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Gyrostim and the Infrastructure of Quackery

It’s frustrating to read yet another story of the process of developing a potential new medical treatment derailed by the current infrastructure of quackery that we have in this and other countries. This is one of the unmeasurable harms that results when pseudoscience is given regulatory, academic, and professional legitimacy. The press then celebrates the nonsense that results.

The basic story is often the same, with a few variations. First, however, let me describe what should happen when someone comes up with an idea for a new medical treatment.

Background research – The first step, whether the innovator is within or without the medical community, is to familiarize oneself with existing research. Is the idea plausible, has it been investigated before, are there any similar treatments that can act as a guide to predicting how this new treatment will work?

Test basic principles – If the idea still makes sense after existing research is taken into account, then new research into the potential treatment is justified. This should start with some basic proofs of concept. Is the treatment safe, does it actually do something, what are the possible mechanisms at work. This level of research may involve in vitro studies (test tubes and petri dishes), and eventually animal research. If the treatment is something that does not have a pre-clinical model (say, for instance, a new therapy technique) then early safety and tolerability studies should be done. If there is any component of the new treatment that involves new or untested scientific principles, they should be studied before they are applied to a treatment (the human energy field and therapeutic touch come to mind).

Preliminary human trials – If the treatment still seems plausible and seems to be safe and supported by basic principles, then some preliminary early human studies are justified. These may be formal FDA phase I trials, or generic pilot studies. These usually involve few subjects, may not be blinded, and are simply intended to get some idea of the effects and safety of the treatment.

Confirmatory trials – Everything so far is simply preliminary and used to determine if large, double-blind, expensive and elaborate studies are justified. These trials are designed to answer, as definitively as possible, if the treatment has specific positive effects and what the risks and negative effects are. These trials may also compare the new treatment to existing standard treatment.

It is only after these confirmatory trials that any health claims can be reasonably justified, that patients should be charged for treatments, that the treatment should be incorporated into medical practice, and insurance companies pay for the treatments. You can make an argument for compassionate use of treatments based on preliminary evidence if there are no other options, but every effort should be made to do this as part of further research.

Press interest in the treatment should also follow this pattern. Only the technical and professional literature and news really should deal with new treatments in the introductory phase. The general lay press should not be trumpeting new treatments that are not even in the preliminary human trial phase. Reporting preliminary human trials should also be done carefully, and put into the proper context. The sensational headlines about a new treatment should be reserved for those that are well established by confirmatory research.

Everything I just described above often does happen when new treatment ideas emerge within the culture of scientific medicine and is handled properly by professionals. Every day medical scientists are sorting out what works from what doesn’t work using some version of this process, and the public usually only hears about new treatments that make it over the finish line.

Alongside this traditional, tested, science-based process there is a growing infrastructure of medical pseudoscience that follows a completely different paradigm. Their process goes something like this:

An innovator comes up with an idea for a new medical treatment (device, supplement, procedure, etc.). They immediately start using the new treatment (if they are a practitioner) or at least trying it out anecdotally on themselves or a few others. Based upon either this limited or no experience, and no actual research, they then market the new treatment directly to the public.

If a pseudoprofessional gets their hands on the treatment, then it is instantly institutionalized. The device is marketed, clinics are established, articles and books are written, and people are treated.

The lay press then give free advertising to the new treatment by writing gullible articles following a predictable narrative – a maverick innovator has come up with a “miracle cure” with dramatic anecdotes. If they developed the treatment in order to treat themselves or, better yet, a loved-one, then that, of course, is the angle. There is token mention of the nasty skeptics, but how could they deny the stunning testimonials?

These two versions of events are simply two ends of a spectrum – science vs. pseudoscience, or legitimate medicine vs. dangerous quackery. I do think that there is a bimodal distribution of new treatments based upon culture. People either function within a culture of science or a culture of pseudo and anti-science, but there is a scattering of treatment across this continuum.

Let’s see where this new treatment, the gyrostim, falls.

GyroStim
The GyroStim was developed by Kevin Maher, who is an engineer, not a medical scientist. He developed the device in order to help his daughter, who suffers from cerebral palsy. He and his wife were told that stimulating the vestibular system, by spinning around or doing somersaults, could help with balance and motor development. Motivated to aggressively treat his daughter to give her the best chance of improvement, they put her through “nearly 1,000 of these spinning motions per day.”

Maher decided to make this process easier by building a robotic chair in which a person can be strapped, and the chair would then spin in every axis. The chair seems to do what it is designed to do – spin a person around in every direction. If your goal is to do this a thousand times a day, this certainly seems like an advantage over doing somersaults. To that extent, the device works.

The deeper question is, however, what are the net risks and benefits of this kind of spinning therapy? But before I get into that, let me finish the story.

A GyroStim machine has apparently been sold to the Mayo Clinic for research, and another to the Air Force Academy for aerospace medical research. So far, so good.

But then Maher apparently was sucked into the rank pseudoscience of chiropractic neurology. His device was purchased by a Richard Turmel, DC, a self-described functional neurologist in Quebec. He says of the machine:

This might be the most amazing machine I’ve ever seen in medicine, and we’re only just at the beginning. I am seeing, quite frankly, new miracles almost every day with this. There are still skeptics out there in the medical community about this, but I’m sure when electricity was first invented, some people said it might be bad.

Hype, anecdotes, and dismissal of legitimate skepticism – the quack trifecta.

Another chiropractic neurologist, Ted Carrick, is also enamored of the GyroStim. I have discussed Carrick before (as has Harriet Hall), he makes many dubious claims and offers only testimonials and poorly-conceived studies as evidence.

The GyroStim is, unfortunately, now associated with the dark underbelly of medicine, the world of pseudoscience. Treatments with the GyroStim cost $2,500 – $6,000 per week, and the claims made for the treatment are expanding – concussion, cerebral palsy, and even autism (of course).

Hopefully the device will at least also go through the standard scientific evaluation. There is some plausibility for this type of treatment for vertigo. In fact, vestibular therapy is already an established and evidence-based treatment for chronic vertigo. Physical therapists develop an exercise program for patients that involve maneuvers to stimulate the vestibular system, which does tend to reduce the vertigo. This probably works through normal brain plasticity.

Vertigo can have many causes, but the common end result is that the brain is not properly integrating various sensory inputs (visual, proprioception, and vestibular) which is necessary for proper cerebellar function (balance and coordination). Forcing the brain to integrate vestibular stimulation may accelerate the process of essentially learning how to establish more normal sensory integration.

One cause of vertigo and poor balance is concussion – the brain is traumatized, which can cause diffuse damage interrupting the amount of connections that the brain makes with itself. This can interrupt sensory integration, causing vertigo. Vestibular therapy is therefore a legitimate treatment for the vertigo that results from head injuries.

The GyroStim is, essentially, automated vestibular therapy. In this regard it is nothing new. The open questions are – is it as or more effective than standard vestibular therapy, and is it cost effective? It’s very expensive, and so the cost-effectiveness question is not trivial. If it is as effective, perhaps there is a niche for it to administer vestibular therapy to patients who cannot physically comply with standard therapy.

Claims that the GyroStim can help with symptoms other than vertigo and balance, however, are not plausible. Existing evidence suggests that the benefits of these types of interventions do not extend beyond the tasks themselves. There is no global brain-training. Training in a task, for example, improves performance on the task, but not general performance.

Likewise – vestibular stimulation can plausibly help with the integration of vestibular sensory information with other sensory information and improve vestibular function, but there is no reason to suspect that it will improve any other aspect of neurological function.

Conclusion
The GyroStim is nothing more than automated vestibular therapy. Before it is mass produced and incorporated into medical treatment, it needs to be tested to see if it is safe, effective, and cost effective for conditions that are already treated by standard vestibular therapy.

If it is effective for vestibular therapy, then it can be studied to see if there are benefits for other conditions. I am skeptical of such benefits, however, because they lack plausibility. Only high quality confirmatory clinical research will be adequate to establish the GyroStim as a legitimate treatment for any such condition. Until then, promoting or using the GryroStim for anything other than vestibular therapy is pure quackery.

Posted in: Chiropractic, Neuroscience/Mental Health

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77 thoughts on “Gyrostim and the Infrastructure of Quackery

  1. windriven says:

    “Only the technical and professional literature and news really should deal with new treatments in the introductory phase.”

    Hmmm … I think there might be some First Amendment concerns raised.

    “He and his wife were told that stimulating the vestibular system, by spinning around or doing somersaults, could help with balance and motor development.”

    In terms of cerebral palsy sufferers, this is, at least, controversial.
    See, for instance, Dev Med Child Neurol. 1980 Aug;22(4):476-83.
    While: http://ptjournal.apta.org/content/63/3/338.long renders a more positive – though nuanced – judgment.

    I went to the gyrostim website and the device is indeed an engineer’s wet dream complete with joystick control. But that begs the questions (which are touched on in the PT Journal literature review referenced above) of what the optimum pattern of stimulation might be and what duration. Gyrostim is apparently a freeform motion device controlled by either the subject or, alternatively, by a remote operator. How much acceleration is beneficial? How much is detrimental? Should rotation be limited to a single axis? If so, which one? The more one thinks about this the more disturbing it becomes.

    So an alternative narrative to the gyrostim story might be:

    Tinkerer subjects disabled daughter to frightening medical experiments.

  2. goodnightirene says:

    @winddriven

    Re first amendment concerns: definitely, but I tend to think Dr. N meant this in the sense of “in an ideal world” where journalists would have sufficient scientific literacy to know when they were treading a thin line.

    —–

    I admit it–I had to look up “vestibular therapy” (is this term related to the term vestibule, the entry area?). As someone with lifelong vertigo, I was intrigued to learn there is treatment! I have never discussed vertigo with a doctor in all my medical life as I guess I’ve become somewhat accustomed to it. There are some PT’s in my area who do this, so I’m going to put it on my list–the one that is headed, “Is this just old age or is something wrong with me”. :-)

  3. ProSubzero says:

    This chair has been getting some publicity recently in the hockey reporting circles stemming from a Denver Post article in the sports section. The highest publication about the Gyrostim I could find. The premiere player in the NHL, Sidney Crosby, has been suffering concussion for much of his career. Somehow it has been leaked out he used the chair, and somebody makes the jump to say it was the real reason he is cured now. I can only assume the clinic was more than happy to let everybody know he used it. They also point out another young NHL player has been treated with it.

    This was of course eaten up by various high profile reporters and forwarded on to tens of thousands of twitter followers. The article had 2 lines pointing out the lack of evidence supporting the claims of the makers. But then paragraph after paragraph with headlines like “Miracles Everyday”. And how it can treat everything under the sun. Pretty obviously biased unresearched uncritical reporting.

    I tried to point out the dangers of promoting something like this to one of the biggest Canadian reporters and was met with a great deal of hostility. He argued that we can’t prove it doesn’t work, that science based medicine fails to help people and need to own our mistakes, who cares Crosby is rich… ect ect ect. Other people witnessed our twitter argument, saw I’m a cancer research and figured I’m just in on the big pharm suppressing a cure scam. Funny how acceptance of snake oil like this chair comes back around to conspiracy theories. Dig a little bit and this stuff always shows a fundamental lack of understanding how science works… and by extension how the reality works.

    It just bums me out that the reporters don’t realize they are being used to exploit desperate people. Frankly who cares if the multimillionaire gets ripped off by a placebo. I’m worried about them clearly targeting families with autistic kids.

  4. windriven says:

    @irene

    ” I tend to think Dr. N meant this in the sense of “in an ideal world””

    I should have put a smiley after my comment. I agree that he wasn’t suggesting a constitutional amendment.

  5. ConspicuousCarl says:

    After considering the possibility of a sea turtle being strapped into one of these things, I think maybe I was wrong about this blog needing more animal pictures. Or maybe I was very, very right.

  6. goodnightirene says:

    @windriven

    No :-) needed. I only meant to say that even though no one wants to step on First Amendment rights, it’s so sad that it enables bad reporting.

    @ProSubzero

    Even if this gizmo-chair helped the hockey player, wouldn’t it be nice if people wanted proof, or better yet; understood why the proof matters?

  7. adriandater says:

    My article from June 2 clearly states that the GyroStim has yet to obtain FDA approval and that studies are currently ongoing to give more of a “science-based” assessment of its possible benefits. Right there in paragraph five of the story: “The Food and Drug Administration is deciding whether to give the device its seal of approval. Double-blind studies have yet to be published.”

    Also from the story: “Miracle machine? A huge breakthrough for the treatment of brain-related injuries? Or quack science, nothing more than an expensive placebo?

    No one is sure.”

    Dr. Novella seems to be criticizing me for not mentioning these facts and/or skepticism of the machine, when they are right there for anyone with functioning eyes to see. The story is about how so many people seem to be getting help using a device that is brand new, after long periods of time without success using more established medical treatment. Yet, the article points out that everything is very preliminary.

    But furthermore, nothing in Dr. Novella’s blog proves that the GyroStim DOESN’T work. He seems to automatically be dismissing the machine as quack pseudoscience on the one hand, while acknowledging that studies double-blind studies have yet to be fully performed (and I know that they are, in fact, ongoing) on the other.

    If anyone, therefore, seems most guilty of kneejerk reactions before having fully done the research, it would seem to be the good doctor himself.
    Adrian Dater
    Denver Post

  8. ProSubzero says:

    @goodnightirene

    I guess real experimental evidence isn’t needed when you have a handful of examples centered around anecdotal reports from the manufacturers and hearsay .

    Now granted, these are sports reporters we are talking about, but it is naive to think this doesn’t go on constantly in all reporting fields. It is scary and depressing the the original reporter didn’t recognize the anecdotal nature of this and published their story with the barest eye toward critical thinking…. and then very high profile reporters just took it and ran with it via twitter.

    And then hide behind flimsy claims they aren’t giving the chair promoting. Shameful and unprofessional in my opinion.

  9. David Gorski says:

    @adriandater

    I saw your complaining that your comment hadn’t been approved after one hour and one minute. You need to understand something. The first comments from a new commenter who has not previously had a comment approved before goes straight to the moderation queue. This is done to help cut down on spam and, especially, to prevent trolls from creating a bunch of sockpuppets, which used to happen a lot before we took that step.

    Moreover, unlike, perhaps, a newspaper’s blog, the editors here do not work on SBM full time—or anywhere near it. Most of us have very demanding day jobs. In addition, I try very hard not to be doing blog-related business while at work, lest I be accused of using university resources for my own private hobby. (That’s not to say that I don’t look at the blog, only that I try not to be moderating comments or commenting myself that much.) I only made an exception for you now because someone made me aware of your little rant about our not having jumped fast enough for your satisfaction when you snapped, leading you to accuse us of shutting down comments from those who disagree with us. I’m here to tell you right here, right now that you need to cool your jets. The only reason your comment wasn’t approved is because you had never commented here before and I hadn’t gotten home yet to approve it. Now that I have approved it, your comments will appear instantly.

    Finally, to be honest, I was more than half-tempted to let your comment sit for a few more hours and not make an exception for you. However, your accusation on your blog irritated me just enough that I decided to approve your comment and to answer your accusation now. I hope some of our regulars here will tell you just how wrong you are about the moderation policy here. In reality, if anything, because we don’t have the time we are probably far laxer in our moderation than we should be, leading to the occasional complaint about how certain trolls get away without being banned far longer than perhaps they should. I’ll take the hit for that, because I’m a bit of a free speech absolutist and tend to be very reluctant to ban even trolls. It takes a lot. So go ahead and criticize away. Steve will probably answer when he has time; he usually does.

  10. norrisL says:

    @goodnightirene

    Proof matters, bah humbug! Well I spoke to a bloke who told me that he knew a bloke whose sister tried it (insert any kind of woo here) and it stopped her smoking, removed her wart and cured her baldness. Proof. “Proof Schmoof” is what I say :)

    norrisL

  11. Earthman says:

    @adrianator

    Unfortunately your argument contains a number of fallacies. For instance you ask to prove a negative, which cannot be done. You seem to still think that anecdotal ‘evidence’ is actually worth something, when it is not. As ever the problem seems to me to be that journalists come from the Arts side of academia, and have no understanding or training in science and how it separates truth from fiction. Do a bit of reading, because you are making simple logical mistakes that can be cured by a bit of training.

  12. ConspicuousCarl says:

    adriandater:

    Greetings.

    I could go into a lot of details, but your own follow-up blog post actually framed the entire issue perfectly right at the end:

    Adrian Dater said:
    But I think the story presented a picture of a machine that is working for a lot of people these days, and that “science” is still trying to determine why and whether it will be long-lasting. That’s it.

    Yes, that is what you presented, and the problem with all of this is that you don’t understand why that is not good science reporting. Everything is wrong with your statement, and you don’t even know it.

    1. You DON’T KNOW that this machine “is working for a lot of people”, and yet you wrote an article presenting that picture. Your article even had a hint of not knowing that it was the machine or something else, but you seem to have accepted one person’s argument that if it happens 2 years after the injury, the machine must get credit.

    2. “Science” is not just trying to figure out how it works or for how long, “science” is still trying to find actual evidence that it works at all.

    I think the two issues above, and your statement to which they apply, are the best summary of what is wrong with your article. And I am glad that we can at least agree that the quote above is an accurate representation of what you did.

  13. WilliamLawrenceUtridge says:

    @ adriandater

    Have you read Flat Earth News? Have you read Snake Oil Science? Have you any understanding of why anecdotes are poor, borderline worthless evidence in science but are frequently used in pseudoscience due to their emotionally-appealing nature? Did you learn anything about the basic scientific and skeptical issues of chiropractic, such as their training or lack thereof? Do you realize why science is a superior form of knowledge compared to anything available historically? Do you know why randomization, control groups and statistical tests are used in scientific testing?

    I doubt it, otherwise you wouldn’t venture such a criticism. Science reporting is hard, even for science reporters. You’ve done little bar advertise the GyroStim device. A long, loving, detailed article, with a single token skeptic response of minimal value, means you’re basically a full-page, free ad, not a news report. Think of it, if you wrote six paragraphs discussing the virtues and benefits of the usefulness of lead in preventing knocking in engines, it’s excellent coverage when used in paint, it’s use in pencils, it’s low melting point and easy bending being a virtue in attaching things together, not to mention it’s delicious sweet taste, how much Neil Armstrong loved having it aboard during both his Gemini trips, and it’s amazing ability to protect you from CIA mind probes, do you think a boiler plate single sentence “Dr. Smith thinks it might be bad for you” is adequate?

    Seriously, here’s a breakdown of your article:
    - Two famous sportspeople say it cured their concussions!
    - Parents of sick children say it helps!
    - An engineer designed it for his sick daughter!
    - A neurologist says it’s exciting and promising!
    - Said neurologist says it dramatically improves previously-unhelped patients!
    - It’s a robot!
    - Here’s all the directions it moves in!
    - Here’s how it might work!
    - The engineer talks about how much it helped his daughter!
    - Some bland history.
    - His daughter is now a grade-A student!
    - Universities want to study it!
    - A chiropractic neurologist loves it! (Do you realize chiropractic neurology was just made up by Ted Carrick?)
    - The engineer thinks it’ll work!
    - Lots of people believe him!
    - One of them is “Dr.” Richard Turmel! (Who is a chiropractor practicing “functional neurology”, also made up)
    - There are lots of testimonials!
    - Here is a testimonial!
    - Here is another testimonial!
    - Let me tell you how amazing my testimonial is!
    - A third testimonial!

    And here’s the “other side”:
    - It might be a placebo (the third of three options, the others being “miracle” and “breakthrough”)
    - The FDA hasn’t approved it (but is looking into it).
    - There isn’t much evidence (never mind there’s minimal prior probability it might work).
    - Carrick and Turmel are not medical doctors (they’re chiropractors, and if you knew the history of that discipline, you’d realize why that’s worth contextualizing)
    - Bummer skeptics are skeptical.

    Sometimes there aren’t two sides. Sometimes the two sides aren’t equal. Sometimes one of the sides is about as lucid and factual as the delusions of a tinfoil-hat-wearing person-with-schizophrenia who has ceased their medications.

    Ever heard of Trine Tsuoderos? You should look her up.

  14. @adriandater

    Thanks for commenting. It’s nice to be able to engage directly.

    You’ll notice I never commented directly on your reporting. I described how the lay press typically handles such stories, and then let your reporting speak for itself. I never wrote that you did not mention any skepticism (you seemed to have made that up). I also did not knee-jerk dismiss the machine. I simply put the current claims into a scientific context. I never claimed it does not work, nor is it up to me to prove that it doesn’t.

    But – since you bring it up – you do follow the typical narrative that is all too common. You give what I would call token mention of skepticism – it’s not FDA approved, some academic wants it to be studied, etc. But this quick mention is sandwiched in between a heart warming story about a father looking for a cure for his daughter, and “miracle” cures from maverick doctors bucking the system, with stunning anecdotes.

    Frankly, this is lazy and irresponsible reporting. You did not mention that Carrick and Turmel are controversial characters with a long history of dubious claims. You did not really put this story into the proper context for the reader, no caution about placebo or non-specific effects, or the fact that the device is really just a fancy method for delivering vestibular therapy, the highly implausible nature of the claims made by these dubious practitioners, the highly misleading nature of testimonials, any consideration of risks or cost-effectiveness.

    We don’t have to guess about what the net effect of this style of reporting is – it is free advertising for the dubious treatment. It drives desperate patients to quacks.

    Now you are mischaracterizing my reporting. I think that speaks volumes.

  15. adriandater says:

    @David Gorski
    @ Dr. Novella

    Your thin-skinned, thou-doth-protest-too-much juvenile responses speak for themselves.

    It does no good to engage in any further petty accusatory situations. You both seem very good at that already without any encouragement from me.
    Best wishes,
    Adrian

  16. David Gorski says:

    Your thin-skinned, thou-doth-protest-too-much juvenile responses speak for themselves.

    My irony meter just exploded.

    After all, I’m not the one who wrote a whole blog post because he was pissed off that his comment wasn’t approved within an hour.

  17. Yes, petty and juvenile responses do speak for themselves.

    Cheers

  18. windriven says:

    @adriandater

    I’m guessing that you have flounced (sorry if this is an obscure Britishism, it calls back to another commenter) but if not I want to assure you as a long time reader and commenter on this site that your suspicions about having your comment blocked or unnecessarily delayed are misplaced. SBM has perhaps the most relaxed posting policy I’ve ever encountered. Disagreeing with the blogger – even disagreement suggesting that the commenter is seriously off their meds – are posted regularly (see Th1Th2, FastBuckArtist, stanmrak, etc.). I believe that it would take flat-out libel or an incoherent comment pocked with f-words to hit the moderator’s trash can.

    Straying a bit from the party line, I didn’t find your report particularly non-scientific by the standards of the popular press. But this site and its habitues tend to be scientifically rigorous and to expect scientific rigor in reportage both specialist and popular. ConspicuousCarl and WLUtbridge have provided ample discussion from the scientific perspective so I’ll leave it at that.

    Speaking for myself, I hope that you’ll stick around. We might be able to close the distance between the way that you as a journalist in major media view science stories and the way that scientists view them.

  19. ProSubzero says:

    @adriandater

    I believe I was the only person that referred to your article directly. Dr. Gorski and Dr. Novella were extremely even in their responses and original post. They even protected you from direct criticism.

    Unfortunately my earlier observation seems to be proven true. Poke and dig a little bit (even doing so professionally as the good doctors have), you start to peel back the facade and see some weird dark energy behind all this. Lots of hostility towards science based medicine and just rational thought.

  20. adriandater says:

    OK, one more:
    What a barrel of laughs you guys are! Seriously, talk about irony: Dr. Novella accuses me of not telling both sides, then he wildly asserts that Dr. Carrick and Dr. Turmel are “controversial characters with a long history of dubious claims.” Without a shred of evidence to support his assertion. You might want to think about getting a lawyer for defamation and slander sir, you might need it.
    I can’t believe I’m defending an article where I had several portions of the story addressing every last criticism of the good doctor and his thin-skinned blog moderator – and that I’m arguing with him about a machine whereby even the good doctor says “more tests are needed, it might just work” but then also saying in the next sentence that even the mere suggestion that it might work is pure quackery. You can’t make this stuff up!
    Cheers,
    AD

  21. ProSubzero says:

    Yeah, a lot of hostility.

  22. ProSubzero says:

    For a laugh. The article is 1,487 words long. Of that, only 52 words are dedicated to the neurosurgeon and the alternate side of the story. That is a grand total of 3.5% of the story. Yup, that is a nice evenly sided critical evaluation of the subject.

  23. ConspicuousCarl says:

    Adrian Dater,

    You didn’t just suggest that it might work, you reproduced loads of unsupported claims (again, by YOUR OWN WORDS, you presented it as working).

    As a reporter, nobody here should have to give you evidence that Carrick is “controversial” (the mildest description of him which is accurate). If you were a competent reporter, you could just google his name to find out that Ted Carrick is a fringe figure. If you had the slightest science education (no ivory tower stuff necessary), you would have found that you were quoting a guy who is a crackerjack.

    You still don’t get it. “More tests are needed” because we have jack for evidence. And your generally glowing article is irresponsible because we have jack for evidence. Those things have a common basis, they are not contradictory.

    Just look at the comments from your fans, as well as your own quote (read it again, maybe you forgot your own words). People, you included, are talking about this as if it is clearly “working for a lot of people” even though we have jack for evidence. Do you not get it? People now believe without question something which might not work at all. Because of you. They believe anecdotes reported by a sports blogger. That’s what happens, and it’s bad. Belief and practice exceed reason and evidence. You are part of the machinery of quackery, and you don’t even know it.

  24. adriandater says:

    @concspicuous carl: examples that he’s a “crackerjack” please? Oh, and that doesn’t sound like a very science-based medical term. At least, not to my lay mind anyway.

  25. adriandater says:

    @conspicuous carl: serious question: have you ever used this machine? Had you even heard of it before this article?
    My hunch on the first is definitely not. Maybe it’s yes on the latter. Regardless, you have as much proof that the machine doesn’t work as these ACTUAL PATIENTS who HAVE used it believe it does.
    And, yes, I’d want to wait for the actual test results, the double-blind studies, come in before asserting anything more about it. But there are people who have actually used it who believe it works. And we have you, who almost certainly hasn’t, but has already made his/her judgment about it.
    Not very scientific.

  26. ProSubzero says:

    Let’s predict the order of the argument @adriandater will use.

    1) what are you talking about? I didn’t endorse the machine at all! {check}
    2) getting extremely defensive and combative indicates you are endorsing it to some degree {check}
    3) but whatever, I’m above this and we’ll just agree to disagree (leaves) {check}
    4) (comes back) one more thing, screw you! {check}
    5) how dare you suggest it shouldn’t be studied more! {check}
    6) you can’t prove it doesn’t work! {check}
    7) look there are real results (dismisses notoriously inaccurate anecdotal evidence)! {check}
    8) science based medicine doesn’t work anyhow so why not do this!
    9) what do experts know anyhow?
    10) who cares if it is just a placebo, these are rich hockey players, they ain’t broke (ignores them trying to sell this to families with autistic children)!
    11) you’re just part of the system and there is too much money to be made not curing people

  27. WilliamLawrenceUtridge says:

    @adriandater

    If you can’t see the value of the feedback you are getting here right now (and in particular rational, calm and civil nature of Dr. Novella’s comments), maybe you want to wait a bit, calm down, and return to re-read them.

    You’re also engaging in a common human failing, one that is depressingly present in essentially everyone on the planet – a reluctance, in fact an outright visceral resistance to admitting you might be wrong. I am quite prone to it, which is a reason why I try to fact-check my claims before making them (notice for instance, I did a nearly sentence-by-sentence review of your article, I think you’ll find it corresponds rather closely to your actual article). May I suggest you read Carol Tavris and Elliot Aronson’s excellent book, Mistakes were made (but not by me), which examines this very trait in exhaustive detail.

    There is nothing wrong with admitting you have made a mistake, there is nothing wrong with noting you have engaged in a common, but pernicious journalistic habit, and there is great virtue in becoming familiar with the basics of science and skepticism – particularly for a reporter. The failings of human memory are particularly worth understanding, they’re a little terrifying when you realize just how flawed and reconstructive our memories are.

    You may also want to familiarize yourself with the traits of pseudoscience and pseudoscientists; there are any number of books on creationism, denialism, alternative medicine and recovered memory which would be instructive – all use similar tactics to win rhetorically what they can’t win through evidence.

    @windriven

    1) “I didn’t find your report particularly non-scientific by the standards of the popular press” – agreed, but I think this has more to do with the low standards and scientific illiteracy of the popular press than anything else. Again, I’ll go back to Trine Tsuoderos, who doesn’t play the false balance game in her reporting.

    2) It’s Utridge, no “b” :)

    3) Don’t forget RusticHealthy. Ugh. A situation where I was warned for my own conduct, which was egregious. But fortunately not unforgivable.

  28. Harriet Hall says:

    @adriandater,

    You are missing a wonderful opportunity. Immersing yourself in the archives of this blog and listening to criticism could make you a far, far better science reporter. Science is hard, and is poorly understood even by many scientists. There is a great deal to learn, and few of your colleagues have learned it. If you take umbrage and flounce off, it’s your loss.

  29. WilliamLawrenceUtridge says:

    @ adriandater

    he wildly asserts that Dr. Carrick and Dr. Turmel are “controversial characters with a long history of dubious claims.” Without a shred of evidence to support his assertion. You might want to think about getting a lawyer for defamation and slander sir, you might need it.

    Do you understand the foundation of chiropractic care? Do you know anything about the central nervous system? Do you believe joint manipulation can have effects on the body beyond sensory and motor channels? Do you believe moving the joints of the spine can cure infections or cancer? Do you believe the bones of the skull are mobile?

    And more fundamentally, do you understand the importance of empirical testing and falsification in science? Are you familiar with the evidence base for chiropractic?

    And, rather important given your final point – have you ever googled “sense about science”, “Simon Singh” or “chiropractor libel UK”? You should, you might find it instructive.

    I’m arguing with him about a machine whereby even the good doctor says “more tests are needed, it might just work”

    Are you aware that doctors are generally prohibited from offering services that are not justified by some sort of research base? That most restrict the use of completely novel therapies based on unproven principles with uncertain safety and side effects to clinical trials only? Do you know that doctors normally don’t charge for clinical trials, in fact will often reimburse patients for their involvement? How do you reconcile this with the fact that patients are now paying several thousand dollars per week for a treatment which is little more than some people essentially eyeballing it and going “meh, sure, why not”?

    There is a tremendous, tremendous difference between “this has some prior probability and should be further investigated before becoming a mainstream treatment” and “hey, let’s charge people lots of money for this”.

    serious question: have you ever used this machine? Had you even heard of it before this article?

    The more important question is – have you ever heard of pubmed? If the answer is “no”, you shouldn’t be reporting on medical items without better consultation.

    My hunch on the first is definitely not. Maybe it’s yes on the latter. Regardless, you have as much proof that the machine doesn’t work as these ACTUAL PATIENTS who HAVE used it believe it does.

    Do you understand the difference between proving a hypothesis and falsifying it? Do you know what the difference between a hypothesis and a theory is?

    And, yes, I’d want to wait for the actual test results, the double-blind studies, come in before asserting anything more about it. But there are people who have actually used it who believe it works.

    Do you know what the placebo effect is? I mean do you really know what it is? You may be surprised, somewhere on this site Dr. Novella has written a post discussing what it tends to mean in practice – and it’s not just “patients are stupid”. There’s expectancy, regression to the mean, desire to please, the Hawthorne effect and more.

    Do you know why researchers double-blind, as opposed to single-blinding? Do you know why researchers randomize patients? Do you know what a p value of 0.05 means, and why it may not be particularly useful in isolation?

    If you don’t understand these relatively basic issues in medical research, I’m afraid your understanding of Gyrostim is, as you say, “Not very scientific.”

    You have a choice – you can continue to hurl insults, or you can learn something. You aren’t presenting the contributors here with anything new, quite far from it. That you are belittling Drs. Novella and Gorski for venturing basic, fundamental criticisms that can be applied to any sort of patient-exploiting pseudoscience is not a point in your favour.

  30. @Steven Novella

    I am skeptical of such benefits, however, because they lack plausibility.

    I can think of a few. When I was young I was suffering from motion sickness, a vestibular disorder. It got better after some sessions on a child swing, a primitive alternative to the Gyrostim device. Trains the brain to interpret the conflicting signals between the eyes and the vestibular apparatus.

    I am not sure where you see the connection between Gyrostim and “Infrastructure of Quackery” (what does that even mean?). It’s not the intention of the inventor to deceive anyone. Such innovation should be encouraged.

  31. pmoran says:

    Speaking for myself, I hope that you’ll stick around. We might be able to close the distance between the way that you as a journalist in major media view science stories and the way that scientists view them.

    I echo these sentiments. Journalists may not quite grasp how medical science can most efficiently and ethically advance, while scientists generally have no idea how foreign their strong, reflex, sceptical instincts are to journalists, politicians, and — well, the rest of the population, really.

    Medical science indeed advances most efficiently on the back of a highly sceptical approach to weakly supported medical claims. Others may be motivated to try out the same methods, not being too bothered by the lack of assurance that they work. Both approaches are legitimate for the underlying, unspoken practical purposes, while other players stand poised to exploit the uncertainties with varying degrees of disregard for the well-being of their fellows.

    This leaves plenty of room for subjective judgments and intransigent perspectives.

    Gyrostim is a further example of how quackery is not a fixed property of any form of medical treatment — it lies in the claims that are being made. Steve acknowledges that the machine may work as “vestibular therapy”, but sees other uses as implausible.

  32. ConspicuousCarl says:

    adriandater on 05 Jun 2013 at 9:19 pm

    @conspicuous carl: serious question: have you ever used this machine? [....] ACTUAL PATIENTS who HAVE used it believe it does.

    Serious question: Did you not learn in high school (or sooner) that the personal testimonial is a non-sequitur? Did you not take some home-economics class which explained that to you?

    you have as much proof that the machine doesn’t work as these ACTUAL PATIENTS who HAVE used it believe it does.

    Yes, and it is very close to zero in both cases. Go ahead and round it down if you like.

    And we have you, who almost certainly hasn’t, but has already made his/her judgment about it.
    Not very scientific.

    This is either confusion or an outright lie on your part: I did not say that it doesn’t work.

    Everything we have been saying here is about your unwitting promotion of something which has virtually no evidence. You have not made much progress in understanding why that is a problem, which is probably the reason why you keep throwing these fallacies at us.

  33. Adrian,

    I really do hope that you engage with the comments here. You are stepping into a fairly deep intellectual community that has spent years exploring the relationship between science, ethics, and medicine. I hope you can try to understand my points rather than just be defensive. We always prefer to work with journalists to make their reporting better if we can.

    Also, it’s very important to try to fairly understand what the other person is saying. You keep grossly mischaracterizing my position, and it’s transparent to the regular readers here.

    For example, you state –
    “Dr. Novella accuses me of not telling both sides, then he wildly asserts that Dr. Carrick and Dr. Turmel are “controversial characters with a long history of dubious claims.” Without a shred of evidence to support his assertion. You might want to think about getting a lawyer for defamation and slander sir, you might need it.”

    I never said you didn’t tell “both sides” – the accusation is that you did not put the information into a meaningful scientific context. What you did was what we call “token skepticism” at best, or “false balance” (it actually wasn’t even balanced). I never said you did not touch on the other side. You keep just making that up.

    Now you are saying that i accused Carrick and Turmel of having a long history of dubious claims without a shred of evidence. In the article, however, I linked to two in-depth articles on this site that go into detail supporting this characterization. Perhaps you missed the links.

    Your comments also indicate that you still do not understand the essence of our criticism.

    The GyroStim may work for vertigo, but there is no evidence it is any better than (or as good as) the far cheaper and already established vestibular therapy.

    Plausibility for vertigo also does not support claims that the GyroStim is useful for any other indication. Now that Carrick and Turmel have their hands on it the list of conditions they claim it treats is growing longer and more implausible. (autism, really). This is a pattern we are very familiar with.

    Offering anecdotes only demonstrates your unfamiliarity with science-based medicine.

  34. ConspicuousCarl says:

    As for Ted Carrick… I guess you haven’t yet taken my suggestion to google him.

    But if “crackerjack” sounds too unscientific for you, understand that “chiropractic neurology” sounds even less scientific to any of us. And I’m not promoting “crackerjack” as a supposedly serious field of science.

  35. ConspicuousCarl says:

    Steven Novella on 05 Jun 2013 at 10:40 pm
    Offering anecdotes only demonstrates your unfamiliarity with science-based medicine.

    Yes, but I think that describing this in terms of his unfamiliarity with science-based medicine is too narrow. This argument would get points deducted in a 5th-grade essay on whether or not the school should start a hockey team. I don’t think that a lack of familiarity with any one field, even a very broad one, is an adequate counterpart for exploring this level of misconception.

  36. Chris says:

    Dr. Novella:

    The GyroStim may work for vertigo, but there is no evidence it is any better than (or as good as) the far cheaper and already established vestibular therapy.

    That is what I was wondering.

    Adrian Dater, where is the data showing is as effective or as safe as the basic swing that is in OT/PT room in most elementary schools with special ed. populations? What incentive would there to buy that expensive bit of equipment to replace a rope hung from the ceiling that has a seat at the bottom?

    Also, it looks a bit scary. My oldest son is disabled (which is why I know about OT/PT), and when he was young he would not have gone near the Gyrostim. Has it been tested with a large collection of young children in special ed?

  37. Coot says:

    adriandater, Ted aka Fred Carrick is a chiropractor who markets himself as a type of neurologist capable of treating autism and traumatic brain injury.

    But chiropractic is not like neurology. It’s more like a vitalistic religion with some back cracking and fancy machines thrown in.

  38. Coot says:

    This is my favorite comment on that sports writer’s blog:

    “We’ve tried Scientific medicine for decades and it has nothing to offer.

    Science as a brand like Pepsi, lol.

  39. adriandater says:

    OK, look: I appreciate the give and take. I’ll keep this to a few final, reiterated points:
    - There is nowhere in my article – nowhere – where I personally state my “endorsement” or “belief” in the GyroStim. A lot of people here seem to take the incorrect leap that just by publishing a story on this chair, that I somehow believe in all of it. I’m just a journalist covering a story that, even if nobody here agrees with it, many out there do and many REAL athletes are saying it gave them the best results they’ve ever gotten after using it. Placebo, a fluke, not rigorously tested enough to be medically certified? Perhaps. That’s what, in fact, my story SAID. I primarily cover NHL hockey, and the biggest star in the sport credited this machine with his recovery. That in itself makes it a “story.”
    - I’m still really struck by the attacking tone by people here. It’s almost as if people here don’t want this machine to succeed. I mean, wouldn’t it be great if it did? Would everyone here not welcome a device that helped successfully treat brain injury in ways that weren’t realized before? Yet, people here seem offended at the suggestion this might actually be so. If I were to interview a lot of people here, including Dr. Novella, I might as a journalist be right to ask, “Is this attitude because it might somehow represent a threat to your ‘methods’ of your own ways of medicine?’ It would seem a legitimate question, though I’m sure it would be roundly and forcefully denied. But it makes you wonder.
    - If this chair is pure junk, if that’s what the studies show, then so be it. I’ll report that too. But I truly believe I had what was a balanced look at this thing, for what it was. Yes, I could have written a lot longer and gotten more points of view perhaps. But I had a prescribed amount of space for this story. A lot of stuff got cut. And I also DID reach out to a lot of MDs out there in the neurological field to get more comments on this. But I often got a lot of “no comment” or no calls back at all.
    My paper is not a medical journal. It’s a general interest newspaper, and I wrote a story on a machine that – even if you all think it’s a bunch of crap – is a new and unique thing that deserved – I believe – a look at.
    Peace,
    AD

  40. Chris says:

    AD:

    - I’m still really struck by the attacking tone by people here. It’s almost as if people here don’t want this machine to succeed. I mean, wouldn’t it be great if it did?

    I just want to know how it compares to the standard swing that is in an elementary school OT/PT therapy room. How is that an “attack”?

    Seriously, is it worth the expense and does it scare kids? Is that too much to ask?

  41. Chris says:

    AD:

    My paper is not a medical journal. It’s a general interest newspaper, and I wrote a story on a machine that – even if you all think it’s a bunch of crap – is a new and unique thing that deserved – I believe – a look at.

    Though without the comparison to the standard equipment used in therapy, some of which are very similar to playground swings*, it kind of looks like a paid advertisement.

    * Some playground swings, especially in special ed. programs, have swings with molded chairs that have seat/shoulder belts. Here is one example from the googles: http://www.especialneeds.com/tfh-high-backed-swing-seats.html. They go back and forth, side to side, and you can even wind them up to spin.

  42. Coot says:

    Adrian Dater,

    If you want to be regarded as a legit journalist, at the bare minimum you have to Google the names of the people you might mention in your article. If you come across concerns that one of them is marketing an unproven medical therapy to the public, you have to email someone like Steve Novella for help. Believe it or not, people like Steve will help you.

    Fake science is making America stupid and that is bad. Do not get suckered into promoting it.

    Think of the word “unproven” as meaning something like “Scientology.” That should help.

  43. Coot says:

    I still like this comment the best:

    “We’ve tried Coherent thinking for decades and it has nothing to offer.

  44. @Adrian:

    The comment section here is very antagonistic, this type of website attracts lots of disgruntled people who think they are the smartest guy in the room. Dont let it get under your skin.

    Your article was interesting to read, to me at least. I find it inspiring that a guy in his garage built a device that improved his child’s medical condition. We need more innovators like him.

  45. Coot says:

    Thinly disguised advertisements masquerading as news articles brings to mind the recent Atlantic fiasco, which you can Google. The Onion’s parody of that event:

    http://www.theonion.com/articles/sponsored-the-taliban-is-a-vibrant-and-thriving-po,30910/

  46. Chris says:

    Mr. Dater, is the Gyrostim better per cost than a playground merry-go-round?

  47. elburto says:

    Adrian – are you reading the same post+comments as I am? You seem to have hallucinated half of the things you’re objecting to.

    Seriously, talk about irony: Dr. Novella accuses me of not telling both sides, then he wildly asserts that Dr. Carrick and Dr. Turmel are “controversial characters with a long history of dubious claims.” without a shred of evidence

    He has all the evidence he needs in one simple word, ‘chiropractor’. That one word is enough to prove that someone lacks the capacity for logic and reason, and has such deep-rooted problems with distinguishing fantasy from reality that they’ve devoted their life to something no more real than the Tooth Fairy.

    To believe in chiropractic alone is bad enough, but to then assert that one is a “chiropractic neurologist” is nothing short of lunacy. Stating that you can treat disorders of the brain and nervous system by “adjusting” imaginary “subluxations” in the spine, is about as rational as declaring yourself to be the Space Messiah, or the King of the Narwhals.

    Your repeated use of the argumentum ad populum, or “Lots of people have used it so it must be good”, shows a real lack of insight. Lots of people use homeopathy, acupuncture, Reiki, and prayer as “healing” modalities, and swear they’ve experienced improvements as a result. Does that mean they’re all valid too? Lots of people inject heroin, beat their wives, and drive drunk. You can’t use popularity as any kind of scientific yardstick. Science requires cold, hard data, facts and figures, not warm and fuzzy anecdata, feelgood testimonials, and credulous reporting.

    Chris also raises a great point – what is there to suggest that Gyrostim is a substantial improvement on existing vestibular therapy devices?

    Perhaps the improvements claimed by Gyrostim users are simply down to the novelty factor of using a shiny new device, as opposed to an apparently simple traditional method?

    Let’s assume that sport-related brain injuries of the kind that negatively impact spatial awareness, could be treated as simply as sitting in a high-backed swing. Do you think you would report that with the same enthusiasm, and would brain-injured hockey/football/American football/rugby embrace it so readily, as has been done with this impressive-looking new piece of tech? Somehow, I doubt it. New things are sexy and sensational, they sell copy. “Player has PT – Feels better” doesn’t have that same ‘Wow!’ factor really, does it?

  48. WilliamLawrenceUtridge says:

    Such innovation should be encouraged.

    I think you mean “tested”. Well, someone who understood the scientific method would say “tested”, someone whose entire profession is based on untested or poorly tested methodologies might indeed say “encouraged”. Otherwise, what would you charge your clients for? Real medicine?

    The comment section here is very antagonistic, this type of website attracts lots of disgruntled people who think they are the smartest guy in the room. Dont let it get under your skin.

    This website also attracts a lot of people who promote CAM, because they need to attack the scientific methods that consistently demonstrate the treatments they charge money for do nothing. Individuals who promote unscientific methods like homeopathy, or complete nonsense professions like naturopathy (whose treatment recommendations consist of conventional advice, “cutting edge” science that are little more than the rat and glass studies that are the starting points for real medicine, or a grab-bag of mutually-contradictory modalities whose only common underpinning are a lack of proof). Comments get antagonistic when individuals like FastBuckArtist (who appears to be a naturopath) consistently repeat the same tropes of CAM promoters and never learns or leaves. You will see, for instance, a willingness to side with and defend anyone who criticizes the existing medical system (flawed as it is) such as Dr. Burzynski. These proponents rarely make positive claims, since it is trivial to demonstrate the flaws in their arguments. Instead they rely solely on a logical fallacy known as a “false dilemma”, the idea that there are only two options and one choice – either real medicine is perfect, or CAM works. The reality is of course quite different – CAM rarely works, and once proven to work it is integrated into real medicine. And real medicine is flawed, but still responsible for incredible increases in longevity, decreases in morbidity, mortality and in particular, infant death. We had acupuncture, herbal medicine, homeopathy and similar modalities used in naturopathy in the past, but it was only with the advent of scientific medicine that life expectancy began its steep increase around 1900. Medicine is also self-reflective, discarding promising modalities that turn out to not work (versus CAM, which praises the virtues of old things as if longevity were more important than effectiveness – to whit, homeopathy and acupuncture).

    Your article was interesting to read, to me at least. I find it inspiring that a guy in his garage built a device that improved his child’s medical condition. We need more innovators like him.

    The flaws in your argument being, of course, that we don’t know if his daughter actually improved. We don’t know if his daughter improved due to the chair. We don’t know if the $30,000 chair is better than a piece of playground equipment. While the aspiration and achievement are inspiring, that doesn’t make them effective. Truly, it would be wonderful if this worked and was a vast improvement over existing methods for cerebral palsy, concussions and other neuropathies. But we simply don’t know. If it’s no more effective than a swing, then that is $30,000 per chair and $6,000 per treatment that is pure waste (again, much like any ineffective treatments offered by naturopaths; if naturopaths were restricted to only treatments proven to work, their income would essentially vanish – one reason why they resist such restrictions and spend much time criticizing real medicine as a distraction). For that matter, it is quite possible the chair is actively harmful and makes people worse. Is the lurching of acceleration and sudden changes in orientation good for someone with a concussion, or will it kill off for good already injured neurons that are delicately trying to repair themselves? What if it is good for certain symptoms but bad for others?

    We don’t know, so we must study.

    So please read what FastBuckArtist says here and elsewhere, and also read the criticisms – and learn from them. True skeptics don’t tell both sides of the story or “teach the controversy” – they look at the evidence for both sides and come to a conclusion. In this case, if you look at the evidence, you’ll find there isn’t any for CAM, and right now there isn’t any good evidence for Gyrostim. We need fewer brave maverick doctors, not more, because brave maverick doctors often treat before researching, and that’s not a good thing.

  49. Adrian – thanks for continuing the conversation. Let me address a few of your points.

    First, I don’t think we are being antagonistic. Criticism can sound harsh, but it is all constructive, and not personal. Contrast this to the personal attacks by commenters on your blog, and even some of the personal attacks you have made. Most readers here (I, of course, can’t account for everyone) have learned to recognize and avoid ad hominem logical fallacies.

    Noone said you personally endorsed the product. What we are saying is that the narrative of your article (which is a typical default journalist narrative) inadvertently promotes the product. We are not “leaping” to this conclusion – there is copious evidence that this is the case. You yourself admit that you are being contacted by people who want to use it. We have seen this hundreds of times – token skepticism does not make up for an otherwise gushing article. You could have told a very different story with the same facts, a more accurate story, in my opinion.

    Don’t confuse our skepticism with not wanting medical advances to work. Honestly, that’s absurd. If new medical technology like this works, we would use it. It would be profitable and we would help our patients. What could be my possible motive for not wanting this? How does this possibly threaten me, my practice, or my profession? Think it through.

    Rather – we have asked many cogent questions that have gone entirely unanswered:
    - Is this device as effective for vertigo as far cheaper interventions?
    - Is it cost effective?
    - Vertigo is one thing, but what possible mechanism is there for an effect on other cognitive function, brain injury, and conditions like Aspergers or autism (which were mentioned in your article)?

    Saying a claim is premature because it lacks basic plausibility and lacks rigorous evidence is not a desire that it doesn’t work. In fact – you missed the central point of my article. This new treatment at least has some potential. If it is properly studied it might be useful. Instead, it has been shunted into the world of quackery. Now it will be abused for false hope, rather than going through the usual process (which I outlined in detail).

    I am not faulting you for covering this story. However, you are not a science journalist. You dealt with a complex scientific medical question as if it were a general interest story. Good science reporting is very difficult and takes an awareness of many issues (like placebo effects, confirmation bias, the pitfalls of using testimonials, controversial pseudoprofessionals, the tendency for sufferers to latch onto any thin hope, the notions of false balance and token skepticism, etc.) We deal with these issues every day. We have written collectively thousands of articles on these topics. Is it really surprising to you that we have some constructive criticism for how you handled this story?

    As others have pointed out – this can be a huge learning experience, or you can just defend and attack.

  50. David Gorski says:

    Personally, I was so blunt mainly because of Adrian’s sense of entitlement (“you didn’t moderate and approve my brilliant comment within an hour; so I’ll attack you in a blog post of my own”). He clearly needed it explained to him how this particular blog works and to have it pointed out to him that no one was trying to “censor” him, his little rant over at his own blog notwithstanding.

  51. windriven says:

    @adriandater

    “My paper is not a medical journal. It’s a general interest newspaper, and I wrote a story on a machine that – even if you all think it’s a bunch of crap – is a new and unique thing that deserved – I believe – a look at.”

    I think this lies at the heart of the issue. The rules of the road are different in the popular press than they are in the scientific community. Many of us on this side of the road would like to see more scientific rigor on your side of the road. But I’m not sure that poking a stick in your eye is the best way to accomplish that.

    There have been untold numbers of products and therapies that have burst onto the public scene with much fanfare and loads of anecdotal miracle cures. Scads of them. And they have nearly all turned out to be fool’s gold. Some of them have done immeasurable harm. Others have brought false hope that drew people away from conventional therapies that, while not curative, would have prolonged life with good quality. So when a new therapy emerges unaccompanied by careful studies … well, we’ve seen it all before. Acai berries to laetrile, antineoplastons to coffee enemas. Real people suffer and sometimes die when people – sometimes well-meaning people – let their enthusiasm trump careful science.

    Science is nothing more than a self-correcting system for discovering truth. It begins with an observation or a conjecture, becomes formalized as an hypothesis and is then rigorously tested with the intention of proving they hypothesis false. Results are shared with other scientists who look for errors in experimental design and testing methodology. Some of them try to replicate the experiments or design new ones to test the hypothesis. It is an intensive process and many promising conjectures go down in flames. But much is learned in the process. And of course sometimes the hypothesis is proved true and even more is learned.

    It is a lot easier to have a promising idea, try it on a few people and trumpet the success of those who believe it helped them. It is easy for a true believer to discount those who were not helped or to talk himself into believing that they were helped but don’t recognize it. But that doesn’t make it true.

    Lastly, you mentioned a couple of times that we had no more proof that gyrostim didn’t work than anyone else had that it did work. I don’t think that anyone took the time to tell you that it doesn’t work that way in science. The extraordinary claim requires extraordinary proof. In the scientific court of law it is incumbent on the person making the claim to provide proof to support it.

  52. WilliamLawrenceUtridge says:

    @adrian

    There is nowhere in my article – nowhere – where I personally state my “endorsement” or “belief” in the GyroStim. A lot of people here seem to take the incorrect leap that just by publishing a story on this chair, that I somehow believe in all of it. I’m just a journalist covering a story that, even if nobody here agrees with it, many out there do and many REAL athletes are saying it gave them the best results they’ve ever gotten after using it.

    No, you don’t, and why would we care if you did? You’re a journalist, not a doctor. You did make the nigh-universal mistakes of all journalists reporting on science and medicine – lack of proper context and understanding for the implications of the story. You don’t realize the importance of methodology and testing in science, just as vital background information (would you write a story on the Israel-Palestine conflict without investigating the history of the Holocaust or the Yom Kippur war? Without investigating the Balfour Declaration? Would you frame it solely in terms of “desperate Israeli citizens under attack by Palestinian terrorists” and only briefly mention that Ali Mohammed, Palestinian citizen, expressed some reservations over the presence of Israeli neighbours on the West Bank?). You’re treating anecdotes and scientific testing as if they were the same thing – and they’re not. Even if you pubilshed negative anecdotes, that’s still not the same thing as systematic research. You should understand why. You told both sides without determining how valid the points made by each side are. You presented chiropractors and doctors as equivalents; chiropractors are not “controversial” doctors, they are fundamentally different from doctors, with completely different practice standards and uncomparable evidence bases (i.e. one doesn’t have an evidence base at all for “mainstream” chiropractic, let alone “chiropractic neurology”).

    And a mistake journalists shouldn’t make, but often do – ignoring the incentives involved. The father who built the chair for his daughter has incentives – financial of course, but also the powerful desire to believe he helped her get better. Both motivations are vitally important in medicine and particularly in quackery.

    Placebo, a fluke, not rigorously tested enough to be medically certified? Perhaps. That’s what, in fact, my story SAID. I primarily cover NHL hockey, and the biggest star in the sport credited this machine with his recovery. That in itself makes it a “story.”

    Yes, you did all that. A very conventional framing, that rather deliberately told two sides as if they were equivalent. As I say above, they’re not. It’s like having a conversation about flight and on one hand you have the NASA physicist who did the calculations to get the Apollo missions to the moon – and on the other hand you have a yogic flyer who hops up and down on a mattress. Except you gave the yogic flyer 90% of the text and the physicist basically got quoted as saying “yes, well, we’re pretty sure you can actually fly by hopping”.

    I’m still really struck by the attacking tone by people here. It’s almost as if people here don’t want this machine to succeed. I mean, wouldn’t it be great if it did? Would everyone here not welcome a device that helped successfully treat brain injury in ways that weren’t realized before? Yet, people here seem offended at the suggestion this might actually be so. If I were to interview a lot of people here, including Dr. Novella, I might as a journalist be right to ask, “Is this attitude because it might somehow represent a threat to your ‘methods’ of your own ways of medicine?’ It would seem a legitimate question, though I’m sure it would be roundly and forcefully denied. But it makes you wonder.

    Nope, we’d love it if it succeeded, we’re just sick of seeing journalists enable quacks to make money off of desperate people through false hope. All you’re doing is advertising for chiropractors. We would welcome a new machine that genuinely helps – we’re just aware that new techniques often don’t help. We’re perfectly willing to accept a new treatment protocol – we just want proof that it works, that it’s superior to cheaper (much cheaper in this case) options, and that it doesn’t have unforseen side effects.

    Seriously, read the archives. This website is full, just full of treatments that promise the moon and have essentially zero proof behind them (but are still sold, often by chiropractors, at high prices). If the GyroStim chair is demonstrated to work, a relatively trivial task, then it will be eagerly embraced by neurologists. I mean Jebus, do you really believe Kevin Trudeau when he talks about health secrets they don’t want you to know about? Are you blind to the incentives that Maher and Carrick have?

    If this chair is pure junk, if that’s what the studies show, then so be it. I’ll report that too. But I truly believe I had what was a balanced look at this thing, for what it was. Yes, I could have written a lot longer and gotten more points of view perhaps. But I had a prescribed amount of space for this story. A lot of stuff got cut. And I also DID reach out to a lot of MDs out there in the neurological field to get more comments on this. But I often got a lot of “no comment” or no calls back at all.

    Sure, except people pay attention to dramatic stories. They’re memorable. Who remembers the retractions?

    The fact that you think you got a balanced look when you got quotes from two chiropractors again indicates you don’t understand the area you are reporting on. Again, look into how Trine Tsuoderos reports on things. You might also want to look into Brian Deer’s work on the MMR vaccine. In fact, in the future you might want to reach out to the skeptical community, they’re far more informed and motivated to report on these issues than the average neurologist. You might try talking to Dr. Novella in the future, I’m sure he could easily explain the issues to you.

    My paper is not a medical journal. It’s a general interest newspaper, and I wrote a story on a machine that – even if you all think it’s a bunch of crap – is a new and unique thing that deserved – I believe – a look at.

    Do you see your role as selling newspapers, informing consumers or increasing ad space? One of those, you’re not really succeeding at.

    A question aimed to make you think about the issue a little differently. If you substituted “Pfizer biochemist” for “engineer whose daughter has cerebral palsy”, and you substituted “new neurogenic drug” for “multiaxial chair”, and “Pfizer drug representative” for either of the chiropractors, would you have reported the story in the same way? I doubt it, because the framing is different. Big Pharma are justifiable villains in the modern world, so you know to be skeptical of them. Here, you know the story and its background.

    You didn’t know the story, the background or the actors in this case, in particular you didn’t recognize the parasitic nature chiropractors have on science, or the importance of testing and falsification in medicine before one can make claims. Doctors are enjoined to “first, do no harm”. Chiropractors are enjoined to “first, get cash up front”.

  53. Liz Ditz says:

    Dear Mr. Dater,

    In your response to Dr. Novella’s article above, you wrote,

    …I am just a dumb sports writer after all.

    I for one do not think that at all. I gather you are a respected expert on the sport of professional men’s ice hockey, and possibly other aspects of ice hockey, such as youth ice hockey. As such, I would expect that you have a comprehensive understanding of the game in terms of strategy and tactics, an in-depth understanding of the relative strengths and weaknesses of current and past players and managers, and thus of that thing that’s hard to talk about cogently, how different teams may stack up against each other.

    Here is the sum total of what I know about ice hockey: it is kind of like field hockey (which I played for three years in high school, with other equally-inexpert players, competing against teams who likewise were relative newcomers to the sport) except on ice skates (which I have used for about 15 hours total in my life). I don’t even know how many players there are on a team. I know nothing about the current players, about the game as a whole, about the details of the game (except I know, from my other athletic pursuits, that there are exquisitely fine-grained details of consummate importance).

    Do I imagine myself as your equal in terms of hockey expertise? No, not at all. You are clearly a hockey expert and I am naive relative to hockey. That in no wise inflates your importance, or deflates mine, vis a vis talking about the subjects of this post: (1) generally credulous and inane reporting on science; (2) the acceptance and promotion of pseudoscience in popular parlance and particularly, cognitive rehabilitation, and more broadly, sports medicine; (3) a particular device (the Gyrostim) and the prior probability of said device being efficacious; and (4) the broader subject of a particular branch of chiropractic, to wit, “functional neurology”.

    In your response to the article above, you wrote,

    I’ve since learned more about the rivalries between the established medical community and the “quacks” in the alternative medicine field. (It’s kind of like the one between mainstream media and bloggers, come to think of it).

    May I respectfully suggest that in the quote above, you are making two fundamental errors? I don’t mean to be talking down to you. How could I? I only have a BA in anthropology and an MBA — about the equivalent to your journalism degree.

    The first error is to somehow equate physicians such as Steven Novella and David Gorski — each with thousands of hours of training, and many more thousands of hours of direct patient contact — with persons such as Ted Carrick. Like I said, I don’t know much about hockey. I imagine there’s not much serious hockey in states such as Florida. I think you would laugh in derision if a hockey player in an amateur league in a state like Florida claimed to be the athletic equivalent of an NHL star like Sidney Crosby, just because the Florida guy had similar scoring stats. But that is a pretty good parallel to what Carrick is claiming.

    The second way you go astray in drawing a parallel between “mainstream media versus blogging” and “science-based medicine versus alternative medicine”. The former is just two alternative forms of publishing — there’s nothing objective there. The latter, on the other hand, have objective standards of evidence — for both causation and efficacy. In the case of “functional neurology” and chiropractic theories about the nervous system can be shown to be objectively misguided (and that is being generous).

  54. WilliamLawrenceUtridge says:

    @Liz Ditz

    Nice analogy, I should have gone with that instead of Israel-Palestine (skating – ahahaha – perilously close to Godwin’s law).

    Nice comment overall, well done.

  55. ConspicuousCarl says:

    adriandater on 06 Jun 2013 at 12:49 am
    – There is nowhere in my article – nowhere – where I personally state my “endorsement” or “belief” in the GyroStim.

    Indeed, there is not. You wrote it from a non-personal point of view. This is not an attack on whatever your personal opinion may be.

    The problem, as has been described already, is that there is currently very little reason to think that this device is as helpful as claimed, possibly not helpful at all, and yet you wrote an article which makes it look like it is working. Yes, you added some statements about it not being proven (in minimal form). But you also included loads of one-sided dramatic statements. And by your own admission, “the story presented a picture of a machine that is working for a lot of people”. That was your own description of your article.

    Maybe your confusion over this objection is because you might have the idea that these things are 50/50 odds, with everyone’s opinions tipping the scale back and forth. They are not. Tons of new devices, medicines, and therapies are proposed all the time. By far, most of them end up being wrong. But reporters talk about them as soon as possible in the most hopeful terms, and occasionally write snarky stories about how the medical claims they over-hyped are always wrong.

  56. ProSubzero says:

    I have been guilty here of maybe a bit of an uncivil tone, and I do apologize but it was sort of intentional.

    I absolutely love to discuss science with other professionals and lay people. I’m at the point in my scientific career where I think I have some level of responsibility to try and inform people and defend science where it needs to be. Either help people understand the truth or try and undo the harm that comes from people bending science to fit their goals.

    I do this regularly in my lab, online and in my everyday personal life.

    In doing so I’ve found three basic types of people.

    The first are the “skeptics” or the ones who understand science… how it works… and all that. This community is that. And it is great to discuss science in that way. Discussion can be heated but they are professional and usually great fun.

    The second group of people don’t understand science but are curious. They want to know the truth but for whatever reason science never came to them easily, or they just never really thought about it. This group is also great fun dealing with. They ask good question that stem from genuine curiosity and the interest to learn.

    The third group has made up their mind. They have come to distrust science for whatever reason. I’ve tried to talk to them in civil tones and work them back to the skeptics side. Unfortunately I’ve found it is virtually impossible to do. Whatever sent them to that side of the spectrum prevents them from understanding and fully processing the ideas that are required to bring them back from the extreme. It is all to clear the reporter here and McLeroy are incapable of budging.

    I love that Dr. Novella and others try to do so, but I just don’t see it happening. At some point to protect my own sanity, it is best to just minimize their arguments and attempt to appeal to the second group of people. Direct discourse just doesn’t sway group 3.

  57. eltonito says:

    An interesting, if not late, observation is that Adrian Dater personally promoted the link to the article as “A look at the machine that cured Sidney Crosby’s concussion…” on his Facebook and Sulia pages.

    He didn’t say “might have cured” and nor did he say “helped cure”, he deployed a word that is absolute in it’s meaning – “cured.” Something about that word in the context of the article raises alarms as to the intent of the author.

    Obligatory link:
    http://sulia.com/channel/colorado-avalanche/f/65c6952c-80da-4b61-895d-bd7b4fd1fdbc/?source=fb

  58. ConspicuousCarl says:

    Busted.

  59. etatro says:

    I think Adrian deserves a lot of credit for reading and engaging in the conversation. Most people aren’t accustomed to their worked being directly challenged (scientists on the other hand … are used to it).

    It’s really, really difficult to see the weaknesses in one’s own work when they are pointed out right away. You really down see the failings in your own products until you produce better work later on down the road. Adrian is not going to be convinced by this conversation that his work had weaknesses, he’s going to have to come to that realization himself. What he CAN do, though, is learn from this experience, maybe apply what he’s learned, think about these points and ideas in his future work. After the quality of his work has improved, he can then go back and see the weaknesses in the present work. As it stands now, you’re not going to beat him into submission with a reason-hammer. (I’m sure we can all insert personal stories of being highly criticized, not recognizing the criticism at the time, not believing the critics …. improving our work, and look back on our past work and see the same weaknesses our enemy-critics saw).

    I think he could learn from example. Here’s a pretty good science article from the popular press that someone sent to me. Notice the points it touched on: Phase 1 trial — safety & feasibility. Too small to be statistically significant. Notes on prior plausibility. Layperson summary background of the disease and mechanism. It doesn’t make claims on a miracle cure; no conspiracy theories, scientists aren’t “baffled,” and it doesn’t try to apply it to all sorts of other indications (even though it could reasonably be applicable to other auto-immune diseases, the author & scientists showed good restraint). It goes into the weeds a little bit on nano particles but I suspect that was the patent-holder scientist pushing his idea. What I think it was missing is a Clinical Trials Registry Number — if the clinical trial were registered, I’d like to look it up. Also: the article could be updated with a link to the June 5 publication in Science Translational Medicine instead of us having to search for it.

    http://www.medicalnewstoday.com/releases/261534.php#.UbHBo85bl4g

  60. Hope4BrainHealth says:

    From a patient:

    I’m ashamed of most of you for being so narrow minded and quick to judge something that you have no idea about. Is it jealousy that something is being utilized to help individuals that so many others have failed to do effectively? Why would you debunk something before knowing all of the facts or witnessing something first hand for yourself?

    Here is some first hand experience for you all to fight and argue over (because the world needs more of that, right?)
    1 regular family doctor, 3 of the “top” Neurologist, 2 neuropsychologist (because of failing memory), 2 Optometrist (I get double and blurry vision despite having 20/20 vision), 1 Audiologist (ringing in my ear and Hyperacusis) and 2 “conventional” Vestibular therapies have all been part of my life as a result of a Mild Traumatic Brain Injury from a car accident. All of them failed me or made me dramatically worse despite doing everything that any of the doctors asked me to do in order to get my life back. (Including basically eating sticks and berries only for 1 year to help reduce any inflammation that might be in my body causing problems)

    This is what the Neurologist would say after their testing and failure of the vestibular therapies.
    “I don’t know what else to do for you or how to fix this. Here’s some anxiety medicine to take because you’re probably going to need it to deal with this.” (Which I never took since anxiety was not one of my symptoms)

    “These are typical symptoms of a brain injury. It may go away on it’s own in 3 months or it may never go away. Good luck and keep us posted.”

    “I don’t understand why you are stuttering and can’t see sometimes since nothing shows up on your MRI.”
    So after 2 1/2yrs of being fatigued when I would do anything, being sound sensitive, not able to drive a car more than a mile or two on “good” days, not able to watch TV, not able to read more than two small 5 x 7 pages – I was given an opportunity to see if I qualified for the Gyrostim treatments. I was fully aware that this was not FDA approved, but I truly felt at the time that I had nothing to lose. My quality of life was not quality by any means and I didn’t even realize it to the full extent until my brain began to heal. I had no expectations and was given none. You will try anything within reason when your life has been taken away from you. None of you will ever understand this until you experience it yourself firsthand.

    I could write a book on this – but I will do my best to make it as short as possible.

    1) “Cracking backs” has nothing to do with the treatments these doctors are providing. In fact, it was an extremely rare occasion that I would be adjusted.

    2) Not anyone can buy a Gyrostim and use it effectively. You are carefully assessed over a full day of testing including VNG and balance studies. Depending on their findings and if they think the treatments would benefit you – you are spun in the Gyrostim at a certain degree and speed for the specific area of your brain affected. It is different for anyone and may change throughout the course of treatments.

    3) It’s not expensive at all. My neurologist charges me $325 for 15 minutes. The doctors at Carrick Brain Centers generally spend 5hrs a day with you. You do the math. What’s more expensive? The only difference is that insurance doesn’t pay for these treatments YET.

    4) FDA approval – seriously? Do you know the amount of drugs they approve daily that are far more harmful than beneficial to most individuals taking them? These doctors are not cutting into the patients or providing unnecessary drugs that may make some individuals worse. They are generally utilizing the base of many common treatment strategies – Just in a more specific manner curtailed to each individual’s specific injuries or problems. By the way – FDA approval can take years and honestly is an animal’s brain identical to humans? Can a monkey tell you if he’s nauseous, has blurry vision, a headache, sound sensitive or anything else similar? In my eyes there is no better testing than on individuals who voluntarily sign up for these trials and get dramatic results. By the way, they didn’t start charging until they had an adequate number of research patients with direct positive results.

    5) Placebo? That’s a joke and an individual’s only explanation due to inadequate knowledge and experience with these specific treatments.

    6) Fact: Many neurologists from around the world are sending their patients directly to Dr. Carrick when they can’t help a patient themselves. You are only reading what you want to read and know about. Everything isn’t published on Google or correctly for that matter.

    7) Due to the Gyrostim – I am not 100% “cured” BUT I can now read 40pages instead of just 2, I don’t have to sleep every afternoon for 3-4 hours because of fatigue, I can actually play with my nieces and nephews without the sounds of their voices affecting me like nails on a chalkboard, memory issues resolved, I can work 4-6 hrs a day 4x a week instead of just 20min-1hr a day 3x a week, I can go to a social gathering for a few hours without my body getting over stimulated, I can go to Yoga without it ruining my day, it eliminated my stuttering (caused by the accident), it eliminated shaking in one side of my body and even more. I think that you would call that an improvement in the quality of my life, right? Please note though that some are effectively so-called “cured” after one week. Each individual is different based on injury, age and so on.

    8) What I’ve witnessed in a few other patients was individuals getting movement in limbs where they had none for up to 20yrs, I’ve seen paralysis in the face eliminated after no other medical professional could help them, chronic migraines eliminated and balance issues eliminated. I didn’t see any of this until I went back for a “lift” after another doctor took me out again. In talking with the patients, learning their stories and watching their progress through a weeks time – it is like seeing miracles right before your eyes. Hope is instilled by actual results where there was none before. You are not a full believer until you see the change in yourself or witness a loved ones results. It’s an indescribable feeling to be able to “think” again and have the clouds part.

    9) There is hard evidence of improvement for patients after treatments through specific test.

    Three professional athletes were in the clinic the week I was there and trust me when I tell you that they have bigger fish benefiting from these treatments that you are not even aware of. If the top athletes in the world (all sports included) are benefiting from these treatments, than why shouldn’t the average person? These athletes are only going there because of A) referrals B) Due to the failure of multiple doctors C) have nothing to lose. They can go anywhere in the world but they are choosing the Carrick Brain Centers. It would be challenging for anyone to make an argument against that.

    We all need to stop being negative and learn to make a difference in the millions of lives with brain injuries. Scientist have called the brain research the last frontier so let’s all get to work together as one and make a difference.

  61. Chris says:

    Hope4BrainHealth:

    Fact: Many neurologists from around the world are sending their patients directly to Dr. Carrick when they can’t help a patient themselves.

    Citation needed.

    Since Dr. Novella is a neurologist, perhaps you can have those neurologists email him with their citations.

    Also, H4BH, how does that $ 100K machine compare with standard therapy equipment like a swing found in many OT/PT therapy rooms? Do you have anything other empty edicts?

  62. pmoran says:

    Hope4BrainHealth, the scientific medical community has an unwritten contract with society to produce secure medical knowledge, which is also used as the basis for advising on the most cost-effective use of scarce public and insurance finances.

    This leaves little room for giving methods the benefit of the doubt, as patients commonly urge, and indeed practicing doctors are constantly tempted to do. There are simply too many weakly-based practitioner claims and too many patient-sworn-by but dubious methods, while resources remain finite.

    This rather harsh, but necessary, standard is the one by which some of the claims of Gyrostim promoters are being judged and found wanting.

    You can argue that this is a narrow viewpoint, that should not necessarily be able to entirely dictate what patients and practitioner such as yourself might choose to do at their own expense and risk, but there remains a case for the promoters of Gyrostim to answer.

  63. Hope4BrainHealth says:

    I am well aware that Dr. Novella is a neurologist. I’m not bashing him or anyone … just simply asking for a more open mind. I think that you would also agree with me that it would be both unethical and unwise due to common lawsuits these days for me to list any specific names of doctors or patients. I may have had a brain injury, but I am far from dumb. I also am not claiming to be a doctor or that I understand fully why it works. Believe me that when I am fully healed, I will be going back to medical school to study the brain more. We have so far to go still.

    My comments are solely based on my experience only and that’s all that I’ve claimed. The only thing that I can say about the difference in treatments is that all of my doctors prior to the Gyrostim treated my whole brain equally from left to right instead of treating the specific area of the problem. Chair or swing rotations haven’t helped me specifically without the Gyrostim. I will leave it to the doctors for “why” the Gyrostim worked over other normal concussion/brain injury treatments being provided. All that I know, is that 13 medical doctors made me worse and told me that their was nothing they could do for me. The doctors at the Carrick Brain Center were the ONLY ones that I have seen dramatic results from for myself; as well as, others.
    More information will come out in time for all of you. We have to remember that this is relatively new. I have no financial or alternative ties to this other than stating my personal experience from my treatments. Personal experience is better than all hearsay, right?

  64. Chris says:

    You are a study of N=1. That is called an “anecdote.” That is not data.

    Please provide the cost/benefit comparison of the $100K machine versus the standard equipment in a typical OT/PT therapy room. This means a study with several people.

  65. Chris says:

    Also, to remind you what you said H4BH: “Fact: Many neurologists from around the world are sending their patients directly to Dr. Carrick when they can’t help a patient themselves.”

    If that is indeed a fact, then you can come up with names and proof that this is true. The proof would be the case reports. If you worry about privacy of those neurologists, then just send those names by email to Dr. Novella. Without any verifiable evidence, you are just arguing from assertion.

  66. @Hope4BrainHealth

    Thanks for sharing the story. Some of the more “devoted” commenters here dont place any value on testimonials but I appreciate them.

    What type of vestibular therapy were you undertaking before Gyrostim treatment? How long did it take for you to start noticing results of the treatment?

  67. pmoran says:

    Hope4BrainHealth — There is an old saying among doctors (I first heard it in the 1960s) — “Blessed is he who sees the patient LAST!”

    It’s a wry comment on the vagaries of medical outcomes with many conditions and who/what gets the credit. It is a fact that after long periods of no progress and many doctor consultations some conditions will rapidly improve no matter what is done — also that some conditions do seem to respond to weirder and less likely treatments than the Gyrostim, perhaps due to unrecognised incidental influences including those related to placebo.

    I am not saying any of these apply to your experiences. Perhaps Gyrostim will prove to be as useful a treatment as you suggest. I am merely trying to point out why your story and those of other Gyrostim patients will be less compelling than you hope.

    You expect further evidence to be forthcoming — our complaint is that certain of the claims could have been withheld until such time. If the treatment is still being offered on an experimental basis that should be made clear to the subjects,, and certain scientific norms adhered to so that we can all learn something useful.

  68. Chris says:

    Also, my concerns are mostly financial. This is a machine that costs much much more than typical therapy equipment. Since my son was treated by an OT/PT in an elementary school special ed. program, I would hate to see funds going to a large expensive piece of equipment if it prevents a number of people from getting treatment due to budget constraints.

    And there is this funny thing about brain injury, getting better is sometimes due to time. Sometimes it goes very slowly and then it speeds up. There is very little rhyme or reason.

    Another quote from H4BH: “There is hard evidence of improvement for patients after treatments through specific test.”

    Provide that hard evidence. I assume it is in the form of a peer reviewed set of case histories on PubMed.

  69. Hope4BrainHealth says:

    Yes, I can certainly see that with some cases. Please note that they were not my last doctors. I tried another vestibular therapy to try and take me to the finish line but they again took me out. Only 2 other doctors even understood my symptoms from the brain injury. (all neurologist shouldn’t claim they do brain injuries. I believe that it should be more of a specialty practice) It was the Gyrostim that took me back to a functioning level again in which I now never want to stray from.

    For me (and the patients that I know well) – It’s not “just” about the Gyrostim but also the doctors providing the service at a different level of care than we are typically accustomed to. You could say that they test you with a finer comb or look at you under a microscope so to speak.

    Placebo can easily happen with some treatments and drug trials. There is truth to mind over matter without a doubt. I wish that was my case but a positive and hopeful attitude have never been a problem of mine. In fact, one doctor told me that I couldn’t possibly have a brain injury because I wasn’t depressed and was good spirited. (Funny, right?) However, placebo with the Gyrostim cannot be possible when they have specific computerized testing validating the changes being made than correlate directly with improved symptoms. For example – I have no control over my eyes being in sink or not. If there is a trick that I’m not aware of … I beg you to please inform me ;)

    We have no idea where this will go. I’m just thankful beyond words that their are forums and treatment strategies to even have discussions about. All egos aside, I fully believe that we could go even further if everyone on both sides of the fence combined knowledge and expertise. Just maybe a whole hell of a lot of people including our military with blast injuries would be able to enjoy life fully again. For me; as well as, others – this is the path that has been placed in front us for a better life. If someone comes out with a more effective strategy for fixing our injuries, than amen. The main goal is just to help people and to better understand each and every element of our brains. The brain truly is one undervalued and underappreciated element of life, which no one can fully ever understand unless it’s been taken away from you specifically.

    Thanks to many doctors, scientist conventional or unconventional – We are just beginning to understand the brain on a new and higher level, which is pretty darn incredible.

    I’m signing out. Many blessings and KEEP asking the question why. It is that question that will lead us all to greater discoveries.

  70. Chris says:

    Le sigh. So when you said:

    “Fact: Many neurologists from around the world are sending their patients directly to Dr. Carrick when they can’t help a patient themselves.”

    and

    “There is hard evidence of improvement for patients after treatments through specific test.”

    … you didn’t realize that we’d actually want proof for those claims?

    Well, best of luck on your recovery from brain injury. I’ve known a few, mostly pediatric, who have had brain injury. Mostly from seizures, one from being dropped as an infant, and another who has a bone growth disorder that causes growths which put pressure on his brain (multiple surgeries). So I know it is slow going.

    Last year my son got more speech therapy as an adult because the therapist who saw him in the hospital after a possible stroke thought he could use some more (it turned out to be a complex migraine, also his speech has never been normal even after ten years of speech/language therapy, but it is better than the total lack of speech he had when he was three years old). When I took him to the sessions I saw lots of folks waiting for both speech/language and OT/PT therapy. Some were from strokes, and others from accidents. I would just hate to see them be denied therapy because too much of the medical budget went to a very expensive machine instead of inexpensive swings, and skilled therapists.

  71. weing says:

    “Why would you debunk something before knowing all of the facts or witnessing something first hand for yourself?”

    Why would we bunk something before knowing all of the facts and seeing the results of rigorous scientific testing?

  72. theLaplaceDemon says:

    Hi H4BH,

    I am really, really glad that you are seeing improvement from your brain injuries. I hope that continues, regardless of which treatments you pursue.

    I know you are checking out of this discussion, but I wanted to bring up a couple points I think you’re missing.

    “Placebo can easily happen with some treatments and drug trials. There is truth to mind over matter without a doubt. I wish that was my case but a positive and hopeful attitude have never been a problem of mine. In fact, one doctor told me that I couldn’t possibly have a brain injury because I wasn’t depressed and was good spirited. (Funny, right?) However, placebo with the Gyrostim cannot be possible when they have specific computerized testing validating the changes being made than correlate directly with improved symptoms. For example – I have no control over my eyes being in sink or not. If there is a trick that I’m not aware of … I beg you to please inform me”

    I don’t think you are correctly understanding the placebo effect here. Placebo isn’t just “positive thinking” or a “hopeful attitude.” Placebo also isn’t something made up – it is real improvement of symptoms when patients think they are given a treatment. This is why you still have placebo groups for non-psychiatric drugs. Placebo CAN be possible with Gyrostim – placebo that leads to physical, measurable changes, such as your eyes being in sync.

    This doesn’t mean that what happened to you was placebo. But placebo is possible. No matter how tightly correlated in time it was to Gyrostim treatment, N=1 is never enough.

    If I am understanding the claims made by Dr. Novella and the commenters here, they mostly fall into four points:

    1) Gyrostim is a possible alternative to regular vestibular therapy, and should undergo clinical trials to see how it stacks up. If it really is better, a well-designed trial will show that.
    2) Charging people lots of money for experimental treatments is unethical.
    3) It is *extremely* unethical to claim Gyrostim is effective treatment for conditions not helped by regular vestibular therapy.
    4) Anecdotal evidence is often flawed. Humans are bad an judging causality when it comes to medical conditions. One person may perceive – or really experience! – an effect from treatment that is not generalizable to the rest of the population. The placebo effect is real. There is a reason randomized double-blinded controlled trials are the gold standard.

    Were Carrick a credible physician or scientist, he would be pushing for this to go into a clinical trial, not claiming miracles.

    I am happy to provide references for any points upon request.

  73. Harriet Hall says:

    “Were Carrick a credible physician or scientist, he would be pushing for this to go into a clinical trial, not claiming miracles.”

    I question whether Carrick knows how to do proper clinical trials, or even whether he can think logically about science. Just read this:
    http://www.sciencebasedmedicine.org/index.php/blind-spot-mapping-cortical-function-and-chiropractic-manipulation/

  74. Dave S says:

    Hi H4BH

    I would like to point out that placebos are used also to assess for the adverse effects of treatments. In a typical double blind study patients in the placebo group might report headaches form the therapy 7% of the time, diarrhea 10% of the time, nausea 8% of the time etc. If the treatment arm patients report diarrhea 25% of the time it’s likely that the drug in question does cause diarrhea in some individuals as a side effect, whereas if only 10% of them report diarrhea, the same as in the placebo group, the effect is not as likely. Procedural studies ideally should have a placebo arm. Some medical procedures that I am aware of that have been tested against sham procedures (the incision, or endoscopy is done but the procedure itself is not carried out) are arthroscopic procedures, kyphoplasties, gastric balloon inflations for weight loss, and cochlear decompressions. Accupuncture has also been tested against sham accupuncture procedures. Regretably, even in mainstream medicine, sometimes a procedure will become popular before the proper testing is done, and then when it is properly tested found not to be very effective. Also, studies need to be repeated and validated. Many years ago a trial in South Africa reported success with bone marrow transplants as a therapy for women with breast cancer. Unfortunately, when the testing was repeated in multiple other centers no beneficial effect was seen. I remember attending an Updates in Medicine course many years ago when the speaker on breast cancer quipped, “If you send a breast cancer patient for bone marrow transplant, make sure she has it done in South Africa because that’s the only place it’s ever worked.”

    Mainstream medicine evolved from a situation where such testing was not done. I wrote in a recent post that I have a twenty volume medical textbook written in 1898, authored by prominent academic physicians of the time from the United States and Europe. They actually knew a fair amount of bacteriology and physiology then and were very astute observers but effective treatment was limited. However, to give an example from the chapter on pneumococcal pneumonia, multiple treatments with endorsements from prominent physicians are given for, among other things, mercury, calomel, and creosote inhalation. I have no doubt these doctors believed these therapies worked – after all, they gave them to patients and some of the patients survived a condition which back then had horrifying mortality rates (Osler called pneumonia the “Captain of the men of death”). These treatments of course are no longer used because they are ineffective. Evidence based medicine did not develop as a way to slam CAM, it was developed for doctors to discover which of the thing they were doing in mainstream medicine were ineffective and which were effective. I personally like to have assurance that the treatments I offer my patients actually work, and in my life I’ve seen a lot of stuff we were using that has not panned out – activated protein C complexes for septic shock, bretylium in cardiac arrests, the aforementioned bone marrow transplants, gallons of antacids for peptic ulcer disease, to name a few. I would hope that CAM practitioners would have the same desire.

  75. mattyp says:

    Just wanted to add my $AU0.02 (which is now not even at parity)…

    This is a very reasonable blog. The arguments of the posters are pretty well constructed in most of the posts. I only comment on those where I feel I can contribute something. Other commenters are not that way inclined and can sometimes post above their head or even outright nonsense. Even some offensive posts get put through – which I am assuming is to illustrate to the readers of the blog that commenter’s either state of mind, lack of logic, or even to illustrate the ad hominen attacks that they receive, often which can be worse than what is printed.
    It would be far more benefical to comment and hope to learn something from here (as I’ve done about the dubious history of my profession and some of the goings on in the US in particular).
    And I can’t find anything in Dr Novella’s original post that would be worth taking offence to. If you think there are errors of fact, try to point them out in a constructive way, as Dr Novella has attempted to do.

  76. WilliamLawrenceUtridge says:

    Heh, for once I agree with Pete :)

    @H4BH

    My apologies for responding so late, I didn’t make the time to read through your full comments until now. My sympathies for your symptoms, it really does sound awful and I’m glad you’re recovering. Not being able to read more than a page or two at a time would be horrible :(

    Many of the points I would have made have already been made, but here are some more.

    Most important is that your recovery could be due to the GyroStim (Dr. Novella states this treatment option may actually work). My most trenchent criticism is that it is being used as part of treatment (and patients are charged for it!) rather than testing. Wouldn’t it be better if, instead of just being better, you were getting better as part of a clinical trial that was responsible in the widespread adoption of this device as standard treatment? Right now it’s helping perhaps dozens of patients. With clinical trials, it could become standard, even first-line care, helping millions of people. Irrespective anything else about Carrick, the fact that he has placed profit before testing (financial, or even just the high he gets from helping patients or being a guru of sorts) is hugely problematic. Even contemptible in my mind.

    Placebo is not merely “people being stupid and weak”. Placebo captures a multitude of effects, only some of which are related to changes in symptoms. Dr. Novella (IIRC) wrote a post on what is collectively classified as “the placebo effect” somewhere, and I wish I could find it so you could read the article. Placebo very much isn’t “mind over matter” (placebo effects do not result in objective changes from what science has been able to tell), it’s at best mind over symptom.

    Focussing on the “back cracking” aspect of chiropractic is indeed imperfect – they don’t focus on back health (though it’s a pity they don’t, as Sam Homola urges them to) but rather on the belief that neurons are all. Back cracking is merely one way to “get at” the nerves. Some (straights) are worse than others (mixers) but in general it’s either redundant to physiotherapy (now that back manipulation is developing an evidence base, physios are indeed starting to adopt it for back pain) or based on a fantasy.

    Animal testing is only one part of the clinical trial process, phases I-III are done exclusively in humans. Animal testing would also have the advantage of allow you to look for objective improvements or worsening, in addition to what sort of negative health effects you might get at higher speeds.

    If GyroStim is as effective as you claim it to be, based on your anecdotal experience, it should be trivial to demonstrate this. Making it again, borderline criminal to bypass testing, clinical trials and widespread adoption. One well-designed clinical trial will do far more good than a dozen Carricks acting as individual practitioners. Though emotionally less satisfying, in terms of genuine benefit it is far superior. Much like having Superman power the world. Seriously, click on it, it’s awesome. Indeed, it should be the common person benefiting from this treatment, not merely elite athletes. That’s why testing is so important, because an effective treatment will be embraced by doctors, patients and insurance companies, who would much rather pay for a short, effective course of treatment versus the expensive options we currently have available.

    So the comments about GyroStim aren’t meant to be negative, they are the kind of valuable criticism needed to improve medicine. Sadly, Carrick isn’t reading them, may not even understand them, and is certainly more interested in his personal enrichment or aggrandizement than helping anyone outside of his small patient circle. Perhaps if you still have contact with Carrick or his clinics, you could mention this to him, convince him to use his experience to inform proper clinical trials with the potential to help millions. If it’s as powerful and effective as people have been claiming, in a very short period of time these chairs will being appearing all over the world, to everyone’s net benefit.

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