It began life as “prominent exostosis” and, at the peak of media coverage, British tabloid The Sun was scaring us with “HELL PHONES” and many people got the impression that our children were growing actual devil horns because of their smartphone use. It turns out that researchers were initially referring to tiny bone protrusions at the base of our skull. “Bony outgrowths” became a “spike-like feature” in the BBC article that started this unsurprising media whirlwind, which became “horns in the back of their head” on Australia’s news.com.au website. The fact that horns are typically made of the same material as our nails and not our bones had little impact. Headline writers everywhere seemed to delight in pointing out that “’horns’ are growing on young people’s skulls”, as the Washington Post warned us, and “phone use is to blame, research suggests.”
The paper that published the findings had a much less, shall we say, demonizing title: “Prominent exostosis projecting from the occipital squama more substantial and prevalent in young adult than older age groups.”
What the researchers did was look at the X-rays of 1,200 people who presented to a single chiropractic clinic (more on that later). They measured their bony protuberance at the back of the skull, and if it exceeded 10 mm, it was called “enlarged”. They compared how common this enlarged protuberance was between different age groups (18-to-29, 30s, 40s, 50s, and 60+), and between men and women, and they tried to calculate what would predispose you to having it. They reported that men were more likely to have this, ahem, enlarged protrusion; also, having a head that sits forward of the shoulders, with the chin jutting out, and being aged 18 to 29 were associated with a greater chance of having a bony spur that exceeded 10 mm.
The authors found this disturbing because these bony projections—the body’s response to stress by protecting the area where ligaments and tendons attach to a bone—tend to become more common with age. Seeing that they are more common in younger people led the authors to speculate, and I repeat, speculate that it could be due to smartphone and tablet usage.
Many people took a crack at this study in the wake of the media attention. Although the paper states that all data supporting the findings can be found in the article, that is not true. Also, cell phone use was not measured. At all. The authors simply wondered if the cause could be portable screens, but it is pure conjecture. Moreover, the person measuring the bony protuberances on X-ray was apparently not blinded to the age and sex of the person when making the measurement, which could have introduced a bias if he or she had a conclusion in mind that they really wanted to come true. Indeed, the authors themselves admit that their results have not been seen before and contradict existing reports. And all their participants visited a chiropractor.
Ah yes, because the lead author is a chiropractor who sells posture-friendly pillows, and this paper is part of his Ph.D. project at the University of the Sunshine Coast in Australia.
Now, I am not saying that chiropractors are incapable of conducting rigorous research. But when you have a hammer, everything looks like a nail, and chiropractors love to tell us that our posture is causing us great harm that only they can allay. We can thank them for the alleged “text neck” epidemic. We are quick to point out that the pharmaceutical industry has a lot to gain by selling us drugs, but often slower to realize that chiropractors benefit tremendously from the acceptance that our modern posture leads to illness.
The media cycle on this story has been quite interesting. The paper was published in February 2018. It was a BBC journalist that wrote about this in June 2019. Then came a trickle of articles reporting on the BBC’s report. Then NBC, the Washington Post, USA Today, and other major media outlets opened the floodgates on June 20, but the pushback was immediate. Vice published a rebuttal that same day, and many news sites published another article within a day or two, correcting the story, commenting on the chiropractic link, highlighting that the sale-of-pillow conflict of interest hadn’t been disclosed in the paper, informing us that the publishing journal was investigating the concerns that had been raised. But falsehood flies, as Jonathan Swift wrote, and the truth comes limping after it… though in this era of “fake news”, that limp is quickly turning into a steady gait.
My first reaction was that journalists who cover the health beat need to be scientifically literate. The Washington Post, for example, was initially rather uncritical of the study, and the journalist who covered it is studying history. But the BBC reporter who gave the study its first day in the limelight has a Bachelor’s degree in biological sciences, a Master’s in medical microbiology, and a Master’s in veterinary medicine! Criticizing biomedical papers is a science and an art form that requires time, experience, and an acute awareness of how a paper can be written to put its best foot forward, and I suspect that the time pressures put on journalists these days is not conducive to this kind of work.
My advice is to be judiciously skeptical of what you see online and in the media. If it sounds too good to be true, if it seems to feed into a moral panic (“cell phones are turning our children into mindless zombies!”), wait a day or two, wait even a week. You might get to see the truth come limping by.
Take-home message:
- Many media outlets reported on a study that seemed to show that younger people are at risk of growing bony protrusions at the back of their skull
- The blame was being put on young people looking at their phone all the time
- The study itself had many flaws, the sample was biased, and the co-author of the study is a chiropractor who thinks there is a bad posture epidemic
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