When chiropractors play at being real doctors

It’s rather odd that I’ll be writing two posts in a row having to do with a chiropractor, given that chiropractic is at best an occasional topic on this blog. Certainly, I don’t hesitate to take on chiropractic when the mood strikes me or, more importantly, when I come across some seriously burning stupid coming from a chiropractor, but other topics tend to dominate my blogging. Let’s just put it this way. Two posts in a row on a cancer quack or about antivaccinationists would be nothing the least bit unusual here, but two posts in a row about chiropractors is.

As regular readers probably recall, my last post was about a rather silly chiropractor named J.C. Smith, who made some rather silly statements regarding the Institute for Science in Medicine. Then I took the Fourth of July off because, well, it’s the Fourth of July and like any red-blooded American I take it off if I possibly can. That includes blogging now. So here we are, the day after the holiday, and over the brief holiday someone forwarded another example of a chiropractor demonstrating the accuracy of my assessment of all too many chiropractors as physical therapists with delusions of grandeur. Of course, that’s not the part that caught my attention so much. After all, chiropractors are constantly making claims that they can treat allergies, asthma, infectious diseases, digestive disorders, and a whole host of systemic diseases and disorders that have nothing to do with the spine or musculoskeletal system. That’s nothing unusual or particularly egregious.

What is particularly egregious is when a major publication in essence parrots the claims of chiropractors, either completely uncritically or with that irritating false balance, the “tell both sides as though they were both valid” fetish that all too many publications and journalists have.

Journalists like Patricia Yollin.

Yollin published just such an example of bad medical journalism a couple of days ago in the SFGate entitled Chiropractor offers hope, treats osteoporosis. It is basically a puff piece that reads far more like an advertisement for a Bay area chiropractor named Lani Simpson than like anything resembling journalism. So how did a chiropractor get involved in osteoporosis, to the point of declaring herself an “expert”? The article describes how right off the bat:

Twenty years ago, Lani Simpson learned she had osteoporosis. She was only 42.

“It terrified me,” she said. “All of a sudden, it made me feel weak. Did it mean I couldn’t jog or play tennis or roller-skate?”

What it meant was that Simpson, a chiropractor who figured she knew quite a bit about the 206 bones in the human body, realized she had a lot more to learn. She is now a clinically certified bone densitometrist – adept at analyzing bone density scans of the hip and spine – and has her own practice in Berkeley, which combines conventional and alternative approaches to address a condition that affects 10 million Americans, 80 percent of them women.

OK. So what we have here is a chiropractor who’s dones some training and now knows how to interpret bone densitometry scans. That’s all it means to be a clinically certified bone densitometrist. For the sake of giving Simpson the benefit of the doubt, I’ll assume that she passed the test to become a Certified Clinical Densitometrist, which according to the International Society for Clinical Densitometry is a “professional designation awarded to individuals who meet specified knowledge requirements measured through a standardized testing process for the interpretation of bone densitometry (offered in the U.S. and internationally).” In other words, apparently Simpson can diagnose osteoporosis and knows how to do DXA scans. That’s all very well and good, but it means nothing. Certainly it doesn’t mean that anything unique to chiropractic is involved.

Indeed, nearly everything I see in the article describing what Simpson does for patients with osteoporosis is, for the most part, consistent with science-based guidelines for treating osteoporosis, all “integrated” (of course!) with woo. For instance, she says that drugs are “overprescribed but sometimes necessary.” Whether it’s true that drugs are “overprescribed” or not, at least she acknowledges that they are necessary at times. I suppose that’s something for a chiropractor. I suppose it’s probably also a good thing that I couldn’t find any evidence that she prescribes spinal manipulation for osteoporosis. Neck manipulation, I would imagine, would in particular be not such a wise idea, particularly if the osteoporosis is bad. In other words, whatever “integration” of science-based medicine and woo Simpson is offering, it has nothing to do with chiropractic. Remember, when D. D. Palmer “discovered” chiropractic 120 years ago, his “theory” stated that misaligned or “subluxated” vertebrae cause “nerve interference” that causes ill health. In brief, chiropractic postulated that removing the “nerve interference” by manipulating the spine to remove blockages of the “innate intelligence” that would maintain health. Yes, it sounds very much like vitalism, with subluxations blocking the flow of “life energy” (a.k.a. qi) and removing subluxations removing those blockages, just as acupuncturists claim that putting tiny needles into specific points can “unblock” the “flow” of qi.

Yes, I know that these days there are a lot of “mixer” chiropractors versus “straight” chiropractors. In “straight” chiropractic, everything is due to vertebral subluxations. It doesnt’ matter if it’s back pain, asthma, allergies, cancer, hypertension, heart disease, autism, or any other condition or disease. Everything. “Mixers” will mix in other woo with pure chiropractic. Clearly, Simpson is a “mixer,” who mixes—excuse me, “integrates”— a bit of conventional medicine with a bit of woo with a bit of back cracking, all in order to produce an “integrative medicine” practice. Or, as some pithily and accurately put it, they pretend to be real doctors. That’s what Simpson is doing: Pretending to be a real doctor.

So what we get is a mix of standard medical therapies, including vitamin D and calcium supplements, plus muscle-strengthening and weight-bearing exercises, plus:

Simpson determined that her client’s osteoporosis was the result of a vitamin D deficiency and premature menopause. Bhonsle said she now takes 1,000 milligrams of vitamin D daily and wears a patch that administers a small dose of bioidentical estrogen, an exact chemical match to the estrogen that humans produce. She walks whenever she can, and eats nuts and calcium-rich yogurt, which is easily digested. As a result, she has gained bone density.

Note that there is no reason to be using “bioidentical” estrogen or “bioidentical hormones.” Moreover, these days, estrogen replacement is not utilized that much anymore because of the potential problems with hormone replacement therapy.

But Simpson’s advice for osteoporosis, at least as presented in this article, is not the real problem. The real problem is that this article not only buys into but promotes the idea that chiropractors are capable of functioning in a primary care role, which is what Simpson appears to be doing, more or less, with her practice for menopause and osteoporosis. Moreover, although the woo content of her website is lower than what I’ve seen for many chiropractors, there’s still quite a bit there. For instance, she seems to think that antiperspirants cause breast cancer:

The most common area to develop breast cancer is in the upper outer quadrant–or in layman’s terms, right next to the armpit. As such, alternative doctors have been arguing for years that there may be a connection between the use of deodorants and the development of breast cancer. It was long thought that the aluminum in antiperspirants might be the culprit (all antiperspirants contain aluminum). However, there is a chemical that is perhaps more deserving of suspicion. Almost all deodorants contain a preservative from the paraben chemical family. On the label it can be listed as methyl-, butyl- or propyl-paraben. It is a known fact that parabens exhibit estrogen-like hormonal activity. The chemical companies do not dispute this, but instead argue that it is such a small amount that it is unlikely to cause breast cancer. Let’s play it safe and not buy into this argument – especially as there is a perfect alternative with no possibility of being carcinogenic.

I’ve dealt with this myth before. The reason that there are more tumors diagnosed in the upper outer quadrant of the breast is because there is more breast ductal tissue there. In other words, the number of cancers is proportional to the amount of breast tissue at risk, and the number of breast cancers diagnosed in the upper outer quadrant is not disproportionate. Nor is there any good evidence to link parabens to breast cancer.

In another article, Simpson claims that hypothyroidism can be…well, see what she says:

While thyroid disease does run in families, the expression of a low functioning thyroid can be caused or worsened by a poor diet, food allergies, adrenal overload (chronic stress), lack of exercise, pregnancy, gluten intolerance and many other triggering factors.

Of course, the most common cause of thyroidism in the U.S. is Hashimoto’s thyroiditis. Other causes include surgery (various thyroidectomies), radiation, viral infections, and some drugs. Worldwide, the number one cause of hypothyroidism is insufficient iodine in the diet, but this is not a problem in the U.S. because of iodinized salt and the addition of iodine to various foods. So, in reality, diet is not a major cause of hypothyroidism, at least not in the U.S. In rarer instances, disorders of the pituitary gland or hypothalamus (secondary and tertiary forms of hypothyroidism) can do it. Of course, gluten intolerance is the woo cause of all disease. Or, at least, so it seems fairly frequently, given how often I see alt-med practitioners blaming virtually every set of symptoms under the sun on gluten intolerance. These days, though, hypothyroidism appears to be the new gluten intolerance, diagnosed by all manner of dubious practitioners on all manner of dubious bases and then treated with—of course!—”bioidentical” hormones, because in alt-med world “bioidentical” is more “natural” and therefore always, always better.

In another article, Simpson blames hypothyroidism on soy products and makes these recommendations:

  • If you do have hypothyroidism, discontinue soy products for 3 months to see if that helps balance your system.
  • If you do eat soy foods stick with fermented soy – tempeh, miso, tamari, natto. These forms are more easily digestible.
  • Make sure soy products are organic and not GMOs (genetically modified organisms)!
  • Keep in mind that the thyroid gland is positively and negatively impacted by the foods we eat. Eat healthy foods and avoid processed carbs and raw cruciferous vegetables.
  • Exercise and do your best to decrease unnecessary stress in your life.
  • Some people are allergic to soy. Pay attention to your body and see if you experience gastrointestinal upset after eating soy.

This is a perfect example of non-evidence-based recommendations mixed with recommendations that are vague and apply to nearly anything, such as to exercise and avoid stress. In fact, there’s no good evidence that soy exacerbates hypothyroidism, although it might interfere with the absorption of thyroid replacement hormone. Even if true, all that means is that people with hypothyroidism shouldn’t eat soy within a few hours of taking their Synthroid. There is some evidence that phytoestrogens in in soy can exacerbate hypothyroidism in patients with inadequate iodine intake, but the evidence is conflicting. It’s certainly not the slam dunk that Simpson implies that it is. And, even if soy were a problem, does it make sense to recommend eating soy forms that are more easily digested if soy actually does interfere with thyroid function and that’s what you’re trying to avoid?

Then, of course, Simpson is into cleanses, even going so far as to offer a 21 day cleanse challenge, complete with “paleo diet” nonsense that includes “paleo meals,” “paleo cleanses” (I didn’t know cave men cleansed), “detox” packets, and, of course, a BPA-free shaker, all for $450 to $650 for three weeks. In return, she promises a whole host of improvements in health that include decreased PMS symptoms, decreased allergy symptoms, and fewer colds and flu.

Lani Simpson is typical of many “mixer” chiropractors in that she seamlessly mixes a little conventional medicine with the woo that is chiropractic with a bunch of other woo ranging from “detox” to “bioidentical” hormones to all sorts of dietary manipulations. Over the last 20 years, she’s made a name for herself in menopause and osteoporosis among “alternative” practitioners, despite no evidence that her recommendations produce any better outcomes than standard medical care—or that they even produce outcomes as good. Meanwhile, she does the talk circuit with other “wellness” practitioners to promote her business, while credulously believing scare stories about the flu vaccine (i.e., Desiree Jennings) and expressing “doubts” about the flu vaccine. This SFGate article portrays her as a trailblazing “expert” in osteoporosis on par with real experts, despite no evidence of her ever having contributed to the peer-reviewed medical literature on the subject, rather than as what she is, a chiropractor playing at being a real doctor.