Sidney Crosby, chiropractic neurology, and the limits of evidence
The good news: Sidney Crosby is back from the concussions that kept him on the bench for more than 10 months, and he had two goals and two assists in his return against the Islanders last night. But one downside, a reader pointed out to me in an e-mail, is that Crosby’s return may give added credibility to “chiropractic neurology,” the alternative therapeutic approach that Crosby turned to during his rehab. What exactly is this? I don’t know — and I’m not alone:
It’s a field that’s unfamiliar to many traditional doctors, including Randall Benson, a neurologist at Wayne State in Detroit who has studied several ex-NFL players. Says Benson, “It’s very difficult to evaluate what kind of training, expertise or knowledge a chiropractic neurologist has since I have never heard of [the discipline].”
That’s a quote from David Epstein and Michael Farber’s excellent look at Crosby’s rehab from Sports Illustrated in October. A couple of other interesting quotes:
In 1998, at Parker University, a Dallas chiropractic college, Carrick [the chiropractic neurologist who Crosby worked with] worked on Lucinda Harman before 300 students. Two car accidents and a neurotoxic bite from a brown widow spider had left Harman, herself a Ph.D. in experimental psychology, wheelchair-bound and with headaches, during which she saw spots.”[Carrick] asked if they were red and yellow,” she says. “I said, ‘No, they’re green, blue and purple.’ ” Carrick informed the audience that this meant her brain was being drastically deprived of oxygen and that, without treatment, she had six months to live. Harman, now 59, says simply, “Miracle.” But Randall Benson says that “there’s nothing out in peer-reviewed literature supporting” an association between the color of spots a patient sees during a headache and the severity of the oxygen deprivation in the brain.
Carrick, who has had a handful of studies that have appeared in scientific journals, has never published data on vestibular concussions. “We don’t have enough time to publish studies,” he says, “but we’re doing a large one at Life [University] right now.”
It’s a great piece — fair but rigorous. In some ways, though, the most important quote may be the kicker:
“I don’t think this is a case of trying to do something wacky,” Crosby says. “When someone came along and invented the airplane, people must have thought they were out of their mind. Who thinks he can fly? I’m sure people thought that person might have been stretching it a bit… . At the end of the day, as long as the person getting the care is comfortable, I think that’s what’s important.“
Much as my evidence-based personality protests, I do think there’s some truth to that. Especially in cases like this, where — as with so many health conditions — there isn’t a well-established “standard-of-care” treatment. It’s totally different from, say, Steve Jobs choosing “alternative” forms of cancer treatment instead of surgery. In that case, the potential benefits of the surgery are well-known and well-understood. But many people face health conditions where the verdict of the Cochrane review is basically “there is insufficient evidence to conclude that ANY interventions do any good.” In that case, it’s hard to argue against trying other, unproven approaches rather than simply doing nothing.
Of course, sports medicine is a little different — it’s not life-or-death. For pro athletes, the incentive to try anything and everything in order to return to play (and earn money during their brief career window) is enormous. If I were Tiger Woods or Terrell Owens, I would have tried platelet-rich plasma to speed tendon healing too, despite the lack of evidence that it actually works. The problem is that the use of these therapies by sports stars gives the general public the impression that they’re proven, established treatments — hence the huge surge in PRP over the last few years. Will the same thing happen with chiropractic neurology? I hope not. But on the other hand, if someone who’s been in two car accidents and been bitten by a neurotoxic spider is in pain and hasn’t been able to get relief from conventional treatment, I’d have a hard time criticizing them if they decided to give it a try.