Value of chiropractors questioned

[Blue Wode]

Here’s an excellent new article about chiropractic from Dr Harriet Hall at Science Based Medicine:

Chiropractic’s Pathetic Response to Stroke Concerns
http://www.sciencebasedmedicine.org/?p=362 (http://www.sciencebasedmedicine.org/?p=362)

She suggests that if chiropractors really wanted to understand the risks and minimise them, they could establish a database of every patient who received neck manipulations.

Interestingly, in August 2005, the UK chiropractic regulatory body, the General Chiropractic Council (GCC), informed the UK-based group, Action for Victims of Chiropractic (AVC), that it understood that the British Chiropractic Association (BCA) was in the process of establishinga database to which patients could report any adverse events they might experience following treatment. See the letter that the GCC sent to AVC in the August 2005 news item in this link:
http://www.chirovictims.org.uk/victims/news.html (http://www.chirovictims.org.uk/victims/news.html)

The following month, in response to a news story "Survey questions safety of alternative medicine (Nature 346,898; 200510.1038/436898b)
which quoted Edzard Ernst as saying that complementary and alternative medicine organisations were not doing enough to monitor adverse reactions, a representative of the BCA, Barry Lewis, responded by saying that, in conjunction with the Anglo European Chiropractic College, the BCA had set up a "chiropractic reporting and learning system" and went on to say that:


“More than 1,200 practitioners who are members of the BCA have recently received an information pack to enable them to participate in the scheme. Resulting data will be analysed at the Anglo-European Chiropractic College and outcomes will be relayed to the profession, through our newsletter, journal and website, so practitioners may learn from the experience of others. The intention is that the scheme will, if successful, be offered to other chiropractic associations within Europe in 2006.”

http://www.nature.com/nature/journal/v437/n7058/full/437476d.html (http://www.nature.com/nature/journal/v437/n7058/full/437476d.html)


However, one can only assume that the scheme was unsuccessful since no chiropractic professional body in the UK seems to have made any further mention of it despite the fact that Item 7 of the minutes of the GCC’s 2nd March 2006 meeting stated very clearly that:



“If chiropractors are to provide a safe clinical experience for patients then a reporting procedure needs to be put in place, within the clinics and within the profession as a whole, which allows for adverse events and near misses to be shared on an anonymised basis so that we can all learn from them.”

http://www.gcc-uk.org/files/link_file/C-020306-Open1.pdf (http://www.gcc-uk.org/files/link_file/C-020306-Open1.pdf)


Nearly a year later, Item C-100107-14 of the minutes of the GCC’s 10th January 2007 meeting saw the following being announced:


Information note of Stroke from Cervical Arterial Dissection

Being very much aware of the alarmist and ill-informed comments the circulate with regard to the perceived risk of stroke associated with neck manipulation, Council had commissioned Professor Alan Breen and Dr David Byfield to produce an information note to address this issue.

In introducing the draft, Professor Breen emphasises that there is no evidence of a causal relationship between chiropractic manipulation and this type of stroke. The information note, therefore, is couched in terms of what to do if a stroke of this nature is in progress.

http://www.gcc-uk.org/files/link_file/C-100107-Open1.pdf (http://www.gcc-uk.org/files/link_file/C-100107-Open1.pdf)


But five months on from that meeting, in Item C-010507-9 of the minutes of the GCC’s 1st May 2007, the following was revealed:



Members noted that the previously agreed information note had been removed from the GCC website in light of the unanimous view of the professional associations that it ran the danger of generating more problems than it might solve.

http://www.gcc-uk.org/files/link_file/C-010507-Openmins.pdf (http://www.gcc-uk.org/files/link_file/C-010507-Openmins.pdf)



So, Harriet Hall seems to be spot on about chiropractic’s *pathetic* response to stroke concerns. Indeed, it’s becoming rapidly apparent that warnings about it are being left to others…

What’s the harm in going to a chiropractor?
http://whatstheharm.net/chiropractic.html (http://whatstheharm.net/chiropractic.html)

…who run the risk of encountering legal action for daring to take a stand….


The [Alberta] College [and Association of Chiropractors] went further in its bad faith by chilling and seeking to prevent scientific debate. Through the Canadian Chiropractic Association, its response to the statement of the Canadian neurologists and chiefs of neurology departments of major teaching hospitals in Canada was to individually threaten each and every one of the physicians whose name was associated with the statement with professional disciplinary action, with challenges to their standing and accreditation with hospitals and with legal action on the basis that their warning the Canadian public and governments about the dangers of neck manipulation was defamatory to chiropractic.

See para 147 here:
http://www.casewatch.org/mal/nette/claim.pdf (http://www.casewatch.org/mal/nette/claim.pdf)


…as happened to Simon Singh for criticising the BCA last year. For up-to-date news on that libel claim, see here:

For Simon Singh and Free Speech - Against the BCA Libel Claim
http://www.facebook.com/group.php?gid=33457048634&ref=mf (http://www.facebook.com/group.php?gid=33457048634&ref=mf)

[Mojo]

Surely there's a potential conflict of interest if a regulatory body such as the GCC is apparently promoting the practices it is supposed to be regulating?

[Blue Wode]

That’s what I’ve always thought, Mojo. Apparently the GCC lost its statutory duty to promote the profession last year:


“With effect from July 2008, our duty to promote the profession has been removed. This implements one of the recommendations of the White Paper ‘Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century’, that health regulators should have a more consistent statutory purpose – that of protecting the public by setting and maintaining professional standards.”

http://www.gcc-uk.org/files/page_file/ANNUAL_REPORT_2007_FINAL.pdf (http://www.gcc-uk.org/files/page_file/ANNUAL_REPORT_2007_FINAL.pdf)


However, it still maintains a very defensive stance, especially with the press. This from July 2008:


The Guardian

Dear Editor

“A bad week for alternative medicine” Rose Shapiro Guardian G2 24 July 08

….Ms Shapiro made several ill-founded and immoderate statements about the UK chiropractic profession, and by implication the GCC, which should be addressed.

The GCC strives to provide accurate information because it is in the public interest to do so; to do otherwise would benefit no-one. The GCC does not ‘downplay’ any risk that may be associated with chiropractic.

…There is no evidence that manipulation of the neck (by any health professional) causes stroke. A recent extensive and well conducted multi-centre research study in Canada demonstrated that, whether a patient sees a GP or a chiropractor, the risk of stroke for a patient susceptible to stroke is identical – very rare. We can extrapolate from this that some people suffering the symptoms of the onset of a stroke consult primary healthcare practitioners – not that the health practitioners cause the stroke.

…UK chiropractors must examine, diagnose and provide care, as necessary, for each individual patient and not continue beyond the point of benefit to that patient. They must not make exaggerated claims or mislead patients about the benefits of chiropractic.

…It is a shame that Ms Shapiro takes a blunderbuss approach in the presentation of her thesis about those who take advantage of patients and the public – in doing so she undermines her argument with extreme scenarios and generalities, denigrating committed health professionals who do not deserve it.

Yours sincerely

Peter Dixon
Chairman
General Chiropractic Council

http://www.gcc-uk.org/files/page_file/Rose%20Shapiro%20Letter%2025Jul08.pdf (http://www.gcc-uk.org/files/page_file/Rose%20Shapiro%20Letter%2025Jul08.pdf)




For a thorough debunking of the Cassidy et al Canadian study mentioned by Peter Dixon, see here: http://www.sciencebasedmedicine.org/?p=362 (http://www.sciencebasedmedicine.org/?p=362)


From August 2008:



The Editor
The Times

Sir,

Re: ‘Regulating quack medicine makes me feel sick’, David Colquhoun, The Times, 29 August 2008

Professor Colquhoun has got his facts wrong about the General Chiropractic Council (GCC) and the UK’s chiropractic profession.

…chiropractic is not a technique or a ‘belief’. Should Professor Colquhoun wish to depart from his belief system and take the trouble to examine the evidence for the effectiveness and safety of chiropractic management of back pain then there is plenty available – taking a look on the Cochrane database would be a good start, as would a glance at European guidelines for the management of back pain and the Department of Health’s Musculoskeletal Services Framework for England.

…The Times would have done better to focus on the pain and suffering caused by the back pain epidemic and how members of the public can access appropriate evidence-based care, such as that provided by chiropractors.

Margaret Coats
Chief Executive & Registrar
General Chiropractic Council

http://www.gcc-uk.org/files/page_file/Letter_Times_re_Colquhoun_29Aug08.pdf (http://www.gcc-uk.org/files/page_file/Letter_Times_re_Colquhoun_29Aug08.pdf)


Notice that little weasel word “…the public can access appropriate evidence-based care, such as that provided by chiropractors”.” The big question is will that care, in the majority of cases, be appropriate? If the results of this recent survey are anything to go by, it’s looks unlikely:




Overall, mechanical conditions of the musculoskeletal system were felt to be treated effectively by chiropractic intervention and there was 100% agreement that it was beneficial in treating mechanical dysfunctions of the spine. Non-musculoskeletal conditions in adults, including asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), were considered conditions that can benefit from chiropractic management. Opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive. Childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma were perceived to benefit from chiropractic intervention by more than 50% of the respondents.

-snip-

Traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of the respondents and 63% considered subluxation to be central to chiropractic intervention.


Aranka Pollentier and Jennifer M. Langworthy, The scope of chiropractic practice: A survey of chiropractors in the UK. Clinical Chiropractic, Volume 10, Issue 3, September 2007, pp147-155.
http://www.cam-research-group.co.uk/POI/The%20scope%20of%20chiropractic%20practice%20a%20s urvey%20of%20chiropractors%20in%20the%20uk%20-%20Aranke%20Pollentier%20-%20Clinical%20Chiropractic%202007%2010%203%20pg%20 147-155.pdf (http://www.cam-research-group.co.uk/POI/The%20scope%20of%20chiropractic%20practice%20a%20s urvey%20of%20chiropractors%20in%20the%20uk%20-%20Aranke%20Pollentier%20-%20Clinical%20Chiropractic%202007%2010%203%20pg%20 147-155.pdf)



And don’t forget that the GCC gives a vague description for the fictitious chiropractic subluxation on this page of its website:
http://www.gcc-uk.org/page.cfm?page_id=6 (http://www.gcc-uk.org/page.cfm?page_id=6)

From October 2008:



Dr Miriam Stoppard
Daily Mirror


Dear Dr Stoppard

Re: ‘Stay safe if you go alternative’ Daily Mirror 22 September 2008

…There is no evidence that examination or manipulation of the neck causes stroke.

Journalists, and a few others, routinely confuse association with cause but as a registered medical practitioner you will be aware of the distinction. If you wish to check sources of information for yourself the following would be an excellent start: Cassidy, Boyle et al ‘Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study, Spine 33(4S): S176-183 2008.

This study analysed a Canadian government database covering over 109 million person years that recorded all primary medical care provider (GP) and chiropractic visits and all VBA stroke admissions in the province of Ontario between 1993-2002. It found that the very slightly increased VBA stroke risk rate for neck pain patients consulting a GP or a chiropractor, as opposed to the general risk in the community, is exactly the same whether the patient receives medical care from a GP or chiropractic neck manipulation.

The increased risks of stroke associated with GP and chiropractic visits are likely to be due to patients with headache and neck pain, which can be warning signs of stroke, seeking care before their stroke.


There is evidence that the chiropractic management of back pain is effective in terms of outcome and cost. Since the 1990’s evidence-based national clinical guidelines for the management of acute and chronic low-back pain, prepared by expert interdisciplinary panels in a variety of countries, including the UK, have recommended spinal manipulation, early activity and patient education as appropriate first line management for patients with non-specific or common mechanical back pain. I don’t want to swamp you with references and so refer you only to the most recent guideline– the European Back Pain Guidelines which can be read on www.backpaineurope.org .

Further, large Medical Research Council trials published in the BMJ, have reported that chiropractic management and skilled manipulation are more effective and cost-effective than usual or best medical care. I’ll give you two references for this:

• Meade TW et al (1990) Low-Back Pain of Mechanical Origin: Randomised Comparison of Chiropractic and Hospital Outpatient Treatment, BMJ 300: 1431-37

• United Kingdom Back Pain Exercise and Manipulation (UK BEAM) Randomised Trial: Effectiveness of Physical Treatments for Back Pain in Primary Care, BMJ Online First, Nov 19, 2004:1-8

Peter Dixon
Chairman
General Chiropractic Council


http://www.gcc-uk.org/files/link_file/Letter_Miriam_Stoppard6Oct08.pdf (http://www.gcc-uk.org/files/link_file/Letter_Miriam_Stoppard6Oct08.pdf)


That data cited by Peter Dixon is also cited in the GCC’s January 2007 publication ‘Advice for General Practitioners, Primary Care Trusts and Local Health Boards’. It is linked to, and critiqued, here:

http://www.skeptics.org.uk/forum/showpost.php?p=26449&postcount=203 (http://www.skeptics.org.uk/forum/showpost.php?p=26449&postcount=203)

So yes, Mojo, I’d agree with you that there’s very definitely a conflict of interest there, although I’ve no idea what can be done about it.

[Blue Wode]

A couple of updates.

Edzard Ernst tells it like it is...


...We do know a little bit about risks of complementary or alternative medicine because, like sailing past the tip of an iceberg during bright daylight, we could not help noticing. But systematic knowledge akin to the one in conventional healthcare is usually not available.

For instance, we know of approximately 700 patients who suffered severe injuries, mostly vascular accidents, after spinal manipulation. Despite this impressive figure – a drug with this track record would probably have been banned long ago – most chiropractors insist that a causal link has not been established.

The website of the General Chiropractic Council has a question and answer section where we find the following:

“Q. Is chiropractic safe?

A. Yes, all the evidence is that chiropractic is a safe and effective form of care when provided by registered chiropractors…”

Really? All the evidence? You must be kidding! But the general public tends to believe such promotional misinformation: after all, natural must be safe.

http://www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4122390&c=2 (http://www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4122390&c=2)

(Registration to his blog is free, and don’t miss the links to his other recent posts – they’re also well worth a read.)


And news just in from Canada…


Under its new budget, Alberta will no longer pay for chiropractic services.
They calculate it will save $53 million:

http://www.edmontonjournal.com/Evans+choice+deficit/1476224/story.html (http://www.edmontonjournal.com/Evans+choice+deficit/1476224/story.html)

[bindeweede]

Apologies if this has been posted before, but apparently Chiropractic can prevent swine flu, which is, well was, in the news The article is 3 weeks old, but I expect the claim still applies.

http://www.huffingtonpost.com/dr-mj-wegmann/3-sure-fire-strategies-to_b_191859.html

[Blue Wode]

Dr Harriet Hall from Science Based Medicine recently debunked similar chiropractic claims about swine ‘flu in a short piece for James Randi’s Swift blog:
http://www.randi.org/site/index.php/swift-blog/538-chiropractics-answer-to-swine-flu-get-adjusted.html (http://www.randi.org/site/index.php/swift-blog/538-chiropractics-answer-to-swine-flu-get-adjusted.html)

Incidentally, for anyone who may not be aware of it, chiropractors are coming under some very severe criticism from skeptics in the UK at the moment as a consequence of Judge Eady’s controversial ruling in the BCA v. Simon Singh libel case. This link gives a comprehensive, up-to-date list of blogger’s posts on all the developments:
http://godknowswhat.wordpress.com/2009/05/16/simon-singh-case-response-roundup/ (http://godknowswhat.wordpress.com/2009/05/16/simon-singh-case-response-roundup/)

[Trinoc]

There was a link somewhere to a chiropractor in (I think) Bristol who was advertising an ability to prevent swine flu. I can't find it - maybe on this forum, maybe Bad Science or SGU - but I'm sure it would warrant an ASA complaint.

[polomint38]

I think Jesus was a chiropractor, that's how he cured Lazarus of death. >:D

[Trinoc]

I think Jesus was a chiropractor, that's how he cured Lazarus of death. >:D
Yes ... but all his patients knew they were just being manipulated ...

[bindeweede]

There was a link somewhere to a chiropractor in (I think) Bristol who was advertising an ability to prevent swine flu. I can't find it - maybe on this forum, maybe Bad Science or SGU - but I'm sure it would warrant an ASA complaint.

Was it this?



We all know that when you are sick, your immune system is the part of your body that fights off viruses and nasties with all its might. Therefore it would make sense to make sure your immune system is functioning optimally while swine flu is making its rounds (in fact, it should be optimal at all times but that’s for a different article). So can Chiropractic help your immune system function at its best?
Sure it can! Studies show that being adjusted once per week can increase your immune system function by up to 400%. (http://www.chiropracticlifeblog.com/ronaldpero.pdf) [1]
http://www.chiropracticlifeblog.com/chiropractic-and-swine-flu/

[Trinoc]

Was it this?

http://www.chiropracticlifeblog.com/chiropractic-and-swine-flu/
Looks like it. I must have got Brighton mixed up with Bristol, which explains why I didn't find it. Surely this has to be an ASA issue.

[JJM]

Blue Wode has posted an excellent analysis of chiropractic http://www.layscience.net/node/566

[Blue Wode]

Thanks for that, JJM. As suspected in my analysis above, it's just been revealed that the NHS is to promote acupuncture, chiropractic and osteopathy for back pain:

Millions of people who suffer from back pain are to given the right to demand free acupuncture on the NHS, under controversial new guidance.

By Laura Donnelly, Health Correspondent
Last Updated: 5:42PM BST 23 May 2009

GPs will be told to offer their patients the traditional Chinese practice, as well as other treatments like osteopathy and chiropracty, as an alternative to conventional remedies like exercise.

Last night critics said the guidelines, which are due to be published by the National Institute for Health and Clinical Excellence (NICE) on Wednesday, amounted to an official endorsement of "mumbo jumbo" medicine with no good evidence to support it.

More...
http://www.telegraph.co.uk/health/healthnews/5374291/NHS-to-promote-acupuncture-for-back-pain.html (http://www.telegraph.co.uk/health/healthnews/5374291/NHS-to-promote-acupuncture-for-back-pain.html)

[JJM]

Acupuncture for low back pain fails http://www.sciencebasedmedicine.org/?p=500

As for osteopathy, they may be as good as other treatments. The literature is conflicted.

[Blue Wode]

The official NICE guidelines on low back pain published today (full details):
http://guidance.nice.org.uk/CG88

[DrS]

BBC report HERE (http://news.bbc.co.uk/1/hi/health/8068427.stm) too.

[Pebble]

The problem is not evidence, it is cost-efficacy of available options.

In essence current therapy for chronic back pain (Advice, booklets plus or minus exercise) is so poor that just about anything inexpensive will meet NICE criteria.

As their analysis reveals the UKBeam trial was the dominant basis for all analysis, since this suggests a small benefit as 3 months and 1 year, then so long as there are patients for whom an exercise program would not be appropriate it is possible to deduce that if the benefit were reporducible then it would cost less than £20k per quality of life year gained.

Since other published studies do not show that such interventions are harmful, and some are supportive, they have accepted the probability of marginal benefit for a low price.

http://www.nice.org.uk/nicemedia/pdf/CG88fullguideline.pdf (http://www.nice.org.uk/nicemedia/pdf/CG88fullguideline.pdf)

7.3.2 Health economics
Two studies were included. One was a UK-based cost-effectiveness study of four interventions for treatment of low back pain, two of which included manual therapy. The second was


Results (base case)
The mean cost (Standard Deviation) of best care was £346 (£602). best care+manipulation cost £195 more than best care. Relative to best care, best care+manipulation generated an additional 0.041 (95% CI 0.016 to 0.066) QALYs per participant. If exercise is not available (n=623) manipulation generates 0.041 more QALYs per patient than best care at an additional cost of £195 per patient , yielding an ICER of £4800 per QALY. The GDG felt that from the evidence presented it was not appropriate to rule out either treatment option. For some people certain therapies may not be suitable therefore manipulation alone remains an option for this population.

[Blue Wode]

What worries me is that NICE's recommendation of spinal manipulation by chiropractors is likely to send unwitting patients headlong into the bait and switch of unscientific medicine:
http://www.sciencebasedmedicine.org/?p=156

For example, a recent survey of UK chiropractors revealed that traditional chiropractic beliefs were deemed important by 76% of the respondents, whilst 63% of them considered subluxation to be central to chiropractic intervention:
http://www.cam-research-group.co.uk/POI/The%20scope%20of%20chiropractic%20practice%20a%20s urvey%20of%20chiropractors%20in%20the%20uk%20-%20Aranke%20Pollentier%20-%20Clinical%20Chiropractic%202007%2010%203%20pg%20 147-155.pdf

Why didn't NICE consider that?

[Pebble]

Now here is a novel approach to 'placebo' controlled data!


http://www.nice.org.uk/nicemedia/pdf/CG88fullguideline.pdf



Evidence suggests that seeing an acupuncturist was better than usual care but that there is not much difference between acupuncture and sham. However, sham acupuncture is used as an active form of treatment by some practitioners, therefore this should be considered as a possible treatment.
:cheesy:

[Matt]

Why does the onion come to mind?

[Blue Wode]

The latest commentary from Edzard Ernst...

Distrust Me, I'm A Chiropractor
http://timesonline.typepad.com/science/2009/05/distrust-me-im-a-chiropractor.html

[Blue Wode]

Another commentary just in from Ernst...

Back pain guidelines touch a raw nerve
Nice's recommendation of chiropractors for back pain overestimates the benefits and underestimates the risks.
http://www.guardian.co.uk/commentisfree/2009/may/27/health-nice-chiropractic

[Blue Wode]

More from Edzard Ernst, this time in the latest issue of New Scientist:

What you should know about chiropractic
http://www.newscientist.com/article/mg20227101.100-what-you-should-know-about-chiropractic.html

ETA - Some interesting comment just in from the British Chiropractic Association:

http://jackofkent.blogspot.com/2009/05/bcas-important-clarifactions.html
http://jdc325.wordpress.com/2009/05/27/bca-response/ (http://jdc325.wordpress.com/2009/05/27/bca-response/)

[Blue Wode]

Commentary on a new paper, ‘Safety of chiropractic interventions: a systematic review’:


"There is a very good chance that you will feel worse after seeing a chiropractor..."

Read on:
http://www.sciencebasedmedicine.org/?p=509 (http://www.sciencebasedmedicine.org/?p=509)

[Blue Wode]

An omnibus complaint - targeting 523 chiropractors - has been sent to the UK General Chiropractic Council (GCC) this morning:
http://www.zenosblog.com/2009/06/omnibus-complaint-to-general.html

For some revealing insight into the GCC, and the problems in general with UK chiropractic, see here:
http://chiropracticlive.com/

[Blue Wode]

For updates on the BCA v. Singh libel case, and the latest criticism on chiropractic regulation in the UK, see this sticky thread at the James Randi Educational Foundation science forum:
http://forums.randi.org/showthread.php?t=121214

[Admin]

Junk moved here: http://www.ukskeptics.com/forum/showthread.php?t=4067

[Trinoc]

McTimoney panic email story in the Guardian (courtesy of Chris French) ...

http://www.guardian.co.uk/science/2009/jun/19/chiropractic-bca-mca-singh

Also some interesting insights into how seriously (or not) some Trading Standards departments take their obligation to enforce the law.

[lost thought]

I think that when the chiro sharp shoopers took aim at Simon the shot themselves in the foot. O0
Or live in glass houses and throwing comes to mind. :cheesy:
If these actions are being taken so suddenly would this mean that they did know their treatments where alleged to be BOGUS. 8)
note I said alleged so don't sue me mister. >:D

[davidrodway]

Thought there would be a lot about the BCA v. Simin Singh case on the debate website friction.tv but apparently nothing, as yet. Odd.

[Blue Wode]

http://scepticsbook.com/2009/07/29/the-simon-singh-article-that-caused-all-the-fuss-reproduced-here/ (http://scepticsbook.com/2009/07/29/the-simon-singh-article-that-caused-all-the-fuss-reproduced-here/)

In a worldwide campaign released today, 29th July 2009, the Guardian article originally posted by Simon Singh back in April 2008, is being republished across the world.

The edited version has the libelous sentence removed, but is reproduced to allow the public at large to understand the intentions of Simon’s original post. Given the current legal action currently in progress by the British Chiropractic Association against Simon, this provides insight into the claims for all to see.

Spearheaded by Sense about Science, the intention of campaign is to alert the public to the potential implications of libel or defamation as it pertains to free speech and journalism, not only in the UK but also across the globe.

Below is the article produced in full, as approved by Simon and Sense about Science.


Beware the spinal trap

Some practitioners claim it is a cure-all, but the research suggests chiropractic therapy has mixed results – and can even be lethal, says Simon Singh.

You might be surprised to know that the founder of chiropractic therapy, Daniel David Palmer, wrote that “99% of all diseases are caused by displaced vertebrae”. In the 1860s, Palmer began to develop his theory that the spine was involved in almost every illness because the spinal cord connects the brain to the rest of the body. Therefore any misalignment could cause a problem in distant parts of the body.

In fact, Palmer’s first chiropractic intervention supposedly cured a man who had been profoundly deaf for 17 years. His second treatment was equally strange, because he claimed that he treated a patient with heart trouble by correcting a displaced vertebra.
You might think that modern chiropractors restrict themselves to treating back problems, but in fact some still possess quite wacky ideas. The fundamentalists argue that they can cure anything, including helping treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying – even though there is not a jot of evidence.

I can confidently label these assertions as utter nonsense because I have co-authored a book about alternative medicine with the world’s first professor of complementary medicine, Edzard Ernst. He learned chiropractic techniques himself and used them as a doctor. This is when he began to see the need for some critical evaluation. Among other projects, he examined the evidence from 70 trials exploring the benefits of chiropractic therapy in conditions unrelated to the back. He found no evidence to suggest that chiropractors could treat any such conditions.

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.
In 2001, a systematic review of five studies revealed that roughly half of all chiropractic patients experience temporary adverse effects, such as pain, numbness, stiffness, dizziness and headaches. These are relatively minor effects, but the frequency is very high, and this has to be weighed against the limited benefit offered by chiropractors.

More worryingly, the hallmark technique of the chiropractor, known as high-velocity, low-amplitude thrust, carries much more significant risks. This involves pushing joints beyond their natural range of motion by applying a short, sharp force. Although this is a safe procedure for most patients, others can suffer dislocations and fractures.

Worse still, manipulation of the neck can damage the vertebral arteries, which supply blood to the brain. So-called vertebral dissection can ultimately cut off the blood supply, which in turn can lead to a stroke and even death. Because there is usually a delay between the vertebral dissection and the blockage of blood to the brain, the link between chiropractic and strokes went unnoticed for many years. Recently, however, it has been possible to identify cases where spinal manipulation has certainly been the cause of vertebral dissection.

Laurie Mathiason was a 20-year-old Canadian waitress who visited a chiropractor 21 times between 1997 and 1998 to relieve her low-back pain. On her penultimate visit she complained of stiffness in her neck. That evening she began dropping plates at the restaurant, so she returned to the chiropractor. As the chiropractor manipulated her neck, Mathiason began to cry, her eyes started to roll, she foamed at the mouth and her body began to convulse. She was rushed to hospital, slipped into a coma and died three days later. At the inquest, the coroner declared: “Laurie died of a ruptured vertebral artery, which occurred in association with a chiropractic manipulation of the neck.”

This case is not unique. In Canada alone there have been several other women who have died after receiving chiropractic therapy, and Edzard Ernst has identified about 700 cases of serious complications among the medical literature. This should be a major concern for health officials, particularly as under-reporting will mean that the actual number of cases is much higher.

If spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.


Simon Singh is a science writer in London and the co-author, with Edzard Ernst, of Trick or Treatment? Alternative Medicine on Trial. This is an edited version of an article published in the Guardian for which Singh is being personally sued for libel by the British Chiropractic Association.

Official link on this latest development:
http://www.senseaboutscience.org.uk/index.php/site/project/380 (http://www.senseaboutscience.org.uk/index.php/site/project/380)


More:
http://www.layscience.net/node/621 (http://www.layscience.net/node/621)
http://www.zenosblog.com/2009/07/what-fuss-is-all-about.html (http://www.zenosblog.com/2009/07/what-fuss-is-all-about.html)

[Question Authority]

Despite the high praises I've heard from others for chiropractors, I can only speak from my own experience and I'd have to say this is quack medicine.

I went in for some back problems I was experiencing on the recommendation of someone whom I trusted and went to this particular "doctor" herself.

During my first session, he asked if he could crack my neck (nice of him to actually ask, really) and I was adamant - "no!" What he did do, though, really helped my back feel much better (and I have since learned that a good professional massage is even better).

Second and subsequent sessions, same thing. (Did he forget who I was between appointments?)

The last time I was there was probably my 5th or 6th visit (?) and he didn't ask. He just did it.

I was nauseous, nearly passed out on the drive home (and it was a long drive), and I've never been the same since then (this was over 10 years ago).

I have a feeling they create problems so that you have to keep coming back to get them "fixed". What money-grubbing fraud doesn't want repeat business?

[Blue Wode]

The following blog post has some relevancy to this topic and the ongoing BCA/Singh case:


The BCA club

What about the issue of four BCA members sitting on the IC [the General Chiropractic Council's Investigating Committee] deciding whether there is a case to answer for the 500-odd BCA members (half their membership) I’ve complained about. We should be in no doubt that the beleaguered BCA will be wanting to pull up the drawbridge! So is it right that the cases of BCA members are judged by fellow BCA members? Will they be impartial, but will they also be seen to be impartial? If they are not seen to be impartial, that would certainly ‘undermine public confidence in the regulation of registered chiropractors’.

Is this something the GCC is really concerned about or are these things just not under their control? Out of the current 48 members of the various statutory committees, 24 are chiropractors and 12 of those are BCA members. If you were wanting to appear independent and in control, would you choose this situation, particularly co-opting yet more BCA members to your Investigating Committee? It just doesn’t look good, does it?

The AECC and other clubs

Then there’s the problem of three of the IC members being employed by the AECC and another one by McTimoney College of Chiropractic.
Kenneth Vall is more than just an employee: he’s their Principal and is also a Director of the AECC. Similarly, Kalim Mehrabi is a Director of McTimoney.

What might happen if even just some of the complaints made by either me or others succeed? What if half the complaints are upheld? All of them?
However many, based on previous experience, it is possible that the news of this will travel far and wide (http://www.senseaboutscience.org.uk/index.php/site/project/380), perhaps even to main stream media (http://www.senseaboutscience.org.uk/index.php/site/project/333/). Can you see the headlines?

Will potential students be reconsidering whether they want to take up chiropractic as a career? What might the effect be on the intake of new students to the AECC? What pressure might this put on those serving on the IC, making decisions about whether there is a case to answer for each of the complaints?

Undermining public confidence

Should the GCC’s Council not be concerned about whether such a situation might be liable to undermine public confidence in the regulation of registered chiropractors? If they are concerned, why have they just co-opted these BCA, AECC and McTimoney College people? They might have had more credibility in carrying out their duty to protect the public if they had co-opted more lay people.

Who knows. But it does look like the GCC are trying to cover all bases.

Expertise required

They are certainly bringing out the big guns of the chiropractic world. But they are not needed: the real expertise required is not in chiropractic, but knowing about the Advertising Standards Authority (http://www.asa.org.uk/) guidance and understanding how the ASA apply this guidance — the guidance that the GCC’s CoP says all chiropractors have to adhere to and the guidance against which my complaints must be judged.

To help understand the ASA’s guidance, I’ve provided a handy guide in various recent posts (with more to come):

When only the best will do (http://www.zenosblog.com/2009/08/when-only-the-best-will-do/)
I see, it’s not who you are… (http://www.zenosblog.com/2009/08/i-see-its-not-who-you-are%e2%80%a6/)
A claim or not a claim: that is the question (http://www.zenosblog.com/2009/08/a-claim-or-not-a-claim-that-is-the-question/)
Another ASA win against quackery (http://www.zenosblog.com/2009/07/another-asa-win-against-quackery/)
Advertising Standards Authority adjudications are fascinating! (http://www.zenosblog.com/2009/07/advertising-standards-authority-adjudications-are-fascinating/)
These are the rules, nothing more, nothing less (http://www.zenosblog.com/2009/05/these-are-the-rules-nothing-more-nothing-less/)
What chiroquacktors are allowed to claim (http://www.zenosblog.com/2009/05/what-chiroquacktors-are-allowed-to-claim/)
What the ASA have to say about chiroquacktic (http://www.zenosblog.com/2009/05/what-the-asa-have-to-say-about-chiroquacktic/)

More...
http://www.zenosblog.com/2009/09/pulling-up-the-drawbridge/

[Blue Wode]

Well worth clicking on the link at the end of the quote below and reading David Colquoun's entire piece on this latest desperate action by chiropractors:



Two lawyers and two journalists squash criticism of chiropractic on TV

September 23rd, 2009

Chiropractors are getting very touchy indeed, all over the world. And no wonder, because their claims are being exposed as baseless as never before, in the wake of their attempts to stifle criticism by legal action (http://www.senseaboutscience.org.uk/index.php/site/project/333/)..
In March, Shaun Holt appeared on Breakfast TV in New Zealand. Holt has done a lot of good work on TV in debunking some of the preposterous claims made by quacks. See him on YouTube (http://www.youtube.com/user/rrmem06).

This time he talked about chiropractic. Here is the video.



One could argue that he was over generous to chiropractic, especially when talking about their effectiveness in treating low back pain. He said, quite rightly, that chiropractors are no better than physiotherapists at treating low back pain.

-snip-

Despite the moderate tone and accuracy of what Holt said on TV, the New Zealand Chiropractors’ Association made a formal complaint. That is what they like to do, as I learned recently, to my cost (http://www.dcscience.net/?s=NZMJ). It is so much easier than producing evidence.

Quite absurdly the New Zealand Broadcasting Standards Authority (BSA) has upheld some of the complaints. Their judgement can be read here (http://www.bsa.govt.nz/decisions/2009/2009-058.html).
The BSA consists of four people (http://www.bsa.govt.nz/aboutus-members.php), two lawyers and two journalists. So not a trace of scientific expertise among them. Having people like that judging the claims of chiropractors makes as much sense as having them judged by Mr Justice Eady (http://jackofkent.blogspot.com/2009/05/bca-v-singh-astonishingly-illiberal.html). They seem to be the sort of people who think that if there is a disagreement, the truth must lie half-way between the opposing views.

-snip-

...perhaps someone should submit a complaint to the New Zealand Broadcasting Standards Authority.

After all, I notice that they have dismissed complaints from one chiropractor (http://www.bsa.govt.nz/decisions/2008/2008-033.htm), Sean Parker, after a TV programme looked at the business practices of his private chiropractic practice, The Spinal Health Foundation. Perhaps the BSA understands business better than it understands science.
Follow-up

Is chiropractic crumbling in New Zealand?
The New Zealand College of Chiropractic featured in my editorial in the New Zealand Medical Journal (http://www.dcscience.net/?p=241), and in the fallout from that article (http://www.dcscience.net/?p=253), It’s principle, “Dr” Brian Kelly (B App Sci (Chiro)) seems to be getting desperate. His college is now canvassing for recruits in Canada (http://www.chirowebs.net/wordpress/?p=533). They are promised all the woo.

Subluxation centered techniques – Gonstead, Toggle Recoil, Thompson, Diversified
Traditional philosophy featuring vitalism and innate healing – congruent curriculum
Perhaps Canada is a good place to recruit, gven the $500 million class action (http://www.cbc.ca/canada/edmonton/story/2008/06/13/chiro-lawsuit.html) being brought against chiropractors in Canada, after Sandrai Nette became tetraplegic immediately after a chiropractor manipulated her neck, Canadian chiropractors must be looking for somewhere to hide.

More...
http://www.dcscience.net/?p=2262 (http://www.dcscience.net/?p=2262)

[davidrodway]

Widely used chiropractic brochure criticized.

The British Advertising Standards Authority (ASA) has upheld a
complaint against a Koren Publications brochure titled "Infants &
Babies," which states:

"There seems to be no limit to the conditions which can respond to
chiropractic care: colic, difficult breast-feeding, Erbs palsy (an
arm is limp and undeveloped), torticollis (twisted neck), unbalanced
face and skull development, foot inversion, nervousness, ear, nose
and throat infections, allergies and sleep disorders, and projectile
vomiting. . . .

"Babies are very top-heavy. Mild to moderate shaking of a child can
result in serious neurological damage since their neck muscles are
undeveloped. This damage has been known to occur after playfully
throwing the child up in the air and catching him/her. The damage
caused is called Shaken Baby Syndrome. In addition to being shaken or
thrown, being spanked can also cause spinal or neurological damage to
a child. Any child who has been subjected to this rough behavior
desperately needs a chiropractic checkup to prevent possible nerve
damage." http://www.korenpublications.com/images/products/00000027.pdf

The ASA stated that the brochure must not appear again in its current
form. http://www.casewatch.org/foreign/asa/koren.shtml

[Blue Wode]

New book:

'Locked In - Chiropractic adjustment gone wrong'
https://scottslockedin.com/Home_Page.html

It was completely compiled by using a mouth/headstick to type.

[Blue Wode]

Just days after Sandra and David Nette’s class action lawsuit was rejected by a judge in Alberta, Canada, comes the sad news from David Nette that quadriplegic chiropractic victim, Diane Rodrigue, has died. Diane Rodrigue featured in this 2005 Irish TV programme which looked at the dangers of alternative medicine:

http://www.rte.ie/news/2005/0505/primetime.html (from 25min 45sec in)

In view of the above, it is well worth reading Sandra and David Nette’s class action lawsuit Statement of Claim:

http://www.casewatch.org/mal/nette/claim.pdf

[Pebble]

Just days after Sandra and David Nette’s class action lawsuit was rejected by a judge in Alberta, Canada, comes the sad news from David Nette that quadriplegic chiropractic victim, Diane Rodrigue, has died. Diane Rodrigue featured in this 2005 Irish TV programme which looked at the dangers of alternative medicine:

http://www.rte.ie/news/2005/0505/primetime.html (from 25min 45sec in)

In view of the above, it is well worth reading Sandra and David Nette’s class action lawsuit Statement of Claim:

http://www.casewatch.org/mal/nette/claim.pdf



Interesting read, do you have access to the judgement? Would be interesting to read the reasoning of the Judge(s).

At a guess:

1. Absence of evidence for efficacy is not evidence for inefficacy - hence all charges of knowingly administering a useless therapy fall.

2. There is evidence of an association between manipulation and stroke not proof of causality

3. If such a relationship exists, the frequency of events (less than 1:20,000) is not sufficient to mandate specific mention of this risk.

Now were this a medical procedure, one is required to mention risks that lead to permenant disability - however, this has only been so in the UK for the last decade, so is not fully enforced. Hence by analogy with the medical position patients are given vaccination without generally requiring specific consent for the low risk of anaphylactic shock.

Arguments based on the risk benefit ratio definitely seem the way to go, but that requires much better evidence on the inefficacy front.

[JJM]

... 1. Absence of evidence for efficacy is not evidence for inefficacy - hence all charges of knowingly administering a useless therapy fall.I don't think that tortured logic works. However, the finding against Nette was that she cannot file a "class action" suit; her personal suit is proceeding unimpeded.


2. There is evidence of an association between manipulation and stroke not proof of causalityI think that when the stroke occurs immediately when the chiro snaps the neck (and many have) that is pretty definitive. We also know the mechanism, artery dissection, that causes the stroke and the anatomy that permits it to happen. http://www.quackwatch.org/01QuackeryRelatedTopics/chirostroke.html

When Nette arrived at the hospital, the neurologist noted the bilateral artery dissection that led to her stroke and he said to her husband "Chiropractor, right?" The bilateral artery dissection is chiro's only unique gift to humanity.


3. If such a relationship exists, the frequency of events (less than 1:20,000) is not sufficient to mandate specific mention of this risk.That may be true for effective procedures; but for procedures whose benefit is zero, it is misleading. Nette serves as a perfect example of this- she was generally healthy and was being given bogus, "maintenance" adjustments by the quack who snapped her neck. When the benefit is zero, risk/benefit involves division by zero (a very large number arguing against the "treatment"). Another woman, who died, was being "treated" for a bruised tailbone by a chiro who subscribes to NUCCA nuttiness- he believes that all problems stem from subluxations of the top two vertebrae.


... Arguments based on the risk benefit ratio definitely seem the way to go, but that requires much better evidence on the inefficacy front."Maintenance" adjustments on healthy people and tailbone "treatments" involving the neck snap make a strong case for the inefficacy of such procedures. When a treatment is scientifically implausible, its routine use is unsupportable.

[Pebble]

While it is easy to argue for an association being causative and the temporal association increases the liklihood of this being a correct deduction - it is not proof.

As for bilateral dissection being uniquely related ti Chiropracty - Nope:



1. Clin Neurol Neurosurg. 2007 Nov;109(9):816-20. Epub 2007 Aug 20.

Spontaneous bilateral carotid and vertebral artery dissections associated with
multiple disparate intracranial aneurysms, subarachnoid hemorrhage and
spontaneous resolution. Case report and literature review.

Marshman LA, Ball L, Jadun CK.

Department of Neurosurgery, North Staffordshire Royal Infirmary, Hartshill,
Stoke-on-Trent, Staffordshire ST4 7LN, United Kingdom.
l.a.g.marshman@btinternet.com

Spontaneous bilateral carotid and vertebral artery dissections (CADs and VADs)
are rare. A 29-year-old female presented with a collapse, 4 weeks after a sudden
onset of severe neck and shoulder pain. CT scan revealed diffuse subarachnoid
hemorrhage (SAH) and early hydrocephalus. Angiography revealed bilateral CADs and
VADs, along with multiple fusiform and saccular aneurysms. Systemic vessels -
including the renal arteries - were normal, and no risk factors or underlying
vasculopathy were apparent. The presumed source of SAH (a posterior cerebral
artery aneurysm) was successfully clipped. Each dissection, by contrast, was
managed conservatively with heparin prophylaxis; and spontaneous CAD and VAD
resolution occurred within 6 months. We present a unique case of four-vessel
dissection associated with multiple disparate saccular and fusiform aneurysms. We
suspect that underlying vasculopathy - perhaps novel - may become apparent with
time.

PMID: 17709178 [PubMed - indexed for MEDLINE]


2. Neuroradiology. 2003 May;45(5):311-4. Epub 2003 Apr 12.

Simultaneous bilateral internal carotid and vertebral artery dissection following
chiropractic manipulation: case report and review of the literature.

Nadgir RN, Loevner LA, Ahmed T, Moonis G, Chalela J, Slawek K, Imbesi S.

University of Pennsylvania School of Medicine, Hospital of the University of
Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.

Single-vessel cervical arterial dissections typically occur in young adults and
are a common cause of cerebral ischemia and stroke. Although the pathogenesis of
multivessel dissection is unclear, it is thought to be a consequence of
underlying collagen vascular disease. We present a 34-year-old previously healthy
man who developed bilateral internal carotid and vertebral artery dissection
following chiropractic manipulation.

PMID: 12692699 [PubMed - indexed for MEDLINE]


3. Ulus Travma Acil Cerrahi Derg. 2003 Jan;9(1):72-5.

[Traumatic dissection of bilateral vertebral arteries]

[Article in Turkish]

Akay KM, Izci Y, Uğurel S, Baysefer A, Timurkaynak E.

Gülhane Askeri Tip Akademisi, Nöroşirürji Anabilim Dali, Ankara, Turkey.
kmakay45@hotmail.com

58-year-old male comatose patient following a motor vehicle accident with a
history of coronary bypass surgery 5 years ago has been presented. The patient
was awake after the accident and he became comatose 30 minutes after the
accident. The early diagnostic investigations showed no responsible cranial or
spinal lesion. At the 2nd day of the accident, diffusion weighted magnetic
resonance scans, magnetic resonance arteriography and digital subtraction
arteriography revealed bilateral vertebral artery dissection at the second part
of the vertebral arteries. Clinical, radiological features and treatment options
of the vertebral artery dissection has been discussed with the ertinent
literature.

PMID: 12587060 [PubMed - indexed for MEDLINE]


4. J Trauma. 2002 Jun;52(6):1186-8.

Bilateral vertebral artery dissection after blunt cervical trauma: case report
and review of the literature.

Taylor MW, Senkowski CK.

Department of Surgical Education, Memorial Health University Medical Center,
Savannah, Georgia 31403-3089, USA.

PMID: 12045651 [PubMed - indexed for MEDLINE]


5. Cardiovasc Surg. 2000 Jan;8(1):72-4.

Complex traumatic dissection of right vertebral and bilateral carotid arteries: a
case report and literature review.

Busch T, Aleksic I, Sirbu H, Kersten J, Dalichau H.

Department of Thoracic Surgery, Georg-August-University, Göttingen, Germany.

A 27-year-old female motorcycle passenger was admitted with bruises and
concussion after a motor-vehicle accident. After a lucid interval of several
hours she became stuporous and progressed to an acute comatose state. Computed
tomography demonstrated extensive cerebral ischaemia in the territory of the
right middle cerebral artery. Angiography after transfer to the authors' hospital
revealed dissections of both carotid arteries and of the right vertebral artery.
The patient underwent surgical reconstruction of the left internal carotid artery
with saphenous vein. The management of this patient is discussed and the
literature reviewed.

PMID: 10661707 [PubMed - indexed for MEDLINE]


6. Mayo Clin Proc. 1999 Sep;74(9):893-6.

Spontaneous bilateral vertebral artery dissections: case report and literature
review.

Chang AJ, Mylonakis E, Karanasias P, De Orchis DF, Gold R.

Department of Medicine, Miriam Hospital, Brown University School of Medicine,
Providence, RI 02906, USA.

Vertebral artery dissection (VAD) has been increasingly identified as a cause of
ischemic stroke in young adults. We report the clinical and radiographic findings
in a case of spontaneous bilateral VADs and review the literature on the causes,
pathophysiology, diagnostic considerations, and treatment options for VAD. A
29-year-old man was admitted to our hospital after sudden onset of headache and
nuchal rigidity that progressed to a posterior lateral medullary syndrome in a
2-week period. The diagnosis of bilateral VADs was based on findings on cranial
magnetic resonance imaging and conventional angiography. The patient was given
anticoagulant therapy and had no further neurologic deterioration. The
differential diagnosis of craniocervical pain in young patients should include
arterial dissection of the neck because early diagnosis and treatment may reduce
the chances of long-term neurologic sequelae.

PMID: 10488791 [PubMed - indexed for MEDLINE]

[Pebble]

I don't think that tortured logic works. However, the finding against Nette was that she cannot file a "class action" suit; her personal suit is proceeding unimpeded.

"Maintenance" adjustments on healthy people and tailbone "treatments" involving the neck snap make a strong case for the inefficacy of such procedures. When a treatment is scientifically implausible, its routine use is unsupportable.


Any info on why the class action failed? Agreed the personal suit has a greater chance of leading to damages, but even here I would be surprised.

The problem with the 'tortured logic' is that it represents the 'standard of care' argument. Medicine is littered with ineffective therapies that are hopefully being weeded out slowly. When sued, it is sufficient that a responsible body of opinion would support the approach taken. Where there is clear evidence that a therapy is ineffective and a consensus exists that it should no longer be used, then you are stuffed.
The problem is that the 'responsible body' in this case is comprised of other chiropracters.

So either one provides clear evidence of inefficacy that cannot be denied by the most battlehardened Chiro, or one campaigns to change the mind of the average chiro against such practices. Alternately one could change the law requring that all health interventions meet a prespecificed standard of evidence (many medical procedures would fall at this hurdle), or finally one could insist that independent committees review the guidelines issued by all 'responsible bodies'.

Just arguing that the benefit is zero, won't solve this problem.

[JJM]

While it is easy to argue for an association being causative and the temporal association increases the liklihood of this being a correct deduction - it is not proof.

As for bilateral dissection being uniquely related ti Chiropracty - Nope: ...Did your articles rule out chiro? As for trauma in (e.g.,) motor cycle accidents, who could be surprised. So, the fact remains that there may be other causes for bilateral artery dissection; but it is the chiro's unique contribution to health concerns.

[JJM]

... The problem with the 'tortured logic' is that it represents the 'standard of care' argument. ...

So either one provides clear evidence of inefficacy that cannot be denied by the most battlehardened Chiro, or one campaigns to change the mind of the average chiro against such practices. ...The "standard of care" argument is the real problem, not the "lack of evidence against it" argument. The problem is not convincing the battlehardend chiro, the problem is convincing the judge/jury.

[Pebble]

So, the fact remains that there may be other causes for bilateral artery dissection; but it is the chiro's unique contribution to health concerns.

A puzzling argument. Either bilateral verterbral artery dissection is caused only by chiropractic manipulation, or it is the sole complication of chiropractic manipulation - if neither then how can it be unique?


Spine (Phila Pa 1976). (javascript:AL_get(this, 'jour', 'Spine (Phila Pa 1976).');) 2009 May 15;34(11):E405-13.
Safety of chiropractic interventions: a systematic review.

Gouveia LO (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Gouveia%20LO%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Castanho P (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Castanho%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract), Ferreira JJ (http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ferreira%20JJ%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstract).
Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal. lilianafog@gmail.com

Comment in:
<LI sizset="148" sizcache="2">Spine (Phila Pa 1976). 2009 Oct 15;34(22):2475-6; author reply 2476-7. (http://www.ncbi.nlm.nih.gov/pubmed/19829264?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVAbstract)
Spine (Phila Pa 1976). 2009 Oct 15;34(22):2476; author reply 2476-7. (http://www.ncbi.nlm.nih.gov/pubmed/19829266?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed _ResultsPanel.Pubmed_RVAbstract)

STUDY DESIGN: Systematic review of reported adverse events. OBJECTIVE: To evaluate the tolerability and safety of chiropractic procedures. SUMMARY OF BACKGROUND DATA: Despite the increasing popularity of chiropractic, there are few properly designed prospective controlled trials, and there is a disproportionate lack of evaluation of its safety profile. The literature reports multiple neurologic complications of spinal manipulation, some of which are clinically relevant and even life threatening. METHODS: We performed an electronic search in 2 databases: Pubmed and the Cochrane Library for the years 1966 to 2007. All articles that reported adverse reactions associated with chiropractic were included irrespective of type of design. The outcome measures were the type of adverse events associated or attributed to chiropractic interventions and their frequency. RESULTS: A total of 376 potential relevant articles were identified, 330 of which were discarded after abstract or complete article analysis. The search identified 46 articles that included data concerning adverse events: 1 randomized controlled trial, 2 case-control studies, 7 prospective studies, 12 surveys, 3 retrospective studies, and 115 case reports. Most of the adverse events reported were benign and transitory, however, there are reports of complications that were life threatening, such as arterial dissection, myelopathy, vertebral disc extrusion, and epidural hematoma. The frequency of adverse events varied between 33% and 60.9%, and the frequency of serious adverse events varied between 5 strokes/100,000 manipulations to 1.46 serious adverse events/10,000,000 manipulations and 2.68 deaths/10,000,000 manipulations. CONCLUSION: There is no robust data concerning the incidence or prevalence of adverse reactions after chiropractic. Further investigations are urgently needed to assess definite conclusions regarding this issue.

[JJM]

A puzzling argument. Either bilateral verterbral artery dissection is caused only by chiropractic manipulation, or it is the sole complication of chiropractic manipulation - if neither then how can it be unique? ..."Unique" the only other contribution from chiro is spinal manipulation as a possible benefit to low back pain; but others do the same thing.

We do not know the prevalence of harm due to chiros. "Spine" is a crappy (poorly refereed) "journal" that caters to chiropracty- here is a review in a better journal http://jrsm.rsmjournals.com/cgi/reprint/100/7/330 on adverse effects from chiro adjustment. Unfortunately, because "Spine" is not worth the paper it is printed on- I don't have ready access to the article you cite. I think they agree, there are adverse effects- we just don't know how common the serious ones are. Most particularly, we don't know how many people leave the chiro office and suffer a stroke and never return.

[Pebble]

"Unique" the only other contribution from chiro is spinal manipulation as a possible benefit to low back pain; but others do the same thing.

We do not know the prevalence of harm due to chiros. "Spine" is a crappy (poorly refereed) "journal" that caters to chiropracty- here is a review in a better journal http://jrsm.rsmjournals.com/cgi/reprint/100/7/330 on adverse effects from chiro adjustment. Unfortunately, because "Spine" is not worth the paper it is printed on- I don't have ready access to the article you cite. I think they agree, there are adverse effects- we just don't know how common the serious ones are. Most particularly, we don't know how many people leave the chiro office and suffer a stroke and never return.

So now you are an authority on journal quality. What is the impact factor for spine versus JSRM? Hint the 'not worth the paper it is printed on' journal wins hands down.

Now I know that impact factors have their problems, but why should anyone take more notice of your opinion?

[JJM]

So now you are an authority on journal quality ...Actually, in the appropriate sciences I am. Aren't you?


Now I know that impact factors have their problems, but why should anyone take more notice of your opinion?Don't take my opinion, do your own research.

[Pebble]

Don't take my opinion, do your own research.


Irony, kind of passes you by then!

[JJM]

Irony, kind of passes you by then!Maybe you don't have the gift of irony.

[Pebble]

Maybe you don't have the gift of irony.


Any info on why the class action failed? .

Enough of the tortured reparite, any info on the main question at hand?

[JJM]

Enough of the tortured reparite, any info on the main question at hand?http://www.google.com/hostednews/canadianpress/article/ALeqM5iAHaTHrIBMKMzHcfJfFVczcZ0tog

[Pebble]

http://www.google.com/hostednews/canadianpress/article/ALeqM5iAHaTHrIBMKMzHcfJfFVczcZ0tog


Thanks.

As I read this, the view being taken is that the courts are not the place to decide scientific issues, so the jury role is being ruled out. The consequence is that unless one can convince the licensing bodies one is stuffed.

Now when it comes to freedom of speech we would all agree that the courts should keep out of scientific debate, evidently such a position comes with a cost!

[JJM]

... As I read this, the view being taken is that the courts are not the place to decide scientific issues, so the jury role is being ruled out. The consequence is that unless one can convince the licensing bodies one is stuffed.

Now when it comes to freedom of speech we would all agree that the courts should keep out of scientific debate, evidently such a position comes with a cost!This is a complicated problem. The licensing bodies are even worse places to settle scientific disputes.

In the case of the chiros vs. Singh, the matter really does not belong in the courts. But, in the Nette case where personal damage needs to be redressed, the courts are the only place to make the scientific arguments and get the appropriate compensation. Scientists who have taken an interest in this topic (neck snap-stroke) are unanimous that the snap is not beneficial (or, of no proven benefit after 100+ years of looking). However, they cannot force chiros to stop, or to recompense their victims.

[Blue Wode]

This is a complicated problem. The licensing bodies are even worse places to settle scientific disputes.

In the case of the chiros vs. Singh, the matter really does not belong in the courts. But, in the Nette case where personal damage needs to be redressed, the courts are the only place to make the scientific arguments and get the appropriate compensation. Scientists who have taken an interest in this topic (neck snap-stroke) are unanimous that the snap is not beneficial (or, of no proven benefit after 100+ years of looking). However, they cannot force chiros to stop, or to recompense their victims.
In today's press:

Court finds chiropractic negligence in manipulation

A new court ruling has again called into question a widely used but controversial chiropractic treatment, concluding that a Newfoundland practitioner made a patient deaf in one ear and caused other debilitating injuries by performing a neck manipulation on him.

More...
http://www.nationalpost.com/news/canada/story.html?id=2465899


Compensation award to be decided today.

[Blue Wode]

This is quite a revealing account of an undercover trip to a chiropractic clinic in the UK:
http://www.skepticat.org/2010/03/inside-the-spine-wizards-den/

IMO, it further justifies the heavy criticism that's repeatedly levelled at the chiropractic industry.

[brianp]

Chiropractic in a pickle by Edward Ernst

http://www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4125665&c=2

[Blue Wode]

The chiropractic subluxation (1895–12 May 2010)
RIP

Obituary: The death of the subluxation
http://www.zenosblog.com/2010/05/obituary-the-death-of-the-subluxation/

UK General Chiropractic Council acknowledge that terms such as joint misalignment or dysfunction have the same meaning as subluxation. Simply using different terminology is not a get out clause:
http://skepticbarista.wordpress.com/2010/05/15/subluxations-we%e2%80%99ve-never-considered-the-research-part-2/

[Blue Wode]

I wonder what the chiropractic industry will make of this, which was published by the UK General Chiropractic Council today:


GUIDANCE ON CLAIMS MADE FOR THE
CHIROPRACTIC VERTEBRAL SUBLUXATION COMPLEX

The chiropractic vertebral subluxation complex is an historical
concept but it remains a theoretical model. It is not supported by any
clinical research evidence that would allow claims to be made that it
is the cause of disease or health concerns.

Chiropractors are reminded that

 they must make sure their own beliefs and values do not
prejudice the patients’ care (GCC Code of Practice section A3)

 they must provide evidence based care, which is clinical
practice that incorporates the best available evidence from
research, the preferences of the patient and the expertise of
practitioners, including the individual chiropractor her/himself
(GCC Standard of Proficiency section A2.3 and the glossary)

 any advertised claims for chiropractic care must be based only
on best research of the highest standard (GCC Guidance on
Advertising issued March 2010)

May 2010
General Chiropractic Council
44 Wicklow Street
LONDON WC1X 9HL
T: 020 7713 5155
enquiries@gcc-uk.org
www.gcc-uk.org (http://www.gcc-uk.org)

http://www.gcc-uk.org/files/page_file/guidance_on_claims_for_VSC_May_2010.pdf

[JJM]

I am afraid that the recent notifications from the GCC means nothing will really change. In short, they may only have to adhere more closely to ASA requirements, they are free to ply quackery as long as they are less overt.

The subluxation remains a "theoretical" model (by which they intend the lay-meaning of that word, as in "notional"). Chiros can continue to talk about the notion (and use other, sometimes descriptive, terms), as long as they don't advertise it as real.

They may not make "unscientific" claims; but they may make "evidence-based" claims (a far weaker standard). If I say "I adjusted the spines of five people with multiple sclerosis and they got better," that is "evidence;" and if I don't advertise it, it is not an ASA violation.

We have a saying that a difference only matters if it makes a difference, and I don't think their "concession" will make any difference.

[Blue Wode]

A couple of interesting blog posts in relation to this latest development:

In Memoriam
http://www.zenosblog.com/2010/05/in-memoriam/ (http://www.zenosblog.com/2010/05/in-memoriam/)


Born again, British Chiropractic Association joins skeptics "attack" on chiropractic
http://www.chiropracticlive.com/?p=697 (http://www.chiropracticlive.com/?p=697)

[Physical Therapist]

A couple of interesting blog posts in relation to this latest development:

In Memoriam
http://www.zenosblog.com/2010/05/in-memoriam/ (http://www.zenosblog.com/2010/05/in-memoriam/)


Born again, British Chiropractic Association joins skeptics "attack" on chiropractic
http://www.chiropracticlive.com/?p=697 (http://www.chiropracticlive.com/?p=697)



Perhaps all the chiros should just go and re-trains in Sports Massage!

[Blue Wode]

Is the UK General Chiropractic Council (GCC) trying to dodge dealing with 500+ complaints regarding false claims made by UK chiropractors concerning the treatment of paediatric conditions?
http://www.zenosblog.com/2010/06/the-long-and-winding-road/

[davidrodway]

FRom a chiropractors website;

Guidelines suggest that 6-8 treatments is an average number of sessions. We would expect that by this time we would have a clear idea as to whether Chiropractic is the answer to your problem.

!!!!
One would have thought that they should get a "clear idea" before starting treatment.

[rbrice1981]

Hmmm....
(MY ANSWERS FOLLOW THE QUESTIONS)
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? You started off with the hardest one to answer and the one for which physical observation is limited. To begin; knowing that Universal Intelligence is the set of "Physical Laws" such as g = -9.82m/s2, laws of entropy, etc.; "Innate Intelligence" is the set of laws and the driving force that allows us to operate outside of the laws of Universal Intelligence. For example, if a homeless person living in London during the winter gets cold, Innate Intelligence drives the biological processes to warm the person up. It is said that when a person passes away it is the Innate Intelligence that loses the battle and then the laws of Universal Intelligence turn over; the body becomes room temperature, the white blood cells stop fighting for the immune system, etc.
What is a subluxation? Subluxation is the misalignment of two or more bones that articulate to form a joint. The subluxation complex explains all of the effects of subluxation on a neurological, biomechanical, biochemical and physical level.
How are subluxations detected? In rare cases, subluxations can be seen on an x-ray, but subluxations are detected by the signs of rubor, calor, tumor, and dolar - just like many other conditions. Also, subluxations are measured by static (positional) palpation and dynamic (motion) palpation. Basically alignment and motion. The presence of an acute subluxation can cause pain, swelling, redness and heat so we look at those things too.
Can a single patient's subluxation be reliably found by more than Chiropractor? Generally yes, however some notate subluxation in terms of the vertebral body while others notate spinous positioning (both of which rotate along the z-axis (transverse plane rotation) of the human). Thus, it's likely you may hear one chiropractor say L5 Right while other may say L5 Left but their note would usually notate if it's relation to the body or the spinous. Also, techniques differentiate. In addition, subluxations are relative so one might say "L5 is Spinous right to L4" while others might say "L4 is spinous left to L5" - it depends on how the other vertebrae are and certainly both statements could be true!
Can subluxations be seen on X-rays? Some say, "no" but I (and most) say you can see them on x-ray but not too many of them. If they're visible on X-Ray, they're bad or potentially a dislocation instead of subluxation.
How do subluxations cause bed-wetting in children and how does spinal manipulation cure this? Wow - this isn't easy to answer in Layman terms (i've never been great with that) but basically you have something called the Reticular Activating System (RAS) which is hooked in to many parts of the brain (and thus body) and it's main job is to cause awareness and alertness. If you're asleep and you hear thunder, your ear communicates to the RAS which wakes you. When the bladder fills, you're supposed to wake. However, if the subluxation causes an interruption in nerve communication, the RAS might not be getting the signal thus not being able to alert the patient to wake like it would otherwise. Also, if it's not that it could be allergies or other things - many times the Chiropractor is the one who ventures on that path.
How does manipulating the spine of a child with ADHD cause an improvement in behaviour? Parasympathetic nerve stimulation has a calming effect. Restoring nerve flow to the atlas (C1 vertebra which is intimate with the brain stem) to decrease hyperactivity and inattention disorder.
Do you recommend vaccinations? If not, why not? Doctors of Chiropractic do not have a license to practice medicine and thus cannot make recommendations to vaccinate or abstain from vaccination (I'm in the USA - I don't know about GB). However, Chiropractors generally educate their patients on the risks and benefits which is within our scope. Some fixate on the risks while others are more open and educate completely. It's in contrast with Medical doctors. Many say, "Just do it" while others will discuss both risks and benefits. Personally, vaccinations make sense to me in many cases; however I am not always excited about the ingredients, effects and toxicity and the certainly some of the vaccines are just unnecessary.

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.

I appreciate the straightforwardness of your questioning and I hope my answers are understandable. I'm not always the best at communicating so that everyone understands!::)

[Pebble]

I appreciate the straightforwardness of your questioning and I hope my answers are understandable. I'm not always the best at communicating so that everyone understands!::)

Wow what a lot of assertions, any chance of backing them up with evidence? Any evidence that RAS malfunction or interruption of afferent communication is responsible for bed wetting for example? (PS in spinal syndromes retention is the usual result of failure of afferent communication).

[brianp]

Does upper spinal manipulation cause vascular accidents? by Edzard Ernst

http://www.pulsetoday.co.uk/story.asp?storycode=4126674&cid=Also_on_pulse_1_280710&sp_rid=NDE0NjI3NTYwOAS2&sp_mid=35646645

[Blue Wode]

A quick update on chirowars in the UK.

AUKC v. GCC and BCA
http://www.surveymonkey.com/s/6GNST8B

Vitalism is alive and well. (For the time being anyway.)


GCC complaints update here:
http://www.zenosblog.com/2010/08/the-beginning-of-the-end-part-three/

[Blue Wode]

A must read!

GCC under pressure over subluxations..


So what we have is a definition of what a subluxation is (functional derangement) combined with research reviews & GCC statements that there is no evidence to support such claims. We also have confirmation from the training establishments that they do not support or teach links between the subluxation and health concerns.

Clearly something has prompted the GCC to issue a revised guidance. Are the GCC in possession of updated research confirming a link, if so then this is truly a breakthrough and should be published ……. Or is there another reason for the U-Turn?

Read on...
http://skepticbarista.wordpress.com/2010/08/30/gcc-subluxation-pressure/ (http://skepticbarista.wordpress.com/2010/08/30/gcc-subluxation-pressure/)

[Blue Wode]

Science Based Medicine has just published an interesting new article by Samuel Homola DC regarding the fictitious subluxation lesion:

Chiropractic Vertebral Subluxations: Science vs. Pseudoscience (http://www.sciencebasedmedicine.org/?p=6839)
http://www.sciencebasedmedicine.org/?p=6839 (http://www.sciencebasedmedicine.org/?p=6839)



“Unlike the mysterious, undetectable and asymptomatic chiropractic ‘vertebral subluxation complex’ alleged to be a cause of disease, a real vertebral subluxation, that is, an orthopedic subluxation, can be a cause of mechanical and neuromusculoskeletal symptoms but has never been associated with organic disease….

A largely ignored landmark review of the literature by a Ph.D. and a chiropractor (Nansel and Szlazak), published in 1995, concluded that there is not a single appropriately controlled study to indicate that any dysfunction in structures of the spinal column is a cause of organic disease…

Unfortunately, the chiropractic profession in the United States continues to be defined by subluxation theory. Too few chiropractors are willing to ‘step out of line’ and announce that the theory (more accurately defined as a belief) is scientifically indefensible and should be dumped… the British Chiropractic Association advised its members to “refrain from making any reference to Vertebral Subluxation Complex in media to which their patients or the general public may have access,” adding that “this advice has no bearing on scope of practice”…

Without some identifying label or degree that distinguishes science-based chiropractors from subluxation-based chiropractors, medical physicians will continue to be reluctant to refer a patient to a chiropractor, lest they deliver a patient into the hands of a pseudoscientific practitioner whose philosophy embraces an anti-medical approach and endangers the patient...

It seems likely that subluxation-based chiropractic, like homeopathy and other belief systems, will be perpetuated to some degree by true believers…

Because the chiropractic profession seems unwilling to abandon these discredited concepts, reform of the state chiropractic practice acts to eliminate subluxation-based chiropractic practice may be the only viable solution to the perpetration of unscientific and unproved healthcare practices…

Good science-based chiropractors who do not subscribe to the vertebral subluxation theory and who use manipulation appropriately can offer a service of value. Unfortunately, such chiropractors are not easy to find.”


Despite the above, chiropractors still seem to be on a subluxation wild goose chase:


The great subluxation debate: a centrist's perspective

Christopher J. Good DC, MAEd
Professor, University of Bridgeport College of Chiropractic, Bridgeport, CT 06604

ABSTRACT

Objective
This commentary describes the debate and some of the associated issues involving the subluxation construct.

Discussion
The long-standing debate regarding the chiropractic subluxation has created substantial controversy within the profession. Currently, this phenomenon can be compared with a country with a 2-party system that has a large silent majority sitting between the 2 factions. It is argued that the position held by those in the middle (the centrists) may be the most rational view when considering all of the available evidence. It is also suggested that the subluxation construct is similar to the Santa Claus construct in that both have a factual basis as well as social utility. Ultimately, the centrists must become proactive if they want to protect the profession and further advance the evidence in regard to the subluxation. They must not only engage in the debate, but fund the research that will investigate various aspects of the subluxation and then help disseminate this evidence to fellow doctors of chiropractic, other practitioners, health care policy makers, and society at large.

Conclusion
The role of subluxation in chiropractic practice, the progression of this debate, and the future of the profession will be directly determined by the role that centrists choose to play.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B9HD4-512N9HK-1&_user=10&_coverDate=09%2F21%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=324e669837df4a009c06b6e16c00b773&searchtype=a (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B9HD4-512N9HK-1&_user=10&_coverDate=09%2F21%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=324e669837df4a009c06b6e16c00b773&searchtype=a)

[JJM]

This
Conclusion
The role of subluxation in chiropractic practice, the progression of this debate, and the future of the profession will be directly determined by the role that centrists choose to play.is rich. One would hope the progression would depend on facts.

[Blue Wode]

The value of chiropractic in the news again:
http://www.infonews.co.nz/news.cfm?id=59215 (http://www.infonews.co.nz/news.cfm?id=59215)


Medical researchers Professor Shaun Holt and Andrew Gilbey have issued a strong warning against parents taking their children to see a chiropractor for any reason. Many chiropractic practices and organizations, in New Zealand and overseas, advocate routine spinal manipulation in infants and children, for conditions ranging from ear infections, colic and asthma to ADHD and even cancer.

"There is no plausible explanation why high-velocity manipulation of the spine can help children with these medical conditions, it is an extraordinary claim" said Professor Holt. "Given that this is a multibillion dollar industry, the lack of good research that has been undertaken is staggering. There is also evidence that many chiropractors advise against routine childhood immunizations, which is irresponsible.”

Andrew Gilbey said that “there are some serious safety concerns related to the unnecessary use of x-rays and the manipulation of childrens’ spines and so we advise parents to instead consult their family doctor who has been trained to recognize and treat a wide range of medical problems. In Canada, an undercover researcher reported that 4 out of 5 chiropractors found serious problems with the spine of a child and said that these required urgent chiropractic treatment, whereas an experienced paediatric orthopedic surgeon who also examined the girl found her to be perfectly healthy.”

Holt and Gilbey's advice echoes similar warnings issued by paediatricians overseas. The Australian Medical Association has stated that chiropractic care for children is a waste of money and inappropriate. They advise parents who are worried about any aspect of their children's health to consult a medical doctor.

[Blue Wode]

Following on from the press release posted above, and staying with the topic of ‘paediatric chiropractic’, the following are excerpts from an interview with Joel Alcantra, Director of Research for the International Chiropractic Pediatric Association. In it he is asked about the differing views in pediatric chiropractic research:
http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54921 (http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54921)

Alcantra:

The decision to pursue or recommend a trial of chiropractic care is based on many factors, with safety and effectiveness at the core of this decision and the principles of evidence-based medicine providing the overall guiding principle. So, what is a clinician to do when the research is not available? Evidence-based medicine allows you to rely on your clinical expertise and the needs and wants of the patient or the parent (in the case of pediatric chiropractic).
With such a slim evidence base, it would appear that chiropractors rely very heavily on the preferences of their patients and their own expertise. For example, here’s what Science Based Medicine’s Harriet Hall (MD) recently had to say on the matter:

The General Chiropractic Council, a UK-wide statutory body with regulatory powers, has just published a new position statement on the chiropractic subluxation complex: “The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.” They remind chiropractors that they must make sure their own beliefs and values do not prejudice the patient’s care, and that they must provide evidence-based care. Unfortunately, they define evidence-based care as cllinical practice that


incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners, including the individual chiropractor her/himself. [Emphasis added.]


This effectively allows “in my experience” and “the patient likes it” to be considered along with evidence, effectively negating the whole point of evidence-based medicine.

http://www.sciencebasedmedicine.org/?p=5339 (http://www.sciencebasedmedicine.org/?p=5339)



Alcantra:

If one closely examines the clinical trials on chiropractic SMT and infantile colic, you will find that no study exists comparing chiropractic SMT versus sham therapy…Wiberg and colleagues found chiropractic superior to simethicone; Browning and colleagues found both techniques decreased the hours of crying compared to baseline; and Olafsdottir and colleagues found their chiropractic technique as ineffective. So, the bottom line is, there is some evidence in support of chiropractic care for infantile colic.
Nevertheless, it is apparent that the quality of evidence for the treatment of colic with chiropractic remains very poor, with the most robust systematic review to date reaching the following pretty damning conclusion:

Some chiropractors claim that spinal manipulation is an effective treatment for infant colic. This systematic review was aimed at evaluating the evidence for this claim. Four databases were searched and three randomised clinical trials met all the inclusion criteria. The totality of this evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials.

Ernst, E. Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials, Int J Clin Pract. (September 2009)

http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2009.02133.x/pdf (http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2009.02133.x/pdf)

Alcantra:

The literature essentially indicates that medications like simethicone are no more effective than placebo and are associated with severe adverse events. Add to this the research that indicates parents may have thoughts of infanticide due to their crying baby. As a researcher and clinician, I think a trial of chiropractic care is warranted, in line with the principles of evidence-based medicine and the principles of biomedical ethics. That is, respecting a patient's autonomy, avoiding harm, placing their interests and well-being first and allowing them access to essential care like chiropractic.
It’s worth noting that Alcantra doesn’t take into consideration the following harmful effects of chiropractic for children, which also involve their parents:

(a) decreased use of immunisation 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"
(d) financial harm due to unnecessary treatment.

Scroll to the end of this National Council Against Health Fraud link: http://www.ncahf.org/digest07/07-14.html (http://www.ncahf.org/digest07/07-14.html)

Alcantra:

Of course, as a researcher, I agree with Drs. Leboeuf-Yde and Hestbaek that we need more research, not only in quantity but also in quality. We differ in our direction and focus for research, but this is understandable given our different interests and methodologies.
One has to wonder how serious chiropractors are about undertaking further research when it could quite easily produce results that would not be welcomed by the lucrative chiropractic paediatric market. For example, it was recently noted that for a multibillion dollar industry, only 46 chiropractic studies were recruiting on clinicaltrials.gov, whilst ‘Big Pharma’ was running nearly 100,000.

Alcantra:

On another point: Vallone, et al., recommend that the inversion maneuver for infants and young children is a relative contraindication. My question is: On what basis do these authors make this recommendation? The scientific literature does not support them in terms of adverse events due to the procedure. Furthermore, their stated reasons for not performing the procedure (possible undiagnosed clinical entities) just does not make clinical sense. It takes clinical uncertainty to a different level and how it affects one's decision to perform a diagnostic test or treatment procedure.
View a chiropractic inversion maneuver on a newborn at 1min 11secs in here
http://www.youtube.com/watch?v=o5Swr4YlUnQ (http://www.youtube.com/watch?v=o5Swr4YlUnQ)

then read, again, why researchers advise parents not to take children to chiropractors
http://www.nzdoctor.co.nz/un-doctored/2010/october-2010/14/researchers-advise-parents-not-to-take-children-to-chiropractors.aspx (http://www.nzdoctor.co.nz/un-doctored/2010/october-2010/14/researchers-advise-parents-not-to-take-children-to-chiropractors.aspx)

[davidrodway]

http://www.facebook.com/l.php?u=http%3A%2F%2Fwww.27bslash6.com%2Foverdue.h tml&h=7d4c6

[Blue Wode]

I wonder how the Alliance of UK Chiropractors (AUKC)/British Chiropractic Association (BCA) meeting with the General Chiroproactic Council (GCC) is going today?


The BCA approached the Alliance to work collaboratively which has culminated in a joint letter to the GCC advising them that we no longer have confidence in the ability of the GCC to regulate the profession. The Alliance and the BCA will be meeting with Council on 17th November 2010 to discuss this matter…
http://forums.randi.org/showpost.php?p=6564649&postcount=5 (http://forums.randi.org/showpost.php?p=6564649&postcount=5)

[Blue Wode]

The value of chiropractors continues to be questioned...

Chiropractors at War with their Regulator, the GCC
http://www.quackometer.net/blog/2010/11/chiropractors-at-war-with-their-regulator-the-gcc.html

...and newly caught out on the subject of evidence here:
http://www.zenosblog.com/2010/11/where-the-evidence-leads/

[Blue Wode]

"Humpty Dumpty chiropractic" by the Editor of the Journal of Clinical Chiropractic
http://www.fnks.org/fnks/sites/default/files/Humpty%20Dumpty%20chiropractic.pdf


...the time is fast approaching when chiropractic will have to decide whether it is informed by 19th century metaphysics or by 21st century science. If it chooses wrongly, then it may not be possible for all the king’s horses and all the king’s men to effect a repair.

[Blue Wode]

The regulation of chiropractors in the UK appears to have some very serious problems:

Humpty Dumpty regulation
http://www.zenosblog.com/2010/12/humpty-dumpty-regulation/ (http://www.zenosblog.com/2010/12/humpty-dumpty-regulation/)


Why should a statutory body (GCC), charged with protecting the public set such low standards?

Do chiropractors now have carte blanche to advertise whatever they want?

[jimwalsh]

@bluewode

did you get that ernst response?

I can email it to you if you still need it...

[Blue Wode]

@ jimwalsh

Yes, I did thanks, and I've highlighted a chiropractic professor's dissatisfaction with it here:
http://forums.randi.org/showpost.php?p=6671671&postcount=93

So far, the chiropractic professor (Stephen Perle) hasn't published my comments criticising his misgivings about Ernst's paper and Ernst's subsequent response.

[Blue Wode]

@ jimwalsh

FYI, my comments still haven't been published by Prof. Perle, so I've posted them here:
http://forums.randi.org/showpost.php?p=6674391&postcount=96