What the chiropractor said

By Grant Jacobs 24/10/2009 18

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.


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


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.

18 Responses to “What the chiropractor said”

  • “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.”

    Given that the original advertorial was published in a public forum (The Star) and that the claims and beliefs of an individual are part of what makes the person I don’t understand the hesitancy to post this persons name. By leaving it out it allows him a certain level of anonymity and removes the ability to defend themselves against your claims.

  • I’m only interested in the claims made, not the person. I am encouraging others who choose to comment to also focus on the claims, not the person. Seems a respectable thing to do, surely?

    There was no “hesitancy to post this person[‘]s name”, “hesitancy to use his name” was not the reason I didn’t use his name. After all it’s trivial for anyone to find out. In fact, I wrote explaining why I left his name out precisely because I wanted to make it clear it’s because I’m interested in the claims made, not the person (or their business for that matter).

    Perhaps this may help: in a discussion what’s is said that matters, not who says it. I disagree with the logic of what was said in his advertisement; who said it isn’t really important to me. A Nobel laureate could have said it, I’d still think that the logic was lacking, who said it is besides the point. And we have to admit there have been some rather ill-advised things said by a few Nobel laureates too!

    As a scientist I prefer to leave the personal aspects out; others can do that should they want to, I’d rather just focus on the claims.

    By leaving it out it allows him a certain level of anonymity

    I’m fine with that (as think is obvious).

    and removes the ability to defend them­selves against your claims

    Excuse my being blunt, but that’s nonsense. He’s perfectly able to defend himself.

    In fact, far from removing his ability to defend himself, I’ve increased his options.

    He could volunteer that he’s the person referred to and defend himself openly, should he want to, but I’ll give him the courtesy of choosing for himself if he wants to, not impose it on him. If he doesn’t want to, that’s fine. After all, it’s his claims I’m interested, not him.

    Alternatively, he could post anonymously and defend his claims. It wouldn’t bother me. I’m not interested in the person, just his claims.

    For that matter, anyone else can come along and defend his claim. That’s fine too. My interest is in the claims, not the people.

    Just fun food for thought: you’re using what I would take to be an anonymous name… 😉 Does that block me from defending myself? If I used an anonymous name would it block me from defending myself? And vice versa for reverse roles.

    I’ll stand by encouraging people to focus on the claims, not the people, on this forum. Sure I didn’t have to do it, it was only a gesture of doing the right thing by others, even if you don’t agree with them.

  • “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.’

    That’s because out there in alt-med world, people only become sick for a *reason* therefore the concept that otherwise healthy people can die from the flu or vaccine-preventable illnesses cannot be accepted. These people believe that if they do the right things – eat right, do “maintenance” chiropractic adjustments, flush out their colon or whatever they become pretty much untouchable and can prevent any disease you can name. A typical quote would run along the lines of “…good health which starts with a balanced diet that includes important vitamins and minerals is safer and more effective at preventing many diseases…” even though that doesn’t do anything to prevent infectious disease of itself. It’s more akin to religious belief and of course if someone dies or is injured there must be something that caused it, if not underlying medical conditions (which is a good one because they can often implicate the medical treatment for the original condition itself in causing the problems) or that they must have not eaten right or not followed the precepts of whatever ritualistic approach to health the alt-medder promotes. It’s just a variation on the normal approach where in this case it simply can’t be that “healthy” people can have invasive disease, there must have been something else wrong with that person like the imaginary “subtle under­ly­ing sus­cept­ib­il­it­ies” that are created to explain this so he forgets that these are all people with grieving families and denies that a person doesn’t necessarily have to have a reason that they were affected so severely or even got ill in the first place. In this case the chiropractor shies away from the question of what that person may or may not have done wrong and focuses in on that there had to be something else medically going on as their redefinition of ‘healthy’ changes from not just feeling well and the absence of disease to having some extra deeper quality (which presumably he can treat) which is considered absent in those that died.

    “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.”

    I’ve tried checking into this myself, and what I found out from the MOH was that “medical practitioner” is a protected term so if he touted himself as such this would be illegal. I believe this is the same for terms like registered nurse. Doctor isn’t a protected term though, you can have people with non-medical PHD’s calling themselves Dr although in most cases they’ll make it clear their speciality or you can even have such things as firms that call themselves Dr. Grass lawn mowing and it’s all fine. It’s not necessary to say in what context you are calling yourself doctor though and in the previous example of the company name it’s fairly obvious that it’s not meant to be in connection with delivering medical services but in the context of chiropractors and the like they call themselves ‘doctor’ plainly to use the term’s association with medical practitioners and the services they provide in the mind of the public. That’s where it gets dodgy, and even worse when it’s used when they don’t even have any advanced qualifications. Because the term doctor is used colloquially in a number of contexts, this is unlikely to change as it would be a nightmare considering the term is used an awful lot in things like company names or in the context of PHD’s in other fields so it means as it is, I can say I’m a doctor to anyone and nothing can be done about it.

  • “He could volun­teer that he’s the per­son referred to and defend him­self openly, should he want to, but I’ll give him the cour­tesy of choos­ing for him­self if he wants to, not impose it on him. If he doesn’t want to, that’s fine. After all, it’s his claims I’m inter­ested, not him.

    Altern­at­ively, he could post anonym­ously and defend his claims. It wouldn’t bother me. I’m not inter­ested in the per­son, just his claims.”

    From this point of view that’s fair enough. No mention had been made that you’d informed the individual that you had made this post though, hence my reaction. Posting something on a blog doesn’t automatically tell everyone that needs to know that it is there.

    “Just fun food for thought: you’re using what I would take to be an anonym­ous name… 😉 ”

    Heh. :) You’d think that, but that is my full legal name. Check with Amiee. 😉

    “Does that block me from defend­ing myself? If I used an anonym­ous name would it block me from defend­ing myself? And vice versa for reverse roles.”

    No, not at all. I guess I’m just one of these people that think that if you believe in something you should be willing to stand up in public and say it. If not, you should really reassess why you’re holding on to it.

  • diaz,

    That’s because out there in alt-med world, people only become sick for a *reason* therefore the concept that otherwise healthy people can die from the flu or vaccine-preventable illnesses can not be accepted. […]

    Thank you for describing all this out so well. I agree; my impression of what lies behind this claim is that chiropractors (as a “movement”) believe what you’ve described. I included links to other sources that have this background under ‘Further Reading’.

    Your comment that “It’s more akin to reli­gious belief” reminds me of the number of “spiritual” movements/organisations at the recent Natural Health Expo (see http://sciblogs.co.nz/code-for-life/2009/10/14/sales-fest-or-science/), it’s not something you’d expected at a medical conference or sales expo!

    I’ve tried checking into this myself, and what I found out from the MOH was that “medical practitioner” is a protected term. […]

    Thank you for the nice explanation. It’s almost as if we need an short-hand for “medical practitioner” and encourage that be used in place of “doctor”. Bit hard to shift a long-established name that has the mindshare, though.

    Further reading: the Chiropractic Board of New Zealand in August 2008 wrote in reply to the article I linked (see the first item in further reading) wrote: “However, it should be noted that Chiropractors are permitted to use the title ‘doctor’ when this is suitably qualified to show that the title refers to their chiropractic role.” ( http://www.nzma.org.nz/journal/121-1280/3224/ )

  • gold,

    if you believe in some thing you should be willing to stand up in public and say it.

    I already have stood up and presented my argument in public; adding names won’t add anything to it. I think it’s quite clear that I “believe” in what I’ve written (but see below regards “belief”).

    Adding names will not make what I’ve written more so or less so. Not naming the writer makes doesn’t make people not believe their argument against the writer’s claims. That “who wrote what” doesn’t change an argument is the bigger part of the reason scientists don’t deal with who wrote what, but with what was said.

    There are a lot of people out there who seem to think that these things “must” be hot-blooded “naming and shaming” “bull fights”. That’s their idea of entertainment and I guess it’s good for getting the blood flowing, if that’s what you want. Some people, like me, may simply prefer to just look at the claims made 😉 Personally, I think I’m stronger for focusing on the substance.

    I can say the same for diaz’s reply for the matter; full of good substance and adding names wouldn’t alter the points diaz made.

    As an aside, as a skeptical scientist I’m not using “belief” or “believe” — see http://sciblogs.co.nz/bioblog/2009/10/12/belief-vs-acceptance/ Pedantic, maybe, but some phrase like ‘my argument is that’ is more accurate… 😉

    If not, you should really reassess why you’re holding on to it.

    The “if not” is an “is”; I’ve already said what my current stance is in public. In any event, and with all due respect, I’ve already explained that all I am doing is keeping the focus on the claims made. There’s no need to try read further into it.

    As a scientist I’m not really interested in the particular person who made a particular claim. It’s my choice. Other people can “name and shame” if that’s their thing. If it’s your thing, set up a blog, if you haven’t one already, and go ahead. You’re free too, after all, just as I’m free to choose to just focus on the claim if that’s how I want to approach it.

    For other issues I may choose other approaches, it’s just how I’ve decided to tackle this one.

  • Oh dear, my last reply was completely taken out of context. :/ I was more aiming that at the unnamed advertiser. Saying that they should be willing to put their name to their beliefs. I was also hesitant at the inappropriate use of the “B” word. I really should stop posting when rushed.

    I understand your points though.

  • honey,

    Certainly, but I suggest you check that you’re really doing much better before pointing at your fellow chiropractor. (While this guy’s argument is clearly silly, it’d be a bit rich to try hold the high ground if your own claims don’t stand up to scrutiny.)

    Since I wrote the article above (which is quite old now) I have pointed to evidence that reports that subluxations don’t exist (which the existence of chiropractic depends on and your website supports) and a more recent survey reporting that the only chiropractic treatment that has evidential support is for “chronic low back pain using spinal manipulation /mobilization.” (I believe the support is approximately the same as that of conventional physical therapy.) For the latter, the article is:


    (See also the second half of this article: http://sciblogs.co.nz/code-for-life/2010/03/06/chiropractic-libel-suit-snagged-by-its-own-international-body/)

    I note your information page implies support where there is none:

    “The increasing interest in alternative forms of care has caught the attention of several health associations and government agencies. A 1993 study in the New England Journal of Medicine reported that “The estimated number of visits made in 1990 to providers of unconventional therapy was greater than the number of visits to all primary care medical nationwide,” and chiropractic was among the most frequently used non-medical therapies.”

    You imply through the larger context that Eisenberg et al’s words offer support for chiropractic when in fact they offer no support for chiropractic as being “better” or even “useful.” Leaving this aside, popularity does not imply effectively or that an idea is sensible, e.g.


    That is to say it is a fallacy, a false type of reasoning.

    This statement implying “support” is repeated verbatim over many chiropractic websites in the USA, as is much of the rest of your ‘information’ page. Could you enlighten me if this was encouraged to be quoted “as supplied” by your national body? That the words prior to and following the NEJM quote are consistently the same, or with very small variations, and that other whole paragraphs are present verbatim elsewhere, would suggest either mass copy-catting or—more probably I think—these words originate from a central source.

    In particular, if you would care to look at the wider research literature, such as in Bonfort’s article, you might understand why my and others’ impression of the overall “increasing interest” is that chiropractic has no support. (No pun intended.) The Singh libel case in England has helped bring the lack of evidence supporting chiropractic to a wider audience.

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