24 Sep

Broadcasting Substandards

Published by MacDoctor on September 24th, 2009
35 Comments »

I have just read on Dr Shaun Holt’s site that the Broadcasting Standards Authority has upheld a complaint against TVNZ about Shaun’s appearance on the Breakfast Show, discussing Chiropractors. To say the least, I am appalled. It is completely unconscionable that two lawyers and two journalists have called into question his medical expertise, without even an attempt to glean some medical opinion from elsewhere. Essentially, they have just taken the word of the chiropractors that Shaun is wrong, without establishing any understanding of the issues involved. They have just said, essentially, that anyone who believes that chiropractic manipulation of the neck is dangerous, is wrong.

The MacDoctor begs to differ. He knows a great deal about this issue and he would not recommend his dog have a chiropractor work on his neck, let alone his patients. Even though the risk of stroke is cited in the literature as low as 1:1.85 million, this is not relevant as there is absolutely no decent evidence that neck manipulation does any good at all. Therefore you are taking this small risk for NOTHING.

I am baffled as to how the BSA managed to reach their clearly stupid conclusion. Shaun was more than gracious to the chiropractors, conceding their expertise in lower back problems. The chiropractor was allowed to stage-manage a very slick sales pitch during his segment. Not one single useful question was asked of him. No questions like – is their any evidence that it works? What about the $500 million malpractice suit in the US?

If TVNZ were slanted in their reporting, it was towards the chiropractor, by virtually allowing him a free ride.

But the section in the BSA report that really gets my goat is this:

“[52] In the Authority’s view, the information supplied to it by Dr Holt (see paragraphs [29] and [30]) does not provide sufficient basis for his statement that chiropractic treatment “can cause stroke”. While the studies may have shown an association or correlation, they do not conclude unequivocally that there is a causal connection. The Authority also notes that both the complainant and Dr Doug Blackbourn maintained that the research shows that the correlation between chiropractic and stroke was no stronger than that between stroke and visiting a GP.

“[53] In these circumstances, the Authority finds that this statement was inaccurate. [emphasis mine]”

This is where the BSA attempts to set itself up as a judge of medical evidence. What they do not seem to appreciate is that the incidence of Vertebrobasilar artery dissection (VBAD) (a tear of the spinal artery in the neck) is very, very small (i.e. it is very rare). Consequently, it is very hard to run any sort of trial on the issue and the information we have is very sparse. A recent trial concluded that the risk of VBAD after a visit to a chiropractor was about three times greater than normal, but that this was similar to the risk of seeing a GP. This trial is quoted by Mr. Doug Blackbourn (Whose website, BTW, clearly suggests he can treat asthma – and calls him a “doctor”). Unfortunately for Doug, the conclusion that the risk is similar is based on the false assumption that the likelihood of someone with a dissecting VBA visiting a doctor is the same as them visiting a chiropractor. Yet less than half of dissecting VBAs present with solely neck pain (most present with a headache at the back of the head). The similarity of incidence is therefore deceptive as far, far fewer VBAD cases from the total pool of such cases will present initially to a chiropractor rather than a doctor. The conclusion of the authors is therefore likely to be wrong and there is probably a causal link between neck manipulation and VBAD.

In addition, the BSA do not seems to appreciate that, in the absence of good studies, one has to rely on anecdotal data. This is the data that Shaun was quoting and which they dismissed out of hand. Should they have bothered to inquire of any neurosurgeon, they would have been told that the wealth of anecdotal evidence is very worrying and is certainly not easily brushed off. Here is an example. These are not wild internet speculations, but well-researched and published cases. One of them is the now famous half a billion dollar lawsuit.

The point here is that the BSA has no brief to try and assess the quality of a technical debate. This is something that should concern any professional who is asked to give his expert opinion on TV. We give those opinions in good faith and we do not expect to have to defend ourselves to the media equivalent of the Spanish Inquisition. It is especially irritating to try and place the debate in accessible terms for laymen to comprehend, only to have people who do not know the first thing about the issue pick apart your every word, regardless of the fact that you have been unable to speak in precise scientific terms.

There are not a lot of professional people who are as able as Shaun to come across well in the sound-bite orientated world of TV. Should the BSA persist in attempting to analyse the scientific content of professional opinions in this highly inappropriate manner, you may rest assured there will be fewer. They have just perpetrated a grave disservice to scientific representation and debate on TV. Shame on them.

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