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A local chiropractor cannot accept that some seriously ill swine flu patients had no underlying health issues: Sorry, no, there is no way that these people were “otherwise healthy”.

The medical examinations showed that they had no underlying health issues. But this chiropractor won’t accept that.

I feel for the families of those who died, or patients that survived, who had no “underlying conditions”. It must be galling to read someone make out that they “must” have had “underlying health conditions”, just to satisfy his beliefs.

He seems to believe that people cannot become seriously ill from a viral infection unless they have some predisposing condition and is trying to find some way to make that true. He even evokes imaginary “issues which aren’t well known or accepted by today’s science” to try excuse the presence of the people with no obvious health issues. Desperate stuff, surely?

His advertisements are advertorials really, as fellow blogger Robert pointed out, advertisements mocked up in the style of an editorial or serious journalistic article (he says so himself on his website, too).

First, a quick word about my quotes: these are typed by hand from his advertorial on page 5 of The Star, October 22, 2009. Despite claiming that you can get the PDFs from his website, he seems to have stopped that in January of this year. I’ve done my best to avoid transcription errors. If any remain let me know, I’m happy to put them right.

I’ve left his name out to emphasise that it is his claims that I am addressing, not the person.

He starts his swine flu claims with an irrelevant and frankly slight bizarre aside about how anti-bacterial soap could not affect swine flu. My impression is that he is trying to show himself as not being pseudo-scientific and make what, to me, is a feeble attempt at humour to curry favour with the reader. It fails for me: it’s clumsy and it’s irrelevant.

But it’s not terribly important, so onwards. He then states his case about underlying health issues in those seriously affected by swine flu:

Out of those who were seriously affected, the vast majority had obvious, substantial underlying health conditions which set them up for problems.

‘Cherry picking’ and ‘inflating the evidence’ are phrases that come to mind.

Most people would take “the vast majority” to mean 90% or thereabouts and “obvious, substantial underlying health conditions” to mean the likes of clinical obesity, long-time heavy smoking, serious heart condition and so on.

He’s overplaying his hand.

Certainly some studies report that a majority of the serious cases of swine flu have some underlying condition. This study does (73%; full text available free) but this one doesn’t (3% of the total cases and by inference ~43% of the hospitalised cases). By selecting one result or other, I could say either. My guess–I have no option but to guess as he hasn’t substantiated his claim in his advertisement nor provided a source for his claim–is that he has cherry-picked the paper presenting the largest figure to suit his case, presenting this as if it were the definitive word, overlooking other studies.

A recent NZ and Australian study reported somewhere in between: “Overall, 229 patients (31.7%) had no known predisposing factor.”

The WHO (World Health Organisation) states clearly in it’s latest update (#70, 11 October 2009):

A significant portion of patients with severe disease requiring intensive care had no predisposing conditions.

and referring to the studies it cited:

All three groups were impressed by the number of severe cases occurring in previously healthy individuals.

The chiropractor is most welcome to take his claim up with the WHO.

You cannot simply take the biggest number and claim it supports your idea. In any event, even the study reporting the highest frequency of patients with underlying conditions (73%) concludes “Although underlying medical conditions were common in the 272 patients we evaluated, we also identified severe illness from H1N1 virus infection among young, healthy persons.” As much as the chiropractor would like the “big number” to support his belief that only those will an underlying condition get seriously ill, it doesn’t.

Simplifying: he’s exaggerating.

The studies noted above indicate at least one quarter of serious ill patients had no underlying health condition, possibly more.

At a deeper level the chiropractor’s argument really needs to take into account more subtle issues. So that I don’t bomb the reader with detail, I’ve given a small sampling of them in colloquial form in the notes.

The “biggie” of these is that pointing to those who have underlying conditions doesn’t explain those who don’t. The chiropractor seems to realise this and struggles with it, as we shall see.

For example, in the USA study: 60% of children had underlying conditions, higher than for typical seasonal flu (31 to 43%), but what of the 40% that didn’t?

But onwards. Next he goes on to “observe”:

However, the news media also reported that some who became seriously ill were younger and “otherwise healthy”. The subtext was that swine flu could get anyone, at any time, with little warning.

Well, the scientific reports do say that some were young(er) and otherwise healthy. Reading your own meanings into other’s words is a dangerous game, usually serving only to feed your own bias.

His subtext appears to be that this is a media whip-up or a conspiracy, to which he replies rhetorically:

Sorry, no, there is no way that these people were “otherwise healthy”.

Bad move, that. Big mistake. You don’t get to dismiss out-of-hand what doesn’t suit you.

Whereas before a supporter might have defended him saying “it was only a little exaggeration”, here he makes a flat-out assertion based on nothing. Well, based on what he might desire to be true, perhaps, but not based on evidence.

He seems to recognise that he has no support for his claim, he goes on to “find” excuses to make these people have underlying conditions:

Their susceptibility may have been subtle or hidden ([...]) but you can bet that it was there. [...] Those “otherwise healthy” persons who fell seriously ill almost certainly had subtle underlying susceptibilities which set them up for increased problems. These may even be issues which aren’t well known or accepted by today’s science.

Based on what? Might be, maybe, with no evidence? Sorry, it doesn’t work like that. If you haven’t got something to back a claim, it’s an empty claim. Begging for evidence that doesn’t exist won’t make it so.

This goes far beyond extrapolating the data, it’s hand-waving, claiming that the evidence “must” say something it does not.

Next he writes:

But instead of reporting that these victims “did not have any known health issues” they were reported as being “otherwise healthy”.

Erm. Same thing, surely…?

Reading further we see the likely reason why he makes this seemingly odd claim: he wants to place his (chiropractor’s) definition of ‘healthy’ into these anonymous reporters’ words.

Sorry, but you don’t get to do that. You get to read their words with their meaning, not read your own meanings into their words, then declare, or imply, that they are telling fibs.

To further compound his troubles, his definition of ‘healthy’ doesn’t do what he seems to think it does, at least not for me:

What does being “healthy” actually mean? It’s not about some fragile state of feeling and looking good. It goes much deeper than that. It’s about internal resilience and developing a sound constitution able to respond quickly, appropriately and effectively when a serious health challenge does arise.

Well, OK. Accepting that it’s vague and lacking specifics, how is this different from saying “sound of body, free of disease” as per the dictionary definition? Sure, he wants to make it more than “feeling good”, but so does modern medicine.

All round, it’s a case of trying far too hard to make true what he would like to be true, when the evidence doesn’t support him.

I’ll give him a tip: stick to talking about the spine.

PostScript

A quick check of the medical registry for the Dunedin area,  suggests that the chiropracter is not a registered doctor, consistent with his claim that his qualification is a B.Chiro. from the New Zealand College of Chiropractic. I believe there is a legal means for these people to place “Dr” by their name, provided that they clearly state that this in a chiropractic role. Personally I feel the use of the title should be reserved for those who are registered medical practitioners as has been argued elsewhere, as few members of the public will be aware of the distinction.  (See also David Colquhoun’s blog.)

Further reading

1. Use of inappropriate titles by New Zealand practitioners of acupuncture, chiropractic, and osteopathy Andrew Gilbey, Journal of the New Zealand Medical Association, 25-July-2008, Vol 121 No 1278

2. David Colquhoun’s blog, July 25th, 2008, has a good article with links to explain the chiropractic story more fully.

3. Two lawyers and two journalists squash criticism of chiropractic on TV from David Colquhoun’s blog September 23rd, 2009 This includes a video of Shaun Holt on Breakfast TV: well worth reading & viewing.

3. UK Skeptics webpage ‘Chiropractic‘.

4. “CHIROPRACTIC BELIEF SYSTEMS” from Chiropractor.com

5. From the ‘Stuff and Nonsense‘ blog

Notes

At a deeper level the chiropractor’s argument needs to deal with more subtle issues. So that I don’t burden the reader with detail in the main article, I’ve given a small sampling in colloquial form in the notes below. There’s much more to this: a whole scientific field, epidemiology, is devoted to this sort of thing. I’m just giving a sprinkling of the gist of it, so that people might see there’s more to it than the simple “majority” he presents:

  • The frequency of the potential underlying conditions in the population with the ‘flu need to be compared to the frequency of the same condition observed without the ‘flu and corrected for relevant things like sex, age, etc. It is difference in frequencies in the two groups that tells us if it is a likely risk factor. It needs to be remembered that the current studies are primarily intended to quickly give the medical community in the northern hemisphere the broad picture. More detailed studies will probably come later.
  • It needs to be established that each potential risk factor in fact causes an increase in the disease, i.e. that it’s causative, not a factor that has no effect. As the WHO update #70 points out, a number of the factors measured are “not considered risk factors for severe influenza outcomes”. If some potential risk factors are in fact not, the frequency of patients with underlying risk factors would fall.
  • Pointing to those who have underlying conditions doesn’t explain those who don’t. In fact that’s what the chiropractor struggles with, as we shall see. In the USA study: 60% of children had underlying conditions, higher than typical seasonal flu (31 to 43%): what of the 40% that didn’t?

Some might say the papers don’t explain these and other issues, the authors assume readers know. That’s the chiropractor’s problem, really: if you’re going to make claims on the basis of expertise, it’s your responsibility to do the homework.

As far as I am aware, the data isn’t in to weigh these and other issues.

The exact frequency of “underlying health conditions” reported each study will depend on what conditions are examined and the criteria used to include (or exclude) them. These vary from study to study, making direct comparisons between the different studies meaningless without some attempt to standardise them.

© Grant Jacobs, all rights reserved.