Value of chiropractors questioned [Archive]

richard

14th November 2007, 12:17 AM

You guys claim to be skeptics and are acceting as truth reports in Fridays Newspapers about ‘chiropractic. This assertion is based on a small research study looking at acute low back pain only and involving GPs and physiotherapists. Not chiropractors which I for my sins practice.

The skeptic "Blue Wode" selectively quotes from Peter Dixons statement for the GCC and skips the part which states "The purpose of the study was not to measure the effectiveness of chiropractors. Neither the research study, nor the Lancet’s press release, mentioned chiropractic or concluded that ‘chiropractic was a waste of time and money’. It is sad to see a piece of research misrepresented in this way."

Thats not cricket "Blue Wode", I would remind you all of your mission statement on this website.
Skepticism is an honest search for knowledge. It is an approach to claims akin to the scientific method (http://www.skeptics.org.uk/../explanation.php?dir=articles/explanations&article=scientific_method.php). It is a powerful and positive method of inquiry which is used to evaluate claims and make decisions. It is used to search for the truth in matters and to make decisions that are based on logic, evidence and sound reasoning. Skepticism is based on a simple method: doubt and inquiry. The idea is to neither initially accept claims nor dismiss them; it’s about questioning them and testing them for validity. Only after inquiry does a skeptic take a stance on an issue.

There has been a lack of any inquiry by the skeptics on this thread and youhave jumped on the bandwagon What ever you may think of chiropractic this is not appropriate use of this evidence.

Real skeptics would have questioned the advice in this study and wondered if it might increase the cost to the NHS from paracetamol poisoning. Legislation was introduced in 1998 to limiting pack sizes of paracetamol sold over the counter, nevertheless sales are rising no doubt fuelled by controversy surrounding arthritis drugs Vioxx and Celebrex.

The burden of paracetamol poisoning on the NHS is high, estimated in 2001 to be over 70 000 episodes a year and as many as 200 deaths. Unsurprisingly a 2005 House of Commons Health Committee report criticized the pharmaceutical industry, for turning this country into an overly medicalised society that believes in a pill for every ill and pouring millions of pounds into research and promotion, fuelling an emphasis on medicinal cures at the expense better therapies or simple prevention.

You ignore this evidence to focus on your dogmatic view of chiropractic. In 1990 The United States Court of Appeals found that the American Medical Association (AMA) and fourteen other defendants guilty of violating the Sherman Antitrust Act by engaging in an illegal boycott of the chiropractic profession, “designed to destroy it”.

:'(A real skeptic would be asking how come all the headlines were chiropractic when the study did not involve them.

bobdezon

14th November 2007, 12:49 AM

Mongrel

14th November 2007, 11:08 AM

Real skeptics would have questioned the advice in this study and wondered if it might increase the cost to the NHS from paracetamol poisoning. Legislation was introduced in 1998 to limiting pack sizes of paracetamol sold over the counter, nevertheless sales are rising no doubt fuelled by controversy surrounding arthritis drugs Vioxx and Celebrex.

The burden of paracetamol poisoning on the NHS is high, estimated in 2001 to be over 70 000 episodes a year and as many as 200 deaths. Unsurprisingly a 2005 House of Commons Health Committee report criticized the pharmaceutical industry, for turning this country into an overly medicalised society that believes in a pill for every ill and pouring millions of pounds into research and promotion, fuelling an emphasis on medicinal cures at the expense better therapies or simple prevention

The 70,000 figure is from 1998 (here (http://www.bmj.com/cgi/content/full/316/7146/1724)), not 2001 and the legislation for the smaller pack sizes reduced deaths from accidental poisoning. There was little change in the amount of deliberate suicides but the level of Paracetamol went down from an average of 10g to 8g, slightly easier to treat (Articles here (http://www.pjonline.com/search/?q=paracetamol+poisoning&action=Search)).

Trying to compare Vioxx and Celebrex to paracetamol though is disingenuous at best, prescription only drugs Vs an over the counter product that's used in many remedies, which is often where the accidental poisoning comes in, consistent monitoring Vs "Well I have a few packs in the medicine cabinet". What they all have in common though is; evidence of efficacy, monitoring of safety through healthcare professionals and information sites (Celebrex (http://www.celebrex.com/content/WhatisanNSAID.jsp?setShowOn=../content/WhatisanNSAID.jsp&setShowHighlightOn=../content/WhatisanNSAID.jsp)- see the warnings associated with it?), follow on studies over the years
and realistic risk\reward assessments, something that chiropracty has yet to produce

Blue Wode

14th November 2007, 11:22 AM

Welcome to the forum, Richard, and thank you for your interesting response.

You guys claim to be skeptics and are acceting as truth reports in Fridays Newspapers about ‘chiropractic. This assertion is based on a small research study looking at acute low back pain only and involving GPs and physiotherapists. Not chiropractors which I for my sins practice.

The skeptic "Blue Wode" selectively quotes from Peter Dixons statement for the GCC and skips the part which states "The purpose of the study was not to measure the effectiveness of chiropractors. Neither the research study, nor the Lancet’s press release, mentioned chiropractic or concluded that ‘chiropractic was a waste of time and money’. It is sad to see a piece of research misrepresented in this way."

Thats not cricket "Blue Wode", I would remind you all of your mission statement on this website.

You are quite right about the study not specifically mentioning chiropractic. However, as I understand that spinal manipulation (‘adjustment’) is the hallmark of chiropractic practice (more so, I believe, than osteopathy and physiotherapy) I think it was fair that some, but not all, of the press reports mentioned the negative implications that the study’s findings would have for chiropractic therapy.

I would also point out that that the NHS has evaluated the study and analysed the press reports and it appears to be happy with both:

Spinal manipulation (and/ or use of diclofenac) does not speed up recovery from back pain reported five newspapers (9 November 2007). The newspaper reports of a well-conducted trial of people with acute back pain were generally accurate. The study's results appear reliable, and are applicable to people with acute lower back pain.

· On 9 November 2007 five newspapers (1-5) reported that chiropractic treatment is ineffective for the treatment of back pain.
· The reports were based on a randomised controlled trial (6) of 240 people with acute lower back pain who were advised to remain active and take paracetamol. Participants received either genuine or imitation diclofenac (a non-steroidal anti-inflammatory drug) and either genuine or imitation spinal manipulation. The trial reported that there was no significant difference in the time to recovery between people receiving active diclofenac and/or active spinal manipulation compared to placebo forms.
· The results of this well-conducted trial appear reliable, and applicable to people suffering from acute lower back pain, however, the results may not be applicable to people with chronic back pain. The newspapers are generally accurate in their reports of the main result of the study. One newspaper failed to mention that the study was conducted in people with acute back pain (5), and only one newspaper highlighted that the results may not be applicable to people with chronic back pain (4).

http://www.library.nhs.uk/rss/newsAndRssArticle.aspx?uri=http%3a%2f%2fwww.librar y.nhs.uk%2fresources%2f%3fid%3d273512 (http://www.library.nhs.uk/rss/newsAndRssArticle.aspx?uri=http%3a%2f%2fwww.librar y.nhs.uk%2fresources%2f%3fid%3d273512)

Regards misrepresenting research, Peter Dixon claims that

The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared. Chiropractic intervention is safe, effective and cost-effective in reducing referral to secondary care

It is simply not true that chiropractic “is” safe. That has not yet been demonstrated to be the case.

And where is the sound scientific evidence that shows that the main treatments of chiropractic have been shown to be consistently more effective than treatment to which they have been compared?

Skepticism is an honest search for knowledge. It is an approach to claims akin to the scientific method (http://www.skeptics.org.uk/explanation.php?dir=articles/explanations&article=scientific_method.php). It is a powerful and positive method of inquiry which is used to evaluate claims and make decisions. It is used to search for the truth in matters and to make decisions that are based on logic, evidence and sound reasoning. Skepticism is based on a simple method: doubt and inquiry. The idea is to neither initially accept claims nor dismiss them; it’s about questioning them and testing them for validity. Only after inquiry does a skeptic take a stance on an issue.

There has been a lack of any inquiry by the skeptics on this thread and youhave jumped on the bandwagon What ever you may think of chiropractic this is not appropriate use of this evidence.
After more than 100 years, what is there left to enquire about? The scientific data continue to come in and continue to show spinal manipulation in a somewhat unfavourable light.

Real skeptics would have questioned the advice in this study and wondered if it might increase the cost to the NHS from paracetamol poisoning. Legislation was introduced in 1998 to limiting pack sizes of paracetamol sold over the counter, nevertheless sales are rising no doubt fuelled by controversy surrounding arthritis drugs Vioxx and Celebrex.
Real skeptics take into consideration increased costs to the NHS from people who have suffered strokes and other injuries following spinal manipulation. Regards drugs, their use is monitored and those that are that are shown to be dangerous are withdrawn. The 1998 legislation to limit the pack sizes of paracetamol was a responsible move in view of the fact that overdosing by a small amount can be fatal. By way of contrast:
What has the chiropractic profession done to limit the use of neck manipulation for neck pain when it is known that safer and less expensive treatments exist for the condition (e.g. exercise)?
Why doesn’t the chiropractic profession have an injury reporting system in place similar to the Yellow Card system that is used for reporting adverse drug reactions?
In the UK, drug medications contain Patient Information Leaflets which include advice on side effects. The chiropractic equivalent is to inform patients either orally or in writing of the risks associated with any procedure (and any available alternatives). This is a legal obligation. Why are large sections of your profession apparently ignoring their duty in this respect and what is being done about it?http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15726031 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15726031)

The burden of paracetamol poisoning on the NHS is high, estimated in 2001 to be over 70 000 episodes a year and as many as 200 deaths. Unsurprisingly a 2005 House of Commons Health Committee report criticized the pharmaceutical industry, for turning this country into an overly medicalised society that believes in a pill for every ill and pouring millions of pounds into research and promotion, fuelling an emphasis on medicinal cures at the expense better therapies or simple prevention.
Proportionately, there’s bound to be a significantly higher rate of complications from paracetamol use than from spinal manipulation since the number of people routinely using paracetamol (presumably because it’s cheap and convenient) will vastly outweigh those receiving spinal manipulation. The ratio is probably hundreds of thousands to one – which would mean that paracetamol is safer than manipulation.

You ignore this evidence to focus on your dogmatic view of chiropractic. In 1990 The United States Court of Appeals found that the American Medical Association (AMA) and fourteen other defendants guilty of violating the Sherman Antitrust Act by engaging in an illegal boycott of the chiropractic profession, “designed to destroy it”.
Here’s what was actually said:

In 1987, federal court judge Susan Getzendanner concluded that during the 1960s "there was a lot of material available to the AMA Committee on Quackery that supported its belief that all chiropractic was unscientific and deleterious." The judge also noted that chiropractors still took too many x-rays. However, she ruled that the AMA had engaged in an illegal boycott. She concluded that the dominant reason for the AMA's antichiropractic campaign was the belief that chiropractic was not in the best interest of patients. But she ruled that this did not justify attempting to contain and eliminate an entire licensed profession without first demonstrating that a less restrictive campaign could not succeed in protecting the public. Although chiropractors trumpet the antitrust ruling as an endorsement of their effectiveness, the case was decided on narrow legal grounds (restraint of trade) and was not an evaluation of chiropractic methods.

http://www.chirobase.org/08Legal/AT/at00.html (http://www.chirobase.org/08Legal/AT/at00.html)
A real skeptic would be asking how come all the headlines were chiropractic when the study did not involve them.

"All" the headlines were not chiropractic. Only some were.

Apart from spinal manipulation and a few mobilisation techniques which are already utilised by the physiotherapy and osteopathic professions, would you please explain what is it that chiropractors actually do that is of any proven value?

Thank you.

richard

14th November 2007, 01:27 PM

What is a real sceptic? As far as I know there are only degrees of scepticism. Some of us are excellent sceptical minds, while others only appear to be partially so. I dont understand what a real sceptic is, unless you consider one to be a person who looks at your claims critically and agrees with you.

By all means look at the claims of chiropractors critically, but this study is not about chiropractors or their technique, however this thread is called "value of chiropractic questioned" and the study you are looking at does not do that.

richard

14th November 2007, 01:58 PM

The 70,000 figure is from 1998 (here (http://www.bmj.com/cgi/content/full/316/7146/1724)), not 2001 and the legislation for the smaller pack sizes reduced deaths from accidental poisoning. There was little change in the amount of deliberate suicides but the level of Paracetamol went down from an average of 10g to 8g, slightly easier to treat (Articles here (http://www.pjonline.com/search/?q=paracetamol+poisoning&action=Search)).

Trying to compare Vioxx and Celebrex to paracetamol though is disingenuous at best, prescription only drugs Vs an over the counter product that's used in many remedies, which is often where the accidental poisoning comes in, consistent monitoring Vs "Well I have a few packs in the medicine cabinet". What they all have in common though is; evidence of efficacy, monitoring of safety through healthcare professionals and information sites (Celebrex (http://www.celebrex.com/content/WhatisanNSAID.jsp?setShowOn=../content/WhatisanNSAID.jsp&setShowHighlightOn=../content/WhatisanNSAID.jsp)- see the warnings associated with it?), follow on studies over the years
and realistic risk\reward assessments, something that chiropracty has yet to produce

Sorry about the date, but at least we are in the same ball park and the study is about paracetamol and adverse events, I got that right,yes.

Read what I said I did not compare Vioxx and Celerex to paracetamol.??

Sales of over the counter drugs like paracetamol are rising. Why?
"Fueled by controversy surrounding arthritis drugs like Vioxx and Celebrex". I would have thought that is a reasonable assumption for skeptics like us to make dont you? Or are we only allowed to be skeptical about Alternative Medicine.

Largest risk assessment study ever was recently published by Thiel and Bolton in Spine. I don’t have the actual reference to hand. (If you insist I will get it).You are not going to like the conclusion, but I guess scientific evidence is not designed to please.

I participated in the study and I am afraid I was not able to report one reaction in 100 cervical adjustment. In all my years in practice I have never had a patient complain or report a reaction. I have never cured or tried to cure cancer, nor restored anyone’s hearing but I do get a lot of satisfaction from my work.

Maybe it is because I am a nice person, my grandmother always told me a smile costs nothing.

Blue Wode

14th November 2007, 02:24 PM

Largest risk assessment study ever was recently published by Thiel and Bolton in Spine. I don’t have the actual reference to hand. (If you insist I will get it).You are not going to like the conclusion, but I guess scientific evidence is not designed to please.[/quote]

Here’s the link:

Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey by Thiel, Haymo W. DC, PhD; Bolton, Jennifer E. PhD; Docherty, Sharon PhD; Portlock, Jane C. PhD, Spine. 32(21):2375-2378, October 1, 2007

http://www.spinejournal.org/pt/re/spine/abstract.00007632-200710010-00016.htm;jsessionid=H7DN7v7h1sQnJYvqTvn1h22bhpq8t Q1VHpf3pXTQ1lYhc3zGLwCz!1600246195!181195629!8091!-1 (http://www.spinejournal.org/pt/re/spine/abstract.00007632-200710010-00016.htm;jsessionid=H7DN7v7h1sQnJYvqTvn1h22bhpq8t Q1VHpf3pXTQ1lYhc3zGLwCz!1600246195!181195629!8091!-1)

Interestingly, the chiropractors on the Skeptical Chiropractic forum, Chirotalk, put it in their ‘humor’ section under the title “Silly chiropractic research”:

http://chirotalk.proboards3.com:80/index.cgi?board=humor&action=display&thread=1194137405 (http://chirotalk.proboards3.com/index.cgi?board=humor&action=display&thread=1194137405)

[quote] So, these chiropractic "researchers" asked a bunch of chiros in the UK if any of their pts had ever had a cerebral event following an adjustment. They all said NO. End of "research."

Cuddles

14th November 2007, 03:06 PM

Sales of over the counter drugs like paracetamol are rising. Why?
"Fueled by controversy surrounding arthritis drugs like Vioxx and Celebrex". I would have thought that is a reasonable assumption for skeptics like us to make dont you? Or are we only allowed to be skeptical about Alternative Medicine.

No, it's really not reasonable. Why would assume that an increase in painkiller sales is solely due to issues with a few drugs from an entirely different class? Where is your evidence for this? Skepticism isn't about criticising anything you feel like without any evidence to back you up, it is about looking at the evidence and accpeting what it tells you. Perhaps you shouldn't use phrases like "skeptics like us", when it is clear that you have no idea what a skeptic actually is.

richard

14th November 2007, 03:17 PM

Welcome to the forum, Richard, and thank you for your interesting response.

You are quite right about the study not specifically mentioning chiropractic. However, as I understand that spinal manipulation (‘adjustment’) is the hallmark of chiropractic practice (more so, I believe, than osteopathy and physiotherapy) I think it was fair that some, but not all, of the press reports mentioned the negative implications that the study’s findings would have for chiropractic therapy.

Spinal manipulation and treatment of back pain is not the hall mark of the Chiropractic profession and chiropractors that do practice like this their technique is different and the training. A bit like asking a rugby player to play football.
Read your own "fact" sheet on chiropractic, on this point I am in full agreement. "Some chiropractors use a technique called Spinal Manipulation Therapy (SMT) for lower back pain. This is not the same as chiropractic itself and should not be confused with it".

I would also point out that that the NHS has evaluated the study and analysed the press reports and it appears to be happy with both:

Why would the NHS analyze the press reports? Surely you are not saying
the press reports influences NHS decisions.

Regards misrepresenting research, Peter Dixon claims that

It is simply not true that chiropractic “is” safe. That has not yet been demonstrated to be the case.

Wrong again Thiel and Bolton in recent Spine journal ( see posting above).

And where is the sound scientific evidence that shows that the main treatments of chiropractic have been shown to be consistently more effective than treatment to which they have been compared?

After more than 100 years, what is there left to enquire about? The scientific data continue to come in and continue to show spinal manipulation in a somewhat unfavorable light.

I would agree there is a lack of scientific evidence to support the efficacy of chiropractic as an intervention beyond back pain. We are a small profession and dont have great resources. Absence of evidence is not evidence of absence.

Real skeptics take into consideration increased costs to the NHS from people who have suffered strokes and other injuries following spinal manipulation. Regards drugs, their use is monitored and those that are that are shown to be dangerous are withdrawn. The 1998 legislation to limit the pack sizes of paracetamol was a responsible move in view of the fact that overdosing by a small amount can be fatal. By way of contrast:

What has the chiropractic profession done to limit the use of neck manipulation for neck pain when it is known that safer and less expensive treatments exist for the condition (e.g. exercise)?

Why doesn’t the chiropractic profession have an injury reporting system in place similar to the Yellow Card system that is used for reporting adverse drug reactions?

In the UK, drug medications contain Patient Information Leaflets which include advice on side effects. The chiropractic equivalent is to inform patients either orally or in writing of the risks associated with any procedure (and any available alternatives). This is a legal obligation. Why are large sections of your profession apparently ignoring their duty in this respect and what is being done about it?
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15726031 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15726031)

You criticise the Chiropractic profession for using anecdotal evidence and you attach great weight to anecdotal evidence to support you unfounded claim that chiropractic is dangerous. 2005 DOH looked at all the risk factors predisposing stroke "Reducing Brain damage, faster access to better stroke care". Every 5 minutes someone in the UK sufferers a stroke some are preceded by arterial dissection

Is it possible that some of these people went to the chiropractor because of the sudden onset of neck pain and the chiropractor failed to pick up the signs of stroke as happened to many GPs in the UK according to this study. They both provide treatment but you are focusing on the chiropractor with only anecdotal evidence. If I thought I was putting people at risk, or saw convincing evidence of risk, I would not do spinal manipulation on the cervical spine.
,
Proportionately, there’s bound to be a significantly higher rate of complications from paracetamol use than from spinal manipulation since the number of people routinely using paracetamol (presumably because it’s cheap and convenient) will vastly outweigh those receiving spinal manipulation. The ratio is probably hundreds of thousands to one – which would mean that paracetamol is safer than manipulation.

Hardly very scientific?

Here’s what was actually said:

"All" the headlines were not chiropractic. Only some were.
TheTelegraph,The Mail,The Guardian, are the ones I saw.The Independent reported the study acuratly. I dont read the Tabloids and did not see The Times.

Apart from spinal manipulation and a few mobilisation techniques which are already utilised by the physiotherapy and osteopathic professions, would you please explain what is it that chiropractors actually do that is of any proven value?

Spinal dysfunction brought on by our sedentary lifestyles inhibits the function of mechano receptors in the spinal joints, which input to the laminae of the spinal cord and central nervous system. Restoring joint movement restores the neurological input tothe CNS.

I am happy to come any where and give a lecture on receptors and the nervous system if anybody is interested. Alternatively you can read about them in Principles of Neural Science;Kendal and Schwartz. McGra/Hill.

Thank you.

I am happy to answer your questions, however I have 4 children and patients to see, so if people just make one poinat a time, it makes it easier for me,thank you.

Blue Wode

14th November 2007, 04:16 PM

Richard,

Spinal manipulation and treatment of back pain is not the hall mark of the Chiropractic profession and chiropractors that do practice like this their technique is different and the training.

Read your own "fact" sheet on chiropractic, on this point I am in full agreement. "Some chiropractors use a technique called Spinal Manipulation Therapy (SMT) for lower back pain. This is not the same as chiropractic itself and should not be confused with it".

So what is chiropractic? Please provide the scientific evidence for it. There must be plenty after more than 100 years.

Why would the NHS analyze the press reports?
Because it gives direction to their employees who may be influenced by press reports.

Wrong again Thiel and Bolton in recent Spine journal
Do you have any idea why that study has been placed under “silly chiropractic research” in the humour section of Chirotalk – a skeptical chiropractic forum moderated by chiropractors?
http://chirotalk.proboards3.com/

I would agree there is a lack of scientific evidence to support the efficacy of chiropractic as an intervention beyond back pain. We are a small profession and dont have great resources. Absence of evidence is not evidence of absence.

You criticise the Chiropractic profession for using anecdotal evidence and you attach great weight to anecdotal evidence to support you unfounded claim that chiropractic is dangerous.
First do no harm. The data on the safety of spinal manipulation, particulary neck manipulation, are not yet in. As you say “absence of evidence is not evidence of absence” and there are plenty of case reports to suggest that manipulation can be life-threatening.

TheTelegraph,The Mail,The Guardian, are the ones I saw.The Independent reported the study acuratly. I dont read the Tabloids and did not see The Times.
So why did you say “how come all the headlines were chiropractic when the study did not involve them”?

I am happy to answer your questions

Would you please answer these ones then:

1.) Re Mr Dixon’s comments. Where is the sound scientific evidence that shows that the main treatments of chiropractic have been shown to be consistently more effective than treatment to which they have been compared?

2.) What has the chiropractic profession done to limit the use of neck manipulation for neck pain when it is known that safer and less expensive treatments exist for the condition (e.g. exercise)?

3.) Why doesn’t the chiropractic profession have an injury reporting system in place similar to the Yellow Card system that is used for reporting adverse drug reactions?

4.) In the UK, drug medications contain Patient Information Leaflets which include advice on side effects. The chiropractic equivalent is to inform patients either orally or in writing of the risks associated with any procedure (and any available alternatives). This is a legal obligation. Why are large sections of your profession apparently ignoring their duty in this respect and what is being done about it?

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=1 7693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.P ubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=1 7693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.P ubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum)

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li st_uids=15726031 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li st_uids=15726031)

richard

14th November 2007, 04:38 PM

No, it's really not reasonable. Why would assume that an increase in painkiller sales is solely due to issues with a few drugs from an entirely different class? Where is your evidence for this? Skepticism isn't about criticising anything you feel like without any evidence to back you up, it is about looking at the evidence and accpeting what it tells you. Perhaps you shouldn't use phrases like "skeptics like us", when it is clear that you have no idea what a skeptic actually is.

I did not used the word "solely", that is your word. I believe the controversy made it more likely that people were looking for alternatives to these drugs.

You disagree fair enough its an opinion they are like noses we all have one. So tell me what does the evidence tell you that people with vascular conditions did when they stopped taking Vioxx.

What is your explanation for increased sales of paracetamol? and then you can tell me why I can not be a skeptic??

Admin

14th November 2007, 05:32 PM

By all means look at the claims of chiropractors critically, but this study is not about chiropractors or their technique, however this thread is called "value of chiropractic questioned" and the study you are looking at does not do that.

The actual article cited was headlined: "Chiropractors may be no use in treating back pain, study says".

I think this is fair as Spinal Manipulation Therapy (SMT) is used by chiropractors and it's about the only thing they do that has any evidence to support its use.

Now that there's some doubt cast upon SMT compared to other interventions then it certainly is relevant to chiropractic.

SMT is not chiropractic as such but as chiropractors use it the link between chiropractic and SMT is highly relevant.

richard

14th November 2007, 06:08 PM

Richard,

So what is chiropractic? Please provide the scientific evidence for it. There must be plenty after more than 100 years.

I thought I had answered that. Chiropractors study the relationship between the structure of the spine and the function of the nervous system.

I would like to see more evidence. But every medical intervention is not supported by evidence, and I rely heavily on experience. I like this quote from David Sackett I think it was in the BMJ. Without clinical expertise, practise risks becoming tyrannised by evidence…. Without current best evidence, practice risks becoming rapidly out of date. David Sackett et al 2000

Because it gives direction to their employees who may be influenced by press reports.

Well then they have been miss informed about this study, if they have been told its about chiropractic as stated in Skeptic Fact Sheet.The NHS have been known to make a few mistakes in their time.

Do you have any idea why that study has been placed under “silly chiropractic research” in the humour section of Chirotalk – a skeptical chiropractic forum moderated by chiropractors?
http://chirotalk.proboards3.com/ (http://chirotalk.proboards3.com/)

Spine is not a chiropractic Journal, they published it. Its the largest study thats been done on the subject, I have not claimed it proves anything however its better than the evidence that says chiropractic is dangerous. Surely you not saying the chiropractor on chirotalk has more credibility than The Spine Journal?

If this guy is a chiropractor it is obvious he did not enjoy his time at chiropractic college. If I were to base my evidence on the opinion of one Chiropractor, I dont think you would take me very seriously, come to think of it you don’t take chiropractic seriously so I guess its a mute point.

First do no harm. The data on the safety of spinal manipulation, particulary neck manipulation, are not yet in. As you say “absence of evidence is not evidence of absence” and there are plenty of case reports to suggest that manipulation can be life-threatening.

Anecdotal, you dont like the Thiel study, fine perhaps Professor Ezard Ernst will do a better study more to your liking.

Would you please answer these ones then:

1.) Re Mr Dixon’s comments. Where is the sound scientific evidence that shows that the main treatments of chiropractic have been shown to be consistently more effective than treatment to which they have been compared?

I guess he is reffering to Meade, Manga, and the Beam study to name a few. He looks at the good ones you look at the bad ones . I don’t think that unusual, my patients judge me on results not evidence. If I was crap at my job I guess the practice would close and they could all come on the site and tell you how bad I was.

2.) What has the chiropractic profession done to limit the use of neck manipulation for neck pain when it is known that safer and less expensive treatments exist for the condition (e.g. exercise)?

Eat healthy, do exercise, drink clean water, reduce stress in life. I agree with you but people dont do all these things and their health lets them down. They seek help most go to Gps and if they are not satisfied they end up in osteopaths, chiropractors, acupuncturists etc. I have no experience of the dangers of chiropractic, I have only seen the anecdotal evidence you have seen, I dont agree that its dangerous. I use it everyday and see no reason to limit its use.

3.) Why doesn’t the chiropractic profession have an injury reporting system in place similar to the Yellow Card system that is used for reporting adverse drug reactions?

One is being put in place now the profession is much larger. Ten years ago there were only 600 chiropractors in the UK and adverse reactions would go through the associations and insurers. What can I say in my experience they are extremely rare.

4.) In the UK, drug medications contain Patient Information Leaflets which include advice on side effects. The chiropractic equivalent is to inform patients either orally or in writing of the risks associated with any procedure (and any available alternatives). This is a legal obligation. Why are large sections of your profession apparently ignoring their duty in this respect and what is being done about it?

If there was evidence of a significant risk of course I would warn people of a risk, in fact I would change to a light technique to stimulate mechano receptors. The risk of stroke is anecdotal and as your fact sheet states one should not attach much weight to anecdotal evidence. You can not have it both ways, on weight of anecdotal evidence to make points against the chiropractic profession.

You cant just accept evidence that supports your point of view, or can you?

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=1 7693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.P ubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=1%207693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.P%20ubmed.Pubmed_Resul tsPanel.Pubmed_RVDocSum)

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li st_uids=15726031 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li%20st_uids=15726031)

Thats me for today, I had only intended spending 20 minutes on this and my kids are starving.

Blue Wode

14th November 2007, 09:15 PM

Richard,

Chiropractors study the relationship between the structure of the spine and the function of the nervous system.

I would like to see more evidence. But every medical intervention is not supported by evidence, and I rely heavily on experience.
Around 80% of medical interventions are supported by evidence. Once again, please provide the scientific evidence for chiropractic.

[Re: NHS employees] Well then they have been miss informed about this study, if they have been told its about chiropractic as stated in Skeptic Fact Sheet.The NHS have been known to make a few mistakes in their time.

John Jackson (one of the founders of UK Skeptics) has addressed that point very adequately in post #15:

"Spinal Manipulation Therapy (SMT) is used by chiropractors and it's about the only thing they do that has any evidence to support its use.
Now that there's some doubt cast upon SMT compared to other interventions then it certainly is relevant to chiropractic.
SMT is not chiropractic as such but as chiropractors use it the link between chiropractic and SMT is highly relevant."
Spine is not a chiropractic Journal, they published it. Its the largest study thats been done on the subject, I have not claimed it proves anything however its better than the evidence that says chiropractic is dangerous.

If you’re not claiming that it proves anything, then why did you cite it in the first place?

Surely you not saying the chiropractor on chirotalk has more credibility than The Spine Journal?
No, I’m not saying that at all. I’m asking you why you think the chiropractors who operate that forum have allowed the post about the study to stay in their humour section.

If this guy is a chiropractor it is obvious he did not enjoy his time at chiropractic college.
That’s an assumption. If he is a chiropractor (and I believe he is) you don’t know why he’s sceptical about chiropractic.

If I were to base my evidence on the opinion of one Chiropractor, I dont think you would take me very seriously, come to think of it you don’t take chiropractic seriously so I guess its a mute point.
I won’t take you seriously until you produce some decent scientific evidence for ‘chiropractic’.

you dont like the Thiel study, fine perhaps Professor Ezard Ernst will do a better study more to your liking.
I stand by what I said. The chiropractic profession, as a whole, appears to take no cautionary attitude towards its practices - preferring, apparently, to spend its energies shouting down its critics (almost all of whom don’t have a vested interest in chiropractic) and cherry-picking studies in its support.

[Re Mr Dixon] I guess he is reffering to Meade, Manga, and the Beam study to name a few. He looks at the good ones you look at the bad ones .
You have that the wrong way round.

The Meade Trial was not the meal ticket that chiropractors made it out to be:
http://forums.randi.org/showpost.php?p=3149877&postcount=66 (http://forums.randi.org/showpost.php?p=3149877&postcount=66)

Regards the Beam study, this was the view of Professor Edzard Ernst (who, incidentally, has been trained in spinal manipulation):

"My reading of the results is that the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch. If this “devil’s advocate” view is correct, the effects have little to do with spinal manipulation per se."http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126 (http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126)

As for the Manga report, I am not familiar with it.

I have no experience of the dangers of chiropractic, I have only seen the anecdotal evidence you have seen, I dont agree that its dangerous
I take it, then, that you disagree with the conclusions of the latest systematic review on adverse effects of spinal manipulation:
http://www.jrsm.org/cgi/content/abstract/100/7/330 (http://www.jrsm.org/cgi/content/abstract/100/7/330)

One [a reporting system for injuries] is being put in place now the profession is much larger. Ten years ago there were only 600 chiropractors in the UK and adverse reactions would go through the associations and insurers.
The profession was regulated over 6 years ago in order to protect patients, why has it taken so long to put one in place?

Would you please provide more details about the one that’s being put in place.

If there was evidence of a significant risk of course I would warn people of a risk, in fact I would change to a light technique to stimulate mechano receptors. The risk of stroke is anecdotal and as your fact sheet states one should not attach much weight to anecdotal evidence. You can not have it both ways, on weight of anecdotal evidence to make points against the chiropractic profession.
Are you saying you don’t warn your patients about the risk of stroke associated with neck manipulation?

JJM

14th November 2007, 09:48 PM

Chiropractors study the relationship between the structure of the spine and the function of the nervous system.What is that relationship, and why do you care? Any such relationship is not available to chiropractic manipulation:
http://www.chirobase.org/02Research/crelin.html

What, specifically, is chiropractic, and what do you treat? You dodged that question from Blue Wode. You can simply cite a web-page with a description you approve.

Specifically, what does the chiro neck-snap do that makes it necessary? When there is no benefit (that cannot be achieved more safely, otherwise) the risk/benefit ratio is an unacceptably large number. One stroke is too many from an unnecessary procedure.

I would agree there is a lack of scientific evidence to support the efficacy of chiropractic as an intervention beyond back pain. We are a small profession and dont have great resources. Absence of evidence is not evidence of absence.Since chiro is irrational, it makes no sense to go ahead as if the evidence were there. In this case, absence of evidence is evidence of absence. The problem is not that you are a small group, there are around 65,000 chiros in North America, the problem is that the best research shows chiro to be ineffective- except for some headaches and acute low-back pain, where it is as good as massage.
I see I am cross-posting with B Wode.

richard

15th November 2007, 12:24 AM

Largest risk assessment study ever was recently published by Thiel and Bolton in Spine. I don’t have the actual reference to hand. (If you insist I will get it).You are not going to like the conclusion, but I guess scientific evidence is not designed to please.

Here’s the link:

Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey by Thiel, Haymo W. DC, PhD; Bolton, Jennifer E. PhD; Docherty, Sharon PhD; Portlock, Jane C. PhD, Spine. 32(21):2375-2378, October 1, 2007

http://www.spinejournal.org/pt/re/spine/abstract.00007632-200710010-00016.htm;jsessionid=H7DN7v7h1sQnJYvqTvn1h22bhpq8t Q1VHpf3pXTQ1lYhc3zGLwCz!1600246195!181195629!8091!-1 (http://www.spinejournal.org/pt/re/spine/abstract.00007632-200710010-00016.htm;jsessionid=H7DN7v7h1sQnJYvqTvn1h22bhpq8t Q1VHpf3pXTQ1lYhc3zGLwCz!1600246195!181195629!8091!-1)

Interestingly, the chiropractors on the Skeptical Chiropractic forum, Chirotalk, put it in their ‘humor’ section under the title “Silly chiropractic research”:

http://chirotalk.proboards3.com:80/index.cgi?board=humor&action=display&thread=1194137405 (http://chirotalk.proboards3.com/index.cgi?board=humor&action=display&thread=1194137405)

It was two years ago, I had to document one hundred consecutive cervical adjustments, the patient filled out a form after the adjustment and on subsequesnt visits.They had to report any adverse reactions which are documented in the study. I had none to report.

You think its better to survey 30 neurologists and ask them if they recall if any of their stroke patients had recieved spinal manipulation prior to the stroke. If every 5 minutes someone in the UK has a stroke, chances are some of them will have been to a chiropractor, I read how a lady was having her hairwashed when it happened.

richard

15th November 2007, 12:46 AM

The actual article cited was headlined: "Chiropractors may be no use in treating back pain, study says".

I think this is fair as Spinal Manipulation Therapy (SMT) is used by chiropractors and it's about the only thing they do that has any evidence to support its use.

Now that there's some doubt cast upon SMT compared to other interventions then it certainly is relevant to chiropractic.

SMT is not chiropractic as such but as chiropractors use it the link between chiropractic and SMT is highly relevant.

Your fact sheet states some Chiropractors also use a technique called Spinal Manipulative Therapy (SMT) for lower-back pain (although it is not recommended for the neck). This is not the same as Chiropractic itself, and should not be confused with it. Medical doctors and physiotherapists also use SMT.

Now because this study agrees with your view of chiropractic, you are "confusing" it with chiropractic. You should be consistant and say "some" chiropractors and the skeptic would qualify it by saying the technique used by the physiotherapists in this study is different from that used by chiropractors.

richard

15th November 2007, 01:53 AM

Richard,

Around 80% of medical interventions are supported by evidence.
15 years ago David Eddy stated in the BMJ it was only 10%, I dont think you have any evidence for 80%. If you have it I will have to think again about my chosen profession.

Once again, please provide the scientific evidence for chiropractic.

The facet joints of the spine are innervated by mechanoreceptors, if these joints are not moving properly it affects the function of the nerves. I get them moving again, that’s all. Do you dispute this?

If you’re not claiming that it proves anything, then why did you cite it in the first place?

Unlike you skeptics I try not to interpret too much from one study. There is anecdotal evidence that people have been injured by chiropractors. I would not dismiss those claims on the basis of one study and a good study at that, a lot more subjects than any of the studies you have mentioned.

No, I’m not saying that at all. I’m asking you why you think the chiropractors who operate that forum have allowed the post about the study to stay in their humour section.

What he said was silly and untrue and like you guys he does not like chiropractors. So he pokes fun at a peer reviewed study which shows no evidence of a link to stroke. You dont always get the results you want.

I stand by what I said. The chiropractic profession, as a whole, appears to take no cautionary attitude towards its practices - preferring, apparently, to spend its energies shouting down its critics (almost all of whom don’t have a vested interest in chiropractic) and cherry-picking studies in its support.

The main critic we have in the UK is Edzard Ernst and while I think the quality of his studies could be improved, he is entitled to have his opinion as are you "skeptics". I hope you dont think I have come on the site to shout you down, I just dont understand why you are so anti what I spent five years studying. As for cherry-picking studies I dont think you can accuse me of that.

The Meade Trial was not the meal ticket that chiropractors made it out to be:
http://forums.randi.org/showpost.php?p=3149877&postcount=66 (http://forums.randi.org/showpost.php?p=3149877&postcount=66)

Regards the Beam study, this was the view of Professor Edzard Ernst (who, incidentally, has been trained in spinal manipulation):
"My reading of the results is that the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch. If this “devil’s advocate” view is correct, the effects have little to do with spinal manipulation per se."
http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126 (http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126)

These are studies people interpret them how they want. There is an average person who will respond in an average way . I would be very surprised if you were able to get a better examination anywhere than you would get from me on your first visit. It takes time and knowledge to interpret the findings. Most of our tutors at college were medical people which may surprise you.

Seven guys out of my class at school choose medicine one of them is a well known surgeon, we are still friends, none of them have any antagonism towards chiropractic like you guys have.Chiropractic like all professions have problems however they are not of the magnitude being implied here.

I take it, then, that you disagree with the conclusions of the latest systematic review on adverse effects of spinal manipulation:
http://www.jrsm.org/cgi/content/abstract/100/7/330 (http://www.jrsm.org/cgi/content/abstract/100/7/330)

Yes and I gave my reasons in another posting. You would not accept as evidence that a survey of 30 doctors showed that they remembered that their patients headaches were gone after they had been to the chiropractor.

The profession was regulated over 6 years ago in order to protect patients, why has it taken so long to put one in place? You would have to ask our leaders. However I know the BCA publishes this information every year for insurance purposes.

Would you please provide more details about the one that’s being put in place. The Anglo European College of Chiropractic is doing it, you can contact them if you are interested.

Are you saying you don’t warn your patients about the risk of stroke associated with neck manipulation?

I tell my patients that there is anecdotel evidence of a risk of stroke. There is no evidence of a causal link and to my knowledge, a patient of mine has never experienced a bad reaction to chiropractic treatment.

richard

15th November 2007, 02:34 AM

What is that relationship, and why do you care? Any such relationship is not available to chiropractic manipulation:
http://www.chirobase.org/02Research/crelin.html

What, specifically, is chiropractic, and what do you treat? You dodged that question from Blue Wode. You can simply cite a web-page with a description you approve.

Specifically, what does the chiro neck-snap do that makes it necessary? When there is no benefit (that cannot be achieved more safely, otherwise) the risk/benefit ratio is an unacceptably large number. One stroke is too many from an unnecessary procedure.

Since chiro is irrational, it makes no sense to go ahead as if the evidence were there. In this case, absence of evidence is evidence of absence. The problem is not that you are a small group, there are around 65,000 chiros in North America, the problem is that the best research shows chiro to be ineffective- except for some headaches and acute low-back pain, where it is as good as massage.
I see I am cross-posting with B Wode.

I think I have answered a lot of your questions in my recent reply to blue wode, not that I think that it will satisfy anyone. I dont believe in miracles.

I did not have time to read the article its 2AM. You ask about what conditions I treat? I dont treat conditions, people with conditions somtimes come to my clinic, I palpate for symetrical movement in the spinal joints and where its lacking I move the joint which stimulates receptors in that joint.

You may think that is not important, I disagree. These receptors have a purpose if only to inhibit pain ( pain gate theory). Why in recent years have doctors stopped advising bed rest? they discovered something chiropractors had been advising for years.Movement, if the joint is not moving you will get compensation and degeneration else where in the spine. Twenty years ago they imobilised the knee joint after surgery for three months now its all about movement ASAP.The key is movement and however you achieve it is good for your health.
Good night:smiley:

JJM

15th November 2007, 08:45 AM

The facet joints of the spine are innervated by mechanoreceptors, if these joints are not moving properly it affects the function of the nerves. I get them moving again, that’s all. Do you dispute this?The relevant question is- can you prove this? Can you prove that joints are not moving properly and that you can correct the problem (you know- medical literature citations)?

How is the functioning of the nerves manifest? In other words, what measurable changes occur in any bodily function after you are done? If you cannot demonstrate a difference (cite medical literature citations), there probably isn't one; as indicated in the article (by Crelin) which I cited.

Blue Wode

15th November 2007, 12:17 PM

Richard,

[RE: Around 80% of medical interventions are supported by evidence] 15 years ago David Eddy stated in the BMJ it was only 10%, I dont think you have any evidence for 80%. If you have it I will have to think again about my chosen profession.

I would be interested to know what conclusions you reach after you have thought again about your chosen profession:
In recent years the claim that only 20% or less of standard Western medicine is evidence-based has been repeated widely by health professionals and others.[1] This assertion is perhaps most often made by proponents of unproven (‘alternative’ and ‘complementary’) therapies with the implication that, if true, it might somehow justify the integration of any number of unconventional modalities with a similar dearth of supporting scientific evidence into main-stream medical practice. It should be immediately noted that this line of reasoning is an example of the logical fallacy tu quoque (‘you did it too’): one party cannot criticize another because both parties are guilty of the same ‘sin.’ While this argument may be without merit, it is often made and widely held to be valid. Therefore, the authors of this paper have attempted to identify the sources of, and examine the evidence for, the ‘20% or less’ claim.
-snip-
In 1991, Dr David Eddy, at a conference in Manchester, UK, claimed that only 15% of medical practice was based on any evidence at all. He apparently based this sweeping conclusion entirely on his studies of treatments for just two specific conditions: arterial blockage in the legs and glaucoma.[10] Subsequently, Dr Eddy’s claim, rather than the much more conservative OTA ‘armchair estimate,’ has been widely cited as a criticism of mainstream medicine.
-snip-
Regardless of the origin or intent of the original assessments, critics of the ‘10 to 20%’ claims were originally unable to refute them because no solid evidence existed either in favor of or against them. That situation has changed in recent years. A growing body of evidence now exists regarding the extent to which medical practice is evidence-based.
-snip-
Evidence for evidence-based practice includes those listed in the box (q.v.).
• 96.7% of anesthetic interventions (32% by RCT, UK)[13]
• approximately 77% of dermatologic out-patient therapy (38% by RCT, Denmark)[14]
• 64.8% of ‘major therapeutic interventions’ in an internal medicine clinic (57% by RCT, Canada)[15]
• 95% of surgical interventions in one practice (24% by RCT, UK)[16]
• 77% of pediatric surgical interventions (11% by RCT, UK)[17]
• 65% of psychiatric interventions (65% by RCT, UK)[18]
• 81% of interventions in general practice (25.5% by RCT, UK)[19]
• 82% of general medical interventions (53% by RCT, UK)[20]
• 55% of general practice interventions (38% by RCT, Spain)[21]
• 78% of laparoscopic procedures (50% by RCT, France)[22]
• 45% of primary hematology–oncology interventions (24% by RCT, USA)[23]
• 84% of internal medicineinterventions (50% by RCT, Sweden)[24]
• 97% of pediatric surgical interventions (26% by RCT, UK)11
• 70% of primary therapeutic decisions in a clinical hematology practice (22% by RCT, UK)[25]
• 72.5% of interventions in a community pediatric practice (39.9% by RCT, UK)[26]
More…
The evidence for evidence-based medicineComplementary Therapies inMedicine(2000), 8, 123–126
http://www.vet-task-force.com/CTiM.htm (http://www.vet-task-force.com/CTiM.htm)
It’s a sad moment for British medicinewhen the chair of the NHS Alliance, Dr M Dixon, states that ‘only 10% of what doctors do in primary care is evidence-based’.1 The actual evidence shows that the figure is around 80%!2 But even if the 10% figure were correct, this would not lend itself, as Dr Dixon does, to the integration of more unproven treatments into the NHS. We first need to ensure that a therapy generates more good than harm and only subsequently should we consider it for general use. This course of action is not ‘integrated medicine’ but follows the principles of ‘evidence-based medicine’.
1. Times, 17 January 2004.
2. Gill P, Dowe AC, Neal RD et al. Evidence based general practice: a retrospective study of interventions in one training practice. BMJ 1996; 312: 819–21.
News, Focus Altern Complement Ther 2004; 9: 160
http://www.medicinescomplete.com/journals/fact/current/fact0902a09n06.htm (http://www.medicinescomplete.com/journals/fact/current/fact0902a09n06.htm)
[RE: Providing the scientific evidence for chiropractic] The facet joints of the spine are innervated by mechanoreceptors, if these joints are not moving properly it affects the function of the nerves. I get them moving again, that’s all. Do you dispute this?

Yes. Once again, please provide the scientific evidence for ‘chiropractic’.

[RE: Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey by Thiel, Haymo W. DC, PhD; Bolton, Jennifer E. PhD; Docherty, Sharon PhD; Portlock, Jane C. PhD, Spine. 32(21):2375-2378, October 1, 2007] There is anecdotal evidence that people have been injured by chiropractors.
And what type of evidence are you using to justify administering ‘chiropractic’ treatment to your patients?

[RE: Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey by Thiel, Haymo W. DC, PhD; Bolton, Jennifer E. PhD; Docherty, Sharon PhD; Portlock, Jane C. PhD, Spine. 32(21):2375-2378, October 1, 2007 in the ‘humour’ section of Chirotalk under the heading “Silly chiropractic research”] So he pokes fun at a peer reviewed study which shows no evidence of a link to stroke.
I’d say that he’s poking fun at the dubious quality of the study.

[RE: The profession not displaying a cautionary attitude towards its practices and cherry-picking favourable study results] I just dont understand why you are so anti what I spent five years studying.

Because so far you’ve refused to provide any references to scientific studies in support of what you’ve spent five years studying.

[RE: The Meade trial and the BEAM study] These are studies people interpret them how they want. There is an average person who will respond in an average way . I would be very surprised if you were able to get a better examination anywhere than you would get from me on your first visit. It takes time and knowledge to interpret the findings. Most of our tutors at college were medical people which may surprise you.

Seven guys out of my class at school choose medicine one of them is a well known surgeon, we are still friends, none of them have any antagonism towards chiropractic like you guys have.Chiropractic like all professions have problems however they are not of the magnitude being implied here.
Bearing in mind that chiropractors in the UK are legally obliged (i.e. must) provide care that’s evidence based, on what scientific evidence do you base your treatment interventions?

[RE: The findings of the latest systematic review on adverse effects of spinal manipulation] You would not accept as evidence that a survey of 30 doctors showed that they remembered that their patients headaches were gone after they had been to the chiropractor.
There is a great deal of information provided in the review to suggest the spinal manipulation (‘chiropractic’) may not be a safe therapy.

Here’s the review again (full text):
http://www.jrsm.org/cgi/content/full/100/7/330 (http://www.jrsm.org/cgi/content/full/100/7/330)

[RE: The length of time chiropractors have taken to start thinking about putting in place an injury reporting system similar to the Yellow Card system that is used for reporting adverse drug reactions.] You would have to ask our leaders.
As far as I can see your leaders are not to be trusted.

[RE: Providing more details about an injuring reporting system that’s apparently being put in place.] The Anglo European College of Chiropractic is doing it, you can contact them if you are interested.

As a practising, registered chiropractor, why aren’t you keen to find out more details about it?

[RE: Are you saying you don’t warn your patients about the risk of stroke associated with neck manipulation?] I tell my patients that there is anecdotel evidence of a risk of stroke.

Good!

JJM

15th November 2007, 02:06 PM

{snip} I dont treat conditions, people with conditions somtimes come to my clinic,That is a standard, unartful dodge. What kind of "people with conditions" do you treat?

I palpate for symetrical movement in the spinal joints and where its lacking I move the joint which stimulates receptors in that joint.

You may think that is not important, I disagree. These receptors have a purpose if only to inhibit pain ( pain gate theory). {snip}Show me the clinical evidence (medical literature) for this.

It sounds to me as though you follow the original Palmer method. In that case, I know there is no support for your claims. Moreover, Palmer's notions have been refuted by many lines of evidence, including the Crelin paper.

In short, Crelin dissected spines out of cadavers and twisted them in a controlled fashion. He determined that the nerves exiting the spine were unaffected by any amount of force up to that which caused the spine to break. Your twisting and popping means nothing with regard to health.

richard

15th November 2007, 02:58 PM

The relevant question is- can you prove this? Can you prove that joints are not moving properly and that you can correct the problem (you know- medical literature citations)?

How is the functioning of the nerves manifest? In other words, what measurable changes occur in any bodily function after you are done? If you cannot demonstrate a difference (cite medical literature citations), there probably isn't one; as indicated in the article (by Crelin) which I cited.

You have attached some importance to this Crelin article, so I sat down at lunch pen in hand to take notes.

“The Scientific Test of Chiropractic’s Subluxation Theory”. I get as far as the first line. Chiropractic is defined in the dictionary as “a therapeutic system based upon the premise that disease is caused by the interference with nerve function,” The skeptic in me is thinking what kind of dictionary would describe chiropractic like this?? Fortunately there is a reference;

The RandomHouse Dictionary of the English Language 1966. The year England won the World Cup. Eric Cantona was Born. Thalidamide was still a wonder drug. Man had not landed on the moon, colour TV was a dream, never mind mobile telephones.

This is your evidence to demonstrate the “theory of chiropractic is erroneous” The ICA definition is from 64, The ACA is 63. The definition of Subluxation is 62. The article was published in 1973. He questioned DD Palmer 1895 theory that a “luxation” was a bone out of place trapping a nerve. I don’t know of a chiropractor who subscribes to this theory today, certainly not in the UK, not for thirty years has anyone believed bone out of place. I have not said it, so why have you presented this as evidence. Where have you been since 1966 Do you have anything recent to support this view of chiropractic even something in the last ten years would be acceptable.

Now for something current if you are interested. The importance of joint motion is well described in the literature as illustrated by the fact it is very rare now to see joints immobilised in plaster. The joint is innervated by the nerves supplying muscles that cross the joint. If functioning normally they send sensory impulses in to the spinal cord which pass through the medulla to the sensory lobe of the brain.

The medulla is important because it houses the cochlear nucleus which receives input from the ear, just correcting another impression in the skeptics chiropractic fact sheet, that “the ear does not connect to the brain via the spine” It’s the spinal cord. If you give someone an audible fright they might jump in response for example.

Manipulation of the sacroiliac joints for the treatment of sacroiliac joint dysfunction has been described in chiropractic literature since the earliest textbooks. Ignored as a cause of back pain by traditional medicine after Mixter and Barr focused attention on disc herniation in1934. The sacroiliac joints until recently were not commonly considered to be mobile enough to cause significant dysfunction from restricted motion. The
slipped disc theory has been completely discredited as a cause of back pain, and sacroiliac dysfunction first described by “quack chiropractors” in 1906 is the generally accepted by most in the medical profession as a major cause of back pain.

I am not a medical therapist and I don’t understand why you insist on me producing “medical research” to validate chiropractic. The study you are all getting excited about clearly demonstrates that physiotherapists are not very skilled at spinal manipulation and you want me to validate what I do using these studies, be serious?? It would be ridiculous for me to say show me a chiropractic study which says orthopaedic surgeons are good at their job yet you are happy to set this standard for me. Perhaps I can find something from the 60s

But before you get too excited the work of British orthopaedic surgeon Gordan Wadell(Back Pain Revolution; Churchill Livingstone 2ed 2006) explains that the key concept for Chiropractic, Osteopathy is musculoskeletal dysfunction. He describes how this dysfunction arises in response to abnormal forces generated within the musculoskeletal system that relate to abnormal posture or abnormal joint movement (hypermobility, hypomobility) ,muscle dysfunction, connective tissue dysfunction, muscle imbalances, and neurophysiological changes that include abnormal sensory input and abnormal neurophysiological processing.

Clearly Waddells description of musculoskeletal dysfunction is nearly identical to what many chiropractors call the Vertebral Subluxation Complex, which has been described on the WHO and GCC websites. Another medical man Kirkaldy-Willis provides a similar description of pathological changes that occur in the spines of patients with back pain.

How do I know I move the joint, I can hear it, I can feel it, so can the patient. How does a doctor know he is listening to noises in the base of the lung and not the stomach, training and experience.

I know this must be annoying but I am very good at what I do and am happy to answer all of your questions as long as I have time. In fact the only error that has been pointed out is the date of the Parmacetamol study. I would appreciate if you would go over what I have covered, if you have any questions, before moving on to new questions.

Blue Wode

15th November 2007, 04:28 PM

He [Crelin] questioned DD Palmer 1895 theory that a “luxation” was a bone out of place trapping a nerve. I don’t know of a chiropractor who subscribes to this theory today, certainly not in the UK, not for thirty years has anyone believed bone out of place. I have not said it, so why have you presented this as evidence.

Are you sure about that? There are several hundred McTimoney chiropractors in the UK and their association’s website says this:

“By correctly training hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements)”.

http://www.mctimoney-chiropractic.org/mca_objectives.htm (http://www.mctimoney-chiropractic.org/mca_objectives.htm)

Isn’t a bony ‘displacement’ a bone out of place?

And what is “innate intelligence” ?

Clearly Waddells description of musculoskeletal dysfunction is nearly identical to what many chiropractors call the Vertebral Subluxation Complex, which has been described on the WHO and GCC websites.

Well the GCC has a duty (incredibly, as part of the regulation of chiropractors) to “promote” the chiropractic profession so of course it’ll carry a vague description of the so-called Vertebral Subluxation Complex (VSC) on its website.

Regards, the WHO’s website, weren’t the majority of those who developed its ‘Guidelines on Basic Training and Safety in Chiropractic’ (which includes a description of the VSC) directly involved with either chiropractic or alternative medicine? See pages 35-37 here:
http://www.chiroeco.com/50/bonus/WHOguidelines.pdf (http://www.chiroeco.com/50/bonus/WHOguidelines.pdf)

Hardly impartial, is it?

JJM

15th November 2007, 04:49 PM

Richard,

You clearly cannot explain anything in concrete terms. Not even specifically what you do for people, even though you are “very good at it.” Of course you are not a medical practitioner. Then again, why do “people with conditions” seek you? Wait, I know- you are a pseudo-medical practitioner.

The reason I request citations to medical literature is that pseudo-medical “literature” exists, and it is worthless. The “research” is very low quality; yet chiros (and homeopaths, and ad infinitem) like to cite it for me. There are articles on chiro in medical journals (e.g., Archives of Internal Medicine), they are just not favorable. There is no reliable research of any sort that validates chiro, except in the magical thinking of proponents.

JJM

15th November 2007, 04:56 PM

Indeed, what is innate intelligence? According to chiro literature:

Lon Morgan, DC, DABCO
http://www.jcca-online.org/Client/cca/jcca.nsf/Articles/52C805D03B6EAB9F852569B40059418F?OpenDocument
As a “magnetic healer” Palmer believed he was correcting an undefined fifth force in the body that is otherwise unknown to science. Palmer believed he could influence this fifth force, termed Innate Intelligence (II), and that it was the explanation for the presence or absence of health.

Today, II remains an untestable enigma that isolates chiropractic and impedes its acceptance as a legitimate health science. Palmer discovered chiropractic. As a cult, it is difficult to repudiate the founder’s notion. A rational group would simply reject the Innate Intelligence. Chiros dance around Palmer’s irrational notions.

World Chiropractic Alliance on “Innate”
http://www.worldchiropracticalliance.org/resources/greens/green5.htm
This modern document is labeled “philosophy.” They can’t dump the Innate; but they can relegate it to, unimportant, philosophy.

“The Meanings of Innate”
Joseph C. Keating, Jr., PhD
(Homewood Professor, Canadian Memorial Chiropractic College.
Vice President, National Institute of Chiropractic Research.)
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/Commentary+The+meanings+of+Innate/$file/3-Commentary%20Keating.pdf
Since the notion was first introduced by D.D. Palmer circa 1904, “Innate Intelligence” has been a source of inspiration, confusion and derision for chiropractors. …

Unlike the subluxation-complex, which is a potentially testable and falsifiable construct, II is one of those untestable principles in chiropractic. The latter comment is interesting because it omits the fact that the chiropractic subluxation is not just potentially falsifiable, it has been tested and it does not exist. When this was demonstrated in the 60s and 70s, the chiro cult could not give up their sublux- so they redefined it. Now they do the same with the II.

These articles make it clear that II is mere philosophy. It has no value in health care; but chiros won’t repudiate Palmer. Keating says that most chiros identify II with homeostasis; which is a blanket term referring to the body’s many mechanisms for maintaining limits on life functions (such as body temperature). Although this suggests II is related to something real, there is no evidence that chiro has any effect on any homeostatic system.

Admin

16th November 2007, 08:50 PM

If anyone wonders what all the fuss about Chiropractic is, this article gives a layman's terms overview: Chiropractic (http://www.ukskeptics.com/article.php?dir=articles&article=chiropractic.php).

For a more in-depth look at Chiropractic there's this excellent critique by Dr. Harriet Hall: Chiropractic, health or hoax? (http://drspinello.com/chiropractic/Chiropractic%20New_files/frame.htm)

I think it's important to look at theory behind Chiropractic as well as looking at the evidence base.

Alternative 'systems of medicine' are often based on very simplistic ideas that do not require one to possess a medical degree to understand. Chiropractic certainly falls into this category. The idea of Innate Intelligence being blocked by Subluxations being far too silly for (almost) anyone to take seriously.

Blue Wode

17th November 2007, 09:41 AM

Hot off the presses and perfectly timed comes this article from Professor Edzard Ernst:

Spinal manipulation: are the benefits worth the risks?
E. Ernst, Expert Review of Neurotherapeutics, November 2007, Vol. 7, No. 11, Pages 1451-1452
http://www.future-drugs.com/doi/full/10.1586/14737175.7.11.1451?cookieSet=1 (http://www.future-drugs.com/doi/full/10.1586/14737175.7.11.1451?cookieSet=1)

…the early chiropractic literature provides ample evidence for the fact that chiropractic was not originally meant as a treatment for musculoskeletal problems, but as a cure for any human condition [1] (javascript:popRef2('ref-1')).

To understand this seemingly bizarre claim a little better, one should glance at the concepts that underlie chiropractic. Palmer was convinced that he had discovered a law of nature. In his view, all human illness and disease were caused by the blockage of the 'innate intelligence’ through vertebral malalignments or subluxations. Therefore, all conditions could and should be treated with adjustments of these abnormalities, in other words, spinal manipulation. This would restore the flow of the innate intelligence and, in turn, would cure whatever condition the patient was suffering from [1] (javascript:popRef2('ref-1')).

It seems obvious to any critical evaluator that these concepts are little more than fantasy: there is no evidence for any innate intelligence, and there is no reason to assume that adjusting malalignments of vertebra (if they at all exist) are the cause of disease or illness…

And yet the McTimoney College of Chiropractic course in the UK apparently instructs its students in the following:

By correctly training the hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements).

http://www.mctimoney-chiropractic.org/mca_objectives.htm (http://www.mctimoney-chiropractic.org/mca_objectives.htm)

Incredibly, that course (which has produced 500 practising chiropractors) is validated by the University of Wales as a BSc (Hons) Chiropractic degree:
http://www.mctimoney-college.ac.uk/cofc.htm (http://www.mctimoney-college.ac.uk/cofc.htm)

Even more bewildering is the fact that the UK General Chiropractic Council stipulates in its Code of Practice and Standard of Proficiency that chiropractors’ provision of care must be evidence based. See section A2.3 of the Standard of Proficiency here:
http://www.gcc-uk.org/files/link_file/COPSOP_8Dec05.pdf (http://www.gcc-uk.org/files/link_file/COPSOP_8Dec05.pdf)

Anyone else confused?

Raph78

18th November 2007, 09:03 AM

good morning

i out myself as a chiropractor. i pride myself in offering accurate neuromusculoskeletal diagnosis and ethical treatment/management.
about semantics: you may call it innate intelligence - or the body's continued attempt to more or less successfully maintain homeostasis. innate intelligence is a vitalistic phrase from the 19th century. any bone surgeon plating a broken bone believes in "innate".

the great sir isaac newton,a passionate alchemist, formulated the law of motion in his free time. he gets all the credit for his scientific achievements. that he could have been a rosicrucian did not do his credentials any harm. on the contrary....yes mr palmer was a magnetic healer, so what....? that does not mean chiropractic 2007 is an unscientific cult... move on, dont be so stuck up!

about science:

when similar problems (e.g. back pain) cause different people to feel in very different ways it is not only the numbers achieved by a clinical trial that matter. maybe one ought to consider quality of life measures as the more appropriate way to research chiropractic and, maybe, alternative medicine. asking patients about their experiences is valuable clinical information. grounded theory studies appear an excellent approach to find out what matters to the patient. what is statistically significant is not always clinically relevant. those of you reflecting purposefully on academica in the safe environment of your ivory towers may not know that everyday busy clinic is messy. thats true also for the 5 min gp consultation as opposed to say 15 min with your chiropractor.

one question about the australian study: if you let physios perform largely flick-type manual mobilisation how on earth do you construct a credible sham group faking manipulation? its impossible. period. no wonder that results are not statistically relevant!

the physio curriculum generally does not include manipulation. its usually a post graduate activity. the question must be asked: how good (bad?) was their level of skill? had the study indicated that manipulation could be of help then it would have been criticized for a lack of numbers. you would have found ways of twisting it your way.

placebo, by the way, is not an excuse for a failed therapy. what is wrong with encouraging or reassuring the patient that their condition (e.g. a back sprain) is self limiting and usually resolves well in terms of symptomatology? this is called good interpersonal skills, not BS. about clinical skills:
a lot of gps in the area here do not even bother to have the patient expose their back when asked for help. maybe it would expose their inability to diagnose accurately. common diagnostic errors by gps: everything shooting down the leg is a "trapped nerve". everything not shooting down the leg is a "pulled muscle". for everyone above 55 its the old "arthritis" causing the problem. pattern recognition, cutting corners and knee jerk responses. where's the evidence for such negligent and incompetent clinical behaviour?

i do find that a skilled, specific high velocity manipulation can influence proprioception. proprioception produces muscle tone. proper muscle tone protects joints and moves them purposefully. poor proprioception causes weakness leading to injury (sprain). one of the features of sprain is muscle spasm and joint restriction. sometimes the muscle spasm or pain is caused by the joint sprain locally. in those cases manipulation helps. sometimes e.g. a distant problem is the cause for muscles failure. watch this clip (hope u dont mind, simon) http://http://www.youtube.com/watch?v=-6R2XAncZCw (http://http//www.youtube.com/watch?v=-6R2XAncZCw)
joint mobilisation or flicking does not provide that sort of nerve response.

you could have put stacey in a double blind randomised trial, have her shoulder mobilised, rubbed and flicked upon by physios and guess what - she would still be no better and prof ernst would have had a good day.

are there ways to assess whats wrong with patients individually? the root cause of their musculoskeletal pain? sure. are they quantifiable? probably not. is there still evidence for it? yes. does that make it bad science? no. does it work? you bet. i dont think that good chiropractors have a waiting lists if they were no good.

over the past 3 years i must have treated about 13.000 cases, of which about 10.000 received cervical manipulation. i recorded one case where a patient had pain down the arm for 1 day after treatment. a few had headaches for a day or two or felt a bit sore temporarily. i have never come across a serious injury leaving lasting damage. but, maybe, in your eyes i should be a flick physio. at least they dont do damage....

i do not intend to spend too much time in here. i just popped in as some of the comments posted here were so outrageous and ignorant that a couple of things needed rectifying.

enjoy your sunday, and have an even better monday O0

JJM

18th November 2007, 12:47 PM

{snip} i out myself as a chiropractor. i pride myself in offering accurate neuromusculoskeletal diagnosis and ethical treatment/management.Of course you do. Pride in their work, and opposition to criticism, are the unifying principles of chiro.

about semantics: you may call it innate intelligence - or the body's continued attempt to more or less successfully maintain homeostasis. {snip}Great, pick one homeostatic mechanism and refer us to the medical evidence it is influenced by chiro. That is, don't show us chiro articles because they are seldom worth reading.

{snip} that does not mean chiropractic 2007 is an unscientific cult...DD Palmer's ignorance does not make chiro an unscientific cult- that is called a straw-man argument. It is what chiros do that makes it an unscientific cult. {snip}

about science:

when similar problems (e.g. back pain) cause different people to feel in very different ways it is not only the numbers achieved by a clinical trial that matter. maybe one ought to consider quality of life measures as the more appropriate way to research chiropractic and, maybe, alternative medicine. asking patients about their experiences is valuable clinical information.Maybe you could provide some evidence?

grounded theory studies appear an excellent approach to find out what matters to the patient.What?

what is statistically significant is not always clinically relevant. {snip}Vague ...

one question about the australian study: {snip}Yes, one question, what is the Australian study?

{snip} about clinical skills:
a lot of gps in the area here do not even bother to have the patient expose their back when asked for help. {snip}First, claimed deficiencies in GPs do not justify chiro. Second, a GP may decide to handle a case conservatively, or refer to medical specialist. Stick to your case.

i do find that a skilled, specific high velocity manipulation can influence proprioception. {snip}Another opportunity to cite the medical literature.

watch this clip (hope u dont mind, simon) http://http://www.youtube.com/watch?v=-6R2XAncZCw (http://http//www.youtube.com/watch?v=-6R2XAncZCw)
joint mobilisation or flicking does not provide that sort of nerve response.A video clip might be a good illustration, after sending us to the medical literature that supports the demonstration.

{snip} [rhetorical banter, no evidence here]

[anecdote, no evidence here]

{snip} i just popped in as some of the comments posted here were so outrageous and ignorant that a couple of things needed rectifying. {snip}
Yes, there was another outrageous and ignorant chiro a bit earlier. He claimed to influence nervous flow. When I cited the evidence that chiros cannot do that, he blustered and said he could not read the article.
http://www.chirobase.org/02Research/crelin.html

So, I will ask you as I did him, what, specifically, do you do for your customers; and what is the evidence behind it?

If you do choose to answer, please use the shift key appropriately. There is, probably, one on either side of your keyboard. It makes things easier to read.

richard

18th November 2007, 01:02 PM

good morning i out myself as a chiropractor. i pride myself in offering accurate neuromusculoskeletal diagnosis and ethical treatment/management.

O0

Ralph, I have to tell your excellent posting will not go down very well with these “sceptics”. The don’t like chiropractors who “shout them down” or who don’t reference, the highly respected researchers, Edzard Ernst MD, Stephen Barrett MD and Hariet Hall MD who have had thousands of articles published on the peer reviewed quack watch web sites. These researchers obviously believe in each other judging by the way they reference each other. They must have gone to the same school of research methodology. Not to forget Edmund Crelin Ph.D refferences from the 60s,which JCC is very attached to. I must say I love the music from the 60s, however the science leaves a lot to be desired. I read somewhere that Stephen Barrett sued a chiropractor for libel and lost. Apparently the chiropractor wanted to clarify Barrett’s MD status “he's a psychiatrist who has never been board certified who failed his board certification 3 times. Apparently Barrett failed the neurology section which might go some way to explaining his lack of understanding of chiropractic. Now not being an expert on quacks perhaps some of our more learned forum members could clarify for me, does this lack of knowledge make Barrett a quack or a chiropractor, my Chambers dictionary describes a quack as a “boastfull pretender to knowledge and skill that he does not possess”. There seems to be a lot of quacks about if this is true.

Ralph, I know I must look really sad spending so much time on this, but it was for a talk I gave to chiropractic students last week. I wanted them to see how evidence can be used and abused and even with the best intentions you can light a candle but if the person is blind it is not going to help. Out of politeness I will respond to the “scientific evidence” (80%) presented by blue wode et al. when I get some time before withdrawing from the thread. Honestly I do have a life. Richard "the ignorant chiropractor" >:D

Blue Wode

18th November 2007, 01:05 PM

Good afternoon, Raph78, and welcome to the UK Skeptics forum.

yes mr palmer was a magnetic healer, so what....? that does not mean chiropractic 2007 is an unscientific cult...

move on, dont be so stuck up!

How can anyone move on here unless good scientific evidence is provided for 'chiropractic' (i.e. not spinal manipulation)?

maybe one ought to consider quality of life measures as the more appropriate way to research chiropractic, and maybe, alternative medicine.

But lots of people find their quality of life improved (i.e. feel better) by simple, cheap, and enjoyable non-medical interventions, e.g. after a couple of whiskies, a nice hot bath, a visit to the hairdressers, a trip to the movies or a walk through the countryside, etc.

what is statistically significant is not always clinically relevant, those of you reflecting purposefully on academica in the safe environment of your ivory towers may not know that every day busy clinic is messy. thats true also for the 5 min gp consulation as opposed to say 15 min with your chiropractor

According to this 2004 survey of UK chiropractors
http://www.gcc-uk.org/files/link_file/ConsultTheProfession.pdf (http://www.gcc-uk.org/files/link_file/ConsultTheProfession.pdf)
52.22% of chiropractors spend somewhere between 0- 15 minutes with their patients. (See page 33)

As for GPs, the length of routine booked appointments is not less than 10 minutes. For practices with only an open surgery system, the average face-to-face time spent by the GP with the patient is at least 8 minutes.
http://www.bma.org.uk/ap.nsf/Content/QualityOutcomes~patient (http://www.bma.org.uk/ap.nsf/Content/QualityOutcomes~patient)

the physio curriculum generally does not include manipulation. its usually a post graduate activity. the question must be asked: how good (bad?) was their level of skill?

Indeed, it would be interesting to know the answer to this question posed by the results of the UK BEAM trial:

Three brief comments on the excellent BEAM Trial (1). My reading of the results is that the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch. If this “devil’s advocate” view is correct, the effects have little to do with spinal manipulation per se.

It would be relevant to know which of the three professional groups (chiropractors, osteopaths, physiotherapists) generated the largest effect size. This might significantly influence the referral pattern. A post-hoc analysis might answer this question.

It is regrettable that the study only monitored serious adverse effects. There is compelling data to demonstrate that minor adverse effects occur in about 50% of patients after spinal manipulation (2). If that is the case, such adverse events might also influence GP’s referrals.

E Ernst, Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth

References

1. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ, doi:10.1136/bmj.38282.669225.AE. BMJ 2004;19 November:1-8.

2. Stevinson C, Ernst E. Risks associated with spinal manipulation. Am J Med 2002;112:566-70.

http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126 (http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126)

[My bold]

placebo, by the way is not an excuse for a failed therapy. what is wrong with encouraging or reassuring the patient that their condition (e.g. a back sprain) is self limiting and usually resolves well in terms of symptomatology? this is called good interpersonal skills not BS.

Just like GPs do in their 8-10 minute consultations without the expense, inconvenience and potential risks associated with visiting a chiropractor.

a lot of gps in the area here do not even bother to have the patient expose their back when asked for help. maybe it would expose their inability to diagnose accurately.

As supported by the Hancock et al study
http://www.medpagetoday.com/Geriatrics/PainManagement/tb/7307 (http://www.medpagetoday.com/Geriatrics/PainManagement/tb/7307)
perhaps clinical experience has taught those GPs that exercise, paracetamol, and reassurance are all that's required.

i do find that a skilled, specific high velocity manipulationc an influence proprioception. proprioception produces muscle tone. proper muscle tone protects joins and moves them purposefully. poor proprioception cause weakness leading to injury (sprain). one of the features of sprain is muscle spasm and joint restriction. sometimes the muscle spasm or pain is caused by the joint sprain locally. in those cases manipulation helps. sometimes e.g. a distant problem is the cause for muscles failure. watch this clip (hope u dont mind, simon) http://http://.youtube.com/watch?v=6R2XAncZCw joint mobilisation or flicking does not provide that sort of nerve response.

you could have put stacey in a double blind randomised trial, have her shoulder mobilised, rubbed and flicked upon by physios and guess what - she would still be no better and prof ersnt would have had a good day.

Anecdotal.

are there ways to assess whats wrong with patients individually: the root cause of their musculoskeletal pain? sure. are they quantifiable? probably not. is there still evidence for it? yes. does that make it bad science? no. does it work? you bet. i don't think that good chiropractors have a waiting lists if they were no good.

What do you mean by ‘good’ chiropractors? Many chiropractors are excellent salesmen who are able to convince asymptomatic and gullible patients that they require ongoing treatment. See here:
http://www.chirobase.org/09Links/pb.html (http://www.chirobase.org/09Links/pb.html)

over the past 3 years I must have treated about 13.000 cases, orfwhich about 10,000 received cervical manipulation. i recorded one case where a patient had pain down the arm for 1 day after treatment. a few had hedaches for a day or two or felt a bit sore temporarily. i have never come across a serious injury leaving lasting damage. but, maybe, in your eyes i should be flick physio. at least they dont do damage....

Anecdotal. See here for the latest on safety:

Spinal manipulation: are the benefits worth the risks?

Today, the chiropractic profession is divided into the 'straights’ who still believe every word of Palmer’s gospel, and the 'mixers’ who have freed themselves, at least partly, from his theories. The straights treat most diseases with spinal manipulation, while the mixers managed to gradually redefine themselves as back specialists.

-snip-

In conclusion, spinal manipulation is based on questionable pathological concepts and therefore lacks biological plausibility [1]. Its risks may be considerable [4] and its benefits have not been convincingly demonstrated in rigorous trials [2]. What follows is sobering: the benefits of spinal manipulation do not seem worth the potential risks.

http://www.future-drugs.com/doi/abs/10.1586/14737175.7.11.1451 (http://www.future-drugs.com/doi/abs/10.1586/14737175.7.11.1451)

i do not intend to spend too much time in here. i just popped in as some of the comments posted here were so outrageous and ignorant that a couple of things needed rectifying.

Thank you for dropping by.

Raph78

18th November 2007, 04:34 PM

hi richard, buddy! how is it going?

wow weve got this going now, have we?

well, my medical friends. get your grays anatomy out but dont let it drop on yer feet. lets give you a neurophysiology talk.

now, your homework will be to understand Turker et al (1994). Reflex response in motor units in human masseter muscle to mechanical stimulation of a tooth. Exp rain Res 100 (2) 307-15 and Slemenda et al (1997) Quadriceps weakness and OA of the knee. ann int med 127 (2) 97-104. and to see the relevance IN TERMS OF PROPRIOCEPTIVE MEDICINE.

grays: read up also on the MYOTATIC REFLEX and how it governs and controls muscle tone. and what changes the rate of firing input into the spinal cord. and how that generates alpha motor neuron activity back to the muscle to close the loop. and how that increases muscle activation. and how that produces tone. and how tone prevents injury.

muscle testing is an art. those who know how to test will be aware of rate coding and muscle recruitment. the size principal also states that motor unit activation depends upon the load forced upon a muscle (manual muscle test, resisted weight test as in video). so, a healthy muscle should not fade. if it DOES its proprioceptively inhibited - which is reversible.

the myotatic reflex gets stimulated by STRETCH (like high velocity manipulation - just an idea). manipulation is a fast stretch.....are you getting the idea? thats why the stuff on the video works. and thats chiropractic in action affecting the nervous system.

evidence that statistical significance may be different from clinical significance? honestly mate, you must be joking. where have you been in the days of evidence based practice? do i need to quote my own study?

quality of life is not "im feeling better". thats rather blunt isnt it? there are some excellent QOL questionnaires out there, e.g. the fine bournemouth questionnaire by bolton and breen. you clearly must be a novice to qualitative science.

but coming back to "quality" science the australian study i referred to was the one you all quoted. the one with the australian researchers and the australian physios. remember? the one that claims chiropractic does not work although not a single chiropractor took part and the physios just tickled the skins of the patients calling this manipulation. ;)

give me one study that proved that a stroke was directly caused by neck manipulation. hang on, that would be a case study. give me randomised double blind clinical trials showing that chiropractic neck manipulation causes strokes. the experts have spoken and found that manipulation does not put more force on the neck than AROM. (Haldemann, Sackett, Herzog and all the big boys who are hot on this topic) http://www.chiropracticawarenesscouncil.org/truth.html

maybe a point against vaccination is that it has a NNT of 23, that means that if you have the jab and DONT get the flu its to only 4-5% thanks to the jab. thats taken from bandolier (http://www.jr2.ox.ac.uk/bandolier/band50/b50-8.html). Its disgusting to call that preventative!

thankfully my NNT is close to 1 and most people are really happy with my care.

i invite ANY of you to shadow me for a whole day and then come out for a drink at night to discuss.

Raph78

18th November 2007, 04:45 PM

Raph78

18th November 2007, 04:49 PM

yes, the practice building including a lot of the seminars are dodgy. i call it the "wellness wallet". its a disgrace.

you find that in (private) dentistry too. this is not exclusive to a certain strain of chiropractors

Admin

18th November 2007, 04:55 PM

What would improve debate here would be if the Chiropractors actually dealt with relevant details regarding Chiropractic rather than attempting to belittle or discredit everyone who questions them (the Ad Hominem fallacy (http://www.ukskeptics.com/forum/showthread.php?t=443)) and introducing medical concepts that are mainstream and nothing to do with Chiropractic.

Raph78

18th November 2007, 05:22 PM

hi john

discussing proprioception is a medical debate. its not a chiropractic insider. it helps explain chiropractic as i was asked to do. it also explains massage, and possibly acupuncture. it does not explain the flu jab.

its just that not many understand the working principle behind proprioception. those might only vaguelyremember it from multiple choice days at medical uni.

Blue Wode

18th November 2007, 05:23 PM

evidence that statistical significance may be different from clinical significance? honestly mate, you must be joking. where have you been in the days of evidence based practice? do i need to quote my own study?

Once again, please provide the scientific evidence for 'chiropractic'.

give me one study that proved that a stroke was directly caused by neck manipulation. hang on, that would be a case study. give me randomised double blind clinical trials showing that chiropractic neck manipulation causes strokes.

Once again, here is the most current systematic review (2007) on adverse effects associated with spinal manipulation:

Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.

http://www.jrsm.org/cgi/content/full/100/7/330 (http://www.jrsm.org/cgi/content/full/100/7/330)

Would you please provide us with the scientific data that shows that spinal manipulation is safe for infants and children under 12.

the experts have spoken and found that manipulation does not put more force on the neck than AROM. (Haldemann, Sackett, Herzog and all the big boys who are hot on this topic) http://www.chiropracticawarenesscouncil.org/truth.html

How can anyone take seriously an organisation that links to the World Chiropractic Alliance (WCA): http://www.chiropracticawarenesscouncil.org/articles.html

For example, here is an excerpt from one of the WCA's position papers:

The correction of subluxation is applicable to any patient exhibiting evidence of its existence regardless of the presence or absence of symptoms and disease. Therefore, the determination of the presence of subluxation may stand as the sole rationale for care.

http://www.worldchiropracticalliance.org/positions/rationale.htm (http://www.worldchiropracticalliance.org/positions/rationale.htm)

maybe a point against vaccination is that it has a NNT of 23, that means that if you have the jab and DONT get the flu its to only 4-5% thanks to the jab. thats taken from bandolier (http://www.jr2.ox.ac.uk/bandolier/band50/b50-8.html). Its disgusting to call that preventative!

Do you view childhood vaccinations as a preventative healthcare measure?

Admin

18th November 2007, 05:24 PM

about semantics: you may call it innate intelligence - or the body's continued attempt to more or less successfully maintain homeostasis. innate intelligence is a vitalistic phrase from the 19th century. any bone surgeon plating a broken bone believes in "innate".

So, what is the difference between homeostasis and innate intelligence?

What's the difference between the body's own self-repair mechanisms and pseudo-medical intervention (Chiropractic manipulation, Acupuncture, Homeopathy, etc.)?

As far as I can see all of these pseudo-medical interventions actually do nothing as the body repairs itself anyway; however, they do seem to have some positive effect on patients (placebo effects in other words).

Here is the essential problem with these placebo interventions: in order for them to 'work' they have to be believed in by the patients (i.e. there needs to be a 'perceived authenticity' about these practises) so the practitioners have to maintain the belief that there really is something medical going on - which leads us to the dilemma at the heart of alternative medicine (http://dcscience.net/?page_id=10).

Chiropractic is a silly idea that was invented back in the 19th century, and it hasn't changed fundamentally since that time. It 'works' via placebo effects, and I'm pretty sure most Chiros know this, but they can't admit it. To do so would remove the perceived authenticity that is required for people to get the benefit of placebo effects from it.

SMT (which Chiros have adopted to treat lower back pain) accepted, there's not really any decent evidence that Chiropractic is a useful medical intervention for anything.

We'll always have stalemate with alternative medicine for the simple reason that the practitioners cannot admit that what they're dealing in is placebo medicine.

Those, like skeptics, who are interested in evidence-based medicine however, can see through the (necessary from alternative medicine's point of view) façade presented to us.

Blue Wode

18th November 2007, 05:55 PM

i read ernst from nov 2007

the guy loves himself just quoting his own articles, doesnt he?

what exactly was his education in manipulation? how long has he practiced and what did he do?

given that he slams ALL cam disciplines he seems a bitter man that realized he wasted more than half his life to study worthless BS

i actually reviewed some of his meta analyses, incluidng the one on treatment of children with asthma. he carefully selects on studies that proof his point and deliberately omits the ones that he doesnt like. thats sad, man

Here's some background information on Professor Edzard Ernst:

It is hard to imagine a member of the UK's medical elite devoting their life to complementary medicine. Ernst, however, comes from a culture where alternative therapies have long blended with the mainstream. He is from four generations of conventional doctors but, he says, "Even as a young boy I was treated with complementary therapies - mostly homeopathy."

His first post was in a homeopathic hospital in Munich, where he was greatly impressed. "If you study medicine and pharmacology, you know [homeopathy] can't work," he says. The active substances in homeopathic medicines are so diluted that pharmacology says they cannot have an effect. "Then you start working in a homeopathic hospital and people get better. Is that a miracle? It certainly is very impressive for a young doctor.

"Looking back, I wonder if a lot was a placebo effect."

More...
http://education.guardian.co.uk/academicexperts/story/0,1392,1048903,00.html (http://education.guardian.co.uk/academicexperts/story/0,1392,1048903,00.html)

"I have received training in spinal manipulation and have applied it clinically, but have no financial competing interests related to spinal manipulation."

See under ‘conflicts of interest’ at the end of this systematic review:
http://www.mja.com.au/public/issues/176_08_150402/ern10520_fm.html (http://www.mja.com.au/public/issues/176_08_150402/ern10520_fm.html)

Raph78

18th November 2007, 06:03 PM

usually the body repairs itself. sometimes not. as in chronic back pain. and there is good evidence that chiropractic can help that.

can you quote anybody else apart from "edzi oops ive done it again"? he just regurgitates his own previous papers. i remember his quote that st johns wort is dangerous because if someone with depression taking it got better then they would have the strength to commit suicide. great scientist...

Blue Wode

18th November 2007, 06:12 PM

usually the body repairs itself. sometimes not. as in chronic back pain. and there is good evidence that chiropractic can help that.

can you quote anybody else apart from "edzi oops ive done it again"? he just regurgitates his own previous papers.

Here you are:

(The value of chiropractic)
Virtually all experts agree that the best available evidence in any area of health care is that provided by Cochrane reviews. The Cochrane Collaboration is a worldwide network of independent scientists dedicated to systematically summarising the totality of the evidence related to specific medical subjects in a rigorous and transparently impartial fashion. Four Cochrane reviews of spinal manipulation are available today.
Back pain is by far the condition most frequently treated by chiropractors. The Cochrane review of spinal manipulation for back pain summarised 39 clinical trials.1 (http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm#fact1002a02t01b0001) The authors’ conclusions were very clear: ‘There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.’

http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm (http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm)

[My bold and underscoring]

Admin

18th November 2007, 06:13 PM

usually the body repairs itself. sometimes not. as in chronic back pain. and there is good evidence that chiropractic can help that.

We've already established that SMT (which has been adopted by Chiropractors) does indeed have some evidence to support it.

Edit: As Blue Wode has pointed out however, SMT is no better than other standard treatments.

can you quote anybody else apart from "edzi oops ive done it again"?

Do you actually think that childish name calling advances your cause in some way?

I've pointed you to the section on the Ad Hominem fallacy. I suggest you read it. ;)

i remember his quote that st johns wort is dangerous because if someone with depression taking it got better then they would have the strength to commit suicide. great scientist...

That's actually a well known problem with severe depression (!)

St John's Wort has supporting evidence that it is useful for mild depression. With severe depression, however, it can lift the depression just enough to raise the sufferer's motivation levels enough to allow them to carry out the thoughts of suicide they were having. This is a potential problem because it is available over the counter and people can take without medical supervision.

Medical professionals are well aware of this problem.

richard

18th November 2007, 06:53 PM

hi richard, buddy! how is it going?

Ralph you are really going over their heads with this neuroscience mumbo jumbo. I gave a reference from Kendal and Schwartz Principles of Neuroscience and they just ignored it. So I tried to keep it simple KISS, hand, fast push, Spinal joint, receptors, spinal cord and brain.

If you have read the skeptic fact sheet on chiropractic they dont realise that the nucleus of the cranial nerves are in the brain stem and attaches to the spinal cord. Why they spent time producing a lovely looking fact sheetlike that when they could have just referred everyone to chirobase or quack watch is beyond me.Nice picture of DD all the same.

I would love to know what these guys do for a living. Blue Wode I suspect has something to do with the NHS. and John nice suit, tie, big smile lots of time on his hands. JCC seems very aggressive compared to the others, I bet he voted Bush.

Ralph dont tell me you are American and voted for him as well. If thats the case we will have to rise above our differences and stick together for the profession.

Admin

18th November 2007, 07:08 PM

Ralph you are really going over their heads with this neuroscience mumbo jumbo. I gave a reference from Kendal and Schwartz Principles of Neuroscience and they just ignored it. So I tried to keep it simple KISS, hand, fast push, Spinal joint, receptors, spinal cord and brain.

If you have read the skeptic fact sheet on chiropractic they dont realise that the nucleus of the cranial nerves are in the brain stem and attaches to the spinal cord. Why they spent time producing a lovely looking fact sheetlike that when they could have just referred everyone to chirobase or quack watch is beyond me.Nice picture of DD all the same.

I would love to know what these guys do for a living. Blue Wode I suspect has something to do with the NHS. and John nice suit, tie, big smile lots of time on his hands. JCC seems very aggressive compared to the others, I bet he voted Bush.

Ralph dont tell me you are American and voted for him as well. If thats the case we will have to rise above our differences and stick together for the profession.

Hmmm....

Another attempt and condescension and name calling. ::)

And these guys expect people to believe they are serious medical practitioners!

We get this sort of crass argumentation from psychics.

Any chance we can actually talk about chiropractic? ;)

How about some answers to:
What is Innate Intelligence?
What is a subluxation?
How are subluxations detected?
Can a single patient's subluxation be reliably found by more than Chiropractor?
Can subluxations be seen on X-rays?
How do subluxations cause bed-wetting in children and how does spinal manipulation cure this?
How does manipulating the spine of a child with ADHD cause an improvement in behaviour?
Do you recommend vaccinations? If not, why not?I'll stop there for now but there's plenty more questions like these that I, and I'm sure readers of this thread, would like to see answers to.

These are all things chiropractors claim or believe in but that evidence doesn't support.

Let's see some answers please.

JJM

18th November 2007, 07:18 PM

{snip}

now, your homework will be to understand Turker et al (1994). Reflex response in motor units in human masseter muscle to mechanical stimulation of a tooth. Exp rain Res 100 (2) 307-15 and Slemenda et al (1997) Quadriceps weakness and OA of the knee. ann int med 127 (2) 97-104. and to see the relevance IN TERMS OF PROPRIOCEPTIVE MEDICINE.

{snip} Türker KS, Brodin P, Miles TS.
Exp Brain Res. 1994;100(2):307-15.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=7813667&ordinalpos=11&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

It is concluded that stimulation of periodontal mechanoreceptors usually activates an excitatory reflex pathway to the jaw-closing motoneurones. I don’t see any mention of chiro or proprioception. These guys tapped a guy's tooth to see how fast his jaw would close!?

Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, Wolinsky FD.
Ann Intern Med. 1997 Jul 15;127(2):97-104
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=9230035&ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

CONCLUSION: Quadriceps weakness may be present in patients who have osteoarthritis but do not have knee pain or muscle atrophy; this suggests that the weakness may be due to muscle dysfunction. The data are consistent with the possibility that quadriceps weakness is a primary risk factor for knee pain, disability, and progression of joint damage in persons with osteoarthritis of the knee. I don’t see any mention of chiro or proprioception.

The objective is to provide reliable evidence of a problem that is helped by chiro. I will stipulate that acute low back pain and some headaches are amenable to manipulation, as long as the neck snap is not fatal.

Rob

18th November 2007, 07:19 PM

And yet the McTimoney College of Chiropractic course in the UK apparently instructs its students in the following:

Quote:
By correctly training the hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements).

http://www.mctimoney-chiropractic.org/mca_objectives.htm (http://www.mctimoney-chiropractic.org/mca_objectives.htm)

Incredibly, that course (which has produced 500 practising chiropractors) is validated by the University of Wales as a BSc (Hons) Chiropractic degree:
http://www.mctimoney-college.ac.uk/cofc.htm (http://www.mctimoney-college.ac.uk/cofc.htm)

I don't want my first post to be a downer, i'm a skeptic through and through - but, the point you seem to be making is that it's "incredible" that the course is validated in light of that single quote from a website. Isn't that a bit....well, weak?

I've had McTimoney chiropractic, and I personally know lots of intelligent people whose back problems have been written off by their GP's who have had excellent outcomes from it. When it was explained to me what was occuring, it added a bit more context to that admittedly ambigous quote above. The "in-the-flesh" version (and this applies not just to McTimoney chiropractic) of the explanation goes on to explain that the body is regulated in part by nerves, that bones can impinge nerves and cause dysfunction/pain, that the bones do know their optimum position (and yes, they do, if all structures and connective tissue were in good form but the bone slightly out of position due to soft tissue fixation, an abormal rotation etc), then providing a small input of kinetic energy, in the right direction, may overcome that fixation and allow the "system" to return to stability.

This makes perfect sense to me and doesn't offend my scientific sensibilities or set off my skeptic spidey-sense. In terms of a mathematical system, it's like a ball in a textured bowl getting stuck on the inside edge, and gravity lacking the energy to pull the ball to equilibrium. A tap on the right part of the bowl kickstarts the system, giving it the energy it needs to overcome the abormal rest-state it has achieved. I *think* this is what they mean when they say innate intelligence - that the system does have an optimum state, like "it knows what's best for it." Before you start pounding the keyboard - the body doesn't really "know", but the "system" does, through a million variables, have an optimum state we casually regard as "normal", that a chiro might see as unsubluxated. Semantics is all.

Blue Wode, you quoted from a cochrane report

There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain

Great! SMT is not superior.....that is NOT the same as saying it has no effect, or that the value of a chiropractor is questioned. How about the chiropractors who have gone into hospitals and got spinal surgery waiting lists down from 2 years to 2 weeks? How about the chiropractors who diagnose life-threatening illnesses in their primary care role that have been consistenly missed by mainstream medics? That is value.

We're talking about lots of different issues here but let me try and spell them out:

SMT is not Chiropractic and Chiropractic is not SMT - they may relate in varying degrees ffrom chiro to chiro.
Evidence-based medicine is not the same as scientific proof - particularly where the only thing that really counts is results. If the evidence shows that people are getting better, by objective measures, then they're getting better.
The value of a chiropractor is NOT dependent upon the availability of convincing research on technique. What it is dependent upon is a debate in itself i'm sure.
It is not good scientific practice to extrapolate an ambigously worded website into an opinion on the standard of chiropractic education at any given college.

Now i'll admit I only skim-read this topic, but as I did, I got the idea that these issues were getting confused a little. As a skeptic I get very sensitive to confusion - I like to plot statements out a bit more to see if they stack up and then try and apply logic to them.

Nice to be here too, post number 1. Hurrah.
Rob

Admin

18th November 2007, 07:22 PM

The "in-the-flesh" version (and this applies not just to McTimoney chiropractic) of the explanation goes on to explain that the body is regulated in part by nerves, that bones can impinge nerves and cause dysfunction/pain, that the bones do know their optimum position (and yes, they do, if all structures and connective tissue were in good form but the bone slightly out of position due to soft tissue fixation, an abormal rotation etc), then providing a small input of kinetic energy, in the right direction, may overcome that fixation and allow the "system" to return to stability.

This 'pinched nerve' theory was discredited a long time ago.

I posted a link to a presentation by Harriet Hall MD which deals with this.

Evidence-based medicine is not the same as scientific proof - particularly where the only thing that really counts is results. If the evidence shows that people are getting better, by objective measures, then they're getting better.

No, you're mistaken there. Evidence-based medicine looks for people getting better above and beyond the placebo control group (or comparison group).

People tend to get better with time anyway and this can cause the illusion of ineffective treatments working. This is why scientific testing procedures were developed - to eliminate such false positives.

It is this illusion of causality that placebo treatments like Chiropractic rely on.

And I'm talking Chiropractic - not SMT.

Rob

18th November 2007, 07:26 PM

Ahhh, this IS one of those websites where people just argue semantics the whole time.

If the pinched nerve theory is discredited, why do people have surgery to decompress or fuse discs that are "pinching nerves?" Only, I was stupid enough to be suckered into this by one of the top spinal surgeons in the country. He said "your disc is impinging a nerve and it's causing pain and dysfunction." Was he wrong? Does Cauda Equina syndrome not exist? Did I have my surgery for nothing? Don't I feel a fool now!

richard

18th November 2007, 07:30 PM

So, what is the difference between homeostasis and innate intelligence?

What's the difference between the body's own self-repair mechanisms and pseudo-medical intervention (Chiropractic manipulation, Acupuncture, Homeopathy, etc.)?

As far as I can see all of these pseudo-medical interventions actually do nothing as the body repairs itself anyway; however, they do seem to have some positive effect on patients (placebo effects in other words).

Here is the essential problem with these placebo interventions: in order for them to 'work' they have to be believed in by the patients (i.e. there needs to be a 'perceived authenticity' about these practises) so the practitioners have to maintain the belief that there really is something medical going on - which leads us to the dilemma at the heart of alternative medicine (http://dcscience.net/?page_id=10).

Those, like skeptics, who are interested in evidence-based medicine however, can see through the (necessary from alternative medicine's point of view) façade presented to us.

John this article is about "alternative medicine" and mentions, Homeopathy, Reflexology and Acupuncture. Chiropractic is neither alternative or medicine. It is not mentioned in the article and no matter how often you say it, it will still not be true.

You keep telling us about all your evidence unfortunatly it keeps comming back to the same people. On this site you have refered us to there is only one small mention of chiropractic. Guess what Edzard Ernst is also there and a link to quack watch,what a surprise. I have given you Spine 2007 and you are not interested. Waddel 2007 you are only interested in Ernst or the quack Stephen Barrett. You claim to be "interested in evidence-based medicine and can see through the façade presented to us"

You may be interested in evidence based medicine, however I would bet my house you have never done a piece of research , and have never done a course in research methodology.

Because Edzard Ernst says something it does not make it true, Do you really believe Ernst would state his survey invalidates the Spine study,and it should be confined to the joke section of quack watch, I think not.

For all its worth I have a masters in Public health and Health Promotion from Brunel University. Not bad for an "ignorant chiropractor"

Admin

18th November 2007, 07:31 PM

Raph78

18th November 2007, 07:33 PM

the relation to proprioception is that if a muscle like the quads is inhibited it can lead to OA of the knee.

i showed you a clip of an inhibited deltoid upon neck flexion. the neck flexion did not proof any further interference with her ability to abduct the shoulder. her chronic shoulder problem got "fixed" as soon as her body used full muscular support of the rotator cuff. (spot the mistake? ;))

the neck vertebra that required treatment to fix her proprioception is the subluxation (in this case structural), the resisted testing was the best way of providing evidence for its presence. the "subluxation" (i hate this word) is the part of the neurological interference most chiropractors go on about without being able to prove it. i hope the clip proves this.

no you dont see subluxations on xrays. maybe areas that could be restricted due to OA and osteophytosis, scoliosis etc

no, im not trying to be a medic. i simply apply known neurophysiology and know my indicators/contraindicators, and use common sense. its fun actually!

blue, youre quoting ernst again. thats your mantra, isnt it?

the flu jab works in 4-5 out of 100 cases according to medical evidence. and, isnt it BELIEVED to prevent flu?

Rob

18th November 2007, 07:35 PM

OK then! ::)

The pinched nerve theory of chiropractic subluxation.

So it's ok if conventional medicine says it's a pinched nerve, but not if a chiropractor says it? That's not skepticism, that's prejudice ;)

Admin

18th November 2007, 07:39 PM

Chiropractic is neither alternative or medicine.

Well I agree with 50% there. It certainly is 'alternative' and it certainly isn't medicine.

You keep telling us about all your evidence unfortunatly it keeps comming back to the same people [.....] Edzard Ernst

He's a leading researcher into alternative medicine and therapies. Why would you not want research from a top scientist in the field being quoted?

Well I know the answer, he's looked at chiropractic and can find no evidence that it is of any use and that it carries significant dangers.

The evidence doesn't support your system of 'health care' and so you resort to attacking the person who's against you and not the evidence.

You may be interested in evidence based medicine, however I would bet my house you have never done a piece of research , and have never done a course in research methodology.

Then you'd lose your house.

Anyway, how about giving us some answers to the questions I posed above?

How do you detect subluxations, for example?

Blue Wode

18th November 2007, 07:41 PM

Hello Rob, and welcome to the UK Skeptics forum.

How about the chiropractors who diagnose life-threatening illnesses in their primary care role that have been consistenly missed by mainstream medics?

And how about the mainstream medics who end up caring for the (occasionally seriously) injured patients that present to them following chiropractic treatment?

It is not good practice to extrapolate an ambigously worded website into an opinion on the standard of chiropractic education at any given college

Then perhaps that college, and others, should be more specific with their wording and also provide the evidence for 'chiropractic'.

Now i'll admit I only skim-read this topic, but as I did I got the idea that these issues were getting confused a little. As a skeptic I get very sensitive to confusion - I like to plot statements out a bit more to see if they stack up

I don't think the issues are getting confused at all. It's really quite simple - where is the scientific evidence for 'chiropractic'?

Admin

18th November 2007, 07:43 PM

So it's ok if conventional medicine says it's a pinched nerve, but not if a chiropractor says it? That's not skepticism, that's prejudice ;)

Rob, I think you need to read up a little more on what Chiropractic actually is.

Work through this: http://drspinello.com/chiropractic/Chiropractic%20New_files/frame.htm

Rob

18th November 2007, 07:55 PM

Rob, I think you need to read up a little more on what Chiropractic actually is.

Work through this: http://drspinello.com/chiropractic/C...iles/frame.htm

Don't patronise me John.
What you mean to say is you think I need to read up a little more on what someone who may or may not be qualified to speak for thousands of people thinks chiropractic is.

I'm only telling you, from a patients perspective, that a spinal surgeon told me a nerve was being impinged, and he caused me a lot of pain and got no results. A chiropractor told me the same thing, and the theory behind it was the same. That chiro also told me that the nerve impingement due to nerve distrbution wasn't necessarily guaranteed to be in the place the MRI showed it (there was a study that showed 75% of cadavers showed major herniations on MRI that were ASYMPTOMATIC), and that it could be piriformis syndrome. A stretching programme later, and problem solved. Nice one.

I don't suppose there is one document showing what chiro is anymore than there is one and only one definitive document showing what conventional medicine is.

richard

18th November 2007, 08:54 PM

Rob, I think you need to read up a little more on what Chiropractic actually is.

Work through this: http://drspinello.com/chiropractic/Chiropractic%20New_files/frame.htm (http://drspinello.com/chiropractic/Chiropractic%20New_files/frame.htm)

Rob you are absolutly right much of the discussion is about semantics. Next someone will tell you you,that you are not a "real skeptic". They say chiropractors dont answer the questions. In the early part of the thread I answered everything, (I am behind reading the references Blue Wode presented about medicine) not that John paid any attention, then when Ralph and yourself came in they go over the same ground ignoring everything said previously. What is Innate, what is homeostasis? Its a nerve study its not chiropractic,its a physiotherapy study its chiropractic. SMT is not chiropractic, for convienence maybe it is.

For example if we go back to my posting no 34 I said.

The don’t like chiropractors who don’t reference, the highly respected researchers, Edzard Ernst MD, Stephen Barrett MD and Hariet Hall MD who have had thousands of articles published on the peer reviewed quack watch web sites. These researchers obviously believe in each other judging by the way they reference each other. They must have gone to the same school of research methodology. Not to forget Edmund Crelin Ph.D refferences from the 60s,which JCC is very attached to.

I must say I love the music from the 60s, however the science leaves a lot to be desired. I read somewhere that Stephen Barrett sued a chiropractor for libel and lost. Apparently the chiropractor wanted to clarify Barrett’s MD status “he's a psychiatrist who has never been board certified who failed his board certification 3 times. Apparently Barrett failed the neurology section which might go some way to explaining his lack of understanding of chiropractic. Now not being an expert on quacks perhaps some of our more learned forum members could clarify for me, does this lack of knowledge make Barrett a quack or a chiropractor, my Chambers dictionary describes a quack as a “boastfull pretender to knowledge and skill that he does not possess”.

What then does John use to show you proof that chiropractic is a sham, Hariet Hall MD of Quack Watch. Now I have nothing against Dr Hall and she does make some valid points about chiropractic practice in the US. Neurology however is not her best subject.

Have I said I am against Ezard Ernst doing research into chiropractic as stated by John? of course not. It might help however if Ernst did involve a few chiropractors and there was a bit more research to support his theory. The biggest study ever looking at risks associated with chiropractic was recently published in Spine a peer reviewed medical Journal. Professor Jenny Bolton PHd one of the authors is not a chiropractor. The study showed there are certain small risks with chiropractic, no strokes however. Cuts no ice with John, as its not been published on quack watch.

John you claim to have training in research methology, is that right. Did you also write the fact sheet? I am seeing more dogmatic argument than skeptic??

Blue Wode

18th November 2007, 09:13 PM

The biggest study ever looking at risks associated with chiropractic was recently published in Spine a peer reviewed medical Journal. Professor Jenny Bolton PHd one of the authors is not a chiropractor. The study showed there are certain small risks with chiropractic, no strokes however. Cuts no ice with John, as its not been published on quack watch.

Richard, you said of that study in post #16:

I have not claimed that it proves anything

For the benefit of drive-by readers of this thread, Chirotalk, the skeptical chiropractic discussion forum (operated by a chiropractor, and moderated be several) has allowed the abstract of the study to remain in its ‘humor’ section under “Silly chiropractic research”:
http://chirotalk.proboards3.com/index.cgi?board=humor&action=display&thread=1194137405 (http://chirotalk.proboards3.com/index.cgi?board=humor&action=display&thread=1194137405)

Regards research, would you please provide scientific evidence (systematic reviews, meta-analyses) in support of ‘chiropractic’ – otherwise this discussion is going nowhere.

JJM

18th November 2007, 09:42 PM

the relation to proprioception is that if a muscle like the quads is inhibited it can lead to OA of the knee. {snip}From the article
In persons with symptomatic osteoarthritis of the knee, quadriceps muscle weakness is common and is widely believed to result from disuse atrophy secondary to joint pain.Bold added.

Even if your mis-understanding were correct, it still does not relate to chiropractic and proprioception. So, was that your best shot at validating some aspect of chiro?

Admin

18th November 2007, 10:01 PM

What then does John use to show you proof that chiropractic is a sham, Hariet Hall MD of Quack Watch.

No, let's not add the Argument to Ignorance (http://www.ukskeptics.com/article.php?dir=articles&article=argumentum_ad_ignorantiam.php) fallacy to the others you're making (!)

It is not anyone's position to prove that Chiropractic doesn't work, it's up to Chiropractors to provide evidence to show that it does - the Burden of Proof requirement.

What is telling is that the Chirporactors on here have neither answered questions relevant to their practises (things like - how do subluxations cause children to wet the bed and how does spinal manipulation cure this? Relevant questions as this addresses a claim that chiropractors make), nor provided any evidence to support Chiropractic in any way (preferring instead to introduce red herrings and talk about those instead).

That, of course, when they're not trying to belittle everyone who doesn't share their views.

Is there any quality evidence anywhere that supports the idea of subluxations blocking Innate Intelligence thus leading to disease and that spinal manipulation can free up the flow of Innate Intelligence to cure the disease?

After 112 years in existence: if not, why not?

For anyone wondering what Innate Intelligence is, it is explained here: The mystical nature of alternative medicine (http://www.ukskeptics.com/article.php?dir=articles&article=the_mystical_nature_of_alternative_medicin e.php).

JJM

18th November 2007, 10:20 PM

So it's ok if conventional medicine says it's a pinched nerve, but not if a chiropractor says it? That's not skepticism, that's prejudice ;)It is okay if you have a pinched nerve and a chiro says so. The problems include whether a chiro can reliably make such a diagnosis, and the fact that they cannot alter a pinched nerve. The only suggestion that they can do so comes from anecdotes (such as yours), and the oft-cited (above) article by Crelin saying it is physically impossible for them to do so.

Richard keeps harping that Crelin's work is old, hey- Palmer's work is older. The difference is- Palmer has been thoroughly discredited, and Crelin has not. In science, research does not have a shelf-life; it stands till it is disputed by further, credible research.

This thread is not about semantics, except for the chiro proponents here. All I want is some reliable evidence that there is some benefit from chiro (beyond what I have stipulated), and all I get are anecdote and spurious citations (and a video-clip, as if YouTube were refereed).

Raph78

19th November 2007, 12:12 AM

who are you gentlemen anyway? whats your degree, your current position held? i just see repetition after repetition and no originality in your argument.

oh, and john. if there is evidence that smt works why are you producing so much hot air?

JJM:

did you get past the first sentence of my reference???? bold italic and underlined for you.......here for all to see:

Background: The quadriceps weakness commonly associated with osteoarthritis of the knee is widely believed to result from disuse atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis.

Conclusion: Quadriceps weakness may be present in patients who have osteoarthritis but do not have knee pain or muscle atrophy; this suggests that the weakness may be due to muscle dysfunction. The data are consistent with the possibility that quadriceps weakness is a primary risk factor for knee pain, disability, and progression of joint damage in persons with osteoarthritis of the knee.

my god you just again disqualified yourself again through your ignorance and incompetence. you clearly have got NO clue whatsoever.

to make it clear: as a chiropractor it is my privileged duty to diagnose and treat such proprioceptive weaknesses (NO PAIN, NO ATROPHY = asymptomatic) to PREVENT OA. much more than just the safe and appropriate application of SMT. You would not even think how much help can be given to people - not in your wildest dreams.

but, again: who are you and what qualifies your "contribution" to this topic?

Admin

19th November 2007, 12:27 AM

who are you gentlemen anyway? whats your degree, your current position held? i just see repetition after repetition and no originality in your argument.

I see another red herring argument all set to lead on to another Ad Hominem point! ;)

I'm a skeptic and I look for evidence for claims so that I can make an informed decision on them. I, indeed we, have asked several times for evidence that supports chiropractic - none has been provided.

oh, and john. if there is evidence that smt works why are you producing so much hot air?

Well as the world and its mother should know by now, SMT is NOT chiropractic - it's simply a technique that chiropractors have adopted.

We already know that there is supporting evidence for SMT (although it's no better than other standard treatments) but what we want is supporting evidence for chiropractic!

Come on guys!!!

How, for example, do you detect 'subluxations' and how could you prove it's actually there?

Simple question so how about a simple answer?

richard

19th November 2007, 01:19 AM

Richard, you said of that study in post #16:

For the benefit of drive-by readers of this thread, Chirotalk, the skeptical chiropractic discussion forum (operated by a chiropractor, and moderated be several) has allowed the abstract of the study to remain in its ‘humor’ section under “Silly chiropractic research”:
http://chirotalk.proboards3.com/index.cgi?board=humor&action=display&thread=1194137405 (http://chirotalk.proboards3.com/index.cgi?board=humor&action=display&thread=1194137405)

Regards research, would you please provide scientific evidence (systematic reviews, meta-analyses) in support of ‘chiropractic’ – otherwise this discussion is going nowhere.

I think the skeptics would agree the issue of safety is more important that whether chiropractic works or not so if everybody does not mind lets deal with this issue first.

One of my patients a GP recently published an article about her positive experience of chiropractic,her husband an ENT surgeon is alsoa patient. She has her spine checked every month for the Spinal dysfunction described by Professor Gorden Wadell. Should I extrapolate from that all GPs think chiropractic is wonderful. Should I extrapolate from that proof that chiropractic works or chiropractic is safe. Of course not that’s why I do not take the Spine study as proof that there is no risk. However the fact is it was a major study and no risk of stroke was found.

For the exact same reason I am skeptical when John attaches so much weight to Hariet Hall MD opinions and extrapolates so much from them. That is not EBM especially when the only place I have seen her work published is on quack watch.

The Spine study is now there now for another scientist like Professor Ernst to repeat. If he could get funding and see if he can reproduce the results or not as the case me be. If you and the others have genuine concerns about the safety of chiropractic raise funds for Professor Ernst to do some high quality research rather relying on case studies and presenting it as quality evidence.

Mr Andrew Upton a Neurologist was hired by the Canadian Chiropractic association to examined all the evidence linking chiropractic to stroke and concluded that the evidence suggesting a link were only case studies. Professor Earnst on his website calls case studies “the lowest standard of evidence” (anecdotes). Mr Upton stated until there is epidemiological evidence to support the stroke hypothesis it is wrong to suggest a link.

Mr Upton also reported on studies by Hertzog et al. ,who were unable to produce dissection on cadavers with the force of an adjustment. Dissection needed far greater force, like a karate chop.

Ariel Sharon's stroke was widely reported in the press. he had bad head pain was taken to hospital. It was later announced that he had suffered a mild stroke and was given anticoagulant medication. Four weeks later he suffers a massive hemorrhage which would have been considerably worsened by the medicine he was taken.

Now imagine if Sharon had happened to go to a Chiropractor for his head pain your reaction would have been completely different.

In November 2005 “The Stationery Office” www.tso.co.uk (http://www.tso.co.uk) Published a report for the department of health Reducing Brain Damage: Faster access to better stroke care. The Report states Stroke accounts for 11% of deaths in England and Wales every year. Every five minutes someone in England will have a stroke, and one in four people can expect to have a stroke if they live to 85 years of age.

Many of these people are chiropractic patients and if they happen to visit a chiropractor prior to their stroke, and their neurologist is asked by professor Ernst had they been to a chiropractor the answer is yes. Does that mean the chiropractor caused the stroke. Is there a greater chance of someone with neck pain as a result of arterial disection consulting a chiropractor of course. These are factors Ernst did not look at in his study, There was also a barber and a number of non chiropractic patients included in the study.

The Risk of stroke are:
• High blood pressure
• Family history of stroke
• Atrial fibrillation
• High blood cholesterol
• Diabetes
• Smoking
• Advancing age
• Unhealthy diet .

There is no mention of Chiropractic in this report, there is no evidence of a causal relationship, yet you continue saying there is one without good quality evidence.

So before I turn to proof of chiropractic and I have not forgotten your 80% Lets deal with the safety issue. I have only three questions for the three Skeptics.

1) Do you have any epidemiological evidence of a causal relationship between chiropractic adjustments and stroke.

This is the criteria asked for when looking at risk from vaccination and studies show there is no causal relationship between autism and MMR.

2) Should case studies be accepted as evidence of a risk of autism from MMR.

3) Does the Ernst survey carry more weight as evidence, compared with thea prospective risk study published in Spine

Blude Wode can I also say while we have a difference of opinion on chiropractic, I do appreciate you remaining civil and not calling me a "quack" or an ”ignorant chiropractor”. John is under the impression that I am doing the name calling and now Ralph is getting agitated with them.

Blue Wode

19th November 2007, 10:15 AM

One of my patients a GP recently published an article about her positive experience of chiropractic,her husband an ENT surgeon is alsoa patient. She has her spine checked every month for the Spinal dysfunction described by Professor Gorden Wadell. Should I extrapolate from that all GPs think chiropractic is wonderful. Should I extrapolate from that proof that chiropractic works or chiropractic is safe. Of course not that’s why I do not take the Spine study as proof that there is no risk. However the fact is it was a major study and no risk of stroke was found.

Richard, am I correct in saying that the Spine study involved 377 chiropractors?

Safety of chiropractic manipulation of the cervical spine: a prospective national survey

Thiel HW1, Bolton JE, Docherty S, Portlock JC
Department of Research and Professional Development, Anglo-European College of Chiropractic, 13–15 Parkwood Road, Bournemouth BH5 2DF, UK and Department of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, UK

Materials and methods

This prospective national survey involved the primary care practices of 377 chiropractors throughout the UK. A total of 19 722 patients provided individual recordings of 28 807 treatment consultations and 50 276 cervical manipulations. Serious adverse events were reported by the chiropractors and side-effects by the patients.

-snip-

Conclusion

Cervical spine manipulation is a common procedure carried out by chiropractors in the treatment of musculoskeletal conditions. Although minor side-effects were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low. This survey provides evidence that cervical spine manipulation is a relatively safe procedure when administered by registered chiropractors.

http://www.medicinescomplete.com/journals/fact/current/fact1105a13a77.htm (http://www.medicinescomplete.com/journals/fact/current/fact1105a13a77.htm)

And am I also correct in saying that the study originally intended to recruit 500 chiropractors? This from March 2003:

Development and design of a study to document outcomes following cervical spinal manipulation treatments by chiropractors

Thiel HW, Bolton JE
Anglo-European College of Chiropractic, 13–15 Parkwood Road, Bournemouth, BH5 2DF, UK

Methods

A total of 500 chiropractors will be recruited into the study, each of whom will report on 100 consecutive cervical manipulation treatments.

http://www.medicinescomplete.com/journals/fact/current/fact0801a13a63.htm (http://www.medicinescomplete.com/journals/fact/current/fact0801a13a63.htm)

What I’m getting at is did the study start with 377 chiropractors, or did 123 chiropractors drop out - possibly because of unfavourable results or, as Ernst touches on in his JRSM systematic review, because they failed to investigate patients who were lost at follow-up?

At present, there is no sufficiently large and rigorous prospective study to generate reliable incidence figures; previous studies have failed to investigate those patients which were lost at follow-up. This could be the subgroup which has been harmed. It is therefore essential that future studies follow up close to 100% of the initial patient sample.

http://www.jrsm.org/cgi/content/full/100/7/330 (http://www.jrsm.org/cgi/content/full/100/7/330)

Or was the study made up of 500 chiropractors from 377 practices?

Incidentally, there does appear to be evidence of a causal relationship between neck manipulation and stroke.

Brain stem infarction due to chiropractic manipulation of the cervical spine

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=6359460 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=6359460)

Cervical manipulation, specifically chiropractic manipulation, is an important cause of vertebrobasilar and occasionally carotid distribution strokes. Neuro-ophthalmologic findings are a common and at times relatively isolated feature of cervical manipulation-induced stroke.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=11130746 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=11130746)

Wallenberg's syndrome secondary to dissection of the vertebral artery caused by chiropractic manipulation

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=14606051 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=14606051)

German neurologists report the case of a 40-year-old woman who had a chiropractic upper spinal manipulation and immediately afterwards suffered increasingly severe symptoms of intracranial hypotension, e.g. headache, nausea and vomiting. After considerable diagnostic confusion a dural tear was found at the level of C1-C2. There were no other causes for the leak of cerebro-spinal fluid. The authors are thus certain that this is the first well-documented case of intracranial hypotension caused by chiropractic. They also speculate that a substantial amount of cases of 'spontaneous' intracranial hypotension may be related to upper spinal manipulation.

http://jnnp.bmj.com/cgi/content/extract/74/6/821 (http://jnnp.bmj.com/cgi/content/extract/74/6/821)

And in the Case Reports section (Table 1) of the study linked to below, 11 cases are listed where a chiropractor was the therapist involved in administering cervical spine manipulation in which the causality of the adverse event is listed as 'certain’. In two of these cases (Corazzo 1998 and Siegel 2001), the adverse event was vertebral artery dissection and stroke.

Cerebrovascular Complications Associated with Spinal Manipulation
[Full text is subscription only]
http://www.ingentaconnect.com/content/maney/ptr/2004/00000009/00000001/art00002 (http://www.ingentaconnect.com/content/maney/ptr/2004/00000009/00000001/art00002)

Regards the evidence for ‘chiropractic’, please would you answer the questions already put to you by John Jackson in post #48. Here they are again:

What is Innate Intelligence?
What is a subluxation?
How are subluxations detected?
Can a single patient’s subluxation be reliably found by more than one Chiropractor?
Can subluxations be seen on x-rays?
How do subluxations cause bed-wetting in children and how does spinal manipulation cure this?
How does manipulating the spine of a child with ADHD cause an improvement in behaviour?
Do you recommend vaccinations? If not, why not?I would also add one more request: Would you please provide the safety data that justifies administering chiropractic treatment to infants and children under 12.

Thank you.

richard

19th November 2007, 11:22 AM

Incidentally, there does appear to be evidence of a causal relationship between neck manipulation and stroke.

And in the Case Reports section (Table 1) of the study linked to below, 11 cases are listed where a chiropractor was the therapist involved in administering cervical spine manipulation in which the causality of the adverse event is listed as 'certain’. In two of these cases (Corazzo 1998 and Siegel 2001), the adverse event was vertebral artery dissection and stroke.

Cerebrovascular Complications Associated with Spinal Manipulation
[Full text is subscription only]
http://www.ingentaconnect.com/content/maney/ptr/2004/00000009/00000001/art00002 (http://www.ingentaconnect.com/content/maney/ptr/2004/00000009/00000001/art00002)

.

These are the case studies Mr Upton investigated they are CASE STUDIES why dont any of you listen to the answers and prevent us going over the same ground again and again.These studies are What Professor Ernst calls "anecdotes" the lowest form of evidence. There is anecdotal evidence that a chiropractor cured deafness in 1895, no Chiropractor in the UK would present that as evidence of a causal relationship between chiropractic and deafness. JJM thinks we believe it is evidence he is wrong.

If a parent claims her child developed autism after having an MMR vaccination, is that proof of a causal relationship?

Blue Wode I have still not had time to reply to your 80% claim and anumber of other questions and now you are firing more questions at me. I have answered lots of your questions, not always to your satisfaction nevertheless I have made the effort.

So I repeat my question from my last posting, then I will deal with the 80% and all your other questions. In that order.

I can see how these 3 questions cause you "skeptics" some difficulty.

My three questions for the Skeptics are: and I ask them mainly to point out how you are using scientific principles in different ways to support your beliefs rather than establish better evidence, which you all claim is your goal.

1)Do you have any epidemiological evidence of a causal relationship between chiropractic adjustments and stroke. This is the criteria asked for when looking at risk from vaccination. Studies show there is no causal relationship between autism and MMR. 2)Should case studies be accepted as evidence of a risk of autism from MMR. 3) Does the Ernst survey carry more weight as evidence, compared with a prospective risk study published in Spine. ( I don’t know the answers to the questions you have asked about the study. I would have thought the peer review board of Spine would have asked these exact questions before publishing the article or it would not be a credible medical journal.

If you are not willing to answer them fair enough, then we can leave the discussion there, and agree to disagree.

Admin

19th November 2007, 11:41 AM

Chiropractors and stroke:

A Canadian study by the Institute of Clinical Evaluative Sciences in Ontario found that patients younger than 45 who had experienced stroke related to posterior circulation are "5 times more likely than controls to have visited a chiropractor within a week of the event" (Stroke 2001;32:1054-60).

Chiropractors admit that neck manipulation can cause strokes; however, they claim that the risk is one in a million. The exact risk is not known, but there is evidence that the likelihood of neck manipulation causing strokes is far higher than the one in a million figure they suggest.

Another study states, "The researchers reported that patients under age 60 who had strokes or transient ischemic attacks from tears in the vertebral artery were six times more likely to have had spinal manipulative therapy in the 30 days prior to their stroke than patients who had strokes from other causes." (Source: eurekalert (http://www.eurekalert.org/pub_releases/2003-05/uoc--cto050703.php) - opens is a new window).

The big problem regarding the number of strokes caused by chiropractors is that there is no proper reporting system to keep track of the number (!) and, indeed, the problem is believed to be under reported because of this.

Chiropractors always deny there's a link between chiropractic neck manipulation and stroke but risk is definitely there. Any doubt about the actual numbers involved is not due to lack of risk, it's down to the failure of chiropractic to take the risk seriously enough to investigate it properly.

See also: http://www.quackwatch.org/01QuackeryRelatedTopics/chirostroke.html

Oops quackwatch - that means it can be instantly dismissed by chiropractors. ;)

JJM

19th November 2007, 11:52 AM

the relation to proprioception is that if a muscle like the quads is inhibited it can lead to OA of the knee. {Snip}

{snip}JJM:

did you get past the first sentence of my reference???? {snip}

Background: The quadriceps weakness commonly associated with osteoarthritis of the knee is widely believed to result from disuse atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis.
{snip}
Bold added.

You interpret the authors as saying that weak quads "can lead to OA" (as in- "causing"). However, they say it may be a factor in the "development" (worsening of) of OA which already exists. You gotta read the whole thing, that is their position (note the word "may" as in- conjecture; i.e., not yet proven); but I digress.
http://www.annals.org/cgi/content/full/127/2/97

You have not established the relationships among quad weakness, proprioception, and the specific value of chiro in treating either condition.

You cited articles about a reflex to close the jaws when a tooth was tapped (!!??), and about muscle weakness; but you have not demonstrated their relevance to chiro.

This is not a difficult concept. I want to know, specifically, what chiro can do that massage cannot do as well.

Let us try another tack. What, specifically does chiro do? We know it has nothing to do with altering spinal joints and nerve conduction (innate intelligence). I hope that will not be your claim. Pick a complaint, any complaint, that would lead someone to your office and cite the (legitimate) literature that justifies your treatment (beyond what I have already stipulated for headache and low back pain- where you can do as well as a masseur).

JJM

19th November 2007, 12:08 PM

{snip} Chiropractors always deny there's a link between chiropractic neck manipulation and stroke but risk is definitely there. {snip}It is equally important to note that there is no evidence that chiro treatments are more effective than safer treatments. Therefore, the risk/benefit ratio is an unacceptably large number (division by zero).

JJM

19th November 2007, 12:25 PM

{snip} There is anecdotal evidence that a chiropractor cured deafness in 1895, no Chiropractor in the UK would present that as evidence of a causal relationship between chiropractic and deafness. JJM thinks we believe it is evidence he is wrong.That is the foundation of chiro- read the history. So, cite the reliable evidence for your current practice. Wait, I asked this before, and you cannot supply any except in the vaguest (and unsupported) terms.

{snip}

1)Do you have any epidemiological evidence of a causal relationship between chiropractic adjustments and stroke.{snip}Yes.
2)Should case studies be accepted as evidence of a risk of autism from MMR.No; they can be a basis for inquiry; but that question has been answered in the negative.
3) Does the Ernst survey carry more weight as evidence, compared with a prospective risk study published in Spine.Yes.

{snip}

Blue Wode

19th November 2007, 12:35 PM

Richard, Raph78, and Rob, I think this is what you’re going to have to eventually face up to:

there is no evidence that chiro treatments are more effective than safer treatments. Therefore, the risk/benefit ratio is an unacceptably large number (division by zero).

Raph78

19th November 2007, 01:14 PM

jjm you get one basic thing right:

background = knowledge up to that point.
conclusion = a new understanding, that OA can be caused by asymptomatic, intrinsic muscle wekaness.

what are your degrees guys, and how long has one to study to become a consultant sceptic?

camon, are you librarians or what have you got to hide?

Highly quality trials carried out by the Medical Research Council in 1990 and 1995 and published in the BMJ found "chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management" (physiotherapy). your cited study proves that physio using muscle tickling does not work, again supporting previous findings.

Blue Wode

19th November 2007, 01:38 PM

Highly quality trials carried out by the Medical Research Council in 1990 and 1995 and published in the BMJ found "chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management" (physiotherapy).

Really?

From 1991:

Effectiveness of chiropractic and physiotherapy in the treatment of low back pain: a critical discussion of the British Randomized Clinical Trial

The results are difficult to extrapolate, because only a small portion of the eligible patients participated, and chiropractic seems to be clearly superior only in the subgroup originally presenting to a chiropractic clinic. We conclude that it is premature to draw conclusions about the long-term effectiveness of chiropractic based on the results of this study alone.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=1833493 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=1833493)

From 1995:

Results were clinically trivial

EDITOR,--T W Meade and colleagues have provided further data from their study comparing chiropractic with hospital physiotherapy.1 Unfortunately, their report is far from convincing. The "headline" advantage of chiropractic over hospital management at three years (29%) sounds impressive but refers to an improvement of three points on the 100 point Oswestry scale, or one and a half responses on the questionnaire. This difference may be statistically significant but is clinically trivial.

In their original article the authors noted that chiropractic was 50% more expensive,2 and in the latest report they note that the chiropractic group had more treatments in the long term. The measured improvement does not seem to support such an expenditure.

The design of the study was criticised after the first paper was published.3 The patients initially presenting to a chiropractor were self selected on the basis that they believed that chiropractic would be effective (as they were expecting to pay for treatment). It is interesting that only the patients referred by chiropractors showed a significant advantage for chiropractic. Those initially recruited in hospital practice showed no significant difference. The study compares private practice with NHS treatment, with all the implications for environmental and personal factors that this brings. The follow up rate (70% and 77%) is inadequate and would preclude publication in some journals.4 Analysis by intention to treat does not obviate this deficiency. Important variables such as psychological disturbance are not addressed, although these are noted to have a greater impact on results than does treatment.5

It is disappointing that in the five years between the reports these and the other criticisms that were raised were not more fully addressed. Despite the acclamation of the first report in the popular media, I do not think that this study has advanced our understanding of the treatment of back pain in any useful way.

http://www.bmj.com/cgi/content/full/311/7015/1302 (http://www.bmj.com/cgi/content/full/311/7015/1302)

From 1998:

“Chiropractors often cite the trial of the UK Medical Research Council in defence. They say it favoured chiropractic over physiotherapy. This trial, however, is much misinterpreted as both its treatment groups received spinal manipulation." Professor Edzard Ernst, The London Independent

http://findarticles.com/p/articles/mi_qn4158/is_19981208/ai_n14204324/pg_1 (http://findarticles.com/p/articles/mi_qn4158/is_19981208/ai_n14204324/pg_1)

Which leads us to this from 2004:

Three brief comments on the excellent BEAM Trial (1). My reading of the results is that the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch. If this “devil’s advocate” view is correct, the effects have little to do with spinal manipulation per se. It would be relevant to know which of the three professional groups (chiropractors, osteopaths, physiotherapists) generated the largest effect size. This might significantly influence the referral pattern. A post-hoc analysis might answer this question. It is regrettable that the study only monitored serious adverse effects. There is compelling data to demonstrate that minor adverse effects occur in about 50% of patients after spinal manipulation (2). If that is the case, such adverse events might also influence GP’s referrals.

E Ernst, Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth References

1. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ, doi:10.1136/bmj.38282.669225.AE. BMJ 2004;19 November:1-8.
2. Stevinson C, Ernst E. Risks associated with spinal manipulation. Am J Med 2002;112:566-70.

http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126 (http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126)

Does anyone know which group generated the largest effect size?

JJM

19th November 2007, 02:11 PM

jjm you get one basic thing right:

background = knowledge up to that point.
conclusion = a new understanding, that OA can be caused by asymptomatic, intrinsic muscle wekaness.Bold added.

You are mistaken, try re-reading it.

what are your degrees guys, and how long has one to study to become a consultant sceptic?

camon, are you librarians or what have you got to hide?Try addressing our points, instead of worrying about this. I don't even know if you are a chiro or a groupie. It does not matter, you have no reliable information to offer. That is what is important.

{snip}Except to note that Blue Wode has replied, and that your citation was vague; you should learn how to cite literature.

Rob

19th November 2007, 03:25 PM

It is okay if you have a pinched nerve and a chiro says so. The problems include whether a chiro can reliably make such a diagnosis, and the fact that they cannot alter a pinched nerve.

On the diagnosis front, surely that's why chiropractors do the full neurological work-up? I had exactly the same tests from a chiro as I did from a lauded neurosurgeon. Then again for occupational health from a private GP.

Neither chiropractors or surgeons are altering the pinched nerve, they are merely both creating space for the nerve to move as it needs to. Are they both wrong?

Richard keeps harping that Crelin's work is old, hey- Palmer's work is older. The difference is- Palmer has been thoroughly discredited, and Crelin has not. In science, research does not have a shelf-life; it stands till it is disputed by further, credible research.

I don't think anyone is saying that Palmer was 100% right and that no further developments have been made. I hope you acknowledge that Hippocrates's work is even older - and he was a bone-cracker.

This thread is not about semantics, except for the chiro proponents here.

Are you seriously saying that only the pro-chiro's are arguing semantics? Isn't that a little holier-than-thou?

Now, this is why I've said it's getting confused. Someone else has said "is chiropractic AS effective as treatments which are safer?" Well that's another point again! Actually I think it's probably the right point.

My surgery was neither safe or effective. I wonder how many people end up worse. I'm fairly sure as far as interventions go, chiropractic in the vast majority is less dangerous than surgery, or even the use of NSAID's. Now, I can only speak as a patient who became interested in backs because of my problems, but i've subsequently met plenty of people who will say the same thing.

Those of you who belittle anecdotal evidence should think first that most things start with anecdotal evidence, and then provide full and comprehensive proof later with double-blind RCT blah. That takes time. The conventional medical professions went through it after people realised (anecdotally) that their techniques were able to positively influence the populations health. If chiropractic is there right now then great, help it mature, and accept that even if it's only anecdotal now, it doesn't make it ineffective regardless of how many researchers quote their own research to prove that it is.

Cuddles

19th November 2007, 05:55 PM

Those of you who belittle anecdotal evidence should think first that most things start with anecdotal evidence, and then provide full and comprehensive proof later with double-blind RCT blah. That takes time.

And don't you think over 100 years should have been enough time? The fact that chiropractic still relies on anecdotes should tell you an awful lot.

JJM

19th November 2007, 06:30 PM

On the diagnosis front, surely that's why chiropractors do the full neurological work-up? I had exactly the same tests from a chiro as I did from a lauded neurosurgeon. Then again for occupational health from a private GP.The question remains how reliable chiropractors are at ordering and interpreting the tests. What impresses you may, or may not, impress a health professional.

Neither chiropractors or surgeons are altering the pinched nerve, they are merely both creating space for the nerve to move as it needs to. Are they both wrong?No, only the chiro is wrong to imagine s/he can "create space." It is a proven, physical impossibility.

I don't think anyone is saying that Palmer was 100% right and that no further developments have been made. I hope you acknowledge that Hippocrates's work is even older - and he was a bone-cracker.Read this statement by the Association of Chiropractic Colleges:
http://www.chirocolleges.org/paradigm_scopet.html
Through the obfuscation and double-talk, it is basically a restatement of Palmer's ideas. They have been forced to abandon his notion that the subluxation is an actual displacement. However, in true cult fashion they have not abandoned their leader's notions- they just substituted a vague description.

{snip} My surgery was neither safe or effective. I wonder how many people end up worse.Surgery is never "safe," nor is it invariably effective. In medicine, the risks and benefits are weighed.

I'm fairly sure as far as interventions go, chiropractic in the vast majority is less dangerous than surgery, or even the use of NSAID's. Now, I can only speak as a patient who became interested in backs because of my problems, but i've subsequently met plenty of people who will say the same thing.The plural of anecdote is not data. The safety and efficacy of chiro is uncertain.

{snip} If chiropractic is there right now then great, help it mature,It is 112 years old, how long does it take to mature?

and accept that even if it's only anecdotal now, it doesn't make it ineffective regardless of how many researchers quote their own research to prove that it is.The logic of this eludes me. There are probably more than 70 thousand chiros working world-wide (there 65k in North America) using unproven and disproven methods of "health care" and you think they should continue until someone bothers to show something they claim is true? Note, sometimes they adopt standard practices and to that extent they do not practice chiro. However, a layperson never knows if they use those methods appropriately.

Raph78

20th November 2007, 09:40 PM

what have a learned so far from having a look around here?

some individuals, apparently driven more by reflex animosity against chiropractic than by the search for objective truth, cant accept the fact that neither the hancock study, nor the Lancet’s press release, mentioned chiropractic or concluded that chiropractic was a waste of time and money. however, they use this for their own greedy crusade against a profession which is well regulated, established and has time and time again proven its safety, effectiveness and produced very high patient satisfaction scores in good quality trials. chiropractic continues to compare favourably against gps best practice, exercise alone, physio and placebo. we all know the studies involved. they are of the best rigor necessary to demonstrate scientific credibility. yes, we do need more studies, but every paper says that anyway.

a small australian physio study using a sham as a real treatment was never likely to demonstrate that physio "skin scratching" was going to work. the conclusion is that seeing physios using low velocity manipulation produce is of little use and a waste of money. too bad diclofenac didnt work either :'(

i apologise for my late summary as i have been very busy in practice. i have seen 8 new patients monday and tuesday (each of them a full hour's attention) which have all requested my service based on personal recommendation - in fact 80% of my clients come in on personal recommendation.

sorry but i think i can see the greed in your eyes - i get a real buzz going into practice and give evidence based high quality assessments, diagnoses and report of findings, and, when i can, aim to deliver the highest quality, drug and surgery free approach to health including evidence based nutrition (yes, im a nutritionist, too), exercise and rehabilitation. and yes, it is an art to help patients feel good about themselves too. its called patient management skills. no need to be ashamed of that.

or does john PONTIFEX (who obviously loves himself for his perceived grasp of latin catch-prases) deny that adjunct therapies used by chiropractors such as the ones mentioned before have any evidence base? vir sapit qui pauca loquitur, john! (please look it up on google)

gentlemen, whatever jobs you do - and from your posting times i see you have the luxury of regular lunch breaks - can you say that your work satisfies you as much?

richard and rob! sorry to have communicated so little with you. richard, i left a message in your inbox.

i think you two have been true gentlemen and demonstrated ability to critically (and sceptically ) appraise the literature and use common sense. i would like to stay in touch in one way or another.

and, in the apt words of Muir: "Evidence based clinical practice is an approach to decision making in which the clinician uses the best scientific evidence available, in consultation with the patient, to decide upon the option which suits the patient best." (Muir Gray, J.A. (1997) Evidence-based Healthcare. Churchill Livingstone, New York.)

in this model, the clinician's role is to coach; the patient's role is to make an informed decision and participate actively in their own care. what a great paradigm to be involved in.

Admin

20th November 2007, 10:27 PM

what have a[sic] learned so far from having a look around here?

I think the most obvious thing that we've learned is that chiropractors do not answer pertinent questions nor can they supply any evidence that supports chiropractic as a medical intervention. ;)

All they appear to be able to do is to attempt to ridicule and/or discredit anyone who asks relevant questions of them and to do the same to any relevant research which shows that chiropractic is nothing more than a placebo therapy for anything other than lower back pain or that there are related dangers, notably chiropractic induced strokes, associated with their placebo interventions.

i apologise for my late summary as i have been very busy in practice. i have seen 8 new patients monday and tuesday (each of them a full hour's attention) which have all requested my service based on personal recommendation - in fact 80% of my clients come in on personal recommendation.

sorry but i think i can see the greed in your eyes - i get a real buzz going into practice and give evidence based high quality assessments, diagnoses and report of findings, and, when i can, aim to deliver the highest quality, drug and surgery free approach to health including evidence based nutrition (yes, im a nutritionist, too), exercise and rehabilitation. and yes, it is an art to help patients feel good about themselves too. its called patient management skills. no need to be ashamed of that.

And, of course, resorting to anecdotes that are actually congruent with chiropractic being a placebo therapy.

or does john PONTIFEX (who obviously loves himself for his perceived grasp of latin catch-prases) deny that adjunct therapies used by chiropractors such as the ones mentioned before have any evidence base? vir sapit qui pauca loquitur, john! (please look it up on google)

Oops, here we go again with the personal insult. ::)

Raphael, they are not Latin "catch phrases" - they're known as 'logical fallacies'. You should Google for them as every time you resort to them you weaken your case even further.

How about answering some questions on chiropractic?
Do you manipulate the spines of children in the course of your work?
Do you advise parents that they should vaccinate their children in accordance with health guidelines?
I notice that you advertise yourself as using 'diagnostic acupuncture' - what exactly is this if not another form of quackery?
I also notice that you use applied kinesiology (http://skepdic.com/akinesiology.html). This is another recognised form of medical quackery. What do you use it for?Any chance that you might answer some of these questions, or are you going to avoid them again and come back with more insults? ;)

Raph78

21st November 2007, 12:44 AM

hi john

congrats you found www.back2strength.com (http://www.back2strength.com) on the web! wanna exchange links? ^-^ i might actually link to your site anyway. for patient education

i am not treating babies as a choice. seems difficult to communicate with them. i do treat teenagers, though (and quite successfully). i do not treat psychological conditions using "AK" - they are too hard work and it tends to leave me wound up and grumpy. i leave that to the experts..

diagnostic acupuncture is what it says. i do not use needles.

it used to be called applied kinesiology - and still is by those who have to use the old "energy model". i use the part of it that i can scientifically explain. this is called the proprioceptive model i explained before- and you didnt even recognise it was ak related! watch that video again i posted. we use objective, non practitioner driven evidence to record neurological changes! this explains why i dont treat babies: some use bad muscle testing like surrogate testing which is not scientific. i distance myself from this testing as i explain on my website (http://back2strength.com/asp_pages/news.asp?type=15). all of this makes sense, is scientific, works and is laid out on the site. indeed muscle efferents are unconsciously triggered, as your reference hyman (1999) found. you would not like too much on how to activate e.g. the flexor withdrawal reflex, would you? 8) please do come over to norfolk uk so i can do a demo on you, and help you with your cpd! by the way: do you check the evidence base for the links leading from your page as well? what do YOU think of flirting tips for men? do they work in practice?

i explain to my patients what is put into vaccines and let them discuss this with their gp to make an informed health choice. it is not my job to recommend or bash vaccination (alhough i have a private opinion about it) but to tell the truth. maybe you can explain to me why streptomycin and neomycin are added to the flu jab?speak to you later

Blue Wode

21st November 2007, 01:06 AM

some individuals, apparently driven more by reflex animosity against chiropractic than by the search for objective truth, cant accept the fact that neither the hancock study, nor the Lancet’s press release, mentioned chiropractic or concluded that chiropractic was a waste of time and money.

Raph78, have you read the Hancock study? In the Discussion section (p.1643) it says the following:

The spinal manipulative therapy given in this trial included a range of low-velocity mobilisation and high-velocity manipulation techniques done by physiotherapists with postgraduate training in manipulative therapy. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal mobilisation is more effective than low-velocity spinal manipulation, or that the profession of the manipulator affects the effectiveness of treatment.

however, they use this for their own greedy crusade against a profession which is well regulated,

Well regulated? With one of its main duties being that of 'promoting the profession', it seems to me that the regulatory body, the General Chiropractic Council, is little more than a self-interest group.

established and has time and time again proven its safety, effectiveness and produced very high patient satisfaction scores in good quality trials.

Then please provide the scientific evidence for the safety and effectiveness of ‘chiropractic’.

chiropractic continues to compare favourably against gps best practice, exercise alone, physio and placebo. we all know the studies involved. they are of the best rigor necessary to demonstrate scientific credibility. yes, we do need more studies, but every paper says that anyway.

Many readers of this thread will not know what studies were involved that were “of the best rigor necessary to demonstrate scientific credibility.” Therefore would you please cite them.

a small australian physio study using a sham as a real treatment was never likely to demonstrate that physio "skin scratching" was going to work. the conclusion is that seeing physios using low velocity manipulation produce is of little use and a waste of money. too bad diclofenac didnt work either :'(

Once again, from the Discussion section (p.1643) of the Hancock study:

The spinal manipulative therapy given in this trial included a range of low-velocity mobilisation and high-velocity manipulation techniques done by physiotherapists with postgraduate training in manipulative therapy. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal mobilisation is more effective than low-velocity spinal manipulation, or that the profession of the manipulator affects the effectiveness of treatment.

Didn't the physios in the Hancock study use high-velocity manipulation as well?

i apologise for my late summary as i have been very busy in practice. i have seen 8 new patients monday and tuesday (each of them a full hour's attention) which have all requested my service based on personal recommendation - in fact 80% of my clients come in on personal recommendation.

Anecdotes and testimonials count for nothing here.

and, in the apt words of Muir: "Evidence based clinical practice is an approach to decision making in which the clinician uses the best scientific evidence available, in consultation with the patient, to decide upon the option which suits the patient best." (Muir Gray, J.A. (1997) Evidence-based Healthcare. Churchill Livingstone, New York.)

So where is the scientific evidence for ‘chiropractic’?

in this model, the clinician's role is to coach; the patient's role is to make an informed decision and participate actively in their own care.

But only if the patient is given adequate information. If the following two (recent) surveys are anything to go by, that is something that is not consistently happening:

Consent or submission? The practice of consent within UK chiropractic.

CONCLUSION: Results suggest that valid consent procedures are either poorly understood or selectively implemented by UK chiropractors.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15726031 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15726031)

Consent: its practices and implications in United Kingdom and United States chiropractic practice.

CONCLUSION: Results from this survey suggest a patient's autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk. Practitioners felt that a serious adverse event occurred so infrequently that this, coupled with a lack of convincing evidence regarding the risk associated with certain treatment, rendered the routine discussion of major risk unnecessary.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

Rob

21st November 2007, 09:28 AM

Oh dear, I think this thread has dengerated into quote after quote tit for tat.

Why aren't chiropractors producing evidence? They are, but too slowly.
Should chiropractic produce evidence? Of course, it absolutely must.
Has it had 112 years to do it and failed? No, don't be daft. The world changes and that's become a bigger deal only more recently. How long has medicine been around?
Does the lack of a large body of convincing evidence for chiro make it unsafe or ineffective. No of course not.
Does the lack of a large body of convincing evidence against chiro make it perfect in every way. Definitely not.

The point I was trying to make, which the semantic army leapt on with out trying to see the spirit in the post was that most chiropractors will agree MUCH more evidence is needed, and despite that, it can still be safe and effective.

Anecdotal reports of success, when seen it great numbers doesn't a research study make - nobody is saying that. I'm just saying that throughout history we see things go from being anecdotally true, through a full batch of research, to completely true. Isn't this PRECISELY how the pharmaceutical industry works? Anecdotal reports on the benefits of xyz plant or fish, by the "natives", points them in the right direction, they synthesise, research which derivative works, and then bang, it's scientific fact.

Did we stop sailing before we had proven the world wasn't flat? Chiropractic may be in its infancy, and yes, you will always find loonies in the profession who state that chiropractic was channelled from god etc, but that does not detract from the value a well educated scientific competent chiropractor, and the thousands that there are, offering safe and effective treatment to the people who visit them.

I think the problem here is that we've got people whose interest is principally logic, who are able to point holes in the logic of chiropractic and then who falsely make the conclusion that it is therefore rubbish. Non Sequitur? You can make the conclusion, and I would absolutely agree, that based on the evidence we can say that the mechanisms by which chiropractic work are not fully understood. How many times has conventional medicine continued to do something that works but that has very little in the way of reasoning to explain WHY? Don't kid yourself it doesn't happen. I've been told that by neurosurgeons and pain doctors "we don't really know why, but we get great results."

JJM, you said what may impress me may not impress a health professional. That's not a smart thing to say. I was talking about standard neurological testing. This is NOT rocket science. It's in half the books i've read. Myotomes, dermatomes, alpha-fibres, posterior horns - this is pretty basic stuff. Basic stuff that my GP had forgotten incidentally, since they don't do it every day. Chiro and neurosurgeons do.

You also said that creating space is an impossibility. Well, I put it in ""'s hoping that you wouldn't attack the semantics. Ok, surgeons create space - are you challenging that - be clear. Perhaps chiropractors are ensuring that pressure on connective tissue is correct by helping to achieve optimum alignment. That would lower pressure on a nerve and relieve symptoms wouldn't it?

God, more semantics. "Surgery is never safe, but it's ok cos doctors weigh it up first." Nice try. INTERVENTIONS are never safe, including drugs, and chiropractors and doctors alike do a risk assessment of the intervention before-hand. I think it says that chiros and surgeons are more like alike in their approach to intervention than different.

Cuddles

21st November 2007, 10:36 AM

Has it had 112 years to do it and failed? No, don't be daft. The world changes and that's become a bigger deal only more recently. How long has medicine been around?

So where is the evidence then? Medicine has existed for thousand of years. Modern medicine started down the scientific route over 150 years ago at least. Why have you failed to say a single thing that actually supports chiropractic? Don't you find it just a little irresponsible to pretend to treat people despite admitting yourself that you don't have any evidence that you can actually do so?

Matt

21st November 2007, 01:21 PM

i explain to my patients what is put into vaccines and let them discuss this with their gp to make an informed health choice. it is not my job to recommend or bash vaccination (alhough i have a private opinion about it) but to tell the truth. maybe you can explain to me why streptomycin and neomycin are added to the flu jab?
speak to you later

I'm not a Doctor but it appears that Streptomycin and Neomycin are antibiotics. I imgine they're added to the vaccines to keep them from going off. What's the problem with that?

I further imagine that it would be possible to frame the question in such a ways as to make these long scary words sound like they have sinister efects and thus discourage vacination. I'm not accusing you of anything but it certainly sounds like you're making excuses for vacination scaremongering.

Mongrel

21st November 2007, 03:03 PM

maybe you can explain to me why streptomycin and neomycin are added to the flu jab?
Easy - they're not.

Go here Electronic Medicines compendium (http://www.medicines.org.uk/) and type Influenza in the search box. It will return the Patient Information Leaflets and Specification of Product Characteristics of the current Flu vaccines.

You're interested in the SPCs, click on each one in turn and you're interested (I presume) in section 2 "QUALITATIVE AND QUANTITATIVE COMPOSITION" and 6.1
"List of excipients". Section 2 tells you what flu antigens are used in the preparation and where it's been propagated (active ingredients) and section 6 is the rest, used for preservation and suspension in this case. Here's the excipient list Imuvac (chosen at random)

Potassium chloride, potassium dihydrogen phosphate, disodium phosphate dihydrate, sodium chloride, calcium chloride, magnesium chloride hexahydrate and water for injections

The PIL states that you should be cautious of your allergic to Neomycin, from that I would presume that it's given to the chickens during their life and that there may be trace's of it carried to the egg where the antigen is grown.

Raph78

21st November 2007, 03:08 PM

hi

@ matt

what do antibiotics do to help against a VIRAL strain?

@ blue wode

yes, i am concerned that low vs high velocity effects may not differ so much as far as documented research goes. i am looking into that and will discuss later.

the physio group used 95% low velocity treatments. do you really believe that post graduate physio education learning it as a treatment intervention is the same as a full time highly specialised, specific course in chiropractic? its a skill based technique, and we are taught WHEN to use WHAT techniques and HOW to use it. a weekend course can never get into so much depth. it is simply a guess that the skill, training, education and experience, technique, and experience do not make a difference.

yes, the gcc may not be all perfect. dont forget: it was possible for anybody to call themselves a chiropractor up until 2002 in the uk. so there was very little patient protection and regulation of the profession. so this has hugely improved since then. we are required to undergo annual cpd training to retain registration (in the uk)

the scientific base for chiropractic? we are treating what kirkaldy willis described as joint dysfunction in his model of spinal degeneration. but yes, joints in younger adults can get stuck too. grays anatomy describes that a mobile facet joint inhibits pain fibres from firing, and that nociceptor activity shuts down type 1-3 fibres (proprioception). that is well documented. inter exmainer reliabilities of motion palpation to diagnose the motion restriction of this problem are not excellent (again, its a skill!) but intra-examiner reliabilities are significantly better. it is subjective, yes, that is why i try to objectify my results using video evidence.

ill give you references once i have time, sorry.

but one thing is for sure. research is produced, and we now have more of it. we do not have the easily available funding from e.g. pharma groups, and many aspects of the clinical encounter here can not be so easily abstracted in numbers. there are other aspects of care that may be better examined using qualitative research methods.

i do not respect certain chiro websites, and certain wacky professional bodies. its those who block further development of the profession. "subluxation" is a poor definition and divides chiropractors. it becomes, often, an unnecessary repetitive treatment for "normal" spinal high points, if you see what i mean. i am all for the least invasive treatment, and the least frequent care as i recognise the bodies recuperative powers (homeostasis?)

tbc

Raph78

21st November 2007, 03:11 PM

thanks mongrel, will check

richard

21st November 2007, 04:39 PM

hi john

congrats you found www.back2strength.com (http://www.back2strength.com) on the web!

Ralph did you give John, your website address, or has he used his position as a moderator of the site to look up your IP number and website.

Matt

21st November 2007, 04:55 PM

I'm not a Doctor but it appears that Streptomycin and Neomycin are antibiotics. I imgine they're added to the vaccines to keep them from going off. What's the problem with that?

hi

@ matt

what do antibiotics do to help against a VIRAL strain?

Do you realy feel qualified to offer medical advice if you can't understand what I said.

However it appears that I was wrong. Mogrel's post, just above yours is very illuminating.

So the stuff you claim is added to vaccines isn't in fact added to vacines. Am I to take it that you were previously unaware that the infomration you've been giving to your patients regarding vaccines is incorrect?

Blue Wode

21st November 2007, 05:01 PM

yes, i am concerned that low vs high velocity effects may not differ so much as far as documented research goes. i am looking into that and will discuss later.

the physio group used 95% low velocity treatments. do you really believe that post graduate physio education learning it as a treatment intervention is the same as a full time highly specialised, specific course in chiropractic? its a skill based technique, and we are taught WHEN to use WHAT techniques and HOW to use it. a weekend course can never get into so much depth. it is simply a guess that the skill, training, education and experience, technique, and experience do not make a difference.

It’ll be interesting to see if you can produce any evidence that shows that ‘chiropractic’ manipulation is superior to manipulation by physiotherapists (or osteopaths for that matter).

yes, the gcc may not be all perfect. dont forget: it was possible for anybody to call themselves a chiropractor up until 2002 in the uk. so there was very little patient protection and regulation of the profession. so this has hugely improved since then. we are required to undergo annual cpd training to retain registration (in the uk)

As far as standards go, where is the scientific evidence to support what is being practiced by the chiropractors who are being regulated by the UK General Chiropractic Council? In other words, how can you regulate effectively something which hasn’t been proven to work?

It's worth remembering here that the House of Lords Report on Complementary and Alternative Medicine (CAM) in November 2000 - and the Government’s Response to it in 2001 - stated clearly that the following three fundamental questions about individual CAM treatments needed to be addressed: (1) To find out if the treatment offered therapeutic benefits greater than a placebo; (2) to ascertain that it was safe; and (3) to compare its cost-effectiveness with other forms of treatment.

So far neither of the chiropractors posting on this thread has produced any scientific evidence to show that ‘chiropractic’ is greater than a placebo and, with regard to safety, we already know that the safety data for ‘chiropractic’ are incomplete (and those that are in are rather worrying).

On the subject of cost-effectiveness, the most recent systematic review reached this conclusion:

Prospective, controlled, cost-effectiveness studies of complementary therapies have been carried out in the UK only for spinal manipulation (four studies) and acupuncture (two studies). The limited data available indicate that the use of these therapies usually represents an additional cost to conventional treatment.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17173105 (http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17173105)

the scientific base for chiropractic? we are treating what kirkaldy willis described as joint dysfunction in his model of spinal degeneration. but yes, joints in younger adults can get stuck too. grays anatomy describes that a mobile facet joint inhibits pain fibres from firing, and that nociceptor activity shuts down type 1-3 fibres (proprioception). that is well documented. inter exmainer reliabilities of motion palpation to diagnose the motion restriction of this problem are not excellent (again, its a skill!) but intra-examiner reliabilities are significantly better. it is subjective, yes, that is why i try to objectify my results using video evidence.

ill give you references once i have time, sorry.

Good. And I trust that both you and Richard will answer the questions posed by John Jackson in post #48.

but one thing is for sure. research is produced, and we now have more of it. we do not have the easily available funding from e.g. pharma groups, and many aspects of the clinical encounter here can not be so easily abstracted in numbers. there are other aspects of care that may be better examined using qualitative research methods.

If sound scientific research was conducted which repeatedly showed that ‘chiropractic’ was no better than a placebo, would your profession call it a day?

i do not respect certain chiro websites, and certain wacky professional bodies. its those who block further development of the profession. "subluxation" is a poor definition and divides chiropractors. it becomes, often, an unnecessary repetitive treatment for "normal" spinal high points, if you see what i mean. i am all for the least invasive treatment, and the least frequent care as i recognise the bodies recuperative powers (homeostasis?)

But Raph, registered chiropractors in the UK are legally obliged to provide care that is evidence based, so why are your regulators allowing wacky/quack practices to continue?

Raph78

21st November 2007, 05:49 PM

matt

i inform patients that the flu vaccine contains antibiotics (for whatever reason - you may guess). it is an understatement to say that i have enough medical knowledge to understand that antibiotics dont help against a virus. patients have a right to be made aware of this paradoxon - and the gp is in the prime position to give a synopsis on the flu jab before administering it. its his treatment after all, isnt it? and the patient's decision to have it or not after weighing all the pros and cons, including being informed about well documented side effects http://www.drugs.com/sfx/streptomycin-side-effects.html

it is commonly used as an antifungal - so it could have been added intentionally

Mongrel

21st November 2007, 06:12 PM

The amounts of Streptomycin and Neomycin potentially contained within the vaccines is so small that it's irrelevant to anybody who doesn't have a strong allergic reaction to them, it's merely an another warning and arse covering by the manufacturer (if they're that allergic to it they would know to stay away from eggs anyway)

If it was a pharmacologically active dose it would, by law, have to be included on the licensing documentation (SPC) either as an active ingredient or excipient. There's nothing sinister about it nor, barring allergy, is there any reason to hint that the recipient may suddenly experience side effects from these other drugs.

JJM

21st November 2007, 07:05 PM

{snip}
the scientific base for chiropractic? we are treating what kirkaldy willis described as joint dysfunction in his model of spinal degeneration.How about a real citation? And what do you mean by "treat;" how do you know your treatment is effective?

but yes, joints in younger adults can get stuck too.Citation? Evidence that you can diagnose and treat?

grays anatomy describes that a mobile facet joint inhibits pain fibres from firing, and that nociceptor activity shuts down type 1-3 fibres (proprioception).Since you cited a paper on a jaw-clench reflex and another on quadriceps weakness the last time you mentioned proprioception, I wonder what you think "proprioception" means; and where is the evidence that chiro affects it.

{snip} ill give you references once i have time, sorry. {snip}I look forward to them.

Cuddles

21st November 2007, 07:23 PM

i inform patients that the flu vaccine contains antibiotics

But as Mongrel has demonstrated, that's a lie. There are no antibiotics in the flu vaccine.

t is an understatement to say that i have enough medical knowledge to understand that antibiotics dont help against a virus. patients have a right to be made aware of this paradoxon

You also don't appear to have enough medical knowledge to understand that preservatives, antibiotics and anything else put in a vaccine is not put there to kill viruses, since that would be extremely stupid. They are put there to stop other things from contaminating the vaccines. Bacteria, for instance. Considering that you don't even understand the concept of a preservative, how the hell can you justify giving medical advice?

Raph78

21st November 2007, 07:43 PM

lol at cuddles

thanks for your lecture. you conradict yourself are there, or arent there antibiotics (for WHATEVER reason, for now) in the flu vaccine?

Cuddles

21st November 2007, 08:05 PM

lol at cuddles

thanks for your lecture. you conradict yourself are there, or arent there antibiotics (for WHATEVER reason, for now) in the flu vaccine?

Wow, I must be psychic. I somehow knew you were going to say that. How does it feel to not only be a complete idiot, but also so amazingly predictable?

I'll put this in very small words so you might have a chance of understanding. There are no antibiotics in the flu vaccine. There are antibiotics in other vaccines. They are not there to kill viruses. They are there to kill bacteria.

Is any of this starting to make sense yet, or should I use even smaller words?

Mongrel

21st November 2007, 08:45 PM

lol at cuddles

thanks for your lecture. you conradict yourself are there, or arent there antibiotics (for WHATEVER reason, for now) in the flu vaccine?
Realistically, no there isn't.

There may be a some present in the egg after the hen has been on a course but after processing and growing the antigens, harvesting and purifying them for the vaccine you could probably count the dosage of these in molecules per vial.

It's potentially enough to set off an allergic reaction but for normal people there are no antibiotics

Raph78

21st November 2007, 09:15 PM

thank you mongrel, for your balanced communication and info.

cuddles, spot the difference. judging by your age you have achieved nothing, you arrogant little schoolboy

Cuddles

21st November 2007, 09:46 PM

cuddles, spot the difference. judging by your age you have achieved nothing, you arrogant little schoolboy

Ooo, such harsh words. There's no arrogance involved. You're a quack who has admitted lying to patients. I really hope you go to jail very soon.

Raph78

21st November 2007, 10:21 PM

yes, cuddly, maybe for practicing medicine without a licence?

compare and contrast your dogmatic generalisations with mongrel's openmindedness to communicate and elaborate.

best of luck

richard

22nd November 2007, 12:56 AM

Ooo, such harsh words. There's no arrogance involved. You're a quack who has admitted lying to patients. I really hope you go to jail very soon.

Cuddles, did you mom ever tell you about sticks and stones.

When I decided to study chiropractic aged 35 one of my best friends a senior ENT surgeon thought I had gone mad. However he understood the skeptic in me that had made me a rebel at school, got me involved in leftwing politics and the fight for social justice took me on this fantastic journey helping people who only wanted better health.

Last week I entered this forum with an open mind and hope the discussion would be fun and helpful to chiropractic students I gave a talk to last weekend. To be told by Cuddles after my first posting that I should not call myself a skeptic was a bit of a shock, nevertheless I soldiered on but I have to say you guys seem to have no idea what David Sackett was intending when he began writing about evidence based medicine in the 90s.There are many articles in the BMJ on the subject.You use the best evidence available, if that hapens to be one case study so be it. My starting point was to be Gordon Waddles spinal dysfunction,you were not interested so there was no discussion of evidence.

You have no interest in evidence that does not support what you believe and then with the exception of blue wode you become rude and aggressive hiding behind pseudonym which allow you to pretend you are experts and authorities on things you know nothing about. You know the price of everything and the value of nothing.

If you are doing such a great public service why does not the NHS or GPs link to "Quackwatch" or your site. I will tell you why because they would not want to be associated with quacks "a boastfull pretender to knowledge that he does not posess" Most of you guys are not skeptics. You advertise yourselves as skeptics but are actually disbelievers. Properly, a skeptic is a nonbeliever, a person who refuses to jump to conclusions based on inconclusive evidence. A disbeliever, on the other hand, is characterized by an a priori belief that a certain idea is wrong and will not be swayed by any amount of empirical evidence to the contrary. Since disbelievers usually fancy themselves skeptics, I will follow Truzzi and call them pseudoskeptics, and their opinions pseudoskepticism.

http://www.suppressedscience.net/skepticism.html (http://www.suppressedscience.net/skepticism.html)
The site tells us how the more belligerent pseudoskeptics have their own organizations and publications. I have plagerised this intro at this website, the article is worth a read.

Wikipedia also recognises the term
http://en.wikipedia.org/wiki/Pseudoskepticism (http://en.wikipedia.org/wiki/Pseudoskepticism) explaining it as thinking that appears to be skeptical, but is not. The term is most commonly encountered in the form popularised by Marcello Truzzi (http://en.wikipedia.org/wiki/Marcello_Truzzi), through his Journal of Scientific Exploration (http://en.wikipedia.org/wiki/Journal_of_Scientific_Exploration), where he defined pseudoskeptics as those who take "the negative rather than an agnostic (http://en.wikipedia.org/wiki/Agnostic) position but still call themselves 'skeptics'.
Characteristics of pseudoskeptics

While a Professor of Sociology at Eastern Michigan University (http://en.wikipedia.org/wiki/Eastern_Michigan_University) in 1987, Truzzi gave the following description of pseudoskeptics:
In science, the burden of proof falls upon the claimant; and the more extraordinary a claim, the heavier is the burden of proof demanded. The true skeptic takes an agnostic position, one that says the claim is not proved rather than disproved. He asserts that the claimant has not borne the burden of proof and that science must continue to build its cognitive map of reality without incorporating the extraordinary claim as a new "fact." Since the true skeptic does not assert a claim, he has no burden to prove anything. He just goes on using the established theories of "conventional science" as usual. But if a critic asserts that there is evidence for disproof, that he has a negative hypothesis --saying, for instance, that a seeming psi result was actually due to an artifact--he is making a claim and therefore also has to bear a burden of proof.
Truzzi attributed the following characteristics to pseudoskeptics:

The tendency to deny, rather than doubt [4] (http://en.wikipedia.org/wiki/Pseudoskepticism#_note-3#_note-3)
Double standards in the application of criticism [5] (http://en.wikipedia.org/wiki/Pseudoskepticism#_note-4#_note-4)
The making of judgments without full inquiry [6] (http://en.wikipedia.org/wiki/Pseudoskepticism#_note-5#_note-5)
Tendency to discredit, rather than investigate [7] (http://en.wikipedia.org/wiki/Pseudoskepticism#_note-6#_note-6)
Use of ridicule or ad hominem (http://en.wikipedia.org/wiki/Ad_hominem) attacks in lieu of arguments[8] (http://en.wikipedia.org/wiki/Pseudoskepticism#_note-7#_note-7)
Pejorative labeling of proponents as 'promoters', 'pseudoscientists' or practitioners of 'pathological science.'[9] (http://en.wikipedia.org/wiki/Pseudoskepticism#_note-8#_note-8) Blue Wode thanks for your efforts. Regarding the 80% that was an article not a study. Most of the examples were small studies and the best were picked to make the 80% point. According to the first response in the BMJ to the BMJ study you referenced they could not reproduce those results and criticised the study. I had intended to write more on this But now you know what a real skeptics do you can practice and discuss the 80% among yourselves and be real skeptics.

Presenting insufficient evidence or proof [10] (http://en.wikipedia.org/wiki/Pseudoskepticism#_note-9#_note-9)
Assuming criticism requires no burden of proof [11] (http://en.wikipedia.org/wiki/Pseudoskepticism#_note-10#_note-10)
Making unsubstantiated counter-claims [12] (http://en.wikipedia.org/wiki/Pseudoskepticism#_note-11#_note-11)
Counter-claims based on plausibility rather than empirical evidence [13] (http://en.wikipedia.org/wiki/Pseudoskepticism#_note-12#_note-12)
Suggesting that unconvincing evidence is grounds for dismissing it [14] (http://en.wikipedia.org/wiki/Pseudoskepticism#_note-13#_note-13)

Admin

22nd November 2007, 01:33 AM

Richard, you obviously put a bit of effort into that posting but, again, it's nothing more than an Ad Hominem argument. All you're trying to do is discredit skeptics and providing no evidence regarding chiropractic.

You'll find similar arguments on quacks' and paranormalists' websites all over the place.

I read Truzzi's paper a long time ago and whilst it seemed to put a compelling case forward what he's really talking about is not modern skepticism but Pyrrhonism. It appeals to people who want to believe in things that aren't real (such as psychic abilities) because pyrrhonism leaves issues that don't have any proof to support them in a state of eternal enquiry - they can't be certain it isn't true so they keep looking basically.

Modern skepticism works just like modern science; skepticism being at the heart of the scientific method.

We look at claims, look at the supporting evidence, and if there's nothing to support the claim we conclude that it is false unless/until it's ever proved otherwise. i.e. we take an a posteriori position on matters. See: Are skeptics disbelievers? (http://www.ukskeptics.com/article.php?dir=articles&article=skeptics_are_disbelievers.php)

This is why we keep asking you chiropractors for evidence that chiropractic (not SMT) actually works. If you can provide any evidence that subluxations exist, how you detect them, how they cause illness and disease and how you put them right then I, and I'm sure other skeptics, will be more than happy to re-evaluate our stance on chiropractic.

I note with interest that chiropractors routinely advertise that they can treat/cure things like asthma, hay fever, bed-wetting in children, ADHD, etc. I'd like to see the evidence to support the claim that making spinal adjustments can do anything for these conditions.

I take it that you and Raphael have degrees in chiropractic, that you're both in practice, and that you treat patients regularly. Surely, if anyone can provide some quality evidence that chiropractic works it should be practitioners like yourselves!

Why have you both failed to do so?

Admin

22nd November 2007, 01:39 AM

Ralph did you give John, your website address, or has he used his position as a moderator of the site to look up your IP number and website.

I used his email address to work out who he is.

Note, however, that Raphael posted the link to his own site - not me. ;)

I know who you are too Richard. Perhaps you'd like to make your identity public too then we'd have more transparency.

Then after you've provided evidence which shows that chiropractic works, we can move onto the topic of chiropractic and its anti-vaccination stance.

You seem to have a lot to say against vaccination don't you? ;)

Matt

22nd November 2007, 10:26 AM

matt

i inform patients that the flu vaccine contains antibiotics (for whatever reason - you may guess). it is an understatement to say that i have enough medical knowledge to understand that antibiotics dont help against a virus.

It would appear that what you're telling your patients is stretching the truth a little. The idea that they are there to kill viruses is a straw man. We both know that they are not, we both know that this is irrelevant.

We both know that vaccines are a preventative and that antibiotics are typically given to fight an infection after it has taken hold. There's little point in giving a flu jab to somebody who already has flu. As such the idea of the antibiotic being in there to fight the flu infection would be ridiculous even if flu was bacterial. You know this and I know this, doctors know this and we both know that doctors know this. Yet somehow it appears that you're representing Doctors as not knowing this, or knowing this and doing it anyway for suspect reasons.

Incidentally as a teenager I visited a doctor and was diagnosed with a viral infection. The Doctor prescribed antibiotics. Knowing that antibiotics are effective against bacteria but not viruses I questioned this.

The Doctor told me that my immune system would fight the viral infection. To relieve the strain on my immune system the antibiotics would tackle the bacteria that it deals with comfortably on a day to day basis. This would also reduce the possibility of a secondary infection taking hold whilst my immune system was strained.

patients have a right to be made aware of this paradoxon - and the gp is in the prime position to give a synopsis on the flu jab before administering it. its his treatment after all, isnt it? and the patient's decision to have it or not after weighing all the pros and cons, including being informed about well documented side effects http://www.drugs.com/sfx/streptomycin-side-effects.html (http://www.drugs.com/sfx/streptomycin-side-effects.html)

it is commonly used as an antifungal - so it could have been added intentionally

Hang on, Mongrel has just explained to you that it remains as a trace due to the production process, it is not added. He has explained to you that it is present in amounts only relevant to the severely allergic and yet you point me towards side effects likely to happen after four weeks of a daily 1.8 to 2 gram dose.

With full understanding there is no paradox. The more you explain your actions the more it looks like you're scaremongering. The longer you persist that it's the right thing for you to be doing the more it looks like a deliberate attack on evidence based medicine intended to drive patients towards "alternative" therapies.

Blue Wode

22nd November 2007, 02:09 PM

You use the best evidence available, if that hapens to be one case study so be it.

Then why do you seem to have a problem with case studies being cited in relation to complications associated with chiropractic treatment? Surely they're useful in helping chiropractors to err on the side of caution (as in “first do no harm”) and use safer, but equally effective treatments, until solid evidence has been gathered?

Properly, a skeptic is a nonbeliever, a person who refuses to jump to conclusions based on inconclusive evidence.

It would seem that “inconclusive evidence” is what chiropractors rely on to keep themselves in business. As I asked Raph in post # 94, if sound scientific research was conducted which repeatedly showed that ‘chiropractic’ was no better than a placebo, would your profession call it a day?

In science, the burden of proof falls upon the claimant; and the more extraordinary a claim, the heavier is the burden of proof demanded.

Chiropractic’s extraordinary claims have been around for 112 years, so where is the proof that it works?

Since the true skeptic does not assert a claim, he has no burden to prove anything

...or do you consider yourself one of Truzzi’s “true skeptics” who has no burden to prove anything?

Blue Wode thanks for your efforts. Regarding the 80% that was an article not a study. Most of the examples were small studies and the best were picked to make the 80% point. According to the first response in the BMJ to the BMJ study you referenced they could not reproduce those results and criticised the study. I had intended to write more on this But now you know what a real skeptics do you can practice and discuss the 80% among yourselves and be real skeptics.

This is all irrelevant, Richard. Your regulators stipulate that chiropractors’ provision of care must be evidence-based, therefore would you please provide the evidence for 'chiropractic'. In doing so, please don’t forget what John Jackson said in post #106, because it’s true:

If you can provide any evidence that subluxations exist, how you detect them, how they cause illness and disease and how you put them right then I, and I’m sure other skeptics, will be more than happy to re-evaluate our stance on chiropractic.

JJM

22nd November 2007, 03:13 PM

Richard,

Philosophy has nothing to do with the effectiveness of chiropractic. I find it curious that you can research and post extensively on how we should conduct our business; yet you cannot show us any support for how you conduct your own business.

Over a week ago you said something vague about relating the spine to the nervous system. How about being specific about that relationship, and how you affect it. I have specifically stated that you cannot do so, and I cited a definitive experiment. Despite the wishful thinking of chiros, definitive studies do not expire- of course they can be replaced by newer, better work; but that has not happened.

Raph78

22nd November 2007, 08:45 PM

matt

i had posted it just after mongrel had posted and missed his contribution.

Raph78

22nd November 2007, 08:52 PM

Admin

22nd November 2007, 09:18 PM

john, you could have never guessed it from my email addie. my ip shows up when i log in here and thats where you got it from as your the admin/mod here.

we could be miles apart in our opinions and still respect each other as human beings. thats not what your after but thats ok ;)

Your IP address, AFAIK, will only give me your internet service provider.

I worked out who you are from your email address.

If you want to dispute that then I will post exactly how I did it on here in public. Your call.

And, it should be noted (again), that I did not post your website details on this forum - you did. ;)

bobdezon

22nd November 2007, 09:52 PM

I can confirm an IP trace will only show the provider source, I traced mine once and It put my location in a dockside building about 7 miles from my actual location ::)

seren

22nd November 2007, 09:56 PM

I have changeable IP addresses. According to my provider I live in four separate places, three of them in the wrong country! Well, OK, not in the right principality.

JJM

22nd November 2007, 10:02 PM

{snip} [quoting an article on quadriceps weakness and osteoarthritis] Background: The quadriceps weakness commonly associated with osteoarthritis of the knee is widely believed to result from disuse atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis.

Conclusion: Quadriceps weakness may be present in patients who have osteoarthritis but do not have knee pain or muscle atrophy; this suggests that the weakness may be due to muscle dysfunction. The data are consistent with the possibility that quadriceps weakness is a primary risk factor for knee pain, disability, and progression of joint damage in persons with osteoarthritis of the knee. {snip}[Emphasis added] So, Raph- I hope you are now clear on the paper's conclusion; the part in the emphasized words. People who already have OA may have a weak muscle. Said weakness may contribute to further development of OA. Muscle weakness is not suggested to cause OA.

I was distracted by your lack of comprehension, and overlooked the claim you made:

to make it clear: as a chiropractor it is my privileged duty to diagnose and treat such proprioceptive weaknesses {snip} to PREVENT OA. {snip}So- tell us how you diagnose and treat this problem, and how you know your treatment prevents OA.

ETA, the cited article http://www.annals.org/cgi/content/full/127/2/97

nick

22nd November 2007, 11:20 PM

Good evening. As i've got a little spare time on my hands i thought that i may join in with this debate. Some on here do not believe that chiropractic has much science to back it up but i hope to help disprove that (yes i am a chiropractor and proud of it). A few questions seem to be apparent:

1. What is a subluxation? and does it exist.
2. If it does exist does a chiropractic adjustment reduce it?

Lets look at the first question. The vertebral subluxation complex involves dysfunction (aberrant motion) between spinal joints and the subsequent effects it has on nerve, muscle, ligamentous, vascular and connective tissue.

Ok so lets have a look at a study from Yale universities school of medicine by Panjabi, M., entitled "A hypothesis of chronic back pain: ligamentous subfailure injuries lead to muscle control dysfunction" in the European Spine Journal July 27 (2005). The author stats that injury to mechanoreceptors (which are densly located in facet joint capsules) reduces neuromuscular control and subsequently alters muscular co-ordination. Over time this produces higher facet loading, increased muscle fatigue and higher stesses and strains in the ligaments, muscles and mechanoreceptors. "These abnormal conditions produce neural and ligament inflammation and over time chronic back pain."

Remembering that mechanoreceptor firing is reduced with restricted joint mobility and injury (also associated with increased nociceptive -pain nerve-firing) Seaman, D., JMPT 20(9) (1997). So it becomes clear that with spinal joint fixations associated pathological changes in the nerves, muscules, ligaments etc occur. IN OTHER WORDS THE VERTEBRAL SUBLUXATION COMPLEX.

So to question 2. The answer is logical that increased mechanoreceptor firing improves neuromuscular control and reduces pain. What increases joint motion and mechanoreceptor activity - Yes THE CHIROPRACTIC ADJUSTMENT. See Indahl, A. et al Spine 22:2834 - 2840 (1997).

Now the real neat thing is that all this excitment doesn't just happen at a segmental level but is also modulated in the spinal cord, affecting input into the cerebellar - brainstem - cortical loops (which is responsible for cognition, emotion and organ functioning) You will have to wait on references as its past my bedtime.

Raph78

22nd November 2007, 11:38 PM

you cannot trace me through me email addies registered with uksceptics. impossible.

so have a go then to justify yourself.

i am not worried about the website. you are invited to have a look. i just asked you to respect my wish to remove it which you keep ignoring because of your very own reasons.

actually, john, its YOUR call if you see what i mean ;)

Admin

22nd November 2007, 11:55 PM

you cannot trace me through me email addies registered with uksceptics. impossible.

so have a go then to justify yourself.

You registered here using the email address: yhvh@gmx.de

I did a Google search for that address: Here (http://www.google.co.uk/search?q=yhvh%40gmx.de&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-GB:official&client=firefox-a)

The page it came up with is this one: http://www.fortunecity.de/kunterbunt/diktatur/512/files/whoiswho.htm

Searching down the page your email address coincides with the name: Schäfer, Raphael

A Google for Raphael Schafer+chiropractor brings up this page: http://www.sca-chiropractic.org/cgi-local/query.pl?member_area=12

Which includes your web address etc.

A check on the GCC register: http://www.gcc-uk.org/chiro_search.cfm and entering your name confirms who you are.

Is that enough of a skeptical analysis, or are you going to persist with your plan to take legal action against me for breaking the data protection act? ;D

NOTE: there is some personal detail revealed here but it was done at the request of Raphael (!) and it's all available publicly via the internet.

JJM

23rd November 2007, 12:30 AM

{snip} A few questions seem to be apparent:

1. What is a subluxation? and does it exist.
2. If it does exist does a chiropractic adjustment reduce it?

Lets look at the first question. The vertebral subluxation complex involves dysfunction (aberrant motion) between spinal joints and the subsequent effects it has on nerve, muscle, ligamentous, vascular and connective tissue.

Ok so lets have a look at a study from Yale universities school of medicine by Panjabi, M., entitled "A hypothesis of chronic back pain: ligamentous subfailure injuries lead to muscle control dysfunction" in the European Spine Journal July 27 (2005). The author stats that injury to mechanoreceptors (which are densly located in facet joint capsules) reduces neuromuscular control and subsequently alters muscular co-ordination. Over time this produces higher facet loading, increased muscle fatigue and higher stesses and strains in the ligaments, muscles and mechanoreceptors. "These abnormal conditions produce neural and ligament inflammation and over time chronic back pain."

Remembering that mechanoreceptor firing is reduced with restricted joint mobility and injury (also associated with increased nociceptive -pain nerve-firing) Seaman, D., JMPT 20(9) (1997). So it becomes clear that with spinal joint fixations associated pathological changes in the nerves, muscules, ligaments etc occur. IN OTHER WORDS THE VERTEBRAL SUBLUXATION COMPLEX.

So to question 2. The answer is logical that increased mechanoreceptor firing improves neuromuscular control and reduces pain. What increases joint motion and mechanoreceptor activity - Yes THE CHIROPRACTIC ADJUSTMENT. See Indahl, A. et al Spine 22:2834 - 2840 (1997).

Now the real neat thing is that all this excitment doesn't just happen at a segmental level but is also modulated in the spinal cord, affecting input into the cerebellar - brainstem - cortical loops (which is responsible for cognition, emotion and organ functioning) {snip}

The articles you cite: Panjabi, M., in Eur. Spine J. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16047209&ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum This article is speculation and, more to the point, is not about chiro.

Seaman, D in JMPT “Joint complex dysfunction, a novel term to replace subluxation/subluxation complex: etiological and treatment considerations.” http://www.ncbi.nlm.nih.gov/sites/entrez This is a chiropractic magazine, not a properly refereed journal. No abstract available. However, the title suggests the author is only trying to distance him/herself from the embarrassing term “subluxation,” without providing any data.

Indahl, A. et al Spine http://www.ncbi.nlm.nih.gov/sites/entrez No mention of chiro.

I have been questioning chiro for a long time. No proponent has ever supplied reliable support for it. Notably, the alt med and chiro publications are not reliable. When proponents cite legitimate literature, it does not support their claims. Can you do better?

Raph78

23rd November 2007, 03:15 AM

Cuddles

23rd November 2007, 10:39 AM

You have no interest in evidence that does not support what you believe and then with the exception of blue wode you become rude and aggressive hiding behind pseudonym which allow you to pretend you are experts and authorities on things you know nothing about. You know the price of everything and the value of nothing.

And yet you still refuse to present a single piece of evidence, and you still haven't admitted that all the evidence which has been presented by others says you are a quack. Do you honestly not realise just how much more stupid you look every time you post?

Matt

23rd November 2007, 11:51 AM

i accept that john. edzard ernst, too, has his email addies on his papers. good luck spamming it!

i dont mind the info as the gcc and sca registers and my website are free to see for anyone, and to make good use of it

now you carry on chiro bashing as id like to go on to welcome nick who will quickly find out that evidence not supporting a the majority's view here is not accepted here.

welcome!

thank you mongrel, will check soon. ill be in touch

Aha, what you should find is that Argumentum ad Populum (http://en.wikipedia.org/wiki/Argumentum_ad_populum) is not respected here. We shouldn't support the majority view simply because it's the majority view.

However I don't see that argument being made anywhere.

What's more I haven't seen any evidence that scepticism about chiropractic IS the majority view.

I see chiropractic and alternative medicine in general being very popular amongst the general populace.

The fact there appears to be no consensus support for chiropractic amongst respected medical journals is not the reason we doubt chiropractic. That would be Appeal to authority (http://en.wikipedia.org/wiki/Appeal_to_authority) again not respected here.

However the reasons that are given by the respected medical journals for not feeling able to give their support to chiropractic are convincing. It is from an analysis of those reasons that those here haved formed their independant opinions. If they happen to be the same conclusions as those reached by rigorous scientific methods then that's simply because reality is fixed for everyone and if whoever looks at a part of it accurately should see the same thing.

I applaud you for being prepared to take a second look at your beliefs.

Mongrel

23rd November 2007, 02:35 PM

Mostly for Raph but others may be interested ;)

I pointed you towards the "Immunisation against Infectious Diseases" book (aka "The Green Book") and have since found out it's available free online here (http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Greenbook/DH_4097254).

This is the standard reference book sent to every clinician within the NHS and is the first point of call for vaccine information

Blue Wode

23rd November 2007, 09:45 PM

Here’s an interesting new development.

The UK chiropractic regulatory body, the General Chiropractic Council (GCC), has just lodged a formal complaint with the Press Complaints Commission (PCC) against three UK newspapers for “inaccurate, misleading and distorted reporting of the purpose and outcome of a research study”.
http://www.gcc-uk.org/files/page_file/Letter%20PCC%2020Nov07%20(Website).pdf (http://www.gcc-uk.org/files/page_file/Letter%20PCC%2020Nov07%20(Website).pdf)

The research study in question, which was this thread’s OP, found that there was no significant difference in the time to recovery, pain, function, global perceived effects or adverse events between people receiving active diclofenac and/or spinal manipulation compared to the respective placebo. The study’s Discussion section (p.1643) included the following comments:

The spinal manipulative therapy given in this trial included a range of low-velocity mobilisation and high-velocity manipulation techniques done by physiotherapists with postgraduate training in manipulative therapy. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal mobilisation is more effective than low-velocity spinal manipulation, or that the profession of the manipulator affects the effectiveness of treatment.

Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial Hancock MJ et al; Lancet:370:1638-43
http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf (http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf)

According to the GCC the offending newspapers are:

Chiropractors ‘are a waste of money’, Daily Telegraph, Rebecca Smith
Chiropractors ‘are a waste of time’, Daily Mail, Jenny Hope
‘Chiropractors may be no use in treating back pain, study says’, The Guardian, Alok JhaWith regard to the third newspaper, The Guardian, as John Jackson pointed out in post #15, it’s important to note that its headline read "Chiropractors may be no use in treating back pain, study says". Indeed, John went on to say:

I think this is fair as Spinal Manipulation Therapy (SMT) is used by chiropractors and it's about the only thing they do that has any evidence to support its use.

Now that there's some doubt cast upon SMT compared to other interventions then it certainly is relevant to chiropractic.

SMT is not chiropractic as such but as chiropractors use it the link between chiropractic and SMT is highly relevant.[My bold]

That summation is pretty accurate in view of the fact that (in the UK) legislation requires that chiropractors’ provision of care must be evidence based and that in the last couple of years the evidence for spinal manipulation has been shown to be very slim.

For new readers to this thread, here is the current scientific evidence for spinal manipulation:

From 2005

The value of chiropractic

Virtually all experts agree that the best available evidence in any area of health care is that provided by Cochrane reviews. The Cochrane Collaboration is a worldwide network of independent scientists dedicated to systematically summarising the totality of the evidence related to specific medical subjects in a rigorous and transparently impartial fashion. Four Cochrane reviews of spinal manipulation are available today.

Back pain is by far the condition most frequently treated by chiropractors. The Cochrane review of spinal manipulation for back pain summarised 39 clinical trials.1 (http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm#fact1002a02t01b0001) The authors’ conclusions were very clear: ‘There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.’

http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm (http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm)

From 2006

A systematic review of systematic reviews of spinal manipulation

CONCLUSIONS: Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.

http://www.jrsm.org/cgi/content/abstract/99/4/192 (http://www.jrsm.org/cgi/content/abstract/99/4/192)

From 2007

Adverse effects of spinal manipulation: a systematic review

CONCLUSIONS: Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.

http://www.jrsm.org/cgi/content/abstract/100/7/330 (http://www.jrsm.org/cgi/content/abstract/100/7/330)

Still on the subject of evidence, the GCC’s 9th November 2007 press statement concerning the Lancet study said the following:

Chiropractors provide an evidence-based approach based on European-wide guidelines compiled by multidisciplinary teams of experts who reviewed all relevant research.

The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared. Chiropractic intervention is safe, effective and cost-effective in reducing referral to secondary care.

http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf (http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf)

Well, just where is the scientific evidence to support the GCC’s claims that “The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatment to which they have been compared”?

And where are the safety data for ‘chiropractic’ (including those for children), and the data for chiropractic’s effectiveness and for its cost-effectiveness?

Richard, Raph, Nick, can you provide it for us please?

And what about national guidelines? Here's some insight into those:

Chiropractors argue that their approach must be safe and effective, not least because the official guidelines on the treatment of back pain recommend using chiropractic. However, this is true only for some, but by no means all, countries. Secondly, guidelines are well known to be influenced by the people who serve on the panel that develops them. Cochrane reviews, on the other hand, are generally considered to be objective and rigorous. Writing about the importance of systematic reviews for health care in the Lancet, Sir Ian Chalmers stated, ‘I challenge decision makers within those spheres who continue to frustrate efforts to promote this form of research to come out from behind their closed doors and defend their attitudes and policies in public. There is now plenty of evidence to show how patients are suffering unnecessarily as a result of their persuasive influence.’ 10

The Value of Chiropractic
http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm (http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm)

Returning once more to its formal complaint to the PCC, the GCC says that it is concerned that the newspapers’ reporting is…

irresponsible and does not serve the public interest. It misleads readers, may prevent members of the public from seeking the help of appropriately qualified, experienced and regulated health professionals, and ultimately undermines the public’s trust in the accuracy and utility of scientific research.

It is likely that such reporting has also undermined the reputation of the chiropractic profession and may have a direct impact on chiropractors’ practices; all chiropractors, apart from a handful, are in private practice. It may also prejudice any chance of increasing public access to chiropractic on a basis of need through NHS funding.

…and it is seeking corrections and clarifications printed in prominent positions in each paper.

Well, presumably any such correction will be accompanied by the scientific evidence for ‘chiropractic’ (whatever chiropractic actually is), and it will also justify why several hundred McTimoney chiropractors (as well as quite a number of others) are allowed to promote the pseudoscientific concept of “innate intelligence”.

For example:

“By correctly training hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements)”.

http://www.mctimoney-chiropractic.org/mca_objectives.htm (http://www.mctimoney-chiropractic.org/mca_objectives.htm)

Finally, it’s interesting to note the following in the GCC’s complaint to the PCC:

Treatment with NSAIDs or spinal manipulative therapy is recommended as second-line treatment for acute back pain in patients not responding to first-line management.

What it doesn’t say is that that recommendation isn’t true of the Royal College of General Practitioners (RCGP) in the UK. Its guidelines for the management of acute low back pain - which had previously recommended spinal manipulation – were withdrawn two years ago. See page 2 of the GCC’s Spring 2005 newsletter (#15) here:
http://www.gcc-uk.org/files/link_file/GCC_news_15.pdf (http://www.gcc-uk.org/files/link_file/GCC_news_15.pdf)

Does anyone else think that the GCC is equally guilty of inaccurate, misleading and distorted reporting?

Whilst we await some answers to the above, please would someone from the chiropractic community answer the questions already posed by John Jackson in post #48. Here they are again:

What is Innate Intelligence?
What is a subluxation?
How are subluxations detected?
Can a single patient’s subluxation be reliably found by more than one Chiropractor?
Can subluxations be seen on x-rays?
How do subluxations cause bed-wetting in children and how does spinal manipulation cure this?
How does manipulating the spine of a child with ADHD cause an improvement in behaviour?
Do you recommend vaccinations? If not, why not? Please also provide the safety data that justifies administering chiropractic treatment to infants and children under 12.

Thank you.

JJM

23rd November 2007, 10:14 PM

The articles you cite: Panjabi, M., in Eur. Spine J. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16047209&ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum This article is speculation about the cause of low back pain and, more to the point, is not about chiro.

Seaman, D in JMPT “Joint complex dysfunction, a novel term to replace subluxation/subluxation complex: etiological and treatment considerations.” http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=9436150&ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/sites/entrez) This is a chiropractic magazine, not a properly refereed journal. No abstract available. However, the title suggests the author is only trying to distance him/herself from the embarrassing term “subluxation,” without providing any data.

Indahl, A. et al Spine http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=9431619&ordinalpos=7&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/sites/entrez) No mention of chiro, this article involves injecting pigs with saline (in the back) to mimic disease.

This corrects the links in my previous post and slightly expands the comments.

Those are articles cited by rick in support of chiro. The only article related to chiro is a proposal to rename the subluxation.

Raph, you cited two articles in support of chiro- one concerned a jaw-clenching reflex and the other concerned a weak quad muscle. Since you cited these, one would think you could demonstrate the connection to chiro when asked; you have not.

It is disingenuous to say we reject articles we disagree with; I explained why I find them irrelevant. I asked what those five articles have to do with the efficacy of chiro. You two cited them, you must know.

nick

24th November 2007, 09:13 AM

1. My post was refering to the prescence of a chiropractic subuluxation. Not have effective chiropractic is.

2. In previous posts on here people have questioned the use of chiropractors performing research so I endevoured to find an article by a professor in orthopeadic medicine at Yale.

3. The article does not mentioned chiropractic.

4. If you read the article you will see that what this professor is referring to is very similar to the discription of a subluxation i posted. Is this not you want?

5. Yes the article is a review supported by research.

6. I suggest that next time you actually read the article instead of just scanning abstracts.

7. My name is Nick.

JJM

24th November 2007, 11:42 AM

1. My post was refering to the prescence of a chiropractic subuluxation. Not have [sic] effective chiropractic is.Only one article referred to subluxation, and that suggested re-naming it. You cannot just take some medical problem and say "That's what I mean." That is how you got saddled with the term "subluxation" at the start. That is a real medical term, it is just not relevant to chiro. (see the last paragraph)

You did try to address how effective chiro is
The answer is logical that increased mechanoreceptor firing improves neuromuscular control and reduces pain. What increases joint motion and mechanoreceptor activity - Yes THE CHIROPRACTIC ADJUSTMENT."The answer may be "logical;" but the jump to chiro is baseless.

2. In previous posts on here people have questioned the use of chiropractors performing research so I endevoured to find an article by a professor in orthopeadic medicine at Yale.I take it that was the speculation about the causes of low back pain.

3. The article does not mentioned chiropractic.??

4. If you read the article you will see that what this professor is referring to is very similar to the discription of a subluxation i posted. Is this not you want?Which article? What I want is reliable proof that chiro in fact is useful for something. (see the last paragraph)

5. Yes the article is a review supported by research.Does that research support chiro?

6. I suggest that next time you actually read the article instead of just scanning abstracts.That is a fair complaint; however, I do not have easy access to the articles. On the other hand, when the title and abstract do not refer to a large, properly-controlled, clinical study (or, studies) of chiro, it is usually safe to conclude the article contains no concrete support for the use of chiro in health care. With respect to the articles you cited- am I wrong about that?

7. My name is Nick.Your on-line 'nym is uncapitalized, people are likely to refer to you that way.

The classic definition of a subluxation refers to an imaginary entity (as I suspect you know). If you want to re-name or re-define it around something real, that might work as long as you demonstrate its relationship to chiro in clinical studies. Until then, your practice is still based on speculation, as it has been for 112 years.

nick

24th November 2007, 01:19 PM

I was referring to Panjabi, M., in Eur. Spine J.

This articule defines what the author (A Yale Phd!) believes happens with a joint fixatation. Very similar to the defination of a chiropractic subluxation. Yes it uses different terms and does not mention chiropractic but that is the beauty of it. He a none chiropractic professor. He dosn't support chiropractic but yet he still describes a chiropractic subluxation just using different terms.

When I have a little more time we can discuss the issue of chiropractic being effective as im off to the seaside.

Have a great weekend.

JJM

26th November 2007, 05:00 PM

Mongrel

26th November 2007, 05:51 PM

Thanks for that.

There is a good discussion of the idiocy of antivaxers here:
http://scienceblogs.com/insolence/2007/11/cries_the_antivaccinationist_why_are_we.php#more

Orac was mentioned as well ;)

It's one of my daily visits

Blue Wode

26th November 2007, 07:04 PM

Thanks for the informative links, Mongrel and JJM.

Regards chiropractors’ attitudes towards vaccination, it’s interesting to note that in JJM’s homeland chiropractors seem to be extremely wary of childhood vaccinations. Indeed, in this 2004 survey of chiropractic practices in Portland, Oregon, not one chiropractor recommended routine vaccination for children:

http://www.chirobase.org/02Research/laidler.html (http://www.chirobase.org/02Research/laidler.html)

(The survey also found a 100% incidence of beliefs and practices that are unsubstantiated or clash with established scientific knowledge.)

As for the UK, this chiropractic website has a section called ‘The truth about…’ which claims the following about vaccinations:

A growing number of health professionals have become disenchanted about compulsory vaccinations. Get the facts! Ask questions and reach an informed decision.

If artificial immunization always worked, vaccinated children wouldn't get measles or other diseases - but they do.

Realize that there is little proof that vaccines work. Many link the decline of certain diseases with the use of its vaccine. Yet, they ignore the improved sanitation, nutrition, and hygiene that vaccinated populations have enjoyed as widespread immunization was introduced.

In addition, vaccines can be dangerous. It's hard to predict how anyone, especially an infant, will react when injected with serums made from barnyard animal blood, cultured monkey tissue, aluminium, and formaldehyde. Reactions can range from the disease itself, to disability and even death!

The fact that children survive inoculation is a powerful testament to the very immune system that is being tampered with by these substances!

Before you agree to vaccinations or any other procedure. Get the facts. Read books. Ask questions. Explore your choices. Maximize your child's natural immunity by breastfeeding and assuring the proper diet, rest, and exercise. Include regular chiropractic checkups to optimise the nervous system, which controls the immune system and every other cell, tissue, organ and system of the body.

http://www.chiropractic-clinic.com/the-truth-about.htm (http://www.chiropractic-clinic.com/the-truth-about.htm)

Richard, Raph, Nick, would you like to comment on those claims?

And would you please provide the scientific evidence that proves that regular chiropractic checkups for children “optimise the nervous system” and have a beneficial effect on the immune system and the rest of the body.

richard

26th November 2007, 08:37 PM

Thanks for the informative links, Mongrel and JJM.

Regards chiropractors’ attitudes towards vaccination, it’s interesting to note that in JJM’s homeland chiropractors seem to be extremely wary of childhood vaccinations. Indeed, in this 2004 survey of chiropractic practices in Portland, Oregon, not one chiropractor recommended routine vaccination for children:

http://www.chirobase.org/02Research/laidler.html (http://www.chirobase.org/02Research/laidler.html)

(The survey also found a 100% incidence of beliefs and practices that are unsubstantiated or clash with established scientific knowledge.)

As for the UK, this chiropractic website has a section called ‘The truth about…’ which claims the following about vaccinations:

Richard, Raph, Nick, would you like to comment on those claims?

And would you please provide the scientific evidence that proves that regular chiropractic checkups for children “optimise the nervous system” and have a beneficial effect on the immune system and the rest of the body.

You obviously believe in vaccinations, you are not being a very skeptical, skeptic blue wode. What I found interesting about this practice is that:

"The clinic is situated in a GP surgery and many of the practitioners recommend people for treatment. This allows a much closer working relationship between both the medical profession and the chiropractors than would normally be attained. This is often invaluable in helping patients receive the best of both types of care and referral for further investigations can be achieved quickly and efficiently".

There are a number of studies on the site about chiropractic if you are really interested, you must have missed them, thanks for saving me the trouble.

I have been away a few days and was surprised no one was skeptical about your claim that 80% of medicine is evidence based.

This was on page [FONT=Verdana]Page 16 of the Telegraph on Saturday. Just goes to show never believe everything you read in the newspapers.

Chiropractors
Contrary to any suggestion in
our headline article (Nov
9), a study published in The
Lancet into treatment of back
pain did not state that visiting
a chiropractor was a waste of
time and money. We apologise
for any misunderstanding.
;D

Blue Wode

26th November 2007, 09:13 PM

You obviously believe in vaccinations, you are not being a very skeptical, skeptic blue wode. What I found interesting about this practice is that:

"The clinic is situated in a GP surgery and many of the practitioners recommend people for treatment. This allows a much closer working relationship between both the medical profession and the chiropractors than would normally be attained. This is often invaluable in helping patients receive the best of both types of care and referral for further investigations can be achieved quickly and efficiently".

Irrelevant.

There are a number of studies on the site about chiropractic if you are really interested, you must have missed them, thanks for saving me the trouble.

I didn’t miss them. They were cherry-picked according to the clinic’s agenda. Also, if you read the link to scienceblogs which was provided by JJM you’ll see that it explains how many of the vaccination studies, and others, misinform.

And yes, after having read all the pros and cons, I agree with vaccinations.

Do you agree with/believe in vaccinations, Richard?

I have been away a few days and was surprised no one was skeptical about your claim that 80% of medicine is evidence based.

Why were you surprised about that?

This was on page Page 16 of the Telegraph on Saturday. Just goes to show never believe everything you read in the newspapers.

Chiropractors
Contrary to any suggestion in
our headline article (Nov
9), a study published in The
Lancet into treatment of back
pain did not state that visiting
a chiropractor was a waste of
time and money. We apologise
for any misunderstanding.
;D

As I said in post #7:

"You are quite right about the study not specifically mentioning chiropractic. However, as I understand that spinal manipulation (‘adjustment’) is the hallmark of chiropractic practice (more so, I believe, than osteopathy and physiotherapy) I think it was fair that some, but not all, of the press reports mentioned the negative implications that the study’s findings would have for chiropractic therapy."
However, what I don't think is fair is the GCC’s 9th November 2007 press statement concerning the Lancet study which claimed this:

"The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared. Chiropractic intervention is safe, effective and cost-effective in reducing referral to secondary care."

http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf (http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf)

Just where is the scientific evidence to support its claims that “The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatment to which they have been compared”?

And where are the safety data for ‘chiropractic’ (including those for children), and the data for chiropractic’s effectiveness, and for its cost-effectiveness?

Can you provide them for us, Richard?

Also, as previously requested, would you please provide answers to the following questions already posed by John Jackson in post #48:

What is Innate Intelligence?
What is a subluxation?
How are subluxations detected?
Can a single patient’s subluxation be reliably found by more than one Chiropractor?
Can subluxations be seen on x-rays?
How do subluxations cause bed-wetting in children and how does spinal manipulation cure this?
How does manipulating the spine of a child with ADHD cause an improvement in behaviour?
Do you recommend vaccinations? If not, why not? Please include the safety data which justifies administering chiropractic treatment to infants and children under 12.

Thank you.

JJM

26th November 2007, 10:02 PM

From Blue Wode:

{snip} Include regular chiropractic checkups to optimise the nervous system, which controls the immune system and every other cell, tissue, organ and system of the body.

http://www.chiropractic-clinic.com/the-truth-about.htm (http://www.chiropractic-clinic.com/the-truth-about.htm)Richard, Raph and nick, do you endorse this statement, and where are the proofs? Blue Wode already asked, and you did not reply. One is left to conclude that you realize that any response you make would be absurd.

I claim that the assertion that "the nervous system, which controls the immune system and every other cell, tissue, organ and system of the body" is demonstrably wrong. Do you dispute my claim?

nick

26th November 2007, 11:39 PM

Unfortunately only have abstracts to inform you of the scientific studies regarding the benefits of chiropractic and immune function. Just three for starters.

1. J Manipulative Physiol Ther 2006 (Jan); 29 (1): 14–21
Over the study period, a significant proportion (P ≤ .05) of sham and control subjects demonstrated progressive increases in the synthesis of tumor necrosis factor alpha and IL-1beta. Conversely, in a comparable proportion of cultures from SMT-derived subjects, the production of both cytokines decreased gradually. Normalization of the observed alterations to reflect the changes relative to self-baselines demonstrated that, within 2 hours after intervention, the production of both cytokines increased significantly (P < .001 to .05) in both controls. In contrast, a significant (P < .001 to .05) reduction of proinflammatory cytokine secretion was observed in cultures from SMT-receiving subjects. In all study groups, serum levels of SP remained unaltered within 2 hours after intervention. SMT-treated subjects show a time-dependent attenuation of LPS-induced production of the inflammatory cytokines unrelated to systemic levels of SP. This suggests SMT-related down-regulation of inflammatory-type responses via a central yet unknown mechanism.

2. J Manipulative Physiol Ther 2000 (Feb); 23 (2): 104–106 (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10714536&query_hl=8)
BACKGROUND: The collective experience of the chiropractic profession is that aberrant stimulation at a particular level of the spine may elicit a segmentally organized response, which may manifest itself in dysfunction within organs receiving autonomic innervation at that level. This experience is at odds with classic views of neuroscientists about the potential for somatic stimulation of spinal structures to affect visceral function.
OBJECTIVE: To review recent findings from basic physiologic research about the effects of somatic stimulation of spinal structures on autonomic nervous system activity and the function of dependent organs.
DATA SOURCE: Findings were drawn from a major recent review of the literature on the influences of somatic stimulation on autonomic function and from recent original physiologic studies concerning somatoautonomic and spinovisceral reflexes.
CONCLUSIONS: Recent neuroscience research supports a neurophysiologic rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function.

3. Chiropractic Research J 1994; 3 (1): 32–39
These tests were performed by the patients independent medical center where they were under medical supervision for the regular group were dramatically increased over the counts of the control group. A 48% increase in CD4 cells was demonstrated over the six month duration of the study for the adjusted group.

Mongrel

27th November 2007, 12:23 AM

I have been away a few days and was surprised no one was skeptical about your claim that 80% of medicine is evidence based.

1) Well, a well supported and evidence based paper has been written about this very subject... There's a summary here (http://www.theness.com/neurologicablog/index.php?p=51) (with a link to the paper)

2) Even if what you were hinting at were true, it still wouldn't validate chiropractic therapy.

richard

27th November 2007, 01:37 AM

1) Well, a well supported and evidence based paper has been written about this very subject... There's a summary here (http://www.theness.com/neurologicablog/index.php?p=51) (with a link to the paper)

2) Even if what you were hinting at were true, it still wouldn't validate chiropractic therapy.

Of course not, there is much more evidence supporting the efficacy of medical interventions, however 80%???? I was hoping the sketics among you would have a go at pulling that apart.

Being a skeptic is why I became a chiropractor and why I refuse to make exagerated claims about its efficacy, every client is different, I never know if chiropractic will help somone, but it usually does.

I do find it odd you all seem to be skeptical about anything unconventional and very accepting of everything biomedical, perhaps I have missed the threads on medical skepticism on the site.

richard

27th November 2007, 02:10 AM

Irrelevant.

Also, as previously requested, would you please provide answers to the following questions already posed by John Jackson in post #48:

What is Innate Intelligence?
What is a subluxation?
How are subluxations detected?
Can a single patient’s subluxation be reliably found by more than one Chiropractor?
Can subluxations be seen on x-rays?
How do subluxations cause bed-wetting in children and how does spinal manipulation cure this?
How does manipulating the spine of a child with ADHD cause an improvement in behaviour?
Do you recommend vaccinations? If not, why not? Please include the safety data which justifies administering chiropractic treatment to infants and children under 12.

Thank you.

What is Innate Intelligence? I call it homeostasis. It is the term chiropractors used in the early days to describe homeostasis, ie the body’s ability to heal and self regulate. Various stressors can interfere with homeostasis. Many chiropractors still use the term “innate intelligence” because it is easier for lay people to understand.

What is a subluxation? A theoretical model of vertebral motion segment dysfunction, that incorporates the complex interactions (homeostasis / innate), of pathologic changes in nerve, muscle, ligamentous vascular and connective tissues that affects adaptability to physical, chemical and emotional stresses and compromises general wellbeing.

How are subluxations detected? I detect the mechanical component with motion palpation. There are a number of other techniques and methods used for assessing subluxation spinal dysfunction.

Can a single patient’s subluxation be reliably found by more than one Chiropractor? Some chiropractors are obviously going to be better than others. I was tested for someone’s study when I was a college and was found to be very good at it. My son is a professional tennis player, there are a few hundred players better than him and he is better than millions of players. Some people are always going to be better than others, when what you do is an art dependent on a high level of skill.

Can subluxations be seen on x-rays? If the subluxation (partial dislocation) is a result of a large displacement between the articulating surfaces of the spinal joints the answer is yes, however that subluxation would be a contraindication for a chiropractic adjustment.

How do subluxations cause bed-wetting in children and how does spinal manipulation cure this? Subluxations do not cause bed wetting. The brain maintains the tonic drive on the motor neurons that innervate the skeletal muscle of the external sphincter of the bladder. Increase urine in the bladder will activate stretch receptors in the bladder wall and excite parsympathetic inervation of the bladder activating a positive feedback loop to keep the sphincter closed, when this mechanism does not work properly children wet their beds. Give someone a fright and stimulate the sympathetic component of the aunonomic nervous system and they might wet them selves.Could spinal dysfunction affect the nerves involved in thess process, absolutely.

Could a chiropractic adjustment affect this condition, there is anecdotal evidence of it. I have helped a few kids and made no difference with others. I would not advertise this as a service offered at my practice, nor would the GCC allow me to do so. However if a parent asked me to try and help, I would. That approach is not out of line with the guidlines laid down by Sackett for evidence based practice.

How does manipulating the spine of a child with ADHD cause an improvement in behavior? Again I have seen anecdotal evidence, however not experienced it with any patients. For example you see someone nodding off on a train, their head tips forward stretching mechano receptors in the posterior neck which fire up to the periacqueductal grey matter, which in turn stimulating various brain centers and the person becomes alert for a while, until the same thing happens again. If one was looking at ADHD type of behavior that might be the type of mechanism one would use to explain a positive outcome. You might be looking to inhibit excessive stimulation of this region of the brain stem caused by spinal dysfunction. Personally I dont like to put these kind of labels on children, if children are behaving like this, I believe it is more to do with their life style.

Do you recommend vaccinations? If not, why not? Why would I recommend vaccinations, or any kind of drug, I am not a medical doctor and for me to to do so would amount to quackery. Parents of new borns are always given their red books with their vaccination appointments,they dont need me to remind them. However the skeptic in me wondered about this as I had seen little evidence demonstrating that vaccinated children were healthier and we decided against it. If you have seen evidence, I could be persuaded otherwise. Are vaccinated children healthier?
A study in Thorax 2002 showed children who have had measles were less likely to develop asthma, not proof but might ring a few bells in a real skeptics mind. There is no doubt vaccination reduces morbidity of child hood infections, however a study by Gilham et al published in the BMJ in 2005 http://www.bmj.com/cgi/content/abridged/330/7503/1294?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=day+care+and+leukaemia&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT (http://www.bmj.com/cgi/content/abridged/330/7503/1294?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=day+care+and+leukaemia&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT) supported the hypothesis that reduced exposure to infection in the first few months of life increases the risk of developing acute lymphoblastic leukaemia. None of my kids have ever had so much as a spoon full of Calpol, they have all had Whooping cough, Chicken Pox and possibly mumps with no complications. They were no danger to other kids because these other children were protected by their vacccination, however my kids can eat nuts and Kiwi fruits and have no allergies so what kind of advice should I offer. I wonder if there is a connection?
It would be wrong of me to advise patients on the basis of my personal experience anyway the GCC would not allow chiropractors to advise patients on vaccination. However there is a pretty good Skeptical website on the subject that comes up number one if you do a google uk search for vaccination.
Please include the safety data which justifies administering chiropractic treatment to infants and children under 12.

I was not aware that there was evidence of a significant risk from chiropractic at any age. All you have presented is anecdotal evidence of a risk. Then you want to put the Spine study in room 101, because you believe there is a risk and this study was unable to find one, get over it.

No doubt Chirobase and Quack Watch have evidence of chiropractors making all sorts of claims, however you wont find that in the UK. "Small misalignments" is not "bone out of place pressing on nerve" from 1895 but believe what you will. I don’t expect you to be remotely satisfied by my answers, but knowing that Cuddles thinks that every time I post I look like a “stupid idiot” amuses me.

Blue Wode we will just have to agree to disagree on this my friend. I am unable to devote much more time to this and as none of you seem to know much neurology we cant really have much of a skeptical discussion about subluxation theory.

Hasta la Victoria Siempre

JJM

27th November 2007, 08:54 AM

Unfortunately only have abstracts to inform you of the scientific studies regarding the benefits of chiropractic and immune function. Just three for starters.

{snip}

2. J Manipulative Physiol Ther 2000 (Feb); 23 (2): 104–106 (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10714536&query_hl=8)
BACKGROUND: The collective experience of the chiropractic profession is that aberrant stimulation at a particular level of the spine may elicit a segmentally organized response, which may manifest itself in dysfunction within organs receiving autonomic innervation at that level. This experience is at odds with classic views of neuroscientists about the potential for somatic stimulation of spinal structures to affect visceral function.
OBJECTIVE: To review recent findings from basic physiologic research about the effects of somatic stimulation of spinal structures on autonomic nervous system activity and the function of dependent organs.
DATA SOURCE: Findings were drawn from a major recent review of the literature on the influences of somatic stimulation on autonomic function and from recent original physiologic studies concerning somatoautonomic and spinovisceral reflexes.
CONCLUSIONS: Recent neuroscience research supports a neurophysiologic rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function.

{snip}I have already explained that chiro magazines are not reliable sources. Normally I do not waste time with them. However, let's look at this; which you seem to think is important:

The collective experience of the chiropractic profession isirrelevant. The collective experience of the medieval medical profession brought us purgatives and bloodletting. Medicine did not advance till we acknowledged "experience" could be wrong.

To review recent findings from basic physiologic researchThis is only notional, we have been asking for clinical support.

... may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function.[Emphasis added] George W Bush may come here and paint my house as an act of charity. "Maybe this" and "maybe that" have been the stuff of chiro rationalization from the beginning. Nothing has been substantiated.

On a positive note, at least this isn't about a jaw-clench reflex after someone taps on a tooth.

JJM

27th November 2007, 09:07 AM

{snip} Being a skeptic is why I became a chiropractor {snip}.I dare say you are a contrarian. A skeptic looks for evidence, and acknowledges when s/he cannot evaluate it. There is no reliable evidence for chiro, yet you imagine there is. I say this because you claim there is evidence; but you have not produced it (just some spurious citations and conjecture).

I do find it odd you all seem to be skeptical about anything unconventional and very accepting of everything biomedical {snip}Conversely, you are cynical of the conventional, and accepting of the unsupported. The difference is, we have studied the topics and are able to discriminate sense and nonsense. You have shown, by your attempts to support chiro, that you cannot.

JJM

27th November 2007, 09:35 AM

What is Innate Intelligence?

I call it homeostasis. {snip}Great, pick an example of homeostasis (e.g., body temperature, blood pH) and cite the literature that shows how chiro affects it.

What is a subluxation?

A theoretical model {snip}In other words, nothing real.

{snip}Can a single patient’s subluxation be reliably found by more than one Chiropractor?

Some chiropractors are obviously going to be better than others. {snip}In other words, "no."

{snip} How do subluxations cause bed-wetting in children and how does spinal manipulation cure this?

Subluxations do not cause bed wetting. {snip} [of course, JJM]

... there is anecdotal evidence of it. {snip}However, you would like to believe otherwise.

How does manipulating the spine of a child with ADHD cause an improvement in behavior?

Again I have seen anecdotal evidence, {snip}That would be "it does not."

{snip} Please include the safety data which justifies administering chiropractic treatment to infants and children under 12.

I was not aware that there was evidence of a significant risk from chiropractic at any age. {snip}Of course.

"Adverse Events Associated With Pediatric Spinal Manipulation"
http://www.pediatrics.org/cgi/content/full/119/1/e275

richard

27th November 2007, 10:18 AM

I have already explained that chiro magazines are not reliable sources. Normally I do not waste time with them.

JJM prefers reliable evidence from 1962.
http://www.chirobase.org/02Research/crelin.html >:D 1-0

richard

27th November 2007, 10:39 AM

Great, pick an example of homeostasis (e.g., body temperature, blood pH) and cite the literature that shows how chiro affects it.

In other words, nothing real.

In other words, "no."

However, you would like to believe otherwise.

That would be "it does not."

Of course.

"Adverse Events Associated With Pediatric Spinal Manipulation"
http://www.pediatrics.org/cgi/content/full/119/1/e275

You do like to "snip" bits out of my postings and take words to support your beliefs, deal with my answers in their entirity if you can, however to that you need an understanding of neurology and the teachings of David Sackettand evidence based practice. Five years full time at the Anglo European College of Chiropractic might help.

If you had bothered to read the Paed's study,you would know it is not about chiropractic it is about Spinal Manipulative Therapy which your skeptic fact sheet states is not the same as chiropractic. However the conclusion of the review of a few case studies (anecdotes) are;

CONCLUSIONS. Serious adverse events may be associated with pediatric spinal manipulation; neither causation nor incidence rates can be inferred from observational data. Conduct of a prospective population-based active surveillance study is required to properly assess the possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients.

That is not evidence of a "significant risk" sorry, I dont know where you studied chiropractic as you have claimed but it can't have been a very good school.

I am left to conclude JJM you are not a true skeptic, a nonbeliever, who refuses to jump to conclusions based on inconclusive evidence. You are a disbeliever, characterized by an a priori belief that a certain idea, chiropractic in this case is wrong and will not be swayed by any amount of empirical evidence to the contrary. Since disbelievers usually fancy themselves skeptics, they are called pseudoskeptics, and their opinions pseudoskepticism. http://en.wikipedia.org/wiki/Pseudoskepticism >:D 2-0

Hasta La Victoria Siempre.

Matt

27th November 2007, 10:39 AM

JJM prefers reliable evidence from 1962.
http://www.chirobase.org/02Research/crelin.html >:D 1-0

What is the half life for reliability?

Mongrel

27th November 2007, 11:13 AM

Of course not, there is much more evidence supporting the efficacy of medical interventions, however 80%???? I was hoping the sketics among you would have a go at pulling that apart.

Being a skeptic is why I became a chiropractor and why I refuse to make exagerated claims about its efficacy, every client is different, I never know if chiropractic will help somone, but it usually does.

I do find it odd you all seem to be skeptical about anything unconventional and very accepting of everything biomedical, perhaps I have missed the threads on medical skepticism on the site.

So which bit of the paper caused you to doubt the 80% figure?

Blue Wode

27th November 2007, 12:49 PM

Posted by Richard (#13 8) [ETA: One, three, eight]

Being a skeptic is why I became a chiropractor and why I refuse to make exagerated claims about its efficacy, every client is different, I never know if chiropractic will help somone, but it usually does.

Richard, would you to please respond to my question about the GCC’s 9th November 2007 press statement concerning the Lancet study in which it claimed:

"The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared. Chiropractic intervention is safe, effective and cost-effective in reducing referral to secondary care."

http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf (http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf)

Bearing in mind that chiropractors in the UK are required by law to provide care that is evidence based, would you:

1. Please cite the scientific evidence to support the GCC’s claims that “The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatment to which they have been compared”.
2. Please cite the safety data for ‘chiropractic’.
3. Please cite the data for chiropractic’s effectiveness.
4. Please cite the data for chiropractic’s cost-effectiveness.

Posted by Richard (#139)

It would be wrong of me to advise patients on the basis of my personal experience anyway the GCC would not allow chiropractors to advise patients on vaccination. However there is a pretty good Skeptical website on the subject that comes up number one if you do a google uk search for vaccination.

Is this http://www.vaccination.co.uk (http://www.vaccination.co.uk/) the site?

If so, why do you think that it’s “pretty good”?

Posted by JJM (#142)

pick an example of homeostasis (e.g., body temperature, blood pH) and cite the literature that shows how chiro affects it.

Richard, would you please respond to JJM’s request.

Posted by Richard (#139)

I was not aware that there was evidence of a significant risk from chiropractic at any age
Posted by Richard (#144)

If you had bothered to read the Paed's study,you would know it is not about chiropractic it is about Spinal Manipulative Therapy which your skeptic fact sheet states is not the same as chiropractic. Here’s what the American National Council Against Health Fraud had to say about that study:

Adverse events associated with chiropractic care of children. A systematic review has identified 34 cases in which spinal manipulation in children was associated with adverse events. [Vohra S. Adverse events associated with pediatric spinal manipulation: A systematic review. Pediatrics 119(1) January 2007, pp. e275-e283] Fourteen of the cases involved "direct" events in which the treatment was followed by death, serious injury, symptoms requiring medical attention, or soreness. The rest involved "indirect" events in which appropriate diagnosis was delayed and/or inappropriate manipulation was done for serious medical conditions such as meningitis. The reviewers commented that despite the fact that spinal manipulation is widely used on children, pediatric safety data are virtually nonexistent. This type of review cannot determine how often adverse events occur. That would require a prospective study with active surveillance. The article did not consider harmful aspects of chiropractic care that are far more common than the reported events. These include (a) decreased use of immunization due to misinformation given to parents, (b) psychologic harm related to unnecessary treatment, (c) psychologic harm caused by exposure to false chiropractic beliefs about "subluxations," and (d) financial harm due to unnecessary treatment.

http://www.ncahf.org/digest07/07-14.html (http://www.ncahf.org/digest07/07-14.html)

[My bold]

So when the GCC said in its 9th November 2007 press statement that “chiropractic intervention is safe”, what safety data was it using to support that claim with regard to chiropractic ‘paediatrics’?

nick

27th November 2007, 05:29 PM

In reply of your questions to my last post.

1. The following is taken from the JMPT website.
"Journal of Manipulative and Physiological Therapeutics (JMPT) is dedicated to the advancement of chiropractic health care. It provides the latest information on current developments in therapeutics, as well as reviews of clinically oriented research and practical information for use in clinical settings. The Journal's editorial board includes some of the world's leading clinical low-back and spine researchers from medicine, osteopathy, chiropractic, and post-secondary education. JMPT, the premier biomedical publication in the chiropractic profession, publishes peer-reviewed original articles, case reports, journal abstracts, commentary, and new media reviews. Readers include chiropractors, osteopaths, physical therapists, physiatrists, radiologists, and sports medicine specialists. The Journal of Manipulative and Physiological Therapeutics is the official journal of the American Chiropractic Association.
JMPT is the only chiropractic journal included in Index Medicus. It is also indexed/abstracted in Current Contents/Clinical Medicine and Index to Chiropractic Literature."

What is Index Medicus I here you cry. From Wikipedia.
"Index Medicus (IM) was a comprehensive index of medical journal articles, published between 1879 and 2004. It was initiated by Dr John Shaw Billings (http://en.wikipedia.org/wiki/John_Shaw_Billings), head of the Library of the Office of the Surgeon General, United States Army[1] (http://en.wikipedia.org/wiki/Index_Medicus#_note-0). Publication began in 1879, and it continued monthly through 1926, with a hiatus between 1899 and 1902[2] (http://en.wikipedia.org/wiki/Index_Medicus#_note-1). In 1927 it was amalgamated with the American Medical Association (http://en.wikipedia.org/wiki/American_Medical_Association)'s Quarterly Cumulative Index to Current Literature (QCICL) as the Quarterly Cumulative Index Medicus (QCIM). The AMA continued to publish it until 1959; from 1960 it was published by the National Library of Medicine under the name Index Medicus®/Cumulated Index Medicus (IM/CIM). The last issue of Index Medicus was published in December 2004 (Volume 45). Its place has been taken by the Medical Subject Headings (http://en.wikipedia.org/wiki/Medical_Subject_Headings) thesaurus (http://en.wikipedia.org/wiki/Thesaurus)[3] (http://en.wikipedia.org/wiki/Index_Medicus#_note-2)."

So I find your disregard quite arrogant.

2. Your second quote is only providing background information and is just scene setting and is not the crux of the articule. You cannot read the first page of a book and say it is rubbish.

3. This is a review of the current research and so is a valid research tool in itself.

4. The article does conclude saying "may" but it is using evidence gleaned from the reviewed research and applying logic and deductive reasoning to produce a working hypothesis . This may not match your criteria of research but this is the process the scientfic community uses along with other types of reasearch. I will provide more.

Blue Wode

27th November 2007, 07:11 PM

The Journal of Manipulative and Physiological Therapeutics is the official journal of the American Chiropractic Association.

…and interestingly, the American Chiropractic Association declares the following in the ‘What is chiropractic?’ section of its website:

The most common therapeutic procedure performed by doctors of chiropractic is known as “spinal manipulation,”

http://www.acatoday.com/level2_css.cfm?T1ID=13&T2ID=61&BT1ID=21&BT2ID=94 (http://www.acatoday.com/level2_css.cfm?T1ID=13&T2ID=61&BT1ID=21&BT2ID=94)

So, once again, here are the most up-to-date scientific data on spinal manipulation:

The value of chiropractic (2005)

Virtually all experts agree that the best available evidence in any area of health care is that provided by Cochrane reviews. The Cochrane Collaboration is a worldwide network of independent scientists dedicated to systematically summarising the totality of the evidence related to specific medical subjects in a rigorous and transparently impartial fashion. Four Cochrane reviews of spinal manipulation are available today.

Back pain is by far the condition most frequently treated by chiropractors. The Cochrane review of spinal manipulation for back pain summarised 39 clinical trials.1 (http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm#fact1002a02t01b0001) The authors’ conclusions were very clear: ‘There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.’

Continues…

http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm (http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm)

A systematic review of systematic reviews of spinal manipulation (2006)

CONCLUSIONS: Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.

http://www.jrsm.org/cgi/content/abstract/99/4/192 (http://www.jrsm.org/cgi/content/abstract/99/4/192)

Adverse events associated with chiropractic care of children (2007) A systematic review has identified 34 cases in which spinal manipulation in children was associated with adverse events. [Vohra S. Adverse events associated with pediatric spinal manipulation: A systematic review. Pediatrics 119(1) January 2007, pp. e275-e283]
http://www.pediatrics.org/cgi/content/full/119/1/e275 (http://www.pediatrics.org/cgi/content/full/119/1/e275)

Fourteen of the cases involved "direct" events in which the treatment was followed by death, serious injury, symptoms requiring medical attention, or soreness. The rest involved "indirect" events in which appropriate diagnosis was delayed and/or inappropriate manipulation was done for serious medical conditions such as meningitis. The reviewers commented that despite the fact that spinal manipulation is widely used on children, pediatric safety data are virtually nonexistent. This type of review cannot determine how often adverse events occur. That would require a prospective study with active surveillance. The article did not consider harmful aspects of chiropractic care that are far more common than the reported events. These include (a) decreased use of immunization due to misinformation given to parents, (b) psychologic harm related to unnecessary treatment, (c) psychologic harm caused by exposure to false chiropractic beliefs about "subluxations," and (d) financial harm due to unnecessary treatment.

http://www.ncahf.org/digest07/07-14.html (http://www.ncahf.org/digest07/07-14.html)

[My bold]

Adverse effects of spinal manipulation: a systematic review (2007)

CONCLUSIONS: Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.

http://www.jrsm.org/cgi/content/abstract/100/7/330 (http://www.jrsm.org/cgi/content/abstract/100/7/330)

Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial Hancock MJ et al; Lancet:370:1638-43 (2007)

Patients with acute low back pain receiving recommended first-line care do not recover more quickly with the addition of diclofenac or spinal manipulative therapy.

-snip-

The spinal manipulative therapy given in this trial included a range of low-velocity mobilisation and high-velocity manipulation techniques done by physiotherapists with postgraduate training in manipulative therapy. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal mobilisation is more effective than low-velocity spinal manipulation, or that the profession of the manipulator affects the effectiveness of treatment.

http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf (http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf)

And regards 'innate intelligence' and ‘subluxations’ …

(From 2007)

Spinal manipulation is a form of treatment that is used occasionally by some doctors, physiotherapists and osteopaths – but, for chiropractors, it is the hallmark intervention. The birth of this branch of healthcare can be dated to 18 September 1895. On this day DD Palmer, a magnetic healer and the founder of chiropractic, manipulated the neck of a deaf man whose hearing was subsequently restored. His second patient was a man with heart problems whose symptoms also improved with spinal manipulation. This history is important: the early chiropractic literature provides ample evidence for the fact that chiropractic was not originally meant as a treatment for musculoskeletal problems, but as a cure for any human condition [1] (http://javascript:popRef2('ref-1')).

To understand this seemingly bizarre claim a little better, one should glance at the concepts that underlie chiropractic. Palmer was convinced that he had discovered a law of nature. In his view, all human illness and disease were caused by the blockage of the 'innate intelligence’ through vertebral malalignments or subluxations. Therefore, all conditions could and should be treated with adjustments of these abnormalities, in other words, spinal manipulation. This would restore the flow of the innate intelligence and, in turn, would cure whatever condition the patient was suffering from [1] (http://javascript:popRef2('ref-1')).

It seems obvious to any critical evaluator that these concepts are little more than fantasy: there is no evidence for any innate intelligence, and there is no reason to assume that adjusting malalignments of vertebra (if they at all exist) are the cause of disease or illness.

Spinal manipulation: are the benefits worth the risks?
E. Ernst, Expert Review of Neurotherapeutics, November 2007, Vol. 7, No. 11, Pages 1451-1452
http://www.future-drugs.com/doi/abs/10.1586/14737175.7.11.1451 (http://www.future-drugs.com/doi/abs/10.1586/14737175.7.11.1451)

[My bold]

Richard, Raph, and Nick, I still think that it looks like you, and your profession, are going to have to eventually face up to what JJM said in post #73:

It is [equally] important to note that there is no evidence that chiro treatments are more effective than safer treatments. Therefore, the risk/benefit ratio is an unacceptably large number (division by zero).

JJM

27th November 2007, 09:35 PM

{snip} So I find your disregard quite arrogant.I like the sound of that. "Arrogant," I might have to start wearing a cravat.

The general rule is that magazines written by and for quacks are peer-reviewed by quacks. Hence, they are not worth noticing. Let's face it, if a chiro ever did a proper study and got an exciting result- why publish in a quack magazine? Why not aspire to convince the medical world?

2. Your second quote is only providing background information and is just scene setting and is not the crux of the articule. You cannot read the first page of a book and say it is rubbish.I hope you will learn "quote management" as it is not obvious what you mean. Sometimes one can read the first page of a book and realize it is rubbish, can't you?

3. This is a review of the current research and so is a valid research tool in itself.[bold added] What is "This" (see above about quote management). Are you referring to clinical studies of chiro? If not, it is irrelevant to the value of chiro.

4. The article does conclude saying "may" but it is using evidence gleaned from the reviewed research and applying logic and deductive reasoning to produce a working hypothesis . This may not match your criteria of research but this is the process the scientfic community uses along with other types of reasearch. I will provide more.You are about 40 years late to lecture me on the scientific method.

If chiro is struggling to produce a working hypothesis after 112 years, you must be doing something wrong (you are).

By all means, provide more; just make sure it is high-quality, clinical data (not speculation).

richard

27th November 2007, 10:51 PM

I like the sound of that. "Arrogant," I might have to start wearing a cravat.

The general rule is that magazines written by and for quacks are peer-reviewed by quacks. Hence, they are not worth noticing. Let's face it, if a chiro ever did a proper study and got an exciting result- why publish in a quack magazine? Why not aspire to convince the medical world?

By all means, provide more; just make sure it is high-quality, clinical data (not speculation).

What was wrong with Spine Journal again or Gorden Wadell. Have we been here before? Many times, you are not interested in anything that does not agree with your beliefs,fair enough.

Come on admit it JJM and Blue Wode you are dissbelievers not true skeptics. >:D

JJM

27th November 2007, 11:10 PM

What was wrong with Spine Journal again or Gorden Wadell. {snip}What?

Come on admit it JJM and Blue Wode you are dissbelievers not true skeptics. >:DIn 112 years, nobody has ever provided reliable, clinical evidence in favor of chiropractic. What do you expect me to believe?

Belief is all a person can have in the absence of evidence. After 112 years, the "absence of evidence" may be taken as "evidence of absence" of proof in favor of chiro. You have not helped, with your feeble attempts at proof.

Think how exciting it would be if you were to present the first incontrovertible, clinical evidence in favor of chiro.

Admin

27th November 2007, 11:46 PM

Come on admit it JJM and Blue Wode you are dissbelievers not true skeptics. >:D

::)

You chiropractors have been given a fair crack of the whip here and plenty of opportunity to provide evidence that what you practise has some evidence to back it up both for skeptics and for those who are reading out of interest.

We've generally been met with two tactics:

1) Obfuscation.

It's notable that chiropractors, when asked for supporting evidence of their claims, resort to quoting studies that have nothing to do with chiropractic's claims. It's no good quoting, as Nick did, a paper because what they are investigating sounds like what some chiropractors might describe as a subluxation!

Let's have the evidence, the clinical studies, showing what subluxations are, how they can be detected, which subluxations cause which particular problems, and how they are put right.

Fair enough, the skeptics here have you over a barrel because we know (and so so you) that no such evidence exists (!)

2) Ad Hominem points, insults and ridicule.

A constant theme with the chiropractors is that instead of dealing with the topic in hand (providing evidence etc.) they spend a lot of their time trying to discredit their opponents in any way they can.

Resorting to ridicule and making desperate attempts to belittle skeptics merely shows that the chiropractors cannot defend their practise and so resort to the fallacy of: don't like the message? Then shoot the messenger.

This is the tactic used by those who know they can't defend their position. If you had evidence to support you, you'd use it. ;)

I think the important thing for people to understand with chiropractic is that:
it a system of alternative medicine (they're not doctors);
None of its basic tenets, particularly the 'subluxation', have ever been proven;
Although they have an image as being 'back doctors' that is not what they are. Yes, they may well treat backs, but they treat backs not just for the likes of road traffic accidents, they manipulate spines for everything;
They use Spinal Manipulation Therapy (which is not chiropractic) for lower back problems, and although this has been supported with evidence in the past, new evidence is emerging that it is not as useful as once thought nor is it better than other conventional treatments;
Their neck manipulation can cause strokes in their patients. Although chiropractors deny it, this is known to be true and, if anything, an even more serious problem than is recognised because of under-reporting of the problem;
They also tend to be into other forms of quackery such as 'applied kinesiology' (muscle testing) to diagnose food allergies etc. and then they sell you the supplements;
They also tend to be vehemently anti-vaccination proponents. This, like most everything else they do, goes against science, evidence, and government medical policy.They want to treat you, and your children. Everything and anything that goes wrong with anyone in your family will be treated with spinal manipulation - even babies and children (who may well be X-rayed in the search for imaginary subluxations).

OK, they're offering a placebo treatment like many other alternative medicine practitioners, but as they do not offer real cures for anything, is it worth the using this form of treatment when the risks are so potentially high?

Unfortunately chiropractic is legal, so it's a case of Caveat Emptor!

Admin

28th November 2007, 08:23 AM

Here's professor Edzard Ernst's paper weighing up the benefits and risks of spinal manipulation:

http://www.ukskeptics.com/documents/spinal_manipulation_benefits_risks.pdf (http://www.ukskeptics.com/forum/../documents/spinal_manipulation_benefits_risks.pdf)

Prof. Ernst is one of the very few people in the world who is assessing alternative medicines and applying scientific rigour to them.

This is exactly the sort of testing that skeptics have been crying out for for years. Let's apply the scientific method to the claims of alternative medicines and find out once and for all which things work and which ones don't.

Ernst does find that some things work (various herbs for example) but one thing that doesn't fare at all well is Chiropractic.

Giddy

28th November 2007, 03:59 PM

Hello to you all. I have just recently be shown this forum by my wife and thought I'd like to take part in your discussions. My avatar probably gives away the fact that I am a practising chiropractor.

I have been involved in the profession for 21 years now after starting my chiropractic degree in Melbourne Australia (5 years human medical sciences).

I now currently work in Sunderland and if you are interested in commenting on my web site you can visit it at www.sunderland-chiropractic.co.uk (http://www.sunderland-chiropractic.co.uk) It has been set up to give prospective clients a chance to investigate us in advance.

The questions and challenges to provide proof of the scientific validity of chiropractic in this forum are not surprising for me. I have been asking them myself constantly over my years of work.

Hopefully I'll be able to put my opinion out there and develop a dialog that examines the strengths and weakness of my profession.

Blue Wode

28th November 2007, 04:47 PM

Hello Giddy, welcome to the UKS forum, and thank you for inviting us to view your website.

The questions and challenges to provide proof of the scientific validity of chiropractic in this forum are not surprising for me. I have been asking them myself constantly over my years of work.

Hopefully I'll be able to put my opinion out there and develop a dialog that examines the strengths and weakness of my profession.

Perhaps, for starters, you could answer the following questions:

The General Chiropractic Council (GCC) claimed in its 9th November 2007 press statement regarding the Hancock study that:

"The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared. Chiropractic intervention is safe, effective and cost-effective in reducing referral to secondary care."

http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf (http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf)

Bearing in mind that chiropractors in the UK are required by law to provide care that is evidence based, would you:

1. Please cite the scientific evidence to support the GCC’s claim that “The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared”.
2. Please cite the current safety data for ‘chiropractic’ including those for ‘chiropractic paediatrics’.
3. Please cite the current scientific evidence for chiropractic’s effectiveness.
4. Please cite the current scientific evidence for chiropractic’s cost-effectiveness.

Thank you.

Raph78

28th November 2007, 05:05 PM

seren

28th November 2007, 08:47 PM

If you don't mind me sticking ma sticky beak in, I've been following this thread for a while now. I'm a layperson, having no medical or scientific qualifications. I could, however, well be/have been a patient of a chiro, and as such I feel qualified to comment. I hope Raph78 that you will agree with me!

Until recently I had no idea chiropractic was a sham. Really. I just assumed because it was so common and you hear such a lot about it that it was legitimate. Therefore I was rather skeptical of skeptic's claims to the contrary when I first heard them.

This thread has totally changed my mind.

Raph, I would like to take your last post as an example of why, I hope you don't mind.

You have linked to a short paper whose purpose is to refute the study done by Ernst that John linked to. But Raph, that doesn't help me.
Firstly, it does nothing to prove that chiropractic is real. In other words:
It says nothing about the validity of chiropractic.
It's not a study of the efficacy of chiropractic.
It is not evidence that chiropractic works.
Secondly, it was written by a qualified chiropractor and published in chiro journal! It's completely and utterly biased. Of course he's going to disagree with someone who doesn't find in favour of his profession. Why should I listen to him?

That kind of thing just doesn't help the case for chiropractic. It just prolongs the debate while people have to say everything I just said and ask again for evidence showing that chiropractic actually works.

I thought we were going to get somewhere with Nick's MM Panjabi article, until that turned out to be not about chiropractic, and only supposition in any case.

I was confident that someone would be able to pitch up with a whole mound of good research that is:
1. Robust and scientific in approach
2. Unbiased (ie not written by chiropractors or for chiro journals)
3. Actually about chiropractic. One defining characteristic of the non-biased research we've been offered is its tangential nature. Not one has been an actual study of chiropractic.

After 112 years I can't believe you lot haven't come here and torn the place apart with sheaf after sheaf of proof that chiropractic has been researched and found to work.

I join Blue Wode in welcoming Giddy and hope that he will provide the evidence that's been so missing here. As I said, I'm a layperson but even I can see that nothing concrete has been provided yet. I urge you to answer Blue Wode's questions with good research and get this all cleared up for me, cuz I've got a sharp pain in my back needs looking at....;)

Blue Wode

28th November 2007, 08:51 PM

ernst's beliefs and resume about the safety and effectiveness of spinal manipulation have been well scrutinised and evaluated by bronfort et al http://www.chiroandosteo.com/content/pdf/1746-1340-14-14.pdf

his methodology has been described as poor and misleading relying on anecdotal evidence.

If you scroll down to the end of this link, you’ll see Ernst’s response to some of his critics regarding that systematic review:
http://www.osteopathy.org.uk/uploads/Letters_on_Ernst_and_Canters.pdf (http://www.osteopathy.org.uk/uploads/Letters_on_Ernst_and_Canters.pdf)
There’s a particularly interesting comment about Breen et al in Ernst’s final paragraph.

With regard to Ernst’s ‘adverse effects’ systematic review, you can see his very considered and revealing response summarised here:
http://forums.randi.org/showpost.php?p=3018741&postcount=76 (http://forums.randi.org/showpost.php?p=3018741&postcount=76)

your cited enst paper, john, is not the gold standard when it comes to the safety and effectiveness of spinal manipulation. he just quotes himself - not good evidence at all.

So what ‘good’ scientific evidence can you provide for the safety and effectiveness of spinal manipulation?

read the prospective national survey by thiel et al from 2007 http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17906581&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

they have estimated that there are 4.000.000 neck manipulations in the uk alone each year. if it was causing stroke: where are the case reports in the literature describing this phenomenon in the uk? and wheres the evidence establishing cause and effect for the stroke claim?

a bit of soreness for a day after a musculoskeletal treatment is likely all you may have to endure.

But can it be taken seriously? As previously posted, Chirotalk, the skeptical chiropractic discussion forum (operated by a chiropractor, and moderated be several) has left the abstract of the study in its ‘humor’ section under the title “Silly chiropractic research”:
http://chirotalk.proboards3.com/index.cgi?board=humor&action=display&thread=119413 7405 (http://chirotalk.proboards3.com/index.cgi?board=humor&action=display&thread=1194137405)

As you’ll see from post #69, several instances have been cited where chiropractic was the cause of a serious adverse event:
http://www.skeptics.org.uk/forum/showpost.php?p=24456&postcount=69 (http://www.skeptics.org.uk/forum/showpost.php?p=24456&postcount=69)
That post also posed a very pertinent question about the Thiel and Bolton study which, so far, hasn’t been answered by any of the chiropractors posting to this thread.

you may all read this (http://www.gcc-uk.org/files/page_file/Letter%20PCC%2020Nov07%20%28Website%29.pdf) to inform yourselves abit more. this, after all was what got the discussion started. the hancock study was just proving that physio-manipulation does not work.

The General Chiropractic Council’s formal complaint to the Press Complaints Commission has already been thoroughly examined in post #125, and, once again, several questions about it remain unanswered:
http://www.skeptics.org.uk/forum/showpost.php?p=24870&postcount=125 (http://www.skeptics.org.uk/forum/showpost.php?p=24870&postcount=125)

MischiefMonkey

28th November 2007, 11:49 PM

I thought I understood Chiropractic but I am now totally confused.

I thought it only dealt with back pain, an alternative or complement to physiotherapy. But bed wetting and vaccine advice?

I have back problems and to refer to the original post & the report it referenced I have to say I am more concerned that diclofenic has been shown not to have a beneficial effect.

Giddy, I had a good look at your web site. You reference research that, to me a lay person, seems to at best equate some chiropractic practices with physio but mostly dismiss chiropractic interventions. As physio is free on the NHS and has been shown to be as effective or more effective, why should anyone (in the UK) pay for Chiro treatment?

nick

29th November 2007, 12:28 AM

Good evening

Just a little thought, do the skeptics out there have the same issues with osteopathy or physiotherapy as they so clearly do with chiropractic?

Similarly are you not skeptical about all the estimated 75 000 artifical chemicals that we are exposed to each day and the various drug interactions that take place that no one really knows whats happening with. (see new scientist 1st Sept 2007 p44).

Does doubt not enter your minds when the four leading killer in the US in 1994 was medications (see journal of the american medical association 1998; 279 1200-1205)
http://youtube.com/watch?v=rHXXTCc-IVg

Are heads not scratched with all that unnecessary low back surgery.
http://www.newyorker.com/archive/2002/04/08/020408fa_FACT

Or is that ok?

Chiropractors like Richard, Ralph and myself may have a different set of philosophical beliefs to you but that does not mean that our belief system is wrong just different.

Sweat dreams

Admin

29th November 2007, 12:35 AM

Just a little thought, do the skeptics out there have the same issues with osteopathy or physiotherapy as they so clearly do with chiropractic?

Actually this was an issue I was thinking of raising. Particularly Osteopathy. Which as far as I can tell is just as wacky as Chiropractic but seems to get by without much critical appraisal.

I seem to remember wanting to appraise it but there's very little information on it at all!

Similarly are you not skeptical about all the estimated 75 000 artifical chemicals

I'd be more concerned if we were being exposed to chemicals that were harmful if we were exposed to a harmful dose. Whether they are artificial or not is irrelevant.

Sweat dreams

Same to you. ;D

Admin

29th November 2007, 12:48 AM

Until recently I had no idea chiropractic was a sham. Really. I just assumed because it was so common and you hear such a lot about it that it was legitimate.

I think that's true of most people.

That's why I highlighted the point about people thinking that they're 'back doctors'.

Fortunately with these crackpot ideas about health and healthcare (unlike with real medicine) a layperson can read the theory behind it and recognise it for the stupidity that it is.

Everything that we (UKS) say about Chiropractic theory is not just supported by people who think like we do (i.e. scientifically) but anyone can research the system of chiropractic put forward by D.D. Palmer himself and realise that we're only presenting the same theory that he did!

When it comes to alternative medicines, I always say to people: read their theories of how it's all supposed to work and see if you still believe it.

The theories behind things like Chiropractic are so inane that anyone with an ounce of rationalism in them will see them for the crazy ideas that they are.

JJM

29th November 2007, 09:22 AM

I thought I understood Chiropractic but I am now totally confused.

I thought it only dealt with back pain, an alternative or complement to physiotherapy. But bed wetting and vaccine advice?I do not know if chiros learn as much as physiotherapists. I do know chiros imagine they are qualified to diagnose (physios do not, they work with doctors who diagnose). As for bed-wetting, the chiros say they cannot treat it; but, they have anecdotes ... In other words, they refuse to make claims (which they know are unsupported); but they like to work as if the unspoken claims are legitimate.

{snip}

JJM

29th November 2007, 09:51 AM

{snip} Just a little thought, do the skeptics out there have the same issues with osteopathy or physiotherapy as they so clearly do with chiropractic? {snip}A little thought, indeed. This is irrelevant to your claims of efficacy; which claims we wait for you to assert and justify.

Chiropractors like Richard, Ralph and myself may have a different set of philosophical beliefs to you but that does not mean that our belief system is wrong just different. {snip}Beliefs are all you can have when you have no data. We have been asking you for data.

Some people believe that prayer can cure type-1 diabetes, they die. Some chiros believe they can cure epilepsy, they kill people. Are their belief systems wrong, or just different?

Your "belief system" is wrong. I can state that with confidence despite you dodging the question of what you think chiro treats successfully.

Chiro does not have any theoretical basis, it has an uneducated notional basis. I have read all about it. If you do not follow Palmer, you are not a chiro, and Palmer was wrong.

I look forward to your actual claims of efficacy, and the reliable, supporting evidence.

Blue Wode

29th November 2007, 11:04 AM

read the prospective national survey by thiel et al from 2007 http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17906581&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

they have estimated that there are 4.000.000 neck manipulations in the uk alone each year. if it was causing stroke: where are the case reports in the literature describing this phenomenon in the uk? and wheres the evidence establishing cause and effect for the stroke claim?

It’s worth mentioning in relation to the above that Ernst, in his July 2007 systematic review of Adverse Effects Associated With Spinal Manipulation (published in the JRSM), pointed out this:

...the adverse effects of NSAIDs are subject to post-marketing surveillance while those of spinal manipulation are not.

http://www.jrsm.org/cgi/content/full/100/7/330 (http://www.jrsm.org/cgi/content/full/100/7/330)

Although we have already been told on this thread that a post-marketing surveillance system is in the process of being set up by the chiropractic profession in the UK - despite the fact that chiropractic regulation came into force well over 6 years ago with its main duty being that of ‘protecting patients’ - I think we should be given the answers to the following:

Are patients themselves going to be able to report (i.e. independently) any complications they might experience during or following chiropractic treatment?
Is an independent (i.e. non-chiro) authority going to oversee the operation of the system (i.e. to prevent the suppression by chiropractors of any unfavourable reports)?
What sort of campaign does the profession intend to conduct to ensure that the public knows about the system once it is in place?Getting back to the OP of this thread, and the Hancock et al study which, just to refresh everyone’s memories, concluded the following…

Patients with acute low back pain receiving recommended first-line care do not recover more quickly with the addition of diclofenac or spinal manipulative therapy.

-snip-

The spinal manipulative therapy given in this trial included a range of low-velocity mobilisation and high-velocity manipulation techniques done by physiotherapists with postgraduate training in manipulative therapy. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal mobilisation is more effective than low-velocity spinal manipulation, or that the profession of the manipulator affects the effectiveness of treatment.

Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial Hancock MJ et al; Lancet:370:1638-43 (2007)

http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf (http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf)

…it's interesting to note that the following article published in the 15th November 2007 issue of American Family Physician made no mention of 'chiropractic' in its list of recommendations for the treatment of non-specific low back pain:

Nonspecific Low Back Pain and Return to Work
http://www.aafp.org/afp/20071115/1497.html (http://www.aafp.org/afp/20071115/1497.html)

As for spinal manipulation, it was mentioned once in a brief list of
“treatments for which evidence of effectiveness is unclear”.

Cuddles

29th November 2007, 11:14 AM

Similarly are you not skeptical about all the estimated 75 000 artifical chemicals that we are exposed to each day

Oh noes! Chemicals! Do you honestly expect anyone to take you seriously when you come out with crap like this?

Mind, you'd better watch out for that hydrogen hydroxide. It's one of the most common chemicals around, they pump it into our water supplies and it kills babies!11eleventyone!

vbloke

29th November 2007, 12:07 PM

Just a little thought, do the skeptics out there have the same issues with osteopathy or physiotherapy as they so clearly do with chiropractic?Yes we do - skeptics question everything that does not have sufficient evidence behind it.

Similarly are you not skeptical about all the estimated 75 000 artifical chemicals that we are exposed to each day and the various drug interactions that take place that no one really knows whats happening with. (see new scientist 1st Sept 2007 p44). I might be if you could let me know what the difference is between an artificial and natural chemical (chemically speaking that is).

Does doubt not enter your minds when the four leading killer in the US in 1994 was medications (see journal of the american medical association 1998; 279 1200-1205)Just because something is dangerous does not automatically make an alternative treatment safe.

Are heads not scratched with all that unnecessary low back surgery.It depends if it is elective or not, I suppose.

Chiropractors like Richard, Ralph and myself may have a different set of philosophical beliefs to you but that does not mean that our belief system is wrong just different. So, if all the available evidence points against a set of beliefs being wrong, it doesn't actually make those beliefs wrong, just different?

Giddy

29th November 2007, 01:10 PM

MischiefMonkey

29th November 2007, 01:30 PM

Giddy, I found this a bit disturbing

I haven't looked into chiropractic paediatrics although I have seen a few colicky babies and my own children with good results, but that's anecdotal isn't it.

As on your web site you clearly advertise your services at (IIRC) £10 a session for children (Under fives free if the parent is a patient).

If you haven't specifically looked in chiropractic paediatrics should you be working on children?

How does chiropractic help with colick?

What chiropractic interventions have you performed on your own children (I understand if you prefer not to answer that - I wouldn't discuss my children's health on a forum)

Blue Wode

29th November 2007, 02:39 PM

Blue Wode I'll do my best to back up the statements with research articles that I find. My web site has only been set up last week and I am still adding and editing it. You may notice that I have put in references and links to articles that are critical of chiropractic, and the debate concerning risks.

As Mischief points out it will cause confusion for the lay person who has not experienced chiropractic care but I feel it is important that my clients inform themselves before and during their care.

I don’t think lay people would be any more confused than they would be by the risks and benefits of treatment options conveyed to them by medical doctors.

Before I get into things I'd like to make a few observations and comments.

I consider myself to be logically orientated, critical thinking and of at least average intelligence. I don't easily accept dogmatic philosophy from any profession without investigation. To be referred to as a quack, crackpot or any other statement along those lines offends and disrespects me. If that's the goal well done. If you were wanting rational responses to your questions it seems strange to entice an emotional response. I'll be naive and assume you are just trying to stimulate an argument.

If you’re referring to me, I haven’t called anyone a quack or a quackpot.

The questions asking for research evidence to back up the subluxation, safety and cost effectiveness are relatively difficult to answer for several reasons.

1.If chiropractic journals and authors are considered to biased that will excluded close to 99% of all research done. Who else has been interested in doing research if not chiropractors. Assuming they are biased presumes that our professional ethical standards are low, the research is poor and geared towards self promotion.

Well, that's what it looks like.

2.Research is expensive. Who funds it has been suspected of leading to bias. Which to a degree validates the concerns above. Chiropractic researchers have been excluded from research grants for many years. Most is funded by personal donations to independant research foundations such as the Australian Spinal research Fund www.spinalresearch.com.au/ (http://www.spinalresearch.com.au/), and chiropractic colleges. Professor Ernst has pointed out that medical charities supply the whole of so called "complementary medicine" with just 0.05% of their funds toward further research. CAM research funding in the UK Complimentary Therapies in Medicine 2003 11:165-167. In 1996 that equated to £45 000 for all groups not just chiropractic.

I believe NCCAM in the USA has spent around $1 billion on CAM research and hasn’t really discovered anything worthwhile. Is research there any different to research here?

3. Chiropractic researchers are generally employed in the chiropractic colleges. The rest of us with family and business restrictions do not have access to the funds, facilities or support infrastructures as our more mainstream medical colleagues. I began a masters degree in Sunderland but found it difficult with family/business to get past literature review stage. It was a choice between bankruptcy or self funded research.

So why are chiropractors in the UK legally required to provide care that is evidence based when there’s hardly any good scientific evidence to support what they’re doing?

4. Therefore many papers are based on case studies because they are easier and cheaper to produce.

So are you saying that it’s acceptable to rely on case studies when they support chiropractic treatment, but when they suggest that serious complications (e.g. stroke) can result from it those studies can be dismissed?

5. The systematic reviews that have been done so far, I suspect have had limited studies to work with, and as such the statement no evidence of effect does not translate into not effective. Ongoing research will be needed and is being done, so we may all have to adapt our opinions in future.

After 112 years, and the NCCAM research budget, why are there only limited studies to work with?

Now to answer Blue Wode I don't think I can find "reviews" that "consistently" show chiropractic to be more effective.

Well, apparently your regulators know of them, so would you please ask them to provide them:

"The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared. Chiropractic intervention is safe, effective and cost-effective in reducing referral to secondary care."

http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf (http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf)

I can point you to studies such as the UK Beam trial which I am sure you already have that supported chiropractic compared to hospital physio.

A follow up of the Beam trial looked at cost effectiveness and came to the conclusion that chiropractic was also more cost effective.

Regarding the BEAM trial, have you read post #77 about it (and the Meade study)? If not, I think you should:
http://www.skeptics.org.uk/forum/showpost.php?p=24476&postcount=77 (http://www.skeptics.org.uk/forum/showpost.php?p=24476&postcount=77)

Canter,Coon and Ernst 2005 found "manipulation" to be the exception in their asssesment of cost effectiveness of complementary medicine, although they found that chiropractic and osteopathy were more expensive than hospital based care. So who knows?

Once again, here are the study’s findings:

Prospective, controlled, cost-effectiveness studies of complementary therapies have been carried out in the UK only for spinal manipulation (four studies) and acupuncture (two studies). The limited data available indicate that the use of these therapies usually represents an additional cost to conventional treatment.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17173105 (http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17173105)

I haven't looked into chiropractic paediatrics although I have seen a few colicky babies and my own children with good results, but that's anecdotal isn't it.

Yes.

Am I right in assuming that there is a fear that chiropractic may be funded by the NHS? I don't think it should be. The NHS/Government/Tax payer shouldn't be responsible for optional care. If a patient cannot afford chiropractic care they can see an NHS physio or GP.

As far as I can see, those that can afford chiropractic care are at risk of being given copious amounts of misinformation designed primarily to keep chiropractors in business.

For the lay person this may seem a strange point but it is the same as shopping at ASDA, for the economy of size, or the local green grocer. The cost of providing services are different, and the type of service is different. I'm not relying on a government pension for my retirement so why would I solely rely on government health care as my only health care option.

Don’t most people like to know exactly what it is they’re getting for their money?

Clinical experience, and researching the medical literature concerned with biomechanics, neurology, immunology, leave me in no doubt that manipulative care (from my perspective the chiropractic adjustment) is effective and has plausible mechanisms that can and will be assessed.

Irrelevant. After 112 years we want the data.

The fact that a relatively small profession (under 2000?) has such imfamy is frustrating for those of us who want to take it forward. I believe that the hang ups from 1970's US AMA policies are partially to blame and have damaged relationships and dialog ever since. The mistrust on both side will and has created an environment where individuals attracted to chiropractic, as clinical care or as professionals, will be anti-establishment and make their decisions based on personal experience and referral.

Unfortunately, I think you’re right. Increasingly, many people seem to be making health decisions based on anecdotes and testimonials rather than evidence. I think the answer lies in education, but only after something has been done to stop the spread of health misinformation.

So calling me a quack may seem like good sport, and we are a pretty easy target, but it will not get the best minds in my profession engaging in your debates. In fact it may in future smack of discrimination based on profession, or just plain old bullying.

I haven’t called you a quack, and as for your profession being an “easy target”, it looks like you only have yourselves to blame for that.

Perhaps your profession’s “best minds” should avail themselves to public debate.

Giddy

29th November 2007, 03:05 PM

Hi Mischief. I have been trained to examine and adjust children in my undergraduate degree and have done so my entire career. Primarily checking crrent clients children and occassionally helping parents seeking help with their child directly.

What I mean't was I haven't actually fully investigated the research. There have been some done with colic and I have participated in professional workshops and seminars that focus on care for children. So i not just winging it.

I suspect that the upper cervical spine is involved with colic. The anatomical arangement of the cervical spine in the infant is different to an adult, things are more condensed. The vagus nerve with its gastric function may be irritated by or cause post occipital muscle spasm, gastric pain and motility, the glossopharyngeal nerve irritation may lead to suckling weakness and air swallowing and mid cervical spine structures such as the scalene muscle may irritate the phrenic nerve. Gentle adjustments to the spine, usually only involving the tip of the practitioners finger and pressure seems to reduce the subocciptal spasm and reflexly the colic. I don't think it would work in all cases but it seems to help pretty consistently.

I had a client last year whose baby was crying so much it was under weight and dehydrated at 6 months. It had 6 months of colic. With 4 sessions it cleared and we had happy parents and baby. i think you'd have a hard time convincing that mum the adjustment didn't have an effect. She had been through the system to the pediatrician and was offered calpol and suggestion she was an anxious mum. Who wouldn't be with no sleep.

I check my own children every few months. They are 4 and 2 and do all sorts of daft things. The 2 year old has cartwheeled down the stairs of several occasions. The gentle adjustment are really precautionary stretches. They were quite good for encouraging bowel function at 1 -2 weeks and neck tension and irritability with teething.

A recent paper produced by Professor Jim Deuchars from Leeds suggested a plausible neurological mechanism for changes in blood pressure when neck structures are moved. The gastric effects are probably very closely related.

Hope that helps

seren

29th November 2007, 03:29 PM

I had a client last year whose baby was crying so much it was under weight and dehydrated at 6 months. It had 6 months of colic.

My word! Colic doesn't usually last that long. If it's been longer than 3 months I'd think it may be something else.

How did you know the baby was underweight and dehydrated? Did the parents tell you or did you diagnose this yourself? I can't believe a paediatrician would ignore an underweight, dehydrated baby and put it down to hysterical parents. I do hope you suggested they went back to the doctor and tried again!

Giddy

29th November 2007, 03:50 PM

Hi Seren,

Yes 6 months is a long time for colic. Yes the GP and paediatrician had investigated the baby fully. What they actually said is based on the mothers feedback. Most parents would understandably be anxious and she probably took their advice the wrong way. I generally have most unusual cases seek parallel medical care as a routine. They have usually been through all that by the time they turn up in my office anyway.

What we are probably seeing in cases that fall through the system are pain patterns and muscle reactions that mimick other conditons. It works a bit like a filter and may explain why we get results with conditions other than back pain that occasionally turn up.

Matt

29th November 2007, 03:56 PM

I had a client last year whose baby was crying so much it was under weight and dehydrated at 6 months. It had 6 months of colic. With 4 sessions it cleared and we had happy parents and baby. i think you'd have a hard time convincing that mum the adjustment didn't have an effect. She had been through the system to the pediatrician and was offered calpol and suggestion she was an anxious mum. Who wouldn't be with no sleep.

I don't really care how open to argument the mother is, that's simply not relevent. Colic clears up on it's own, usually after 3 to 4 months. If after 6 months it still hadn't cleared up that would be mildly unusual but not unheard of. Given that that though, it clearing up after 7 months is hardly a supprise. That you managed to get 4 weeks worth of money out of the mother whilst it cleared up is hardly evidence that your techniques work. It's evidence that after 6 months of crying and sleepless nights you'll try anything for relief.

As the parent of a 3 month old I can tell you what can often shut up a crying baby. Hand the baby to a stranger. The baby knows from your scent that you're an unfamilar person and won't play you up as much as they do for an understandably anxious mother. After a little while though they to cry and want they mother back. So simply do some quick backrubbing and baby stops crying as expected anyway. Stop handwaving as if you've actually done something. Why would you continue if you've fooled yourself into thinking you've had success? Then hand baby back to mother before baby starts screaming again. Viola you've convinced not only the mother but yourself that you've had an effect. Carry on in that vein and when the colic permanently clears up all by itself you can claim credit for that too.

So how do you make sure you're not just fooling yourself?

Double blind controlled studies comparing chiropractic, sham chiropractic and no treatment.

If you're required by law to provide only evidence based treatment I assume you have an evidence base on which to guide the treatment you gave this baby. Can you provide it?

Giddy

29th November 2007, 04:09 PM

Hi Matt,

It's a nice concept to wait until the double blind controlled trial data surfaces but I like to also use my clinical judgement as well.

I see nothing wrong with a diagnosis, a clinical impression, a clinical course of care and reviewing the outcome.

My fees cover my knowledge skills and overheads. I don't wave my hands or burn incense to achieve results and encourage patients to remain critical until results occur.

Unlike social health care poor results mean no business. It sort of forces you do do what is most effective.

JJM

29th November 2007, 04:14 PM

{snip} There have been some done with colic and I have participated in professional workshops and seminars that focus on care for children. So i not just winging it.

I suspect that the upper cervical spine is involved with colic. ...

There is no convincing evidence that spinal manipulation alone can affect the duration of infantile colic symptoms.Husereau D, Clifford T, Aker P, Leduc D, Mensinkai S. "Spinal manipulation for infantile colic"
Ottawa: Canadian Coordinating Office for Health Technology Assessment; 2003. Technology report no 42. http://www.ccohta.ca

What you suspect is unfounded. I don't understand the notion that a practice with no foundation should just proceed as if it has one. Can you explain that to me? That notion pervades pseudo-medicine, and your previous posts invoke it; so I hope you can explain it.

Note- the Canadian report, just cited, looked for research on the topic. They found 36 articles that related chiro and colic. Out of those, only four were of sufficient quality to review (and two of those were not truly published). This is typical of chiro research: it is mostly low-quality and, when it is properly done, does not support chiro claims.

The claims of poverty preventing research don't ring true in the face of all the poor studies your people produce. What is more, there is money for basic research (maybe not as much as we wish); the problem with pseudo-medicine is that proponents cannot write grant proposals that compete in quality with applications from evidence-based health professionals. Therefore, as Blue Wode mentioned, supporters of quackery in the US Congress set-up the NCCAM so some money is earmarked for low quality research.

{snip} A recent paper produced by Professor Jim Deuchars from Leeds suggested a plausible neurological mechanism for changes in blood pressure when neck structures are moved. The gastric effects are probably very closely related.

Hope that helpsIt would help a lot more if you provided a proper citation, please do so; a search for "Deuchars J" turns up a lot of articles.

JJM

29th November 2007, 05:02 PM

{snip} It's a nice concept to wait until the double blind controlled trial data surfaces but I like to also use my clinical judgement as well.Evidence-based medicine (EBM) is merely a "nice concept"? EBM brought us an enormous increase in life-expectancy, cures for diseases that were often fatal (e.g., pneumonia) or invariably fatal (e.g., Hodgkins lymphoma), and preventive medicine (e.g., the dangers of tobacco). There is a long list of accomplishments, and chiro has not played any part in it. Chiro is still mired in the ignorant notions of a 19th century quack.

I see nothing wrong with a diagnosis, a clinical impression, a clinical course of care and reviewing the outcome. {snip}This is the poor "reasoning" that brought us terrible purgatives, homeopathy, blood-letting, water cures, chiropractic, radionic healing, surgical implantation of goat testes in humans, ... This list is, also, quite long.

Blue Wode

29th November 2007, 05:08 PM

I suspect that the upper cervical spine is involved with colic. The anatomical arangement of the cervical spine in the infant is different to an adult, things are more condensed. The vagus nerve with its gastric function may be irritated by or cause post occipital muscle spasm, gastric pain and motility, the glossopharyngeal nerve irritation may lead to suckling weakness and air swallowing and mid cervical spine structures such as the scalene muscle may irritate the phrenic nerve. Gentle adjustments to the spine, usually only involving the tip of the practitioners finger and pressure seems to reduce the subocciptal spasm and reflexly the colic.

Giddy, in view of the following, don’t you think that you’re being somewhat irresponsible in using chiropractic spinal manipulations (no matter how ‘gentle’) to treat infants for colic?

AIMS: To investigate the efficacy of chiropractic spinal manipulation in the management of infantile colic. METHODS: One hundred infants with typical colicky pain were recruited to a randomised, blinded, placebo controlled clinical trial. RESULTS: Nine infants were excluded because inclusion criteria were not met, and five dropped out, leaving 86 who completed the study. There was no significant effect of chiropractic spinal manipulation. Thirty two of 46 infants in the treatment group (69.9%), and 24 of 40 in the control group (60.0%), showed some degree of improvement. CONCLUSION: Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic. This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic.

Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation. Olafsdottir E, Forshei S, Fluge G, Markestad T. Arch Dis Child 2001 Feb;84(2):138-41
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11159288&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11159288&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

“The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic.”

Is chiropractic an effective treatment in infantile colic?
Hughes and Bolton Arch Dis Child.2002; 86: 382-384
http://adc.bmj.com/cgi/content/full/archdischild%3b86/5/382 (http://adc.bmj.com/cgi/content/full/archdischild%3b86/5/382)

[Subscription only]

Adverse events associated with chiropractic care of children

A systematic review has identified 34 cases in which spinal manipulation in children was associated with adverse events. [Vohra S. Adverse events associated with pediatric spinal manipulation: A systematic review. Pediatrics 119(1) January 2007, pp. e275-e283]

Fourteen of the cases involved "direct" events in which the treatment was followed by death, serious injury, symptoms requiring medical attention, or soreness. The rest involved "indirect" events in which appropriate diagnosis was delayed and/or inappropriate manipulation was done for serious medical conditions such as meningitis.

The reviewers commented that despite the fact that spinal manipulation is widely used on children, pediatric safety data are virtually nonexistent. This type of review cannot determine how often adverse events occur. That would require a prospective study with active surveillance.

The article did not consider harmful aspects of chiropractic care that are far more common than the reported events. These include (a) decreased use of immunization due to misinformation given to parents, (b) psychologic harm related to unnecessary treatment, (c) psychologic harm caused by exposure to false chiropractic beliefs about "subluxations," and (d) financial harm due to unnecessary treatment.

http://www.ncahf.com/digest07/07-14.html (http://www.ncahf.com/digest07/07-14.html)

[My bold]

How can you reconcile the above with section A2.3 of the GCC's Standard of Proficiency which requires that "chiropractors' provision of care must be evidence-based"? See page 28 here:
http://www.gcc-uk.org/files/link_file/COPSOP_8Dec05.pdf

Cuddles

29th November 2007, 06:42 PM

1.If chiropractic journals and authors are considered to biased that will excluded close to 99% of all research done. Who else has been interested in doing research if not chiropractors.

And this should really tell you something. Why is all the research in journals started specifically to publish this research? That's pretty much unheard of in real science. A new field can grow out of other fields and split off to start new journals, but new ones never appear out of nowhere. Where is all the research that led to the formation of these journals? If there isn't any, what makes you any different from the 9/11 conspiracy nuts who started their own "journal" because no-one else would publish their crap?

Assuming they are biased presumes that our professional ethical standards are low, the research is poor and geared towards self promotion.

Yes. Considering that one of the stated goals of the regulatory agency of chiropractic is to promote chiropractic, I really don't see how you could argue otherwise.

It's a nice concept to wait until the double blind controlled trial data surfaces but I like to also use my clinical judgement as well.

So how long should we wait? Another 112 years? What kind of judgement accepts completely unfounded quackery after over a century of failing to produce any evidence to support itself?

Mongrel

29th November 2007, 09:39 PM

Evidence-based medicine (EBM) is merely a "nice concept"? EBM brought us an enormous increase in life-expectancy, cures for diseases that were often fatal (e.g., pneumonia) or invariably fatal (e.g., Hodgkins lymphoma), and preventive medicine (e.g., the dangers of tobacco). There is a long list of accomplishments, and chiro has not played any part in it. Chiro is still mired in the ignorant notions of a 19th century quack.

Sorry, just posted the same notion on a Homeopathy blog and so will repeat here. Took 2 minutes on Wiki and another 3 minutes to confirm.

200 years ago - Average Life expectancy: 20-30

100 years ago - Average Life expectancy: 30-40

50 years ago - Average Life expectancy: 65

Current average life expectancy: 70

Life expectancy from birth (2005): 75-80

I'm hard pressed to think how homeopathy, or any other alt-med, has helped this nearly threefold increase of life expectancy.

Sources: http://en.wikipedia.org/wiki/Life_expectancy#Life_expectancy_over_human_history
http://earthtrends.wri.org/pdf_library/country_profiles/pop_cou_826.PDF

Giddy

30th November 2007, 01:41 PM

Mongrel

30th November 2007, 02:36 PM

As for Mogrels comments about life expectancy I always understood that the firgures in earlier years had been skewd by infant and maternal mortality, poor sanitation, poverty and war. If you escaped those your longevity wasn't much worse than today's.

Infant and maternal mortality - decreased due to improvements in EBM
Sanitation - EBM; John Snow (http://en.wikipedia.org/wiki/John_Snow_%28physician%29), Joseph Lister (http://en.wikipedia.org/wiki/Joseph_Lister) and Louis Pasteur (http://en.wikipedia.org/wiki/Pasteur) spring immediately to mind
Poverty - not a lot that medicine can do about the causes but can help the effects (sanitation, free access to Doctors, mass vaccination programs and better health education)
War - No figures but I imagine a lot more men and women would be dead without the assistance of modern medicine.

The increase around the 1945-50 is probably due penicillin mass production and the much stricter requirements for clinical trials and safety evaluations.

richard

30th November 2007, 03:55 PM

Giddy, in view of the following, don’t you think that you’re being somewhat irresponsible in using chiropractic spinal manipulations (no matter how ‘gentle’) to treat infants for colic?

[My bold]

How can you reconcile the above with section A2.3 of the GCC's Standard of Proficiency which requires that "chiropractors' provision of care must be evidence-based"? See page 28 here:
http://www.gcc-uk.org/files/link_file/COPSOP_8Dec05.pdf

“The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic.”

Is chiropractic an effective treatment in infantile colic?
Hughes and Bolton Arch Dis Child.2002; 86: 382-384
http://adc.bmj.com/cgi/content/full/archdischild%3b86/5/382 (http://adc.bmj.com/cgi/content/full/archdischild%3b86/5/382)

[Subscription only]

I know it may come as a surprise to many of you that a "quack" like me would subscribe to a number of clinical journals.Fortunately Archieves of Disease in Childhood is one of them and I am able to provide the rest of the paragraph BLUE WODE provided as his "proof".

It is difficult to take you seriously when you misuse evidence by taking a "Snip" as JDD calls them and presenting it as evidence of the truth of what you believe.

"The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic". is dishonest. The conclusion of the article is IF YOU LOOKED AT IT IN ITS ENTIRITY IS:

CLINICAL BOTTOM LINE

The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic. However, there is good evidence that taking a colicky infant to a chiropractor will result in fewer reported hours of colic by the parents.
In this clinical scenario where the family is under significant strain, where the infant may be at risk of harm and possible long term repercussions, where there are limited alternative effective interventions, and where the mother has confidence in a chiropractor from other experiences, the advice is to seek chiropractic treatment.What that means clinically is Chiropractic is not a "cure" for Colic however there is convincing evidence that it can help children with Colic and why the GCC does not have a problem with chiropractors seeing babies with colic. You may not like it, but fortunatly people have choices and they dont have to do everything you would like them to do.

Neither is chiropractic a cure for bedwetting, could it help some children yes, by a mechanism I have explained which unfortunatly because you are not chiropractors you do not understand. Then one could not teach medicine on a forum either.
>:D 3-0 If you could ever get someone on TV to believe in your ideas, and you want to debate a chiropractor please invite me.

Matt

30th November 2007, 04:26 PM

CLINICAL BOTTOM LINE

The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic. However, there is good evidence that taking a colicky infant to a chiropractor will result in fewer reported hours of colic by the parents.
In this clinical scenario where the family is under significant strain, where the infant may be at risk of harm and possible long term repercussions, where there are limited alternative effective interventions, and where the mother has confidence in a chiropractor from other experiences, the advice is to seek chiropractic treatment.What that means clinically is Chiropractic is not a "cure" for Colic however there is convincing evidence that it can help children with Colic and why the GCC does not have a problem with chiropractors seeing babies with colic. You may not like it, but fortunatly people have choices and they dont have to do everything you would like them to do.

Neither is chiropractic a cure for bedwetting, could it help some children yes, by a mechanism I have explained which unfortunatly because you are not chiropractors you do not understand. Then one could not teach medicine on a forum either.
>:D 3-0 If you could ever get someone on TV to believe in your ideas, and you want to debate a chiropractor please invite me.

Actually I read that a little differently. It says chiropractic is a placebo. Placebo's are effective. If the patient's mother subscribes to that placebo then by all means take advantage of the placebo effect.

Cuddles

30th November 2007, 05:33 PM

>:D 3-0 If you could ever get someone on TV to believe in your ideas, and you want to debate a chiropractor please invite me.

I always find it sweet how people like you can have every single point they try to make utterly destroyed and yet still not only imagine they are winning, but actually shout it out for the whole world to see. Have you ever looked at any of the 9/11 Truth sites? They behave almost exactly the same way as you. It's all rather sad really.

MischiefMonkey

30th November 2007, 05:44 PM

Blue Wode

30th November 2007, 07:13 PM

The blood pressure quote is based on the press release sent from Leeds University. Here is a web link to one article
www.sciencedaily.com/releases/2007/08/070802090711.htm (http://www.sciencedaily.com/releases/2007/08/070802090711.htm) . They give the details of chiropractic claims in this release. Interestingly an article in the Daily Mail refers to neck massage and doesn't mentions the chiropractic link. I guess they didn't have the space. www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=472532&in_page_id=1774&ito=1490 (http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=472532&in_page_id=1774&ito=1490)

Another pilot study along the same lines reveals an effect of upper cervical spine adjustments being equivalent to two blood pressure medications. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. Bakris G (http://www.ncbi.nlm.nih.gov/sites/?Db=pubmed&Cmd=Search&Term=%22Bakris%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus) et al, J Hum Hypertens. (http://javascript:AL_get(this,%20'jour',%20'J%20Hum%20Hypertens.'); ) 2007 May;21(5):347-52. Epub 2007 Mar 2

How many strokes would this prevent? Once again more research.

Giddy, I don't have enough information to comment on the blood pressure studies and it’s obviously still very early days regarding the research.

Speaking of which here is a link to a pdf file that outlines a potential role of chiropractic in the future for anyone who may be interested. It also gives some history and research quotes. www.altfutures.com/pubs/Future%20of%20Chiropractic%20Revisted%20v1.pdf (http://www.altfutures.com/pubs/Future%20of%20Chiropractic%20Revisted%20v1.pdf)

Here's some more on that:

The Future of Chiropractic

Big Lou Sportelli, former ACA and WFC notable and now chairman of NCMIC, boldly asked in the opening plenary session, no doubt shocking the audience, “Where the hell are we going?” before he introduced Dr. Clem Bezold from the Institute of Alternative Futures, who answered that question when he gave a glimpse of our future possibilities, The Future of Chiropractic Revisited—2005-2015. [www.altfutures.com]

Although four possible scenarios were given by Dr. Bezold, it’s clear the worst case scenario, Scenario #2: Downward Spiral, is the most accurate now inasmuch he said 15% of DCs have quit the profession. Meanwhile, there has been a 39% drop in chiro education student enrollment from 1969-2002 and, while the use of CAM in general has increased, the largest decrease occurred for chiropractic (9.9% to 7.4%) according to the recent Eisenberg study. Indeed, there’s little to cheer about when faced with the hard facts about this profession.

If these stats don’t cause anxiety for you, perhaps Dr. Bezold’s Hard Times Scenario will. While some may argue more optimistically about the current status/future of this profession, Dr. Bezold’s characterizations certainly didn’t seem as hopeful.

He characterized this scenario as the Hard Times Scenario:

* External trends go against chiropractic; chiropractic misses many of the opportunities presented. [FSU; Trigon, HHS lawsuits]
* Cost Squeeze in healthcare: economic downturn; pressure to reduce costs [ASHN]; chiropractic looses coverage mandates. [Ontario]
* Public Relation disasters: no public outreach campaign, disunity in the profession, highly visible malpractice cases grad media attention [Markson lawsuit, Life debacle, Gallagher conviction, to name but a few]
* Little Evidence of improved efficacy: SMT is not proven better than mobilization, massage, or self care; outcomes are not monitored. [Where’s our research?]

Dr. Bezold also mentioned the challenges we face on the demand side of medical economics:

1. Cost squeeze in healthcare: all payors will look to costs and restrict benefits.
2. Cultural Legitimacy: chiropractic will have to ‘play in the system’ to increase its share of the healthcare pie.
3. Evidence/Outcomes Based Medicine (EBM): will be a deciding factor on who wins and loses in the healthcare market.

He also mentioned our competition is also encroaching more than ever before: by 2012 we will be greatly outnumbered by those within the mainstream treating similar cases:

1. 70,000 DCs
2. 185,000 PTs
3. 117,000 MTs
4. 27,000 Acupuncturists

http://chirotalk.proboards3.com/index.cgi?action=display&board=outlook&thread=1112967697&page=1 (http://chirotalk.proboards3.com/index.cgi?action=display&board=outlook&thread=1112967697&page=1)

As for Mogrels comments about life expectancy I always understood that the firgures in earlier years had been skewd by infant and maternal mortality, poor sanitation, poverty and war. If you escaped those your longevity wasn't much worse than today's. I think modern medicine help with the recent improvement in some of this but so did a huge change in socioeconomic and international policies world wide.

It's quite interesting to look at the cost per head of medical care and life expectancy. America has the highest spend but only comes in at 38 in a list of life expectancy.

How can you make any conclusions about the role of CAM? Doesn't dietary advice or exercise advice count? Or is that not considered to be irrelevant too?

Regards life expectancy and “conclusions about the role of CAM”, if chiropractors’ provision of ‘wellness care’ and ‘preventive maintenance’ really worked, wouldn’t you expect their own longevity to be on a par with that of medical doctors or, at the very least, the general population? Interestingly, according to this recent survey (which was carried out by a chiropractor), chiropractors’ life-spans are shorter than both:

The chiropractic cliché “Chiropractic Adds Life to Years and Years to Life” was examined for validity. It was assumed that chiropractors themselves would be the best informed about the health benefits of chiropractic care. Chiropractors would therefore be most likely to receive some level of chiropractic care, and do so on a long-term basis. If chiropractic care significantly improves general health then chiropractors themselves should demonstrate longer life spans than the general population.

Two separate data sources were used to examine chiropractic mortality rates. One source used obituary notices from past issues of Dynamic Chiropractic from 1990 to mid-2003. The second source used biographies from Who Was Who in Chiropractic – A Necrology covering a ten year period from 1969–1979. The two sources yielded a mean age at death for chiropractors of 73.4 and 74.2 years respectively.

The mean ages at death of chiropractors is below the national average of 76.9 years and is below their medical doctor counterparts of 81.5.

This review of mortality date found no evidence to support the claim that chiropractic care “Adds Years to Life.”

Full text here:

Morgan, L. Does Chiropractic ‘Add Years to Life’? J Can Chiropr Assoc. 2004 September; 48(3): 217–224

http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V48-3-P217-224/$file/V48-3-P217-224.pdf (http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V48-3-P217-224/$file/V48-3-P217-224.pdf)

On another matter, can any of the chiropractors posting here provide the links to the reviews mentioned by the General Chiropractic Council in its 9th November 2007 press statement?

"The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared. Chiropractic intervention is safe, effective and cost-effective in reducing referral to secondary care."

http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf (http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf)

[My bold]

Blue Wode

30th November 2007, 07:24 PM

I know it may come as a surprise to many of you that a "quack" like me would subscribe to a number of clinical journals.Fortunately Archieves of Disease in Childhood is one of them and I am able to provide the rest of the paragraph BLUE WODE provided as his "proof".

It is difficult to take you seriously when you misuse evidence by taking a "Snip" as JDD calls them and presenting it as evidence of the truth of what you believe.

-snip-

What that means clinically is Chiropractic is not a "cure" for Colic however there is convincing evidence that it can help children with Colic and why the GCC does not have a problem with chiropractors seeing babies with colic. You may not like it, but fortunatly people have choices and they dont have to do everything you would like them to do.

Richard, here is the complete commentary:

Is chiropractic an effective treatment in infantile colic?

Report by Stephen Hughes (1) and Jennifer Bolton (2)
1. Paediatric SpR, Northwick Park Hospital, Harrow
2. Director of Research Anglo-European College of Chiropractic, Bournemouth B5 2DF

Mrs A presents with her 6 week old baby, complaining of his excessive and uncontrollable crying behaviour, particularly in the evening and at night. The child is otherwise healthy, thriving, and has normal weight gain. Following questions regarding the pattern of crying, and associated signs, it is apparent that the child is exhibiting typical colic behaviour. There are clear signs that the continual and excessive crying behaviour is impairing the mother-child relationship, and you consider the child might be at an increased of risk of harm (or neglect). In discussing the treatment options, Mrs A tells you that her chiropractor has offered to treat her baby for the excessive crying behaviour. She herself has been treated by this chiropractor in the past for back pain, and it is obvious she has considerable confidence in him. She asks your advice.

Structured clinical question

In an otherwise health 6 week old infant with typical colicky pain [patient], is chiropractic effective in reducing the severity of the colic, or the length of time spent crying [outcome]?

Search strategy and outcome

The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic. However, there is good evidence that taking a colicky infant to a chiropractor will result in fewer reported hours of colic by the parents.
In this clinical scenario where the family is under significant strain, where the infant may be at risk of harm and possible long term repercussions, where there are limited alternative effective interventions, and where the mother has confidence in a chiropractor from other experiences, the advice is to seek chiropractic treatment.Hughes and Bolton [I]Arch Dis Child.2002; 86: 382-384
http://adc.bmj.com/cgi/content/full/archdischild%3b86/5/382 (http://adc.bmj.com/cgi/content/full/archdischild%3b86/5/382)

[Subscription only]

Note that one of the co-authors is directly involved with chiropractic education and research. Also note that the last paragraph of the commentary says:

Where the infant may be at risk of harm and possible long term repercussions…the advice is to seek chiropractic treatment.

Now here is the most up-to-date (2007) evidence on the safety of spinal manipulation (chiropractic) for children:

Adverse events associated with chiropractic care of children

A systematic review has identified 34 cases in which spinal manipulation in children was associated with adverse events. [Vohra S. Adverse events associated with pediatric spinal manipulation: A systematic review. Pediatrics 119(1) January 2007, pp. e275-e283]

Fourteen of the cases involved "direct" events in which the treatment was followed by death, serious injury, symptoms requiring medical attention, or soreness. The rest involved "indirect" events in which appropriate diagnosis was delayed and/or inappropriate manipulation was done for serious medical conditions such as meningitis.

The reviewers commented that despite the fact that spinal manipulation is widely used on children, pediatric safety data are virtually nonexistent. This type of review cannot determine how often adverse events occur. That would require a prospective study with active surveillance.

The article did not consider harmful aspects of chiropractic care that are far more common than the reported events. These include (a) decreased use of immunization due to misinformation given to parents, (b) psychologic harm related to unnecessary treatment, (c) psychologic harm caused by exposure to false chiropractic beliefs about "subluxations," and (d) financial harm due to unnecessary treatment.

http://www.ncahf.com/digest07/07-14.html (http://www.ncahf.com/digest07/07-14.html)

And here are a couple of snippets from the Ernst 2007 systematic review of adverse effects associated with spinal manipulation:

The effectiveness of spinal manipulation for most indications is less than convincing. A risk-benefit evaluation is therefore unlikely to generate positive results: with uncertain effectiveness and finite risks, the balance cannot be positive.

spinal manipulation is used mostly for self-limiting conditions

http://www.jrsm.org/cgi/content/full/100/7/330 (http://www.jrsm.org/cgi/content/full/100/7/330)

In addition to that, it’s worth remembering that many chiropractors in the UK and the USA aren’t giving their patients adequate information about their treatment:

Consent: its practices and implications in United Kingdom and United States chiropractic practice.

CONCLUSION: Results from this survey suggest a patient's autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk. Practitioners felt that a serious adverse event occurred so infrequently that this, coupled with a lack of convincing evidence regarding the risk associated with certain treatment, rendered the routine discussion of major risk unnecessary.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

Consent or submission? The practice of consent within UK chiropractic.

CONCLUSION: Results suggest that valid consent procedures are either poorly understood or selectively implemented by UK chiropractors.
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15726031 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=15726031)

Richard, in view of all the above how can you consider it ethical for chiropractors to manipulate the spines of infants as a (placebo) treatment for colic?

Mongrel

30th November 2007, 08:03 PM

How can you make any conclusions about the role of CAM? Doesn't dietary advice or exercise advice count? Or is that not considered to be irrelevant too?

Sorry Giddy, didn't see this first time around.

But....

Dietary advice -the very basic (English) Mums advice is still a good rule if you don't want to think about it. Meat, potatoes and two veg, eat all your greens. Beyond that, and barring special requirements, alt-med has had very little to do with sensible nutritional advice. EBM pushed foward with the studies of vitamins (http://en.wikipedia.org/wiki/Vitamins) and the pharmaceutical companies (Pfizer (http://www.pfizer.com/about/history/timeline.jsp)in particular) pushed forward with mass production. Still not seeing alt-med in there, unless you're talking about the scams like Nouni juice, shark cartilage, de-toxing or any other one of the other thousands of "Flavour of the Month" products then good nutrition has been pushed forward by EBM.

As for Exercise, the redeeming qualities of that have been known for centuries. All (and that is a big all) modern science has done is to bust a few of the myths (exercise doesn't improve your immune system), learn how the muscles work, move and interact thus giving professional athletes a greater advantage in being able to target muscle groups for training. Once again I'm at a loss as to how any alt-med can claim exercise as their own.

richard

30th November 2007, 08:15 PM

Richard, here is the complete commentary:

Note that one of the co-authors is directly involved with chiropractic education and research. Also note that the last paragraph of the commentary says:

Where the infant may be at risk of harm and possible long term repercussions…the advice is to seek chiropractic treatment.

Now here is the most up-to-date (2007) evidence on the safety of spinal manipulation (chiropractic) for children:

And here are a couple of snippets from the Ernst 2007 systematic review of adverse effects associated with spinal manipulation:

http://www.jrsm.org/cgi/content/full/100/7/330 (http://www.jrsm.org/cgi/content/full/100/7/330)

In addition to that, it’s worth remembering that many chiropractors in the UK and the USA aren’t giving their patients adequate information about their treatment:

Richard, in view of all the above how can you consider it ethical for chiropractors to manipulate the spines of infants as a (placebo) treatment for colic?

The Fact is ADC states there is little evidence of anything working for a colicky baby. Remind me again how the placebo effect works on a 4 week baby that has been crying for over three hours. Does it matter if the baby believes in chiropractic or not.

In Denmark and Norway its the taxpayers, not "gulible parents" who pay for chiropractors to treat babies with colic, most GPs send children to chiropractic there, so you should take your complaint to the EU,not the GCC.

Something else,chiropractors that I know who adjust babies dont "manipulate" a babies spine the way you under stand SMT cracking sounds and force.

I will tell you something else if you had a diagnosed colicy baby rather than a whingy baby you would try anything. Anything even a chiropractor because the screams go right through you, hours after hour. I have had parents kiss and hug me and they could care less if its this placebo which you need to explain by the way. One time the effect was so sudden the mother did think at first I had harmed the baby.

That must be why my kids are so healthy "Placebo kills all known germs faster than calpol" and I am not going to complain about it.

Mongrel

30th November 2007, 08:27 PM

Oh pants, Slight error on my last post

"Dietary advice -the very basic (English) Mums advice is still a good rule if you don't want to think about it."

should read

Dietary advice -the very basic (English) Mums advice is still a good rule if you think about it.

Should stop trying to do three things at once :-[

MischiefMonkey

30th November 2007, 08:44 PM

The Fact is ADC states there is little evidence of anything working for a colicky baby. Remind me again how the placebo effect works on a 4 week baby that has been crying for over three hours. Does it matter if the baby believes in chiropractic or not.

In Denmark and Norway its the taxpayers, not "gulible parents" who pay for chiropractors to treat babies with colic, most GPs send children to chiropractic there, so you should take your complaint to the EU,not the GCC.

Something else,chiropractors that I know who adjust babies dont "manipulate" a babies spine the way you under stand SMT cracking sounds and force.

I will tell you something else if you had a diagnosed colicy baby rather than a whingy baby you would try anything. Anything even a chiropractor because the screams go right through you, hours after hour. I have had parents kiss and hug me and they could care less if its this placebo which you need to explain by the way. One time the effect was so sudden the mother did think at first I had harmed the baby.

That must be why my kids are so healthy "Placebo kills all known germs faster than calpol" and I am not going to complain about it.

Calpol doesn't kill germs. It relieves pain and reduces a temperature.

JJM

30th November 2007, 08:49 PM

richard

30th November 2007, 10:49 PM

Calpol doesn't kill germs. It relieves pain and reduces a temperature.

Sorry, I meant Domestos, we use Calpol to clean the toilets.

Blue Wode

1st December 2007, 07:44 AM

The Fact is ADC states there is little evidence of anything working for a colicky baby. Remind me again how the placebo effect works on a 4 week baby that has been crying for over three hours. Does it matter if the baby believes in chiropractic or not.

In Denmark and Norway its the taxpayers, not "gulible parents" who pay for chiropractors to treat babies with colic, most GPs send children to chiropractic there, so you should take your complaint to the EU,not the GCC.

Something else,chiropractors that I know who adjust babies dont "manipulate" a babies spine the way you under stand SMT cracking sounds and force.

I will tell you something else if you had a diagnosed colicy baby rather than a whingy baby you would try anything. Anything even a chiropractor because the screams go right through you, hours after hour. I have had parents kiss and hug me and they could care less if its this placebo which you need to explain by the way. One time the effect was so sudden the mother did think at first I had harmed the baby.

That must be why my kids are so healthy "Placebo kills all known germs faster than calpol" and I am not going to complain about it.

Irrelevant.

You are still administering a placebo treatment for a self-limiting condition in the absence of safety data.

Giddy

1st December 2007, 11:10 AM

Yes, a pilot study. The results look interesting; I wonder why they did not publish in a first- or second-tier journal. It makes me think a proper peer-review found something wanting. This only refers to a sub-cult (NUCCA) of chiro.

Also, note that the two studies may or may not be looking at the same thing. Much more research is needed, Bakris et al say they are planning to expand their work with chiro.

Neither study is definitive concerning current chiro practices. I am still hoping for some definitive clinical evidence supporting chiro. It is sad that you people continue to work as if it exists for your procedures.

Your right about those points, but it indicates that joint manipulation (adjustments in chiro speak) seems to have a significant neurological effect. Chiropractors have been making anecdotal claims for many years but the research methods to look at neural pathways have not been available until the last 10 years.

Past research has been using outcome measures such as pain reduction, range of motion and algometry. These are pretty crude devices and may not provide enough detail to draw meaningful conclusions, hence everything looks to do the same thing, even placebo. Spinal pain syndromes are difficult to quantify medically at the individual level let alone groups.

This is what I a talking about when I mentioned access to infrastructure and expertise to look at the neural component of the effects of manipulation. Collaborations as in this particular case produced some interesting early results.

On the point about diet and exercise and even hygene for that matter it is pretty difficult to draw a line between what is "medical" and what is "alternative". No field of endeavour improves without adopting best practices from all sources. Medicine can sometimes seem to be a monopoply and makes claims to advances. The acceptance of new approaches has always been a lenghty battle. Helicobacter Pylori and gastric ulceration is an modern example of resistance from within the field. The Australia doctor who proposed the idea had to infect himself to prove his point.

I am extremely uncomfortable having chiropractic mentioned alongside homeopathy, reflexology and aromatherapy. The latter three are without doubt suspect. To put chiropractic into the same sentence seems to promote guilt by association. I have noted Ernst commentary does this effectively. He is supposedly in a positon to see the difference in the body of knowledge between the groups but has used the media to create a pretty clever illusion.

When the BCA recently presented a press realease about research concerning safety of chiropractic the editor of a national uk paper, he declined to use it because " everyone knows chiropractic is safe". Good news is no news.

JJM

1st December 2007, 11:28 AM

The Fact is ADC states there is little evidence of anything working for a colicky baby. {snip}

In Denmark and Norway its the taxpayers, not "gulible parents" who pay for chiropractors to treat babies with colic, most GPs send children to chiropractic there, so you should take your complaint to the EU,not the GCC. {snip}So, the GPs unload intractable, self-limiting cases on chiros for placebo "treatments." That is not really an endorsement of chiro as much as an acknowledgment that they are repositories for people who really need no treatment (with the hope they will not harm).

JJM

1st December 2007, 11:59 AM

Your right about those points, but it indicates that joint manipulation (adjustments in chiro speak) seems to have a significant neurological effect.The chiro claim is that adjusting the spine improves neural functioning, the author from Leeds does not say anything of the sort. He claims that spinal "adjustments" coincidentally trigger a normal reflex in a muscle (not an improvement in neural function).

Chiropractors have been making anecdotal claims for many years {snip}And they continue to do so. Four or five of you have failed to provide any reliable clinical evidence.

{snip} On the point about diet and exercise and even hygene for that matter it is pretty difficult to draw a line between what is "medical" and what is "alternative". {snip, usual derail}No, it is easy- "medical" is based on reliable evidence, "alternative" is not.

I am extremely uncomfortable having chiropractic mentioned alongside homeopathy, reflexology and aromatherapy. The latter three are without doubt suspect.Their proponents are as confident and uniformed as chiropractors. Who are you to judge that the musings of Hahnemann are not equal to the musings of Palmer? Your evidential bases are the same. The age of evidence-based medicine left your cults behind.

To put chiropractic into the same sentence seems to promote guilt by association. I have noted Ernst commentary does this effectively. He is supposedly in a positon to see the difference in the body of knowledge between the groups but has used the media to create a pretty clever illusion.Okay- what is the difference in the "body of knowledge" between your groups? (See above.) I say it is all irrational anecdote.

This could be great, a chiro confronting homeo. Pot- kettle black.

Giddy

1st December 2007, 12:52 PM

[quote=JJM;26012]The chiro claim is that adjusting the spine improves neural functioning, the author from Leeds does not say anything of the sort. He claims that spinal "adjustments" coincidentally trigger a normal reflex in a muscle (not an improvement in neural function).

And they continue to do so. Four or five of you have failed to provide any reliable clinical evidence.

quote]

That's what is generally thought to be the case with adjustments we stimulate a normal reflex effect in the neural system. The "improvement" is the hypothesis that the normal reflex has not been functioning or has in some way changed the functioning of the system via stimulation or inhibition.

Solomonow has produced an article detailing the reflexogenic nature of the ligamentous structures. Senrory-motor control of ligamentous and associated neuromuscular disorders. Journal or electromyography and kinesiology 2006 (my pdf file was prior to printing so no specifics) 2006 ISEK Congress keynote lecture.

Again we are using research from another field but the knowledge being extracted points towards plausible mechanism for the clinical outcome that have been reported anecdotally.

richard

2nd December 2007, 12:39 AM

Irrelevant.

You are still administering a placebo treatment for a self-limiting condition in the absence of safety data.

Baby is crying for hours and stops straight after an adjustment, this is well documented, does not happen every time but often enough for ADC, to say chiropractic is worth trying and Danish and Norwegian tax payers pay for the treatment, and you are saying its just a coincidence or a placebo? Fair enough.

Now even an "ignorant quack" like me understands how an adults response will be greatly influenced by touchy feely chiropractors, taking the time to do a proper examination and take a history but you will have to explain to me how this placebo effect works on a four week old baby.

You are certain then stimulating spinal mechanoreceptors has no effect on the CNS is that right? You believe a chiropractic adjustment can kill people but does not effect the CNS is that right?

Blue Wode

2nd December 2007, 09:29 AM

Baby is crying for hours and stops straight after an adjustment, this is well documented, does not happen every time

How do you know that stopping crying “straight after” an ‘adjustment’ isn’t a sign of harm? There are case reports in the medical literature of adults fainting following spinal manipulation.

but often enough for ADC, to say chiropractic is worth trying

No, two authors said it was worth trying, one of whom (Jennifer Bolton) is directly involved in chiropractic research and education. Interestingly, both authors completely ignored chiropractic paediatric safety issues.

and Danish and Norwegian tax payers pay for the treatment

As JJM said in post #198:

So, the GPs unload intractable, self-limiting cases on chiros for placebo "treatments." That is not really an endorsement of chiro as much as an acknowledgment that they are repositories for people who really need no treatment (with the hope they will not harm).
It also suggests that safety issues regarding chiropractic treatment are being ignored by the health authorities in Denmark and Norway. Indeed, it would seem that their guidelines need to be revised.

and you are saying its just a coincidence or a placebo?
Or a sign of harm.

Now even an "ignorant quack" like me understands how an adults response will be greatly influenced by touchy feely chiropractors, taking the time to do a proper examination and take a history but you will have to explain to me how this placebo effect works on a four week old baby.

I would venture that it’s a placebo effect by proxy, i.e. because the parents feel that something’s been done by a person in an authoritative position, they start to relax. This is sensed by the infant who then also starts to relax.

You are certain then stimulating spinal mechanoreceptors has no effect on the CNS is that right?

As far as ‘adjusting’ for infantile colic goes, yes. All the data indicate that it’s a placebo effect.

You believe a chiropractic adjustment can kill people but does not effect the CNS is that right?

The chiropractic ‘adjustment’ can kill people by tearing or severing blood vessels and it cannot be justified when safer (and cheaper) interventions exist.

Remember, “First do no harm”.

Now, for the umpteenth time, please would the chiropractors here produce the citations for the reviews mentioned by the General Chiropractic Council in its 9th November 2007 press statement:

"The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared. Chiropractic intervention is safe, effective and cost-effective in reducing referral to secondary care."

http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf (http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf)

[My bold]

Blue Wode

5th December 2007, 07:19 PM

Well, we no longer have to wait for a chiropractor to give us the answer to the question posed at the end of the last post. It can be found on the General Chiropractic Council’s website in its January 2007 publication ‘Advice for General Practitioners, Primary Care Trusts and Local Health Boards’.
http://www.gcc-uk.org/files/page_file/GP%20Care%20Pathway.pdf (http://www.gcc-uk.org/files/page_file/GP%20Care%20Pathway.pdf)

Here is the relevant quote…

The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared. 3,4,5 Chiropractic intervention, including manipulation, is safe, effective and cost-effective in reducing referral to secondary care. 6

…and here are the four references:
3. UK BEAM Trial Team 2004. The UK Back Pain Exercise and Manipulation (BEAM) Randomised Trial: Effectiveness of Physical Treatments for Back Pain in Primary Care. BMJ,329 (7479): 1377
4. Meade TW, Dyer S et al 1990. Low Back Pain of Mechanical Origin. Randomised Comparison of Chiropractic and Hospital Outpatient Treatment, BMJ 300: 1431-37
5. Meade T W, Dyer S et al 1995. Randomised Comparison of Chiropractic and Hospital Outpatients Management for Low Back Pain Results from Extended Follow Up, BMJ 311: 349-351
6. UK BEAM Trial Team (2004). The UK Back Pain Exercise and Manipulation (BEAM) Randomised Trial: Effectiveness of Physical Treatments for Back Pain in Primary Care. BMJ,329 (7479): 1381Although those reviews were looked at earlier in this thread, for the benefit of drive-by readers, here are the criticisms of them once again:

Refs. 3 and 6:

Three brief comments on the excellent BEAM Trial (1).

My reading of the results is that the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch.

If this “devil’s advocate” view is correct, the effects have little to do with spinal manipulation per se. It would be relevant to knowwhich of the three professional groups (chiropractors, osteopaths, physiotherapists) generated the largest effect size. This might significantly influence the referral pattern. A post-hoc analysis might answer this question.

It is regrettable that the study only monitored serious adverse effects. There is compelling data to demonstrate that minor adverse effects occur in about 50% of patients after spinal manipulation (2). If that is the case, such adverse events might also influence GP’s referrals.

E Ernst, Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth References

1. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ, doi:10.1136/bmj.38282.669225.AE. BMJ 2004;19 November:1-8.

2. Stevinson C, Ernst E. Risks associated with spinal manipulation. Am J Med 2002;112:566-70.

http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126 (http://www.bmj.com/cgi/eletters/bmj.38282.669225.AEv1#88126)

Ref. 4

Effectiveness of chiropractic and physiotherapy in the treatment of low back pain: a critical discussion of the British Randomized Clinical Trial

The results are difficult to extrapolate, because only a small portion of the eligible patients participated, and chiropractic seems to be clearly superior only in the subgroup originally presenting to a chiropractic clinic. We conclude that it is premature to draw conclusions about the long-term effectiveness of chiropractic based on the results of this study alone.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li st_uids=1833493 (http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li st_uids=1833493)

Ref. 5

Results were clinically trivial

EDITOR,--T W Meade and colleagues have provided further data from their study comparing chiropractic with hospital physiotherapy.1 Unfortunately, their report is far from convincing. The "headline" advantage of chiropractic over hospital management at three years (29%) sounds impressive but refers to an improvement of three points on the 100 point Oswestry scale, or one and a half responses on the questionnaire. This difference may be statistically significant but is clinically trivial.

In their original article the authors noted that chiropractic was 50% more expensive,2 and in the latest report they note that the chiropractic group had more treatments in the long term. The measured improvement does not seem to support such an expenditure.

The design of the study was criticised after the first paper was published.3 The patients initially presenting to a chiropractor were self selected on the basis that they believed that chiropractic would be effective (as they were expecting to pay for treatment). It is interesting that only the patients referred by chiropractors showed a significant advantage for chiropractic. Those initially recruited in hospital practice showed no significant difference. The study compares private practice with NHS treatment, with all the implications for environmental and personal factors that this brings. The follow up rate (70% and 77%) is inadequate and would preclude publication in some journals.4 Analysis by intention to treat does not obviate this deficiency. Important variables such as psychological disturbance are not addressed, although these are noted to have a greater impact on results than does treatment.5

It is disappointing that in the five years between the reports these and the other criticisms that were raised were not more fully addressed. Despite the acclamation of the first report in the popular media, I do not think that this study has advanced our understanding of the treatment of back pain in any useful way.

http://www.bmj.com/cgi/content/full/311/7015/1302 (http://www.bmj.com/cgi/content/full/311/7015/1302)

Returning to the original topic of this thread, the Hancock et al study and its conclusions…

Patients with acute low back pain receiving recommended first-line care do not recover more quickly with the addition of diclofenac or spinal manipulative therapy.

-snip-

The spinal manipulative therapy given in this trial included a range of low-velocity mobilisation and high-velocity manipulation techniques done by physiotherapists with postgraduate training in manipulative therapy. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal mobilisation is more effective than low-velocity spinal manipulation, or that the profession of the manipulator affects the effectiveness of treatment.

Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial Hancock MJ et al; Lancet:370:1638-43 (2007)
http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf (http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf)

…and not forgetting this….

Spinal manipulation is a form of treatment that is used occasionally by some doctors, physiotherapists and osteopaths – but, for chiropractors, it is the hallmark intervention.

Spinal manipulation: are the benefits worth the risks?
E. Ernst, Expert Review of Neurotherapeutics, November 2007, Vol. 7, No. 11, Pages 1451-1452

http://www.ukskeptics.com/documents/spinal_manipulation_benefits_risks.pdf (http://www.ukskeptics.com/documents/spinal_manipulation_benefits_risks.pdf)

… or this from the ‘What is chiropractic?’ section of the American Chiropractic Association’s website…

The most common therapeutic procedure performed by doctors of chiropractic is known as “spinal manipulation,”
http://www.acatoday.com/level2_css.cfm?T1ID=13&T2ID=61&BT1ID=21&BT2ID=94 (http://www.acatoday.com/level2_css.cfm?T1ID=13&T2ID=61&BT1ID=21&BT2ID=94)

…it’s interesting to note the following in the GCC’s 9th November 2007 press statement regarding Hancock study…

The purpose of the study was not to measure the effectiveness of chiropractors

-snip-

It is sad to see a piece of research misrepresented in this way

-snip-

Chiropractors provide an evidence-based approach based on European-wide guidelines compiled by multidisciplinary teams of experts who reviewed all relevant research

http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf (http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf)

…because, as far as I can see, the European guidelines mention only ‘spinal manipulation’ and not chiropractic for the management of low back pain. See page 26 here:
http://www.backpaineurope.org/web/files/WG1_Guidelines.pdf (http://www.backpaineurope.org/web/files/WG1_Guidelines.pdf)

It’s also interesting to note that Alan Breen, Professor of Musculoskeletal Heath Care at the Anglo European College of Chiropractic (AECC), collaborated in the development of the European Acute Back Pain Guidelines:
http://chirocruise.com/lecturers.html (http://chirocruise.com/lecturers.html)

Now, here again are Professor Edzard Ernst’s recent comments on the official guidelines for the treatment of back pain (after presenting the lack of evidence for chiropractic in four Cochrane reviews):

Chiropractors argue that their approach must be safe and effective, not least because the official guidelines on the treatment of back pain recommend using chiropractic. However, this is true only for some, but by no means all, countries. Secondly, guidelines are well known to be influenced by the people who serve on the panel that develops them. Cochrane reviews, on the other hand, are generally considered to be objective and rigorous. Writing about the importance of systematic reviews for health care in the Lancet, Sir Ian Chalmers stated, ‘I challenge decision makers within those spheres who continue to frustrate efforts to promote this form of research to come out from behind their closed doors and defend their attitudes and policies in public. There is now plenty of evidence to show how patients are suffering unnecessarily as a result of their persuasive influence.’ 10

The Value of Chiropractic
http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm (http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm)

At least the Royal College of General Practitioners (RCGP) seems to be up to speed with the evidence on spinal manipulation. Its guidelines for the management of acute low back pain - which had recommended spinal manipulation - were withdrawn two years ago. See page 2 of the GCC’s Spring 2005 newsletter (#15) here:
http://www.gcc-uk.org/files/link_file/GCC_news_15.pdf (http://www.gcc-uk.org/files/link_file/GCC_news_15.pdf)

Interestingly, its decision now appears to be supported by the findings of these two recent systematic reviews:

A systematic review of systematic reviews of spinal manipulation (2006)

CONCLUSIONS: Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.

http://www.jrsm.org/cgi/content/abstract/99/4/192 (http://www.jrsm.org/cgi/content/abstract/99/4/192)

Adverse effects of spinal manipulation: a systematic review (2007)

CONCLUSIONS: Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.

http://www.jrsm.org/cgi/content/abstract/100/7/330 (http://www.jrsm.org/cgi/content/abstract/100/7/330)

Now, who’s really misrepresenting the research findings?

Blue Wode

16th February 2008, 08:41 PM

The integrity of the chiropractic profession in the UK has been newly questioned by Professor Edzard Ernst in the latest issue of Focus on Alternative and Complementary Therapies (Vol.13. Issue 1. March 2008, pp43-44) in an article entitled ‘The safety of chiropractic cervical manipulation’:
http://www.medicinescomplete.com/journals/fact/current/fact1301a07g04.htm (http://www.medicinescomplete.com/journals/fact/current/fact1301a07g04.htm)
[Subscription only]

It looked at this study in Spine:

Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey
http://www.spinejournal.com/pt/re/spine/abstract.00007632-200710010-00016.htm;jsessionid=H3CXkGBZlZtPyLtFwhPrfgWQpPTQk 3mD0WBzhpyBP4LVX6xmHJ7K!-383192544!181195628!8091!-1 (http://www.spinejournal.com/pt/re/spine/abstract.00007632-200710010-00016.htm;jsessionid=H3CXkGBZlZtPyLtFwhPrfgWQpPTQk 3mD0WBzhpyBP4LVX6xmHJ7K!-383192544!181195628!8091!-1)

Ernst:

This is a most laudable attempt to define how often serious adverse effects of cervical manipulation happen. To generate certainty, such studies need to be very large, must not lose patients to follow-up and have to rely on accurate reporting. The sample of this survey was sizeable but not large enough to exclude rare events. Thus the authors can only state that, at worst, the risk of serious adverse events within 7 days after manipulation is 2 per 10,000 treatment consultations. If the average patient has a series of 10 treatments, this risk could therefore be as high as 1 in 500 per patient. Given the nature of the risk, i.e. stroke or death, this is by no means negligible.

The picture gets more complicated when considering the 698 treatment consultations of patients who failed to return for their next treatment. Theoretically some or most or all of these patients could have died of a stroke. Overlooking even one single serious adverse event would change the estimated incidence rates from this study quite dramatically.

In my view, the most confusing aspect about the results of this survey is the fact that the incidence of minor adverse events is so low. Previous studies have repeatedly shown it to be around 50%. The discrepancy requires an explanation. There could be several but mine goes as follows: the participating chiropractors were highly self-selected. Thus they were sufficiently experienced to select low-risk patients (in violation of the protocol). This explains the low rate of minor adverse events and begs the question whether the incidence of serious adverse events is reliable.

Studies of this nature are very difficult to conduct such that we can trust the results. One of the problems is that one has to rely on the honesty of the participating therapists who could have a very strong interest in generating a reassuring yet unreliable picture about the safety of their intervention.

The study’s lead authors, J E Bolton and H W Thiel responded with this:

Ernst talks about ‘certainty’ in research studies and a sample size that was not large enough to exclude rare events. Just what is ‘large enough’ to achieve certainty? Choosing the worst risk estimate (~2 per 10,000 treatment consultations), Ernst infers that this is a cumulative risk as well as for a patient instead of a single treatment. There is no evidence to suggest that the risk is cumulative and increases with repeated exposure. Even if this was the case, our design would have accounted for this by including not only the first but subsequent treatment consultations. Of course, Ernst is correct in saying that an adverse event could have occurred in those patients lost to follow-up. However, by any reckoning 1.4%, particularly in a sample of 50,000 treatments, is not only acceptable but, in our view, strengthens rather than weakens the credibility of the risk estimates. Ernst uses the difference in this study’s rate of a single minor side-effect with those reported in others to argue that the recruitment of chiropractors and patients was biased and therefore could have resulted in an underestimation of risk. When taking into account all minor side-effects observed in this study, this difference diminishes considerably. In endeavouring to provide research evidence and in debating its limitations, we should not lose sight of the bigger picture. In the UK alone, there is an estimated 4 million manipulations of the neck carried out by chiropractors each year. In the absence of any significant numbers of reported serious events (i.e. stroke or death), including those in which a causal link is based on extremely weak evidence, there can be little doubt that the risk is very low. In failing to find a serious event, the risk was estimated based on sample size. It can therefore be argued that this risk estimate is a conservative one, and that had it been possible to achieve a ‘large enough’ sample, we might then have been ‘certain’ of a very rare event.

J E Bolton, H W Thiel
Anglo-European College of Chiropractic,
Bournemouth, UK

Note that Bolton and Thiel say...

In the UK alone, there is an estimated 4 million manipulations of the neck carried out by chiropractors each year.
...yet in October 2007, in a letter to the Journal of the Royal Society of Medicine (in response to Ernst’s July 2007 ‘Adverse effects of spinal manipulation’ systematic review) they said

In the UK, there are estimated to be well over two million cervical spine manipulations by chiropractors each year.

http://www.jrsm.org/cgi/content/full/100/7/330 (http://www.jrsm.org/cgi/content/full/100/7/330)
(Unfortunately the letter is behind a pay wall)

How could that estimate have doubled in under 6 months?

Further, they say

In the absence of any significant numbers of reported serious events (i.e. stroke or death), including those in which a causal link is based on extremely weak evidence, there can be little doubt that the risk is very low.
What they don’t say is that there has never been a formal reporting system in the UK for chiropractic patients who have experienced serious adverse effects associated with spinal manipulation:

...the adverse effects of NSAIDs are subject to post-marketing surveillance while those of spinal manipulation are not.

http://www.jrsm.org/cgi/content/full/100/7/330 (http://www.jrsm.org/cgi/content/full/100/7/330)

In addition to that, in 2002, one of the lead authors of the study, Jennifer Bolton, seemed to have no qualms about recommending chiropractic placebo treatment for infants in the absence of safety data:

Is chiropractic an effective treatment in infantile colic?

Report by Stephen Hughes (1) and Jennifer Bolton (2)
1. Paediatric SpR, Northwick Park Hospital, Harrow
2. Director of Research Anglo-European College of Chiropractic, Bournemouth B5 2DF

Arch Dis Child.2002; 86: 382-384
http://adc.bmj.com/cgi/content/full/archdischild%3b86/5/382 (http://adc.bmj.com/cgi/content/full/archdischild%3b86/5/382)
[Subscription only]

Search strategy and outcome

The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic. However, there is good evidence that taking a colicky infant to a chiropractor will result in fewer reported hours of colic by the parents.
In this clinical scenario where the family is under significant strain, where the infant may be at risk of harm and possible long term repercussions, where there are limited alternative effective interventions, and where the mother has confidence in a chiropractor from other experiences, the advice is to seek chiropractic treatment. Just to emphasise the point, note that the last paragraph of the commentary says

Where the infant may be at risk of harm and possible long term repercussions…the advice is to seek chiropractic treatment.
Yet the most up-to-date evidence on the safety of (chiropractic) spinal manipulation for children in January 2007 had this to say:

The reviewers commented that despite the fact that spinal manipulation is widely used on children, pediatric safety data are virtually nonexistent.

http://www.ncahf.com/digest07/07-14.html (http://www.ncahf.com/digest07/07-14.html)

Now let’s have another look at Ernst’s last sentence in the March 2008 article:

One of the problems is that one has to rely on the honesty of the participating therapists who could have a very strong interest in generating a reassuring yet unreliable picture about the safety of their intervention.

Make that one of the BIG problems.

JJM

17th February 2008, 01:28 PM

The chiro fan magazine Dynamic Chiropractic had a recent article titled "Chiropractors Eating Their Own."
http://www.chiroweb.com/archives/26/02/11.html
The author bemoans the fact that some chiros are now advertising "Spinal correction without twisting or popping the neck." He thinks this emphasis on safety makes their industry look bad.

We know that chiros cause strokes: it happens (sometimes) immediately after the neck-snap and we know the mechanism for it (vertebral artery dissection). We also know the mechanism by which the stroke can be delayed for several days post neck-snap. So, now the chiros are trying to downplay the frequency of this consequence.

No matter how infrequent strokes may be, there is no reason to cause even one, since there is never any reason to snap someone's neck. It does nothing that cannot be achieved more safely otherwise (e.g., by a gentle massage).

Blue Wode

19th February 2008, 11:50 AM

It looks like the integrity of North American chiropractors is also highly questionable.

Via JJM’s Chiroweb link above, I see that the current issue of Dynamic Chiropractic has an article entitled ‘Neck Pain Task Force Releases Findings’ which says:

The task force also conducted several original studies, including “Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study.” According to the task force, their findings suggest the risk of suffering a stroke following a cervical manipulation is attributable to a vertebral artery dissection (VAD) that is already in progress prior to the adjustment. The dissection likely results in neck pain that brings the patient to the chiropractor’s office seeking relief.

The authors also documented only a handful of stroke cases following chiropractic cervical manipulation in a massive study population spanning nearly 100 million person-years. Even more impressive, the data suggest that while spinal manipulation may increase the risk of an embolism in those with a VAD in progress, which can then lead to a stroke, the association between the stroke and the office visit was no higher in patients who sought the care of a chiropractor than in patients who sought the care of a general physician.

http://www.chiroweb.com/archives/26/05/14.html (http://www.chiroweb.com/archives/26/05/14.html)

[My bold]

This is the link to the Neck Pain Task Force Supplement in Spine:
http://www.spinejournal.com/pt/re/spine/toc.00007632-200802151-00000.htm;jsessionid=H60BkmzxyFhfJ17GFTb777WT6T08V L2cbh4WQ1rt0CjhGnrSSS12!-809317659!181195629!8091!-1 (http://www.spinejournal.com/pt/re/spine/toc.00007632-200802151-00000.htm;jsessionid=H60BkmzxyFhfJ17GFTb777WT6T08V L2cbh4WQ1rt0CjhGnrSSS12!-809317659!181195629!8091!-1)

And this is the link to the ‘Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study’ in Spine:
http://www.spinejournal.com/pt/re/spine/abstract.00007632-200802151-00019.htm;jsessionid=H60BkmzxyFhfJ17GFTb777WT6T08V L2cbh4WQ1rt0CjhGnrSSS12!-809317659!181195629!8091!-1 (http://www.spinejournal.com/pt/re/spine/abstract.00007632-200802151-00019.htm;jsessionid=H60BkmzxyFhfJ17GFTb777WT6T08V L2cbh4WQ1rt0CjhGnrSSS12!-809317659!181195629!8091!-1)

Now, here’s some interesting criticism of the study, and its lead author, David Cassidy, which comes from a letter written by Sharon Mathiason whose daughter died following chiropractic neck manipulation:

This new "study" itself is a review of billing records. No patient charts or tests were examined. There was no new scientific data. The authors took 819strokes and then used billing records to see who had seen a doctor in thepast year and who had seen a chiropractor. Considering that billing paymentswere very limited for chiropractors in Ontario and now thank God have beencompletely eliminated, this is a very poor record of the actual number ofvisits to a chiropractor. Did the scientists not realize this simplestatistical fact? Of course, the strokes caused by the chiropractors happened in their officeswhile none happened in the office of the doctors. Where did they tell usthat? According to the logic of this study, if my daughter Laurie or anyoneelse saw your medical doctor in January and then had a stroke in Decemberafter having a neck manipulation, it did not count against the chiropractor.Almost everyone has seen their doctor within a year. You would get the sameresult if she had stopped at McDonald’s to buy a hamburger and then went tothe chiropractor. The Globe and Mail is also negligent in not identifying the principalauthor, David Cassidy, as a chiropractor, one who has been sued inSaskatchewan, in 1999, by his research assistant for falsifying data, andone whose work is stated in the New England Journal of Medicine as "all ofthe study’s authors conclusions are completely invalidated by theirmethods". David Cassidy, before he was dismissed from the University of Saskatchewan,was called as an "expert" witness by the Chiropractic Association ofSaskatchewan (CAS) at my daughter’s inquest. In the Globe and Mail articleco-author David Cassidy is quoted "Has it ever happened that a chiropractorhas caused a stroke? I can’t say it’s never happened. But if it’shappening, it’s not happening at a greater risk than when it is at a GPoffice". Well guess what, chiropractor David Cassidy admitted on the stand into thedeath of my daughter they he had manipulated the neck of a woman and causeda stroke, a very severe one called Wallenberg’s syndrome. Did he say itnever happened because this poor woman also saw her doctor in the past year?I doubt if he has ever seen a patient coming out of a doctor's office havinga stroke after a neck manipulation.

More…http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html (http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html)

(Scroll down the link a little to locate the letter)

It’s also worth noting that David Cassidy was a co-author of another one of the Task Force's studies:

Examining Vertebrobasilar Artery Stroke in Two Canadian Provinces

"At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.”

http://www.spinejournal.com/pt/re/spine/abstract.00007632-200802151-00018.htm;jsessionid=H60BkmzxyFhfJ17GFTb777WT6T08V L2cbh4WQ1rt0CjhGnrSSS12!-809317659!181195629!8091!-1 (http://www.spinejournal.com/pt/re/spine/abstract.00007632-200802151-00018.htm;jsessionid=H60BkmzxyFhfJ17GFTb777WT6T08V L2cbh4WQ1rt0CjhGnrSSS12!-809317659!181195629!8091!-1)

The Neck Pain Task Force should be ashamed of itself for including a discredited researcher on its team.

Blue Wode

24th February 2008, 12:20 PM

From today’s CBS news, 'Risk of chiropractic treatment':

Britt Harwe hasn't eaten a meal in 15 years. She survives on nutritional drinks poured directly into her stomach through a feeding tube.

"If I try to swallow, it goes into my lungs, I aspirate," said Britt.

She says it's the result of suffering a stroke during a visit to her chiropractor.

"I slumped over to the left and he helped me straighten out and I couldn't really focus. I couldn't talk," said Britt. The chiropractor had just finished adjusting her neck.

More…
http://cbs3.com:80/health/Risk.of.Chiropractic.2.661491.html (http://cbs3.com/health/Risk.of.Chiropractic.2.661491.html)

(Don’t forget to watch the 2-minute video which accompanies the CBS article)

And here’s a critical evaluation of chiropractic from Professor Edzard Ernst which has just been published in the Journal of Pain and Symptom Management:

Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today.

Currently, there are two types of chiropractors: those religiously adhering to the gospel of its founding fathers and those open to change. The core concepts of chiropractic, subluxation, and spinal manipulation, are not based on sound science.

Back and neck pain are the domains of chiropractic but many chiropractors treat conditions other than musculoskeletal problems. With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition.

Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence.

Its cost-effectiveness has not been demonstrated beyond reasonable doubt.

The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.

More…
http://www.ncbi.nlm.nih.gov/pubmed/18280103?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum (http://www.ncbi.nlm.nih.gov/pubmed/18280103?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)

Time for another airing of this Ernst quote from 2005:

I fear that chiropractors’ views on their very own treatment might not be entirely free of conflicts of interest.

http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm (http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm)

If the posts by the chiropractors who contributed to this thread are anything to go by, he's right.

Blue Wode

9th March 2008, 01:14 PM

Well worth viewing:

The Kinsinger Report on Chiropractic (approx. 42 mins)
http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv (http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv)

This presentation was included in the curriculum of the course PHTH 7990 “Advanced Spinal Manipulation for Physical Therapy Students” for physical therapy students taught by Dave Johnson, PT, PhD, Clinical Assistant Professor, Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center (OUHSC), USA. It was also included in the continuing education program “Spinal Manipulation: 5th Annual Update for Physical Therapists, Osteopathic Physicians, and Medical Doctors” sponsored by the Department of Rehabilitation Sciences, College of Allied Health, OUHSC, USA.

Bill Kinsinger, MD, is past President of the Oklahoma Society of Anesthiologists, and since 1994 has been in private practice of obstetric anaesthesiology. Since 1990 he has conducted investigations and research of the chiropractic industry.

Dr Kinsinger is associated with the Neck911 network, a volunteer organisation devoted to raising awareness of injuries associated with the practice of chiropractic:
http://www.neck911usa.com/ (http://www.neck911usa.com/)

Janot

9th March 2008, 04:48 PM

bindeweede

9th March 2008, 08:43 PM

I hope people won't mind this. I am about half way through Rose Shapiro's "Suckers". Her chapter on osteopathy and chiropractic I found fascinating, as I didn't really know much about either. Unless I've got it wrong, they were both established by ignorant conmen with spiritual overtones, simply as money-making cons. Not really like MLMs, but with a similar objective - conning the gullible. Chiro seems especially dangerous.

Neuromuscular Therapist

10th March 2008, 09:57 AM

Actually, osteopathy and chiropractic are different.

Most osteopaths, as well as using some thrusting techniques, do use soft tissue techniques too, which I believe are beneficial, rather than one or the other.

I am a physical therapist and also do sports massage. When I did sports massage, I learned a lot of advanced techniques for stretching tissue, such as MFR (Myofascial Release Technique), Muscle Energy Technique and so on and so forth. Osteopaths learn most of these techniques when they are training and they are of proven value.

Please don't lump osteopaths and chiropractors together in the same breath. They are different and in the States a DO (Doctor of Osteopathy) has the same status as an MD. However, osteopathic training in Canada and European countries is different and is not the same as the States.

In Europe, DO stands for what was the old Diploma of Osteopathy before the training achieved degree level status.

Blue Wode

10th March 2008, 12:14 PM

Hello Neuromuscular Therapist, and welcome to the UK Skeptics forum.

Actually, osteopathy and chiropractic are different.

-snip-

Please don't lump osteopaths and chiropractors together in the same breath.

I don’t think that present-day osteopathy is quite so mired in quackery as chiropractic, however they are quite similar in that both use spinal manipulation – although it’s probably true to say that osteopaths tend to use it less in favour of soft tissue work (which is gentler).

For anyone who has read ‘Suckers’ it’s really quite understandable why Bindeweede lumped osteopaths and chiropractors together. Here’s a reminder of what he said:

I hope people won't mind this. I am about half way through Rose Shapiro's "Suckers". Her chapter on osteopathy and chiropractic I found fascinating, as I didn't really know much about either. Unless I've got it wrong, they were both established by ignorant conmen with spiritual overtones, simply as money-making cons. Not really like MLMs, but with a similar objective - conning the gullible. Chiro seems especially dangerous.

In support of Bindeweede’s comments, the following is a summary of pages 130-135 of the ‘Bad Backs’ chapter of Suckers - the pages which look specifically at osteopathy:

Chiropractors are more likely to manipulate the spine directly; osteopaths may use the limbs as levers and in this way try to mobilise the spine.

Both osteopathy and chiropractic originated in America. They were a development of the medieval folk medicine practice of bone setting.

In America today there are more than 49,000 Doctors of Osteopathy (known as DOs) who are trained in orthodox scientific medicine with additional training in manipulative therapies. They have the same entitlements to prescribe and perform surgery as mainstream medical practitioners and make up 20% of all general practitioners is the US.

The UK’s 5,000 or so osteopaths, require no scientific medical training and so are more firmly established in the ‘alternative’ camp. Very few are MDs and many combine osteopathy with dubious practices such as naturopathy and cranial osteopathy. They are regulated by statute.

In a review of current research that ‘enraged’ osteopaths and chiropractors, Professor Edzard Ernst concluded that here was no evidence to suggest that spinal manipulation was an effective intervention for any condition and that the finding applied to both osteopathy and chiropractic.

Osteopathy and chiropractic were invented, or ‘discovered’ by a pair of determined and charismatic Americans in the late 19th century – Andrew Taylor and Daniel David Palmer. They both could be described as chancers and fantasists who had tried and failed to make their fortunes in a variety of jobs and get-rich-quick schemes. They saw themselves as visionaries and spiritual leaders and believed they had discovered a single cause and a single cure for all diseases.

Andrew Still claimed he had been a battlefield surgeon, but no record of it exists. He found phrenology and mesmerism interesting and following the deaths of three of his children he became a magnetic healer. He went on to have a ”prophetic vision” which apparently revealed a truth to him that if bones could be manipulated back into alignment then the nerves would “properly conduct the fluids of life” and so-called diseases or effects would trouble the patient no longer. In the mid 1880s he coined the word ‘osteopathy’ and business was booming.

Not exactly reassuring.

As for chiropractic, for the benefit of any drive-by readers of this thread, this recent video presentation (42 mins) is well worth viewing:

The Kinsinger Report on Chiropractic 2008
http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv (http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv)

WARNING: Chiropractors won’t like it.

JJM

10th March 2008, 05:41 PM

{snip}
For anyone who has read ‘Suckers’ {snip}

Not exactly reassuring.They have not even announced the release date for that book in the USA.

As for chiropractic, for the benefit of any drive-by readers of this thread, this recent video presentation (42 mins) is well worth viewing:

The Kinsinger Report on Chiropractic 2008
http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv (http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv)

WARNING: Chiropractors won’t like it.In that video, Kinsinger makes a clear distinction between chiros and osteos (but, only in passing, the topic is chiros). However, there are still some dubious osteo practices:
http://www.quackwatch.org/04ConsumerEducation/QA/osteo.html

Mongrel

10th March 2008, 07:07 PM

They have not even announced the release date for that book in the USA.

Amazon.co.uk (http://www.amazon.co.uk/s/ref=nb_ss_w_h_?url=search-alias%3Daps&field-keywords=Rose+Shapiro&Go.x=9&Go.y=13&Go=Go) deliver to the States, use the link and UKS gets a few pennies ;)

Alternatively I'd be happy to get it and post it across the pond for you if you want to PM me :smiley:

Neuromuscular Therapist

25th March 2008, 08:47 AM

Where have all the Chiropractors gone?

Blue Wode

6th April 2008, 09:57 AM

Could they be looking for the evidence for chiropractic?

It’s interesting to note that the author of an article in the current online issue of Dynamic Chiropractic (the print edition of which is sent to every chiropractor in North America) thinks that skeptical chiropractic websites are...

“…opinionated, biased and prejudicial…based mainly on opinion, apologetics, cherry-picking of data, testimonials and hyperbole…"

and that

“Chiropractic also should maintain high-quality evidence-based sites that specialize in back pain, neck pain, public health, wellness and the risks of CVA following manipulation.”

However, he fails to mention where his profession can find the evidence for ‘chiropractic’. See here:

Our profession has been suffering from asymmetrical cyber attacks by a small group of activists seeking to bring about public doubt and to change public opinion – and our losses have been substantial. Go to your favorite search engine and key in the word chiropractic. Check out the results on the first page…on that crucial first page where most searchers linger are two to three extremely critical Web sites maintained by only a few individuals. If you were a member of the public, a student or a medical doctor interested in finding out about chiropractic, you would be exposed to the most opinionated, biased and prejudicial sites you can imagine while searching the word chiropractic.

-snip-

If you visit these condescending sites, you will find they are sustained by only one or two strongly opinionated cynics. These sites are based mainly on opinion, apologetics, cherry-picking of data, testimonials and hyperbole.

-snip-

It does not matter how many people are enticed to learn more about chiropractic through our outreach efforts if they are exposed to the extremist views of a group of cynics when they search the Internet. To have a comprehensive outreach program that covers all aspects of modern media, the chiropractic profession needs to dominate the first 20 sites that appear when the word chiropractic is entered in a search engine. Chiropractic also should maintain high-quality evidence-based sites that specialize in back pain, neck pain, public health, wellness and the risks of CVA following manipulation.

-snip-

While every health care provider has the right to establish a Web site, every provider also has the responsibility to temper their Web site with an adherence to evidence and ethics. The use of hyperbole or inaccuracies is a violation of the public’s trust and gives the entire profession a public-opinion black eye.

http://www.chiroweb.com/archives/26/09/02.html

More here:
http://chirotalk.proboards3.com/index.cgi?action=display&board=chitchat&thread=1207286860&page=1

Interestingly, similar search results can be obtained for the UK. For example, if you do a ‘pages from the UK’ Google search for “chiropractic”, listed third on the first page of results is the superb UK Skeptics critique of chiropractic which was written by John Jackson in 2004. Better still, if you do a search for “chiropractic evidence” the critique appears at the top of the first page!

Invitation to chiropractors

With regard to the above, UK Skeptics can help you. If you can produce the scientific evidence for ‘chiropractic’ (not the sparse evidence base for spinal manipulative therapy – that’s not chiropractic), then I’m sure that John Jackson would be only too happy to include it in his UK Skeptics chiropractic article. After all, here’s what he said on this very thread in the recent past:

Modern skepticism works just like modern science; skepticism being at the heart of the scientific method.

We look at claims, look at the supporting evidence, and if there's nothing to support the claim we conclude that it is false unless/until it's ever proved otherwise. i.e. we take an a posteriori position on matters. See: Are skeptics disbelievers? (http://www.ukskeptics.com/article.php?dir=articles&article=skeptics_are_disbelievers.php)

This is why we keep asking you chiropractors for evidence that chiropractic (not SMT) actually works. If you can provide any evidence that subluxations exist, how you detect them, how they cause illness and disease and how you put them right then I, and I'm sure other skeptics, will be more than happy to re-evaluate our stance on chiropractic.

http://www.skeptics.org.uk/forum/showpost.php?p=24728&postcount=106

So, if you’re a chiropractor, and you have the scientific evidence for chiropractic, one of the most popular chiropractic articles on the internet is waiting to be updated with that information. Here’s the article:

‘What is chiropractic and does it work?’
http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php

We look forward to hearing from you.

JJM

7th April 2008, 01:39 PM

It always strikes me, when chiros complain about critical information, that all they have to do is show us what is wrong with the criticism. However, they cannot do that any more than they can justify their own claims.

Giddy

15th April 2008, 01:19 PM

Sorry for the absence folks we have had a new addition to the family and my wife is doing 50 + hours working at hospital. Yep she's a medic!

I'm just going to make a couple of quick points with regard to the latest few postings here.

The evidence for the existence of the subluxation as a specific entity depends on which component of the hypothesis you want to look at.

There are Physical- anatomical, neurological and biomechanical
Chemical-physiological changes at nerves, joints and end
organs
Mental-psychological, emotional responses.

From a purely physical point of veiw altered spinal biomechanics can be classed as a subluxation. Palpation of the mobility of spinal segments, pelvis and other joint systems is pretty simple way of assessing this.

Long term reduced joint mobility affects articular cartilage and intervertebral disc nutrition and results in osteoarthritic changes. The term "wear and tear" is used to describe the condition and implies that overuse is underlying cause. More correctly it is poor and abnormal mobility, chondrocyte nutrition with subsequent release of inflammatory agents and invasion by the immune system that leads to the changes.

Specific adjustments/manipulations would aim to correct the joint mobility (Does it work? That's the question). Chiropractors are probably the first group to sytematically seek out the hypomobile segments and attempt to correct them.

It is interesting that now SMT has been adopted by other professions that postive outcomes from investigations into it are considered not to be relevant to chiropractic. Who cares who does the research. Most other non health professions are drawing data from across fields to improve their models of the world.

This is an example of a simplified version of subluxation theory and by no means have I expanded into enough detail, there are neurological and physiological changes that should be remember as well. Most of it is accepted orthopaedic knowledge albeit from the other end of the spectrum, that is, prior to medical relevant pathology. Dentistry changed lifestyle habits and went from barber tooth extraction to scale and cleaning by focusing on early intervention. To me preventitive care has been the essence of the chiropractic approach.

Chiropractic is not a disease treatment healthcare approach. The fact that apparent disease states respond is a phenomenon that has to be confirmed but does happen anecdotally. Ive seen regularly it in my clincal work. To ask for proof that it leads to a cure of a disease is to misunderstand the approach. Research that looks at disease specific treatment outcomes are only useful for examining any apparent effects that adnormal spinal biomechanics and neurological feedforward and feedback mechanisms have on body.

There is no validity that chiropractic is a disease treatment method.
However I believe we are dealing with misdiagnosis of symptoms that may in some cases mimic well known pathological conditions. In other cases the medical diagnosis is based on flawed concepts with regard to the origin of the symptomatology.

Last but not least, here is a recent paper with regards to the association between cervcal spine adjustments and stroke. The findings point to the case of random chance of presenting for care whilst experiencing stroke symptoms rather than causation.
http://www.spinejournal.com/pt/re/spine/abstract.00007632-200802151-00019.htm;jsessionid=LGLNhn2nYTprspCjRjd2zhTGj0WLf VT1lVrT7v6prmcK52Kkl7x5!-1990489359!181195628!8091!-1

Giddy

15th April 2008, 01:20 PM