Value of chiropractors questioned

[brianp]

http://www.guardian.co.uk/science/20...edicalresearch


Going to a chiropractor to treat back pain could be a waste of time, according to a new study.

[Blue Wode]

It seems to confirm what Professor Edzard Ernst has been saying about spinal manipulation for some time:

A systematic review of systematic reviews of spinal manipulation

CONCLUSIONS: Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.

http://www.jrsm.org/cgi/content/abstract/99/4/192

Adverse effects of spinal manipulation: a systematic review

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

http://www.jrsm.org/cgi/content/abstract/100/7/330

For anyone not familiar with the controversy surrounding chiropractic, this article by John Jackson provides a good introductory read:
http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php

[Blue Wode]

Re: Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial Hancock MJ et al; Lancet:370:1638-43
http://www.medpagetoday.com/Geriatrics/PainManagement/tb/7307


Peter Dixon, Chairman of the UK General Chiropractic Council (GCC), has just issued a statement in which he declares that the GCC is appalled by press reports that ‘chiropractic is a waste of time and money’. He goes on to say…

Chiropractors provide an evidence-based approach based on European-wide guidelines compiled by multidisciplinary teams of experts who reviewed all relevant research.

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

http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf

Note the total absence of scientific references in support of Mr Dixon’s claims.

Regards guidelines, here’s what Professor Edzard Ernst has to say about them:

And what about national guidelines? Chiropractors argue that their approach must be safe and effective, not least because the official guidelines on the treatment of back pain recommend using chiropractic. However, this is true only for some, but by no means all, countries. Secondly, guidelines are well known to be influenced by the people who serve on the panel that develops them. Cochrane reviews, on the other hand, are generally considered to be objective and rigorous. Writing about the importance of systematic reviews for health care in the Lancet, Sir Ian Chalmers stated, ‘I challenge decision makers within those spheres who continue to frustrate efforts to promote this form of research to come out from behind their closed doors and defend their attitudes and policies in public. There is now plenty of evidence to show how patients are suffering unnecessarily as a result of their persuasive influence.’ 10

The Value of Chiropractic
http://www.medicinescomplete.com/jou...1002a02t01.htm

[richard]

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

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

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

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

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

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

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

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

[bobdezon]

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

[Mongrel]

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

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

The 70,000 figure is from 1998 (here), not 2001 and the legislation for the smaller pack sizes reduced deaths from accidental poisoning. There was little change in the amount of deliberate suicides but the level of Paracetamol went down from an average of 10g to 8g, slightly easier to treat (Articles here).

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

[Blue Wode]

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

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

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

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

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

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

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

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

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

Regards misrepresenting research, Peter Dixon claims that

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

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

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

Skepticism is an honest search for knowledge. It is an approach to claims akin to the scientific method. It is a powerful and positive method of inquiry which is used to evaluate claims and make decisions. It is used to search for the truth in matters and to make decisions that are based on logic, evidence and sound reasoning. Skepticism is based on a simple method: doubt and inquiry. The idea is to neither initially accept claims nor dismiss them; it’s about questioning them and testing them for validity. Only after inquiry does a skeptic take a stance on an issue.

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

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

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

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

1. What has the chiropractic profession done to limit the use of neck manipulation for neck pain when it is known that safer and less expensive treatments exist for the condition (e.g. exercise)?
2. Why doesn’t the chiropractic profession have an injury reporting system in place similar to the Yellow Card system that is used for reporting adverse drug reactions?
3. In the UK, drug medications contain Patient Information Leaflets which include advice on side effects. The chiropractic equivalent is to inform patients either orally or in writing of the risks associated with any procedure (and any available alternatives). This is a legal obligation. Why are large sections of your profession apparently ignoring their duty in this respect and what is being done about it?

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

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

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

Proportionately, there’s bound to be a significantly higher rate of complications from paracetamol use than from spinal manipulation since the number of people routinely using paracetamol (presumably because it’s cheap and convenient) will vastly outweigh those receiving spinal manipulation. The ratio is probably hundreds of thousands to one – which would mean that paracetamol is safer than manipulation.

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

Here’s what was actually said:

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

http://www.chirobase.org/08Legal/AT/at00.html

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

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

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

Thank you.

[richard]

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

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

[richard]

The 70,000 figure is from 1998 (here), not 2001 and the legislation for the smaller pack sizes reduced deaths from accidental poisoning. There was little change in the amount of deliberate suicides but the level of Paracetamol went down from an average of 10g to 8g, slightly easier to treat (Articles here).

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

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

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

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

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

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

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

[Blue Wode]

[quote=richard;23986]Largest risk assessment study ever was recently published by Thiel and Bolton in Spine. I don’t have the actual reference to hand. (If you insist I will get it).You are not going to like the conclusion, but I guess scientific evidence is not designed to please.[/quote]

Here’s the link:

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

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


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

http://chirotalk.proboards3.com:80/index.cgi?board=humor&action=display&thread=119413 7405

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

[Cuddles]

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

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

[richard]

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

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

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

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

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

Regards misrepresenting research, Peter Dixon claims that


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

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

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

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

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

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

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

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

In the UK, drug medications contain Patient Information Leaflets which include advice on side effects. The chiropractic equivalent is to inform patients either orally or in writing of the risks associated with any procedure (and any available alternatives). This is a legal obligation. Why are large sections of your profession apparently ignoring their duty in this respect and what is being done about it?
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=1 7693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.P ubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

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

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

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

Hardly very scientific?

Here’s what was actually said:


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

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

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

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


Thank you.

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

[Blue Wode]

Richard,

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

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

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

Why would the NHS analyze the press reports?

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

Wrong again Thiel and Bolton in recent Spine journal

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

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

You criticise the Chiropractic profession for using anecdotal evidence and you attach great weight to anecdotal evidence to support you unfounded claim that chiropractic is dangerous.

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

TheTelegraph,The Mail,The Guardian, are the ones I saw.The Independent reported the study acuratly. I dont read the Tabloids and did not see The Times.

So why did you say “how come all the headlines were chiropractic when the study did not involve them”?

I am happy to answer your questions

Would you please answer these ones then:

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


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

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

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

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

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

[richard]

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

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

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

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

[Admin]

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

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

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

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

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