Marcus Aurelius Antoninus Augustus (121 – 180)

Current evidence that best guides manipulative intervention is recently described in the work of Bronfort et al. 2010, ‘Effectiveness of manual therapies: the UK evidence report’ and discussed by Haldeman and Underwood 2010 in: ‘Commentary on the United Kingdom evidence report about effectiveness of manual therapies’. Both articles should really be considered mandatory reading for practitioners, regulators and educators occupying whichever flavour of manual health care. Be advised however that Journal reading is not an endorsed continuing professional development (CPD) choice for osteopaths. It is not an activity sanctioned by the statutory body, the Osteopathic Council of New Zealand. Regrettably therefore, in New Zealand it may take considerably longer to breach a threshold of wider professional awareness.

Reading the UK evidence report (Bronfort et al. 2010) might quickly be followed by a purging dose of Hartman 2009, ‘Why do ineffective treatments seem helpful? This brief review provides helpful insight into practitioner and patient perceptions that believe therapeutic benefit may be occurring clinically. Hartman 2009 states:

“Independent of direct, effective, therapeutic support, patients often come to feel better. This is not trivial, but ethics of all healing professions demand that such effects not be falsely credited to specific treatments.”

Based on the UK evidence report (Bronfort et al. 2010), Haldeman (Haldeman and Underwood 2010) echoes this stating:

“It is however a serious mistake to try to attack or disagree with the evidence when treating patients. It does not serve patients to provide treatment that has been shown to be ineffective or where there is insufficient evidence to reach a conclusion when there are other options available that have been demonstrated to be beneficial. It is not acceptable today to claim that a treatment is effective in helping patients when there is no evidence to to support these claims.”

Underwood (Haldeman and Underwood 2010) continues by underlining the key message:

“There is evidence to support the use of manual therapies for a range of, primarily musculoskeletal, disorders for which it is biologically plausible that they might have a specific effect. There is not evidence for their use for a range of other disorders for which a biologically plausible mechanism for a specific effect is unclear.”

Today a potential exists for legislative pressure to develop that would seek to ensure a formalised presence of evidence based practice in regulated health care. Hunt and Ernst (2009) describe the UK House of Lords Select Committee advising that the “ethos of evidence based practice should extend to alternative and complementary medicine.” Their study highlighted that only the British Osteopathic Council, Chiropractic Council and General Regulatory Council for Complementary Therapies oblige their members to adopt evidence based practice.

It remains a matter of deep interest to this writer to observe how long it is before the regulators in New Zealand step up to the practical and ethical challenge of instigating a code of evidence based practice in osteopathic and wider manual health care. It would obviously be far better were the professions to pre-empt a directed development of this nature. In a sense the process has started elsewhere through AMSEC (Australian Musculoskeletal Education Competencies), which has sought to establish defined core competencies in musculoskeletal medicine for the implementation into the curricula in all Australian medical schools.

For osteopaths, the implementation of evidence based practice is not only feasible but a vitally important project. Much of the necessary expertise in tertiary education exists to provide an Australasian expert guidelines group. All that is required is for the regulatory boards to wake-up to the reality that almost all osteopathic academic and clinical expertise resides in tertiary institutions, in spite of a persistent and unspoken denial that this is the case – as evidenced by a bizarre and inexplicable reluctance to acknowledge substantial professional and clinical development accruing to those in tertiary osteopathic and related manual medicine education and research.

A suggestion made to the New Zealand Osteopathic Council in the form of a ‘Terms of Reference’ document in February 2009, described  ‘A possible role for evidence assimilation explicit in the scope of practice’ (McGrath MC 2009) was greeted by deafening silence. To quote a salient passage:

“The development of an osteopathic guidelines process may offer a dynamic way in which to assimilate current research and practice paradigms with distinctiveness. This could also offer a responsive and evolutionary way to modify scope of practice. Extant scopes of practice might reflect specific professional guidelines developed by a professional guideline group. Consideration of the possibility that some of the scope of practice be represented by current guidelines (developed by osteopaths) for the treatment of common conditions.

Such an approach would require the establishment of a formal guidelines group charged with a review of evidence and the synthesis of professional guidelines that are show osteopathic distinctiveness. Made available to the profession, the maintenance of currency in professional guidelines maybe considered a feature of currency of scope of practice (SOP). In this way, the SOP would assist moving usual practice towards best practice, assimilating evidence based guidelines.”

Nevertheless, an acknowledgment of evidence based practice continues to remain on the fringes of statutory perception as does the development of a professional mechanism to assist and support a ‘species specific’ guidelines group – surely a tremendous opportunity and practical first step in drawing all the professions involved in manual musculoskeletal practice closer together.

A recent paper hot of the press, so to speak (Murphy DR 2010), suggests that the current evidence shows that cervical (neck) manipulative treatment is associated with but may not be causally related to vertebral artery dissection and stroke (VADS). The article points out that VADS is rare but potentially serious and that some of the initial symptoms of this disorder can mimic more common and relatively benign neck and headache problems. The article goes on to indicate that diagnosis may be difficult so that some individuals and their health care providers are not always aware that they are experiencing VADS. The important thing is the recognition of subtle signs and symptoms (derived from an appropriate physical examination and history). This nicely written article is very well worth reading critically. It is available through BMC open access.

Anyone interested in having a look at evidence based medicine/practice might check out the following helpful links:

http://library.ncahec.net/ebm/pages/learning.htm#online

http://www.cebm.net/index.aspx?o=1014

http://www.nice.org.uk/

http://www.sciencebasedmedicine.org/

http://www.patient.co.uk/guidelines.asp

http://library.umassmed.edu/EBM/index.cfm

And finally, to quote directly from a recent article by Goldstein M (2010):

‘Modern medicine now requires that OMT’s present and future clinical application be evaluated utilizing methodologies that are reliable and reproducible. The randomised controlled trial (RCT) is a critical methodology for meeting that objective. It is a methodology that the osteopathic profession must foster so that its identifying characteristics of patient care become part of conventional medicine rather than continuing to be considered complementary medicine’.

Goldstein (2010) goes on to raise the crucial issue of funding for contemporary osteopathic research, stating that it is only through research expertise that the osteopathic profession will address its responsibility to be ‘active participants in what is rapidly becoming the basis for modern clinical care — evidence-based medicine’. This is precisely the same issue that requires intelligent and urgent attention from the osteopathic profession in New Zealand and Australia. Indeed, it is imperative that the relevant statutory bodies recognise, promote and support a tertiary based culture of research and teaching expertise. Without such recognition and support it is sad and likely that the profession will continue a progressive slide toward irrelevance, unable to define meaningful clinical distinctiveness.

Thank you for your engagement.

Bibliography

Bronfort G et al. 2010. Effectiveness of manual therapies: the UK evidence report. Chiropractic and Osteopathy, 18:3. Biomedcentral.

Haldeman S and Underwood M, 2010. Commentary on the UK evidence report about effectiveness of manual therapies. Chiropractic and Osteopathy, 18:4 Biomedcentral.

Hartman SE, 2009. Why do ineffective treatments seem helpful? A brief review. Chiropractic and Osteopathy, 17:10. Biomedcentral.

Murphy DR, 2010. Current understanding of the relationship between cervical manipulation and stroke: what does it mean for the chiropractic profession? Chiropractic and Osteopathy, 18:22. Biomedcentral.

Hunt K and Ernst E, 2009. Evidence based practice in British complementary and alternative medicine: double standards? J Health Res Serv Policy 14(4):224 – 5.

McGrath MC, 2009. Proposed terms of reference for the development of a discussion document relating to a requirement for a scope of practice for osteopaths by the Health Practitioners Competence Assurance Act (2003)’. Commissioned by the Osteopathic Council of New Zealand.

Goldstein M, 2010. Osteopathic manipulative treatment for pneumonia. Osteopathic Medicine and Primary Care 4:3. Biomedcentral.

When considering the evidence based health care management of an episode of acute back pain it has been of longstanding interest to me that the message ACC promulgates as evidence based is to remain active – and most preferably, at work. The financial imperative here is evident. The costs associated with income related compensation are very substantial. In addition, the risk of chronicity associated with disengagement from normal everyday activities including work, escalates. So the Corporation puts out the following EBP advice:

In most cases, the patient can be advised to continue working normally. Communication with the patient must include clear statements like ‘working heals rather than harms the back’. The patient should also be reassured that while there may be some temporary increase in pain, the physical activity is beneficial to their rehabilitation, (Non-specific acute low back pain: Return to work – Issue 10; May 2004. http://www.acc.co.nz/for-providers/clinical-best-practice/acc-review/WCMZ003162)

Staying active and continuing usual activities, even though there may initially be pain and discomfort, usually results in a faster recovery from symptoms, less chronic disability and less time off work. NZ Acute Low Back Pain Guide Oct 2004, p12.

The evidence suggests that in the absence of ‘red flags’ – indicators of potentially significant or serious pathology, most individuals improve quite quickly from an episode of acute low back pain. It should be pointed out here that this does not mean they ‘get better’ or make a ‘full recovery’. The implication also exists that as the condition is not diagnosable (at least without expensive, sophisticated imaging or invasive diagnostic tests – and, so it goes, there’s no point anyway as most patients get better)………then it follows that there’s nothing really wrong, which is another subtle reinforcement of the keep moving, stay at work message. The trouble is that the literature also suggests that there is a 50% chance of recurrence within a year after an acute episode which leaves one in little doubt that for a significant proportion of acute low back pain sufferers, an injury of consequence has been incurred -  MRI studies suggest that 35 – 40% of the population have intervertebral disc bulges.

When an injury occurs it requires a period healing. The healing process takes a period of time but it will permit the progressive resumption of pain free activity in a manner that is physiologically consistent with the degree of injury and the role of the structure involved.  In addition, the neurological recovery from a episode of acute pain may arguably take longer – pain pathways are sensitised and some central expansion of related central somatosensory areas may ensure and importantly, the pain experience will not be forgotten.

Now, there is little doubt if one were to fall over, hands outstretched, in a manner that results in the forcible over extension of a knuckle joint, the joint is likely to swell and become painful. It was sprained. More than likely, one will limit the amount of movement until the pain and swelling subsides. Almost certainly, one will not actively wiggle the joint in order to promote a more rapid recovery. In this instance, such behaviour is both inconsistent with a speedy physiological recovery and a pain free life .

A patient experiencing an acute episode of low back pain will sometimes barely be able to walk, let alone think of working. Usually and fortunately, this period is short – days. In most cases individuals do press on as best they can but they will instinctively limit their activities commensurate with their pain. Moving may not be of therapeutic use. And indeed, this is what the evidence now tells us. The ACC Acute Low Back Pain (2004), which refers to the Cochrane Collaboration as a source of data, does not appear to reflect recent Cochrane Collaboration findings.

The Cochrane Collaboration has quite recently withdrawn advice to stay active as a single treatment for low back pain and sciatica (Hilde et al. Cochrane Collaboration, Issue 4, 2009) and highlights the idea that remaining active and engaged in daily activities as normally as possible is the best EBP advice. This stands in notable contrast to the ACC statement that ‘working heals rather than harms the back’ or  ‘In most cases, the patient can be advised to continue working normally’. Such statements are incorrect generalisations that may inadvertently encourage unintended consequences.  They may inhibit rapid physiological recovery by promoting the notion that activity per se is useful – which it clearly isn’t – and they may result in a prolongation of injury and increased risk of chronic back pain. The new evidence however, is consistent with the physiological requirement for recovery from injury, although the Corporation may view it as a fiscally risky recommendation. We’ll see. I suspect fiscal risk will win out.

So the take away message to patients and practitioners, having clinically excluded ‘red flags’, is to pay attention to the symptoms, listen to your body and move about in a manner consistent with managing your discomfort at a tolerable level. Exercise (remember wiggling the knuckle) and acute back pain do not enjoy some secret inverse relationship. In fact, they are not related at all. However, you will find that if you move about in a manner you can tolerate and you stay engaged with life, friends and work you’ll recover with less struggle and potential complication, and you’ll remain saner. I sometimes frame such advice in the following way; number one rule is to stay comfortable and engaged and number two is to move, but not in a manner that compromises number one rule. Needless to say this advice is not only patient specific but also takes into account other potential risk factors associated with the development of a chronic condition.

Commentary on the United Kingdom evidence report about the effectiveness of manual therapies. Chiropractic & Osteopathy, 2010, 18:4. Haldeman, S. Underwood, M.    doi:10.1186/1746-1340-18-4

Some key points made by Prof. Haldeman in this commentary stand out. In particular, the idea that it is not acceptable to claim that treatment is effective in helping patients when there is no evidence to support such a claim. On the positive side, Haldeman points out that there is now little dispute amongst knowledgeable scientists that manipulation is of value in the management of back pain, neck pain and headaches. His key exhortation to practitioners is to ensure attendance at scientific meetings in which the latest clinical studies are presented and discussed, and that they keep up with the latest research.

Prof. Underwood also highlights the utility of manual intervention (massage, joint mobilisation, manipulation) though avoids maintaining a particular focus on any specific manual discipline. As indeed I have stated elsewhere, individual manual disciplines are quick to opportunistically point out the usefulness of manual intervention – irrespective of the source of the research – if it helps their own case and yet, in a curious double standard, get quite coy with each other in the political or funding arenas.

Refreshingly, academic research and evidence based practice highlight the spuriousness of maintaining philosophical and historical discipline differences that originate in the late nineteenth and early twentieth centuries. The intellectual focus is shifted to what is actually done -  including ideas that embrace a more contemporaneous biopsychosocial model of healthcare practice. Evidence based practice importantly will inevitably move patient expectations steadily away from the more esoteric conceptualisations of a mystical woo-woo process that some practicing in manual therapy appear to foster, and dare I say it, not a few of their willing patients appear to enjoy.

Prof. Underwood states that manual therapists need to indicate to their patients the risk of minor and major adverse events, particularly in the context of the presenting complaint and mechanism of injury. He concludes his commentary by highlighting the popularity of manual intervention for some non-musculoskeletal disorders. In this instance, without evidence being available for such intervention he urges that there is a real need for new trials to produce evidence of effectiveness / ineffectiveness and it is incumbent on manual practitioners to be aware of non-manual treatment, to be able to consider the comparative evidence and to be able to explain this to a patient who may then make an informed treatment decision.

Prof. Underwood observes that the majority of osteopaths and chiropractors in the UK  (and equally in Australia and in New Zealand) are in private practice. He suggests that this could lead to the concern that unproven treatments are being inappropriately offered for short term commercial gain. This statement by Prof. Underwood goes directly to the heart of a rarely spoken about issue amongst osteopaths and chiropractors that centers around what I might less delicately describe as an Integrity Conflict -  a potential conflict between the commercial imperative and professional integrity. One possible way of characterising aberrant osteopathic or chiropractic practice is through over-servicing. This is usually self-evident to the informed patient who will unilaterally terminate continuing treatment as they improve. They understand natural history and risk, instinctively or otherwise. The less aware may unfortunately become ongoing practice cash flow and capital. Regrettably, the concern that  unproven treatment is inappropriately offered for short term commercial gain is not only limited to the osteopaths and chiropractors but as Prof. Underwood states, ‘might be raised for my medical colleagues who work in private practice’.

In New Zealand, where the Accident Rehabilitation Compensation Insurance Corporation – known by the contracted acronym – ‘ACC’  funds a model of practice that in no small part, it could be argued, drives practitioner behaviour. No where is this so well seen but in the ‘management’ and treatment of musculoskeletal ‘strains and sprains’. Inevitably, and as we have recently seen, this practice funding model is apt to eventually be caught up by reality, leading to Ministerial intervention. In the truest sense it is unsustainable. The predictable hiatus associated with reduced funding has, in this particular instance, been rather muted. Unsurprising really, as the evidence shows that outcomes have not been usefully influenced by unfettered grazing at the funding trough.

We may all, patients and practitioners alike, live in hope for a future where evidence based practice increasingly guides and informs clinical practice, and contributes to professional ethics. Brontfort et al (2010) – Effectiveness of manual therapies: the UK evidence report – together with the comments of Professors Haldeman and Underwood, have undeniably raised the bar in the manual healthcare professions and in time, this will also be felt in patient expectations.

Irrespective of the discipline of practice eg. osteopath, chiropractor, manipulative physiotherapist, musculoskeletal general practice, the key message from a substantive and recently published report, which provides a comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal condition is that effective utility resides in manual intervention.

Effectiveness of manual therapies: the UK evidence report. Chiropractic & Osteopathy, 2010, 18:3. Bronfort G et al.    doi:10.1186/1746-1340-18-3

Commentary on the United Kingdom evidence report about the effectiveness of manual therapies. Chiropractic & Osteopathy, 2010, 18:4. Haldeman, S. Underwood, M.    doi:10.1186/1746-1340-18-4

The study concludes the following:

‘Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain.’ (Bronfort et al. 2010).

The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension- type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults.’ (Bronfort et al. 2010).

‘Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation.’ (Bronfort et al. 2010).

‘Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic’. (Bronfort et al. 2010).

A more detailed analysis of the report is underway and you can read it here in the next week.

The advance article published online in the prestigious scientific journal Nature, 27 January 2010, doi: 10.1038/nature08797 – Direct conversion of fibroblasts to functional neurons by defined factors – Vierbuchen, T. and colleagues highlights this work of such tremendous potential. The researchers took embryonic and postnatal mouse fibroblasts and identified a combination of three genes that were capable of inducing these fibroblasts to become functional neurons capable of generating action potentials and forming synapses.

It is known that fibroblasts may be genetically re-programmed to a pluripotent state using a number of genetic transciption factors but it was unknown whether they could be persuaded directly into another defined somatic cell. Vierbuchen et al. have shown that this is feasible by their work on mouse fibroblasts. The implications are huge for the treatment of disease, the regeneration of compromised, traumatised or aged nerves and the therapeutic intervention in development, to name a few.

The world is a fabulous place, full of opportunity and joy. Develop the habit of looking for positive things, surrounding yourself with positive people and projects, doing something new and interesting, rediscovering some of your passion and enthusiasm for life. Take one day, one moment, one hour, one step at a time. This is one of many routes leading to better health and well being.

Dunedin Osteopathic Clinic positively and distinctively offers you focused osteopathic care. The clinical goal is to have you diagnosed, comfortably functional and as pain free as possible within the shortest possible time. Our treatment is informed by research, evidence, experience and qualifications second to none. We think positively and we aspire to have you doing the same. Our pre-eminent aim is to save you time and therefore money; not to over-diagnose, over-treat or over-service your condition or indeed to foster clinical ‘dependence’. We believe in delivering the minimum amount of treatment for your maximum benefit, and providing you with the ability to manage future risk. And we believe in doing this collaboratively with you.

We wish you a positively prosperous and healthy 2010!

The first set of temperature data that comes from the New Zealand Crown Enterprise, The National Institute of Water and Atmospheric Research (NIWA). The actual temperature record shows a gradual decline in temperatures since around 1850 to the present day. The published temperature record shows the opposite, a gradual warming trend. This is achieved by ‘manipulating’ the data in unknown and unstated ways. This manipulation has caused concern in the scientific community and a call for transparency. The well identified climate bias of the NZ media ensured a brief report through gritted teeth for one day.  As I mentioned in my previous blog, I have written to the NZ Minister of Climate (Dr Nick Smith) whose secretary advises me that he is aware of the issue and will respond in the new year. Astonishing. Dr Smith has a PhD in the sciences and is well capable of understanding the scientific issues at stake here. At the very least, this data manipulation needs to be fully disclosed immediately to quell any suggestion that might arise around scientific integrity.

The second set of temperature data that I want to highlight is referred to on the Science and Public Policy Institute web site and applies to Brisbane airport between 1950 and 2008. Once again, the manipulated data is graphed and published (GISS), showing a warming trend over the period. However, graphing of the actual data reveals instead, the opposite – a cooling trend. It turns out that the manipulated data is adjusted downward pre-1978 and upward, post-1978 to produce a overall upward gradient and an appearance of  ‘warming’. The reason for adjustment is not stated and is completely inconsistent with good scientific practice, once again raising potential issues of integrity.

Create a problem (anthropogenic driven climate change) and provide the political solution (Kyoto, Copenhagen, Save the World et al.) is the exercise of a timeless and well worn practice by which influence and control are brought to bear on a wider populous. As distasteful as it may seem, it would appear that some echoes of bygone eras, Germany 1930, may still be heard. The ‘solution’ of Copenhagen is little more than a grandstanding political rally of the faithful but the implications are considerably more serious for impoverished countries, for wider sovereignty, for freedom and for the global and local economies. Those that seek to raise scientific evidence to the contrary, struggle to be heard. The scorn and ridicule of ad hominem attacks are the usual currency of defense by the faithful. And their fanaticism grows more strident and worrying -   see the eye witness blog on the SPPI web site ‘Hitler Youth in Denmark again’ Dec 11th  by Christopher Monckton.

Many scientists other than IPCC atmospheric modelers, suggest that the planetary climate cycle is commencing a cooling period and that we may eventually see winters of the 1600 – 1700′s where the River Thames froze over completely. There may be an irony in this and it would be that those of the warming consensus would eventually claim that their insight and action had led to the cooling.

‘Climate change’ – an absurd axiomatic statement of the obvious and one that has replaced ‘global warming’ because the latter stopped in the last 11 years. It is a no-brainer that arguing for policy on the basis of a phenomena that fails to live up to its name is politically inept. ‘Climate change’ on the other hand, is an undisputed truism that has given us ice ages and interglacial warm periods, and which has sculptured the landscape and the species that inhabit the planet for billions of years. The tricky bit here is to determine to what extent, if any, does the signature of mans activity, in particular the generation of carbon dioxide influence the recent warming Holocene period since 1750. Man made or anthropogenic carbon dioxide amounts to 4% of the total atmospheric carbon dioxide – a minute figure of 4% of 0.04% of the total atmosphere. It is truly minute. Some scientists doubt we may actually be able to detect such a ‘signature’.

The United Nations, International Governmental  Panel on Climate Change (IPCC) bases its atmospheric science view predominantly on mathematical models. These endeavour to predict climate and importantly the effect of greenhouse gases on climate. They have not predicted the recent cooling period which has occurred against a background of increasing carbon dioxide levels. Articles in scientific peer reviewed literature demonstrate the substantial weakness of the various mathematical models used, highlighting their inability to predict a non-linear and chaotic climate system. That 90% of greenhouse gas composition is water vapour is worth remembering as well. Recently, the Environmental Protection Agency in the USA wanted to list water vapour as an atmospheric pollutant. Fortunately, their political masters erred on the side of caution (and political survival) and stepped in, in time. However, they have managed to list carbon dioxide as a dangerous pollutant, but appear to have overlooked the obvious fact that it is inextricably linked with plant and animal life on Earth. Plants flourish as they photosynthesize, taking up carbon dioxide. The biomass increases and flourishes with increasing carbon dioxide levels. This is good for animals and plants……food!

The IPCC models suggest that as temperatures increase (which it has not done for the last decade – something not predicted by the models) the amount of greenhouse gas in the atmosphere increases. The effect of this is to increase the heat entrapment and lead to further warming, further greenhouse gases and more heat trapping. This is the nightmare scenario of runaway positive feedback which the media portrays would ultimately be like living on Venus. A recent paper published by Lindzen and Choi (GEOPHYSICAL RESEARCH LETTERS, VOL. 36, L16705, doi:10.1029/2009GL039628, 2009) analyzes real  data and shows that in spite of atmospheric temperature increase, radiative planetary cooling has increased and there is a natural negative feedback taking place. This means that observed reality is exactly the reverse of IPCC model predictions, that climate is not sensitive and that it undergoes negative feedback. Furthermore, the increase of water vapour in the atmosphere means that there are more clouds. More clouds leads to a higher level of planetary albedo or reflectance, which reduces the amount of sunlight reaching the surface, which reduces the heating effect due to solar radiation. Suggestions that diminishing polar caps will lead to a significant decline in planetary albedo, thereby allowing more solar radiation to reach and heat us is very questionable and most unlikely. In the first instance, the Antarctic ice cap coverage is at a 28 year maximum, and the Arctic ice coverage fluctuates naturally, mainly due to winds and currents from the Tropics. The Arctic sea ice has retreated a number of times previously, in the very early twentieth century, and allowed the passage of shipping. The first evidence of polar caps on Earth suggests that until about 25 million years ago, they were absent. Since then Earth has passed through several ice ages of 100,000 years, as well as warm periods and Antarctica was covered by trees 12,000 years ago.

A recent article published in Pravda highlights the preoccupation of the IPCC with very short time spans. Russian scientists and paleoclimatologists, take a much longer view and believe that we are approaching an ice age. The terrestrial climate has beat with a 100,000 year ice age, followed by a 10,000 year warm interregnum very reliably for the last 400,000 years. That carbon dioxide levels lag substantially behind warming trends by 800 years means that we might well not be looking in the right direction as we slide into another ice age. Furthermore, studying and basing policy on climate over a 1000 year period and climate modelling is as meaningful as looking at daily weather. IPCC atmospheric scientists are always at pains to point out that ‘climate’ and ‘weather’ are quite different entities but at the same time appear to overlook their own myopia. However, Russian paleoclimatologists, who recognise the insignificance of a 1000 year view and maintain that it is too short to make any reliable and major assumptions about climate. Does the science look settled to you?

Given that most of the recent post glacial warm period (Holocene) has been warmer than today, that atmospheric carbon dioxide levels have been substantially higher (2000 parts per million -  they are around 360 parts per million presently)  than at present (without humans around), that the ice caps have waxed and waned in and out of existence ever before humans were about, that solar activity is at a steady low, and that orbital Milankovitch cycles have a periodicity which synchronise with glacial periods, are observations relevant to climate that ought to stimulate open and continued scientific debate and investigation. They do not. Instead, they are persistently drowned out in favour of the politicized view that has settled on one infinitesimal variable – the amount of man made (anthropogenic) carbon dioxide.

A graph recently published by the New Zealand, National Institute of Water and Atmospheric Research (a Crown enterprise) shows temperatures in NZ since around 1850. The temperature data has been adjusted to show a slight rise. This adjustment is not stated. The original data however, demonstrates no change in temperature. NIWA do not explain what ‘fudge factors’ were used and more importantly, why. That such methodology is transparent and defensible goes to the heart of scientific integrity, no better highlighted by the debacle that has developed around the release of the University of East Anglia emails. I have written, as indeed have many others,  to the Minister of Climate, Dr Nick Smith and expressed my concern and be assured of a response…..in the new year.

Happy new year to you all. May it dawn free of servitude, impoverishment and global taxation without purpose. Most importantly, may it be free of fear. For this, it needs to be free from the mantra of fanatical belief, whatever noxious form such beliefs may take. May we also be free from those that endeavour to predict chaotic systems, whether with mathematical models or crystal balls.

Bibliography

McGrath, MC. Osteopathic Treatment and TMJ pain dysfunction syndrome. (1991) New Zealand Register of Osteopaths Journal, vol 5.

McGrath, MC. (1993) Osteopathic Management of the degenerative hip joint. New Zealand Register of Osteopaths Journal, 1993: vol 6.

McGrath, MC. Review of the role of intra-abdominal pressure as a mechanism for the reduction of axial loading in the lumbar spine. New Zealand Register of Osteopaths Journal, 1990, 4:8–14. (abridged from dissertation for Postgraduate diploma in Biomechanics, University of Strathclyde, Glasgow. 1990)

McGrath, MC. Sacral stress fracture in a female distance runner. Journal of Osteopathic Education, 1994, 4(2):63-4.

McGrath, MC. New Zealand Osteopathic Snapshot Survey 1995. New Zealand Register of Osteopaths, May 1995.

McGrath, MC. Spina bifida occulta in the lumbosacral spine: anatomical observations of the posterior soft tissues related to radiological findings in cadavers. Thesis by research, submitted in fulfilment for the degree of Master of Science, anatomy, University of Otago, Dunedin, NZ. June 1998

Inaugural (1st ICAOR) international conference on Advances in Osteopathic Medicine Research, British College of Osteopathic Medicine, London. Accepted abstract (based on MSc (anat)(Otago) thesis: Spina bifida occulta of the lumbosacral spine: anatomical observations of the posterior soft tissues related to radiological findings in cadavers, May 1999.

New Zealand Acute Low Back Pain Guide October 2004 Accident Rehabilitation and Compensation Insurance Corporation (ACC), Wellington. Acknowledgements: Member of ALBP Guide developing Expert Panel and Osteopathic representative (since 1997).

McGrath, MC. A review of the physiology of cranial osteopathy: viewpoint. Journal of Osteopathic Medicine, 2003, 6(2):84-86.

International Conference (3^rd ICAOR) for Advances in Osteopathic Medicine Research, Victoria University of Technology, Melbourne. Anatomical evidence for sutural motion of the cranial bones.Review of the anatomical literature of the cranial bones and sutural biology; McGrath MC, Mercer S, Received  ‘best young researcher award’ .  Presentation highlighted the paucity of morphological and biological evidence for cranial bone movement, February 2002

McGrath, MC. Clinical considerations of sacroiliac joint anatomy: a review of function, motion and pain. Journal of Osteopathic Medicine, 2004, 7(1):16-24.

McGrath, MC. Tayles, N. Anatomical observations related to radiological findings in spina bifida occulta (SBO) of the lumbar spine. Journal of Osteopathic Medicine, 2004, 7(2):70-78.

McGrath, MC. Zhang, M. Lateral branches of the dorsal sacral nerve plexus and the long posterior sacroiliac ligament. Surgical and Radiological Anatomy, 2005, 27(4):327-30.

McGrath, MC. Palpation of the sacroiliac joint: an anatomical and sensory challenge. International Journal of Osteopathic Medicine 9 (2006) 103 – 107 March 2006. doi: 10.1016/j.ijosm.2006.03.001

McGrath, MC, Zhang, M. Australia and New Zealand Association of Clinical Anatomists Conference (ANZACA) 3rd/4th September, 2005, Otago School of Medical Sciences, Dunedin, NZ.  Poster presentation : ‘The detailed morphology of the long posterior sacroiliac ligament’

Keynote address Australian Osteopathic Convocation, September 2007 Christchurch, NZ: Chronic Back Pain: The Sacroiliac Region: The Devil’s in the Morphological Detail’.

Dunedin Osteopathic Peer Group: organised, developed and run in the Department of Anatomy and Structural Biology, University of Otago, November 24^th, 2007: Review of SIJ morphology and motion, new morphological research in the posterior sacroiliac region, anatomy laboratory session of pelvis.

McGrath MC, Nicholson H, Hurst P. The long posterior sacroiliac ligament: a histological study of morphological relations in the posterior sacroiliac region. Joint Bone Spine. 2009 Jan;76(1):57-62. Epub 2008 Sep 25.(2008), doi:10.1016/j.jbspin.2008.02.015

Dunedin Osteopathic Peer Group: organised. developed and run in the Department of Anatomy and Structural Biology, University of Otago, May 24^th, 2008 Clinical and anatomical considerations of the thoracic outlet syndrome. A review of morphology and current clinical research at the superior thoracic aperture and anatomy laboratory session.

Dunedin Osteopathic Peer Group: organised. developed and run in the Department of Anatomy and Structural Biology, University of Otago, December 5th, 2009 Clinical and anatomical considerations of the shoulder joint: anatomical ‘hot spots’ at the shoulder. Lecture and lab.

McGrath MC The relationship between the long posterior sacroiliac ligament and the posterior sacrococcygeal plexus. Record number: 151710, Australasian Digital Thesis Program. Identfier: http://adt.otago.ac.nz./public/adt-NZDU20070824.142033

McGrath MC, Nicholson H. The sacral thoracolumbar fascia. Conference abstract: Fifth meeting Australia and New Zealand Association of Clinical Anatomists, November 27 – 28, 2008, University of Auckland Medical School. Clinical Anatomy 20:399 – 409 (2009)

McGrath MC, Nicholson H, Hurst P Le long ligament sacro-iliaque posterieur : etude histologique de ses rapports dans la region sacro-iliaque posterieure. Revue du rhumatisme, November 2008. doi: 10.1016/j.rhum.2008.02.022

McGrath MC, Composite sacroiliac joint pain provocation tests: a question of clinical significance. Published online 21.08.2009 International Journal Osteopathic Medicine, doi:10.1016/j.ijosm.2009.06.002

McGrath MC, Nicholson H, Hurst P.  Branch blockade of the dorsal sacral rami. Letter to the editor. Pain Medicine (acceptd for publication 2009)

If you have any doubt about the ‘changing seasons’ go to the excellent Antarctic Centre in Christchurch, near the airport. Wander on through and notice the fossils demonstrating the presence of beech forests over Antarctica a mere 12,000 years ago. It takes a minimal leap of insight to realise that things were much much warmer then. In fact, temperatures throughout the Holocene period have been warmer than the present day. In the fifteenth century the River Thames in London was recorded to be completely frozen over, solid, in an unbelievably cold winter. Fortunately though, since 1750 (the Maunder minimum) the global climate has gradually warmed until the present day, the gradient of the temperature rise  unaffected by the advent of industrialisation. The Maunder minimum is so named because it is a particularly quiescent period in solar activity with few sunspots. Today, we find ourselves in a similar solar situation. Sun spot activity is notably and unusually silent and we’re undeniably cooling and have been since 1998………………in spite of rising CO2.

Rather more recently, it is considered by some that anthropogenic CO2 (that is, CO2 generated by man) is a cause of rising global temperatures. Unfortunately for those that name human activity as the main cause, since around 1998 there has been no significant warming, and since 1998. Instead, there has been global cooling, the global mean surface temperatures falling on a trend of >1C per century (SPPI – Monckton 2009), and all the while atmospheric CO2 levels have risen.

A recent paper in the Journal of Hydrological Sciences shows how the retrospective application of the climate mathematical model was used to generate data which was then compared with the actual known temperatures over the same period. No concordance existed between the modeled data and actual temperature data sets, the latter remaining unsurprisingly normal and a long way south of IPCC model trends. Climate is a non-linear,  stochastic and chaotic system that cannot be predicted or modeled by the linear, deterministic and simplistic models relied upon by the IPCC. However, these poor mathematical models of reality provide a significant basis for indicative statements made by the IPCC and therefore much of the current political and economic (cap and trade, ETS) orientation.

However, just put the numbers in to perspective. Vital ‘green house’ gases comprise about 5% of the atmosphere by volume. Without these the Earth would be a globe of ice. Greater than 90% of this small fraction is water vapour (4% of total atmospheric volume) and entirely ‘natural’, a fact usually ignored by the protagonists of anthropogenic caused climate change . This substantial water vapour componet that provides a basis for clouds remains ‘unhandled’ by the IPCC mathematical models. To what extent an increase in atmospheric water vapour as the result of warming, with the generation of more clouds, and therefore greater planetary albedo (reflectance of sunlight) lowers the incident solar energy and therefore warming effect, is unknown.

On the other hand, CO2 accounts for 0.033% of the total atmosphere by volume and about 3% of this fraction is man-made (eg. 0.00099%). The human contribution to ‘global warming’ (CO2 and H2O) lies around 0.28%. It is undisputed that were everyone to scrupulously observe the Kyoto Protocol, global temperature would decline a meaningless infinitesimal amount over the next century.  So, if the goal is temperature reduction, the Protocol is ineffective. If there are other unstated goals such as energy diversification, less reliance on petroleum oil, an increase in the power of globalised central government and policy making, then it could be argued to be a success, particularly since the US has become a more interested player of late. India and China do not appear to be interested, which may be an insight into potential future economic and political power blocks.

‘Emperor Al’, can fool some of the people some of the time, but not all of the people all the time. The dispassionate wisdom of science is inexorably revealing itself. Undeniably true, science has never been and never will be a ‘consensus’ activity. Appeals made to ‘consensus’ as a means of adding a certain weight of compulsion, are only political means of implying concordance and justification, which may in fact not be present. Consensus is certainly not evidence.

The legitimate ecological and environmental  concerns of the many have been opportunistically hijacked by the power hungry quest of the few. Make no mistake, green eco-politics has little to do with environmental concern. It is a political force that endeavours to win hearts and minds in order to achieve power and control. Political, economic and emotional coercion are all stock tools of the trade. Capitalising on the ‘feel-good’ factor of ‘save the planet’, is a ruthless exploitation of the unquestioning faithful, the uninformed majority who seem willing to readily believe what they read and hear in the media. Seeking knowledge through science or exploring the scientific debate, is unfortunately less of a choice for many. Yet, this is a crucial time to question and seek the truth, particularly as the media is notoriously unreliable and unashamedly biased.

The recent global economic demise of uncontrolled credit and the ensuing economic slump have ambushed the climate ‘consensus’.  The global recession has led to a scenario where the economics of irrational and useless ‘cap and trade’ policies are more visibly exposed as the stunningly expensive follies that they are. The hard edge of economic realism is a sure and sharp guillotine to the implementation of extravagant  ‘feel good’ policies with meaningless outcomes.

Intelligent energy utilitisation and diversification, freedom from dependence on a single energy source will eventually lead to an increasingly sophisticated global society. Humankind will not be returning to till the soil with bullocks, drive a horse and trap or even run a car driven by porcine flatulence. On the contrary, I believe that humankind will continue to flourish, realising a potential that embraces ever increasing numbers. But we really do need to develop an intolerance of, and a healthy skepticism for, the crusading political proclamations originating from the ministries and departments of ‘we know best’. It is this present societal phenomena of epic global proportion that sees the surrender of the many to the few.

Hearts and minds in the bag, power and control a short step behind – totalitarianism by any other name, is alive and well.