathy, chiropractic, acupuncture, and a raft of other ineffective medical practices.

Section 2706 opens the door to anyone who provides what they claim is health care - no matter how ridiculous the claim - to file a lawsuit claiming discrimination if an insurance company won't pay for their services.  You could start offering dried bird poop for arthritis, call it "avian nature therapy," and if an insurer won't pay for it, you can sue.

Some in Congress have realized how truly bad an idea this is, and just a few weeks ago, a new bill was introduced to get rid of it, HR 2817.  The American Medical Association supports the new bill. This has some CAM proponents alarmed.

Over at the Huffington Post, John Weeks, an outspoken apologist for questionable medical practices, offers the predictable, whining claim that this is all about "discrimination" by legitimate health care providers (the big, bad AMA) against poor, defenseless integrative medicine providers.

Make no mistake: this is all about greed.  The CAM industry sees Obamacare as a chance to reap huge profits, by forcing insurance companies to pay for ineffective treatments, including many that are wildly implausible.

Homeopaths, naturopaths, acupuncturists, reiki practitioners, energy healers, and other CAM practitioners don't want to subject their methods to rigorous tests of effectiveness.  They know that their methods have failed scientific scrutiny, time and time again.  So now they want to force health care providers to pay for anything the patient wants. "Our patients believe us," they argue, "so pay us."

Forcing health care providers to pay for anything a patient wants, even if it doesn't work, is guaranteed to drive up costs, without any benefit to patients.  Let's ditch this bogus "discrimination" clause in the ACA, and insist that all medical care be held to the same high, scientifically rigorous standards.

Questionable for-profit cancer center profits from alternative therapies

It sounds like a crazy conspiracy theory: a secretive businessman founds a for-profit medical center to treat cancer.  His hospitals offer conventional treatments but also sell highly questionable, unscientific treatments to vulnerable patients. These treatments help to increase profits.  The businessman uses the profits from his cancer hospitals to support his favorite right-wing causes.  Patients have no idea that the fees they pay for treatment help support these causes.

It may sound unbelievable, but it's true.  Most of this story was described in a lengthy exposé just published in the Washington Post on Christmas day.  The Post revealed that Richard Stephenson, the founder of a large for-profit cancer center, is also one of the primary funding sources for Freedom Works, a right-wing Tea Party organization that played a major role in the 2012 elections.  As the Post story described him:

[Stephenson is] "a reclusive Illinois millionaire who has exerted increasing control over one of Washington’s most influential conservative grass-roots organizations."

Among other examples, the Post describes how

"more than $12 million in donations was funneled through two Tennessee corporations to the FreedomWorks super PAC after negotiations with Stephenson over a preelection gift of the same size....  The origin of the money has not previously been reported."

What the Post story didn't explain was the source of Stephenson's millions: Cancer Treatment Centers of America (CTCA), a private, for-profit company with five cancer hospitals scattered around the U.S.  Stephenson is the founder and chairman of CTCA.

For-profit hospitals present a big ethical problem, even when they provide proper care.  The problem is that motivation to increase profits may work against the interest of patients.  I don't want to debate that here, because CTCA has another, more serious problem.  Alongside standard, science-based cancer therapies, CTCA also offers an array of questionable, unscientific therapies, which it proudly labels as part of its "integrative cancer treatment."  CTCA advertises many such treatments, including:

• Acupuncture
• Acupressure
• Chiropractic
• Naturopathy 
• Homeopathy
• Mind-Body medicine (including Reiki and Qi Gong)

None of the treatments in this list has any scientific support showing that they provide a benefit to cancer patients.  Some of them carry a real risk of harm, as I've written about previously.  Acupuncture carries a risk of infection and chiropractic treatment has a risk of stroke - very small risks, admittedly, but no risk is acceptable when the benefit is nonexistent.  (See Science-Based Medicine for a summary of the science behind these and other alternative therapies.)

CTCA makes multiple unsupported, unscientific claims for its alternative treatments, such as:

• "Naturopathic medicine can help reduce these [cancer-related] symptoms, strengthen the immune system and support the healing process throughout your brain cancer treatment." 
• "Acupuncture may help to alleviate [cancer] treatment-related side effects, such as nausea and vomiting." 
• "When used during your leukemia treatment, our chiropractic care services can help correct bone, muscle and joint problems and restore nerve function." 

These are just a few examples. These claims, and CTCA's marketing of the therapies involved, present a huge ethical problem.  Cancer patients are facing some of the most difficult decisions in their lives, often while suffering through painful treatments, not to mention the fear that their cancer will kill them.  When a cancer hospital offers an "integrative" treatment with the promise that it may help, the patient is highly likely to try it, regardless of the cost.  These are extremely vulnerable patients, and CTCA is taking advantage of them to sell ineffective therapies.  CTCA and its owners, including Richard Stephenson, are profiting from their unsuspecting patients.

Offering treatments that are little more than snake oil to cancer patients is ethically indefensible.  Believers in acupuncture, naturopathy, Reiki, and homeopathy will argue that they are not unethical, because the treatments work.  This argument, though, flies in the face of overwhelming evidence to the contrary.  Those who argue that these therapies really work only demonstrate that they are unqualified to offer medical care.

Cancer Treatment Centers of America presents a very welcoming, positive picture of itself through its website, and much of what it describes is accurate.  However, its errors of omission are huge: nowhere does its website say that CTCA is a for-profit center, nor does it tell you that its founder is a major donor to right-wing political organizations.  And most critically for patients, CTCA offers a palette of pseudoscientific treatments, making medical claims that are not supported by any evidence and that in some cases violate basic principles of physiology and biology - although the website claims that its integrative treatments are "scientifically-based supportive therapies."

Let's put aside the right-wing propensities of its owners and simply focus on the science and the ethics of CTCA's "integrative" therapies.  Even if the treatments were free, there is no justification for offering treatments based on pseudoscience.  In the context of a for-profit hospital, where every treatment provided adds to the bottom line, the practice of pushing illegitimate treatments onto cancer patients is even more reprehensible.

[Note: the publisher of Forbes magazine, Steve Forbes, is a board member for Freedom Works.  In case it's not obvious, I don't speak for Forbes and they don't endorse the content of my blog, which appears both here and on the Forbes site.]

[Note 2: for a more detailed, critical look at some of CTCA's offerings and its claims, see this post by Orac at Respectful Insolence from mid-2010.]

Government subsidies for chiropractic education

Source: daryl-cunningham.blogspot.com

The U.S. is having a political debate about college tuition loans.  Everyone seems to be in favor of keeping the loan rates low, but politicians disagree about how to pay for the subsidized rates.  (The interest rate on government-guaranteed loans will double this July, from 3.4% to 6.8%, unless Congress takes action.)

Lost in this fight is any discussion at all about which students - and which colleges - get these subsidies.  Right now, the subsidized loans are available to almost any institution that calls itself a college or university.

But what about institutions that provide a substandard education?  Or worse, what about institutions that educate people in quackery and pseudoscience?  Subsidies to these institutions are worse than useless.  These so-called colleges spread misinformation that will require much more investment to correct, if it is even possible.  Why, to be specific, is the U.S. government subsidizing students to attend chiropractic colleges?

Chiropractic colleges are a relatively new invention, as is the entire profession.  Chiropractic was invented out of whole cloth by D.D. Palmer in the 1890s.  He mistakenly believed that misalignments of the spine, which he called subluxations, caused a vast range of health problems, even infectious diseases.  Over a century later, chiropractic colleges continue to preach this nonsense; here is what Palmer College of Chiropractic says:

"Improper function of the spine due to slight misalignments—called subluxations—can cause poor health or function, even in areas far removed from the spine and spinal cord itself."

Subluxations have never been shown to cause disease. In fact, subluxations of the spine have not even been shown to exist.  Despite the thorough lack of evidence, chiropractors appear to be quite skilled at keeping patients returning for "adjustments" to maintain good health.  I wonder how much time is spent in chiropractic colleges teaching students about the need for regular spinal adjustments? As retired chiropractor Sam Homola wrote recently:

"The only thing unique about chiropractic is its basic definition as a method of adjusting vertebral subluxations to restore and maintain health....  The subluxation theory has been the chiropractic profession’s only reason for existence since its inception in 1895."

I wonder, too, if chiropractic colleges educate their students about the risk of stroke from their treatments. The rapid head-twisting move that many chiropractors use, which produces a startling cracking sound in the neck, also carries a small but real (and frightening) risk of tearing one of the arteries in the neck.  Chiropractors dispute this claim, but studies have shown that patients with vertebral tears are much more likely to have recently visited a chiropractor.  A systematic review of the evidence in 2010 concluded

"Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit."

On top of their dubious educational programs, chiropractic colleges pay their presidents astonishingly high salaries, as documented recently in the Chronicle of Higher Education, which pointed out that

"the presidents of chiro­practic colleges are taking in some of the biggest paychecks in higher education." 

For example, the president of Logan College of Chiropractic, which has a budget of $24.5 million, earned $791,418 in 2009.  That's the same salary earned by the president of CalTech, which has a budget 100 times larger.

Low-cost student loans provide a benefit to many students and their universities.  But we don't need to subsidize erroneous and misguided colleges that teach their students nonsense.  If Congress is going to extend the student loan program, they should take this chance to make the program far more selective.  Helping students get a good education helps the country.  Lending students money to learn pseudoscience does just the opposite.

Chiropractic adjustments can heal your DNA?

The headline above should be good for a laugh, but believe it or not, chiropractors around the world are claiming that they can help your body repair its DNA. All of them cite the same 2005 article as evidence, so I read the article to find out what it was all about.

The article is titled "Surrogate Indication of DNA Repair in Serum After Long Term Chiropractic Intervention – A Retrospective Study," written by Clayton Campbell, Christopher Kent, Arthur Banne, Amir Amiri, and Ronald W. Pero. They published it in 2005 in a chiropractic journal called the Journal of Vertebral Subluxation Research. This journal has many of the trappings of a scientific journal, but it's really all make-believe: it does not appear to be properly peer-reviewed, it is not indexed by standard biomedical databases, and (most damning of all) it is based on a concept, "subluxation," that does not exist. That's right, even the UK's General Chiropractic Council admitted in 2010 that subluxation was a mirage, saying:

"The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns."

So about that journal article. The claim that chiropractic treatments could somehow improve your body's ability to heal its own DNA seems wildly implausible, but that's what Campbell and colleagues claim. Their press release, which was reproduced verbatim on many chiropractor's websites, said:

"In a landmark study published in the Journal of Vertebral Subluxation Research, chiropractors collaborating with researchers at the University of Lund found that chiropractic care could influence basic physiological processes affecting oxidative stress and DNA repair."

(I can't help remarking that authors don't usually boast that their own work is a "landmark study," but let's move on.)

Unfortunately for Campbell and colleagues, their study has fundamental flaws that completely undermine their claims, as we'll see below. Nonetheless, many chiropractors' websites are touting this amazing "benefit" today, including sites that were updated as recently as a few weeks ago, such as: this one (updated Oct 31 2011), this one, this one, this one in Australia (updated Oct 2011), this one in Australia, and many more.

So what did Campbell et al. actually study? First, they didn't measure DNA repair at all. They measured serum thiol levels, which at best are a very indirect indicator of DNA repair. And they ran a very small study, with just 76 patients, all who came to chiropractic clinics with back pain, whom they divided into 3 groups. The three groups were:

1. No chiropractic treatment, 30 patients
2. 2-12 months of chiropractic, 21 patients
3. 1-6 years of chiropractic, 25 patients

It was not placebo-controlled, blinded, or randomized, which presents major methodological problems regardless of what happened. Before I tell you the results, which group do you think the chiropractors would want to do the best? Bingo! The group that saw chiropractors for many years did the best, as measured by plasma thiols. At least that's what Campbell reported.

But the results were very odd: first, they saw a drop in plasma thiol levels (a drop is a bad outcome, for this study) in patients treated for 2-12 months, from 124 down to 105. But hang on: in the long-term chiropractic treatment group, the average level was 146. So are we supposed to believe that chiropractic is bad for you in the first year, but good for you after that? The problem gets worse, though, when you look at their claim that "there were statistically significant differences in the serum thiol levels of the three groups." None of the serum thiol levels were significantly different: their claim is simply wrong.

[Note: skip the next paragraph if you don't care about the statistics. But the statistics matter.]

Yes, that's right - Campbell et al. got their statistics wrong. Oops! They reported that the 2-12 month group had signficantly lower serum thiol levels, and the 1-6 year group was significantly higher levels, with a p-value of 0.001. From the numbers in their own tables, I was able to compute the true significance values, to determine if their reported value of 146 (plus or minus 60) was significantly higher than the control group's average of 124 (plus or minus 48). It turns out that this difference isn't significant at any level, and certainly not at a p-value of 0.001. A decent journal would never have published this painfully bad analysis.

There are other problems, but this huge error in their central result is devastating. And not surprisingly, no one has replicated these non-results since.

This hasn't deterred Chad Mathey, a chiropractor in Colorado, from posting this comment on his blog just a few weeks ago:

"This [the Campbell et al. study] is an incredible article! This talks about one of the many reasons people do and should stay under regular Chiropractic care. It’s not just for pain and people are starting to finally understand this."

Incredible indeed. As in "not believable" and "not even close to true."

This is another illustration of how pseudoscientists use the trappings of science to do make-believe science, and then advertise their "findings" to the world, just as Dr. Oz did in his recent apple juice and arsenic experiment. Dr. Oz didn't even publish his findings - he just announced them on his show. Campbell and colleagues used a pseudoscience journal. After all, who's gonna know?