What do Father Christmas, arthritis ‘cures’ and ‘alignment x-rays’ have in common?

They are all well intentioned jiggery pokery.

As a physiotherapist it is depressing to hear patients confidently recount the fabricated diagnosis that they have been given by a quack. No I am not going to hold back on this one. I am proud to be a member of a profession that is highly regulated both by its professional bodies (the HCPC and the Chartered Society of Physiotherapy) and, most importantly, by the culture engrained in physiotherapists. However, there are certain ‘professions’ out there, and far more than people realise, who exploit those in pain. They are often incredibly convincing and very popular with their patients. Here are a few common falsities:

1) That they can ‘reverse knee arthritis’ and enable full recovery of cartilage by manipulating the joint in a certain way (frequent and expensive, but worth it of course,) IMPOSSIBLE (advice on knee pain here) 
2) That their back pain is caused by a spinal scoliosis (note the scary word) and without regular (expensive) treatment they will be at best unable to continue their chosen sport and at worst be unable to walk UNTRUE (advice on back pain here)
3) They tell them that medications stop the body from healing. INCORRECT
4) They give them an x-ray (a high dose of radiation) of their spine and tell them vertebra are out of alignment by several centimetres and need manipulating back into place. INAPPROPRIATE SCAN, IMPOSSIBLE DIAGNOSIS, IMPOSSIBLE TREATMENT
5) They tell them that their discs have slipped out of place and therefore need to be moved back into position by their (expensive) hands IMPOSSIBLE DIAGNOSIS, IMPOSSIBLE TREATMENT.

Not only are these things impossible, untrue and/or incorrect but they are also harmful. If you would like to know why please get in touch either in the comments below or by email and I will happily give you a full explanation for each one. However, in the meantime I am interested in your opinion and broader discussion,

Whether these people believe their own tales is debatable. I have enough faith in humanity to believe that they probably do and there is no malice in their myths. However, irrespective of their intention, if you understand medical science (note that I say understand medical science not believe in medical science,) then what they spout is utter rubbish and dangerous to boot,

What scares me the most is that the quacks that perpetuate these myths and provide these ‘treatments’ as well as those that receive them seem to have no respect or understanding for medical science and clinical reasoning based on established medical anatomy, physiology and pathology,

They create their own theories to back up their treatments and use medical terminology (and use medical testing like x-rays) to make the theories sound like they hold the same validity as established medical fact. Unlike established medical fact however their theories have not undergone decades of scientific verification. When medical doctors and physiotherapists make clinical decisions, they base them on a combination of clinical evidence which has undergone rigorous scientific testing and on clinical reasoning. Clinical reasoning is based on established medical theory. Frustratingly this is where the quacks jump in with the ‘it’s your theory/opinion against mine’ rubbish.

Let me give you an example. I recently went to an informal teaching session with a health professional (NOT a doctor or a physio) who at one point said that the VMO (a muscle or part of a muscle on the inside of the thigh that contributes to the correct positioning of the knee cap) is best trained with the knee fully bent. At the end of the session I quietly pointed out that this muscle works when the knee is slightly bent to fully straight. His reaction was ‘well that’s your opinion and this is mine.’ I continued to explain that as the muscle is close to the surface it is one of the easiest muscles to put electrodes on and test whether it is firing or not and therefore, based on this scientific testing, we can be certain what range the muscle works in. His response was ‘we will have to agree to disagree.’

This extraordinary lack of respect for clinical research and clinical reasoning is the reason for people believing in quackery. Where it comes from culturally is an important debate because without understanding peoples distrust of the ‘experts’ that are trained in medical science we will never be able to divert people away from the quackery that is not only a waste of their time and money but is detrimental to health and, in some cases, dangerous.

This is where it gets important. Medical doctors and physiotherapists are governed by the precautionary principle that compels us to use only those therapies which generate more good than harm. In other words, if you are going to choose a therapy that is not backed up with medical clinical reasoning, at least don’t choose one that could cause serious harm whether that is in the form of unnecessary x-rays or aggressive joint manipulation. Edzard Eartz in the Health Spectator writes an excellent article on this.

I would love to hear your opinions on how we can tackle this culture of believing in quacks and, in the meantime, at the very least, if you are ever offered an x-ray by someone other than a medical doctor please say NO!