Monday, January 30, 2006

Dubious therapy of the week: "Touchless" chiropractic

I've been looking critically at various claims of alternative medicine practitioners and outright quacks for a while now. I thought I had heard everything. I didn't think there was a claim that I could come across that was so outrageous, so obviously and ridiculously bogus, that it would still have the power to surprise or shock me.

Then I came across "touchless" chiropractic manipulation.

Touchless? Yes touchless:
The popping sound, the grunting and the hands all belong to Dr. Johanna Hoeller. What she does has been described by some as nothing short of a miracle.

Dr. Hoeller is a chiropractor who specializes in a procedure where the atlas or C1 – the small doughnut-shaped ring at the top of the spine – is carefully adjusted back to center, thus balancing the spine.

This practice is part of NUCCA – National Upper Cervical Chiropractic Association.
But it's how the doctor does the adjustment that leaves many of her patients wondering.

Mike West, the morning DJ for KMTT, has been seeing Hoeller for more then 7 years.

“I remember going on the radio and all of sudden, click, and I would have to crawl off the floor to go to the doctor to get her to fix,” he said. “I don't know what she does but it works.”

What has West and other patients – some from as far away as Alaska – scratching their heads is the fact that Joanna Hoeller does not really touch them.

“I'm not a witch doctor,” said Hoeller.
But wait, you say. Isn't chiropractic dependent upon spinal "manipulation" to treat everything from back problems to, say, migraines or asthma? And doesn't that manipulation or "spinal adjustment" depend upon the chiropracter's supposed skill in realigning your spinal column using good old-fashioned muscle? At least that's what I always thought chiropractic involved.

You can learn about it from a video segment done by a particularly credulous host named John Curley for a show in Seattle called Evening Magazine. After the Curley's introduction, in which he describes how his wife had been suffering neck pain after an auto accident and had given up on getting relief, the video segment went to a photo of Joanna Hoeller leaning over a patient moving her hands over his neck and grunting. We hear popping sounds. It certainly seems as though she's doing something. But what? No movement of the patient's neck or head is observed.

"I'm not a miracle-worker," she says. "The miracle is the human body. It's just a gentle procedure, and, when it's gentle, people have a difficult time with it sometimes."

The procedure is apparently so gentle that it doesn't even require Dr. Hoeller to touch the patient.

No, Dr. Hoeller, I don't have a difficult time with your procedure because it's so "gentle," but rather because there's no physical basis for it to work unless you believe in some sort of magic or "energy transfer." Even by the stated basis of chiropractic of realigning the spine as a means of treating disease, it can't work. Indeed, one of her patients interviewed on the segment unintentionally seems to nail it on the head when he said, "I used to try to figure out what she did, and how she did it. I do believe she has some sort of magical powers. I just think she's that kind of a person."

Another patient: "Like I said, if it works I like it. I don't care what it is. Hocus-pocus, whatever. If it takes the pain away, hooray."

Hocus-pocus indeed, Hoeller's claims sure sounds like magic or hocus-pocus, and it would take such a belief in magic to think that such a ridiculous "therapy" could work. (Calling the Amazing Randi!) For one thing, it's not the patient's neck that's popping, but Dr. Hoeller's wrists, something Curley himself narrates later in the segment, when he says that Dr. Hoeller will keep doing the adjustment until the "popping in her wrist stops." Says Hoeller, "My body is my instrument, so to speak. When the atlas and the structure is correct, my hand tends to stop popping. So that's how I generally have a feedback of whether something is now locked, and then no more force can get in there." Worse, she takes before and after X-rays of the patient's skull and cervical spine. The first one shows (of course) that the patient's spine is horribly "out of alignment," with her head sitting at least a 2 cm lateral to where it should be relative to the atlas (never mind that if her head were truly that much out of whack relative to her spine, her spinal cord would probably have been crushed or severed). And--miracle of miracles!--the second one is almost "perfectly" aligned. In fact, if you look closely at the two X-rays, all that changed is where Dr. Hoeller drew her blue and red lines, as Skepdic showed very nicely here.

Hard to believe that anyone falls for this, isn't it? What's even harder to swallow is the part where Curley shows Dr. Hoeller a videotape of herself in action, and she claims she had never realized that she wasn't touching the patient. Come on, give me a break! What we have here is simply confirmation bias and self-deception on Dr. Hoeller's part, probably with a dash of magical thinking thrown in for good measure, and the placebo effect on the part of the patients. There's almost certainly a bit of regression to the mean (also known as the regressive fallacy) in there as well.

Of course, even if Hoeller could do what she claims without touching her patient, there is no basis in science to assume that upper cervical adjustment will do anything. She uses a method called N.U.C.C.A (for National Upper Cervical Chiropractic Association). This flavor of chiropractic teaches that many diseases can be treated by "adjusting" the upper cervical spine, specifically C1 (the atlas) back to "center," thus supposedly "realigning" the spine. To quote Joanna Hoeller, "Just when you thought you have tried everything, have you checked to see if your head is on straight?"

No, Joanna. Have you?

To see a whole bunch of pseudoscientific altie claims, one need only look at NUCCA's website, which greets visitors with:
An era of amazing recoveries from illness began over 100 years ago, with the discovery of Chiropractic by an American, Dr. Daniel David Palmer. Thousands of patients, who had given up hope of finding any help, recovered from their illness by the improvement of their nervous system function.

Sixty years ago, a study of upper-cervical cases revealed that sick folk, possessed by over 5,000 different types of diseases, were in large measure restored to good health and long life by restoring a good communication link between the brain and body!
Over 5,000 types of diseases can be restored to good health with this method? Apparently so, according to NUCCA:
After an upper cervical correction...

"An 80 year old man, suffering from numbness in both legs, receives an upper cervical adjustment and immediately experiences a return of normal feeling and mobility in his legs."

"A new scientific research study just concluding reveals Chronic Fatigue Syndrome and Fibro Myalgia cases have recovered in 3-12 months, but the Mayo Clinic reports 3 years of drug treatment with no improvement or hope."

"ADD (Attention Deficit Disorder) and similar cases have shown remarkable recovery with neck correction, enabling the freedom from the harmful drugs used in such cases... drugs now suspected of addicting some children."

"A thirty year old father was sent by his neurologist for an upper cervical analysis and correction. He had suffered from migraine headaches for ten years with severe side effects which disabled him from his work for 3 to 5 days per week. No treatment which he had received had helped him. Two adjustments left him symptom free for two years. A truck accident caused a temporary relapse but for over 5 years he has been symptom free!"

"A child with bronchial asthma breathes normally again, the acute attack stilled by a chiropractic adjustment!"
Nothing but testimonials.

I can see how one might--I repeat, might--get relief from spinal manipulation for nerve root compression or back pain, but no chiropracter has yet been able to explain to me how it can do anything for asthma, migraines, ADD, or chronic fatigue syndrome, or any other disease not related to the spine. The NUCCA site (like every other chiropractic site I've seen) is long on testimonials and impressive-sounding jargon about nerves and the spine and short on actual data from scientific studies and clinical trials.

What's next? Autism? Yes, chiropractors even claim they can treat autism and hiatal hernias. Is there any disease chiropractors can't treat by manipulating the spine?

Apparently not. And at least one of them doesn't even need to touch the patient to do it.

Traditional Chinese medicine healers who practice qigong (energy healing) had better watch out. It looks as though at least one chiropracter is getting ready to muscle in on their business.

11 example(s) of insolence returned:


At 1/30/2006 9:04 AM, Anonymous TheProbe said...

Several years ago there were a flurry of messages in the AD/HD support group from chiropractors advocating adjusting C2. I told one, who was particulary obnoxious, that causing quadriplegia was a great way to control hyperactivity, but really sucked as treatment for attention control. He was none too pleased.

However, now that they have invented "touchless chiropractic" I think Orac should spend some time developing and perfecting touchless cancer surgery. Look at the advantages: the end of the surgical scrub as we know it, you can start operating when you get in your car in the morning, you never freally have to speak with a patient, all sorts of things...

Following that, touchless proctology, hands on psycholoanalysis....the list is endless...

 

At 1/30/2006 9:06 AM, Blogger John Stone said...

Vera Schrieber's "Therapeutic Touch" on crack???

 

At 1/30/2006 10:19 AM, Anonymous Mark Paris said...

This just shows that when it comes to the placebo effect, you really can just phone it in.

 

At 1/30/2006 12:05 PM, Anonymous Anonymous said...

Goddamnit, you know I hate altie therapies almost as much as Orac (great blog, been a reader for a long time now), but the worst thing is what this is doing to a legitimate chiro. I had intermittent back pain, especially while driving, went to a guy twice, and never had a problem again. Of course, first question I asked him was if he believed he could cure a cold with manipulation. He laughed and said that was the usual shit he heard at conferences, and knew just how stupid it sounded, and was. It's a shame these people can't just stick to the problems that they CAN treat, and leave viruses, bacterial infections and the like to the people who, I don't know, actually STUDY these things?

 

At 1/30/2006 5:03 PM, Anonymous Anonymous said...

Later tonight I'm going for a touchless Shiatsu followed by a touchless happy ending

 

At 1/30/2006 6:03 PM, Anonymous Anonymous said...

Maybe they can add this as a service at the "touchless" car wash I use.

 

At 1/30/2006 8:50 PM, Anonymous HCN said...

I have a teenager who uses this philosophy when he vacuums. He just kind of waves the floor tool in the vicinity of the floor when he "vacuums".

Maybe there is a future for him as an "energy healer".

 

At 1/30/2006 9:06 PM, Blogger clone3g said...

HCN said...
I have a teenager who uses this philosophy when he vacuums. He just kind of waves the floor tool in the vicinity of the floor when he "vacuums".

That's called a Kirby,
Kinda sucks, just touches the surface, and keeps going and going.....

 

At 1/31/2006 9:41 AM, Blogger Clark Bartram said...

I admit she's one of the worst. I showed the video of her to a few other pediatricians at work and used it as a great opportunity to learn them on the quackery of chiropractic. It amazed me that so many MD's(myself included until about a year ago) don't realize how often things like this go on in the real world. That's why I did my Grand Rounds on chiropractic. Keep up the great work and thanks for the plug on my blog.

 

At 2/10/2006 3:34 PM, Anonymous alternative health said...

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I just thought I'd write a short note to let you know that I think you have a very good blog. I enjoyed the posts I read here today. I'll be back. Keep the good info coming.
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At 2/10/2006 4:11 PM, Anonymous herbal remedies said...

This comment has been removed by a blog administrator.

 

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