The random thoughts of a sceptical activist

I get anonymous chiropractic mail, I do!

A few weeks ago, I was sent a copy of  the 12 August edition of the Southend Echo, which carried an advert for a chiropractic clinic in Westcliff-on-Sea, Essex. The paper was folded to expose this advert for the Cliffs Chiropractic Clinic Ltd:

Cliffs Chiropractic Clinic - Advert 1

What was strange about this was that it was sent to me anonymously. Through the post. To my home address.

Questions have to be asked: who sent it, why and how did they know my home address?

Since a relative, friend or fellow sceptic would have at least mentioned it in passing, I can only assume it came from someone who got my address from the General Chiropractic Council when they sent out letters to all the chiropractors I had complained about.

We already know that the chiropractic ‘profession’ is riven with disputes between the various ideological factions. These particular advertisers are all British Chiropractic Association members. We also know that many chiropractors consider the BCA’s libel against Dr Simon Singh to be A VERY BAD MOVE.

So perhaps someone from a different faction wanted to create trouble? Maybe there is a chiropractor out there who now understands why scientists think it is woo. Or perhaps someone working for a chiropractor has a conscience that is now bothering them? Perhaps it’s a simple attempt to disrupt the business of a competitor? We’ll probably never know (unless the person wants to identify him/herself?).

Claims

Just look at the claims being made:

  • Back pain
  • Joint stiffness
  • Sports injuries
  • Infantile colic
  • Headaches
  • Whiplash
  • Frozen shoulder
  • Pregnancy back pain
  • Shoulder/arm pain
  • Leg pain sciatica [sic]
  • Neck pain
  • Hip/knee pain

One stands out in particular: infantile colic.

I complained to the ASA.

When the ASA contacted the chiropractors concerned, they said they would not use the advert again without removing the offending claims and getting it vetted by the ASA’s free Copy Advice team.

But you have to wonder, in the light of the intense focus and scrutiny there has been on chiropractic claims in the last six months, why any chiropractor would bother to try to make claims so obviously out of kilter with the ASA’s acceptance criteria. Did they think no one was watching?

It would, of course, have been open to the advertiser to present evidence for their claims: the ASA are — as scientists are — open to new robust evidence. I can only assume the advertiser could not provide that robust evidence.

Scientific evidence?

Is there any scientific evidence for, say infantile colic? That’s one of the claims that they will have to remove from any future advert (as well as whiplash, headaches, etc — I’ve already detailed what the ASA will and will not accept).

The BCA’s plethora has already been totally demolished, but the International Journal of Clinical Practice published a paper by Prof Edzard Ernst in their September 2009 issue: Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials (pdf).

This concludes:

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.

In conclusion, the current evidence from RCTs does not show that chiropractic spinal manipulation is an effective treatment for infant colic.

Nope. Not a jot. This adds to the knowledge the ASA already holds that claims about chiropractic treatment for infant colic are misleading and reinforces their guidance.

Because the advertiser didn’t contest my complaint, the ASA decided to make this an informally resolved complaint. It therefore doesn’t go before the ASA’s Council for a formal adjudication. But the chiropractors still get a special mention on the ASA’s website (click on Informally Resolved Complaints).

Another crisis for the General Chiropractic Council?

While you’re there, look at the list of other complaints. A little further up from the Cliffs Chiropractic Clinic, you’ll see something even more interesting. This time, a complaint made by the inimitable Simon Perry, co-scourge of nonsense chiropractic claims, against the General Chiropractic Council itself for their Patient Information Leaflet. I’ll let Simon Perry tell the whole sorry story in his own words.

However, I see that even though the ASA ruled against the GCC’s leaflet, they still have it on their website (where the ASA have no jurisdiction)!

This is their revised leaflet: the GCC decided to tone down their leaflet earlier this year. It used to say:

Chiropractors mainly treat:

  • back, neck and shoulder problems
  • joint, posture and muscle problems
  • leg pain and sciatica
  • sports injuries.

You may also see an improvement in some types of

  • asthma
  • headaches, including migraine; and
  • infant colic

The ‘watered down’ version says:

Chiropractors mainly treat

  • back, neck and shoulder problems
  • joint, posture and muscle problems
  • leg pain and sciatica
  • sports injuries

There is some evidence, though more research is needed, that you may see an improvement in some types of:

  • asthma
  • headaches, including migraine and
  • infant colic.

Note the woolly weasel words. Now it seems even this is too much for the ASA!

What if the GCC leaves those claims on their website for all to see? Remember that it is against the GCC’s own rules for a chiropractor to claim anything that is not in line with the ASA guidance. If there was any doubt before, there certainly can’t be any doubt now about what the ASA thinks of such claims. So if the GCC leaves the claims there, are they not encouraging chiropractors to do something that is against their very own Code of Practice?

What an interesting situation that would leave them in.

68 Responses to I get anonymous chiropractic mail, I do!

  • 1) Yes, one would have to think that this is from a very disgruntled local competitor (sad).

    2) As you said, the ASA have no jurisdiction over websites. So how can the GCC ever prosecute any Chiropractor as the ASA will not give guidance as this is not within their remit, and the GCC promote these conditions in their own leaflet and on their own website.

    3)The ASA have the same to say about other forms of manual therapy and do not recognise the effectiveness of Physiotherapy for the treatment of neck pain, yet there is no mention of this and yet they may promote their threatments and techniques. Some claim to be medically trained and some hospital based musculo-skeletal/orthopaedic physiotherapist are given the title of “consultant” without any vexatious complaints.

    4)There are Osteopaths out there “specialising” in craniopathy and the treatment of paediatric conditions, and no complaint about these issues either. Or, have there been complaints and it is because their council have a procedure in place to vet and weed out vexatious complaints, thereby saving alot of time and money and not having to dealing with this farce.

  • “We also know that many chiropractors consider the BCA’s libel against Dr Simon Singh to be A VERY BAD MOVE.”

    I believe it’s true that some chiropractors regret the libel action taken against Simon Singh by the BCA, largely because of the strength of the backlash. However, it should be remembered that Mr Singh was found against in the action brought against him, and that this is because his comments were defamatory and libelous. They were not an expression of opinion, but a statement of fact that was untrue and which he refused to withdraw.

    He has managed to garner an impressive amount of support from a large number of people, but all on the false premise of his case being a matter of freedom of speech. So far his attempts to appeal against his conviction have failed because the judges have deemed he has no grounds for appeal.

    I’m interested, but very saddened, that this vendetta against the profession of chiropractic has attracted so much attention. There are of course different philosophies taken by different chiropractors in their work. However, the vast majority of chiropractors practice with honesty and integrity and endeavor to do so in an evidence based manner. To condemn the whole profession because of the unsubstantiated (not necessarily untrue) claims made by some individuals for the conditions they treat, it disingenuous.

  • David,

    Your comments are ill-informed and before embarrassing yourself further, you would be advised to do a bit of research and find out what has actually happened so far in the BCA v Simon Singh case, which is far from over.

    Simon has not been “found against in the action against him” and he has not been convicted of anything.

    Goodness knows, enough of us have blogged about this so you’ve really no excuse for getting it so wrong.

  • David

    You really do need to get your facts straight.

    There was a preliminary hearing at the High Court earlier this year that was held to determine the meaning of the words complained of. Whilst Mr Justice Eady somehow or other came to decide a meaning that clearly was never intended by Simon Singh, the libel trial has not yet taken place and is not even scheduled yet.

    Simon was refused leave to appeal against Eady’s ruling on meaning, but there is further opportunity to appeal this preliminary ruling at a hearing next week.

    Once – and only once – the meaning of the words complained of has been finalised, and all other preliminaries taken care of will the actual libel case be held.

    As Skepticat has said, Simon has not been convicted of anything and the BCA have emphatically not won any libel case.

    I’m glad you agree that some chiropractors are making claims for which there is no evidence. If you read the GCC’s Code of Practice that all chiropractors have signed up to as part of their statutory registration, you’ll find that all claims they make must be in accordance with the guidance issued by the ASA. As I’ve said in many posts, the ASA’s guidance is very clear on what they do and do not accept as claims and what level of evidence they require, so it is very easy for any chiropractor to decide whether he or she is within the terms of his or her legal registration and to decide whether – in the words of the ASA – their claims are misleading the public.

  • Whether you like it or not, the legal judgements so far have been in favour of the BCA.

    Sadly, it seems that this current mobbing of the chiropractic profession by fanatical bloggers is nothing to do with improving public health or safety. It seems much more concerned with scoring points and enjoying another round of mutual congratulation.

    Skepticat’s comment in his blog typifies the mentality of those involved. I quote: “Simon has three weeks in which to appeal against Eady’s extraordinary ruling. Whatever happens, the battle against batshit loopy and potentially dangerous so-called ‘therapies’ like chiropractic will continue unabated.”

    The basis for most of the criticism of chiropractic seems to be around claims for the treatment of non-musculoskeletal disorders eg asthma and infantile colic. There seems to be a desire to believe that these are the conditions that chiropractors wish to be seen to be treating. My experience of chiropractic is very different. It is concerned with treating mechanical pain disorders, and improving physical function, particularly with respect to the spine. Also, that it compares rather favourably with the other options that patients might have available to them, both in terms of safety and efficacy.

    Of course there’s more research to be done and I know that the chiropractic profession will incorporate the results of good studies into its future protocols.

    Meanwhile, the General Chiropractic Council exists to fulfill the role of regulating the profession, protecting the public and raising standards of care. It is still evolving but I am confident that it will do its job well, with or without your “help”.

  • David

    The BCA has won nothing: the ruling on meaning that Eady gave was not even the meaning the BCA had claimed had defamed them. It was a meaning that Eady put on it himself and was perverse.

    It has everything to do with public safety: there is scant evidence for the vast majority of claims (musculoskeletal or not) made by chiropractors and even the best evidence shows it as bad as other treatments for back pain – and even this could be due to other factors. This has been well described on many blogs and journals.

    For any treatment, a balance has to be struck between potential benefit and potential side effects. For a treatment that has robust evidence that for efficacy but which also has some side effects, that balance has to be considered and a decision made whether to make it available or not.

    With chiropractic, there is no robust evidence for efficacy, so that balance of efficacy versus harm is made very easily.

    And if you think that chiropractors don’t try to claim they can treat infantile colic, look at the figures: just under one third of all chiropractors in the BCA’s register who give a website made claims that they could treat colic. This is not a rogue few – it is endemic.

    (Of course, there are far fewer of these claims ever since many decided to remove them from their websites and leaflets.)

    As for the need for more research, chiropractors have been charging for their treatments for well over 100 years: how much longer do they need to come up with robust evidence?

    But you have missed the point: are chiropractors abiding by their own rules or not?

  • David,

    I think this ‘mobbing of the chiropractic profession’ is more to do with a group of people (the merry band of skeptics) who are driven by a desire for the truth.

    As far as I am aware, it is not just chiropractic treatement of asthma and infantile colic that the majority of skeptics have a problem with, it is the idea that chiropractic manipulation can work for anything. In much the same way as a hefty thump on the side of a TV isn’t likely to cure an overheated chip or transmitter fault (although sometimes it actually makes the TV work again), why the heck would a chiropractic manipulation help infertility, colic, carpal tunnel syndrome, headches, migraine…etc.

    This is just my opinion, of course.

  • Indeed, Andrew.

    The reason why I call chiropractic ‘batshit loopy’, David, is because of statements like this:

    “A subluxation means a slight dislocation (misalignment) or biomechanical malfunctioning of the vertebrae (the bones of the spine). These disturbances may irritate nerve roots and the blood vessels which branch off from the spinal cord between each of the vertebrae. This irritation may cause pain and dysfunction in muscle, lymphatic and organ tissue, as well as neurologic imbalance in the normal body processes.”

    Source: http://www.chiro.org/acc/What_is_Subluxation.shtml

    What would you call it?

  • What David has also not considered is the BCA’s chosen response to Singh’s article. Let’s face it: if they had not reacted, most people might have forgotten all about it, and not so very much would have changed. The BCA were offered a chance to respond, which they turned down. If they had evidence against Singh’s statements, they could have provided it – but they chose not to do so. A good scientist, and especially a good health scientist, is open to criticism: it refines your method, it looks for the best. In health science this is life and death, not wounded feelings. By attempting to silence rather than answer Simon Singh, the BCA has made a bad reputation for itself.

    Do NASA attempt to sue conspiracy theorists over the Moon landings? Do doctors sue patients who tell each other that such and such a treatment didn’t work? Of course not, they’re not that pathetic. Even the government, to my best knowledge, don’t sue people who claim to have been damaged by fluoride in water.

    You need to distinguish between free speech and free scientific debate. Free speech can be abused for malicious purposes, yes. Free scientific debate, on the other hand, is not personal, but on matters of evidence. If it is forbidden to state what you best know to be true about health scientists, the forbidder could well kill people. That’s what us skeptical bloggers are interested in; we’ve got better things to do than mob mindlessly.

  • I’m with David… I am sad that Chiropractors are being stigmatized against. I have actually gone to some really great chiropractors who have done a great job in helping heal my aches and pains. Dr. Richard E. Busch III, nationally well known Dr. Chiropractics’ just recently came out with a very informational book titled, “Surgery not Included: Freedom from chronic neck and back pain,” and is about getting treatment for chronic back and neck pain without surgery. His book was a godsend for me… don’t know what I would have done had I not stumbled across it.

  • Skepticat, I am not defending the term subluxation. I personally have never used it in relation to spinal dysfunction because it has a very definite meaning that I do not believe fits with the concept that it gets applied to. However, “biomechanical malfunctioning of the vertebrae” certainly does cause irritation to local structures, including nerve roots, and this can have consequences. Mostly, these consequences are the types of problem that chiropractors spend their time helping people with. Namely, pain, disability, weakness, paraesthesia to name a few. Or are we going to argue about whether back problems exist or not?

    A mistake that many commentators make is to reduce the work that chiropractors do to simply “manipulation”. Manipulation is just one tool in the toolbox that chiropractors possess. It can be very effective as well as being statistically very safe, when applied appropriately. Chiropractors are well trained in its use, (certainly to a much higher standard than the GPs who quite regularly try to emulate it in their practices.) But, in my experience it is never applied alone in the chiropractor’s office, only as one part of the whole strategy employed to improve mechanical function.

    Zeno,
    “But you have missed the point: are chiropractors abiding by their own rules or not?”
    If the whole point of this is whether chiropractors abide by the rules or not, the GCC is the body to police that matter.

  • On a minor point it’s not clear to me that when you talk about the government in “Even the government, to my best knowledge, don’t sue people who claim to have been damaged by fluoride in water.” that the government would actually be able to sue even should they want to. IANAL and all that.

    And Becky, we’re all glad that you had success resolving your back issues, and you’ll find that many of us do not dispute the (as Zeno says above, not particularly outstanding) effectiveness for back issues – we could probably even dig it out for you so you don’t have to resort to single anecdotes in future comments ;-)

    This was never the source of Simon’s complaint and has not been the target of recent campaigns to improve the standard of claims made by chiropracters through the complaints to various agencies. David says it himself – “The basis for most of the criticism of chiropractic seems to be around claims for the treatment of non-musculoskeletal disorders eg asthma and infantile colic.”

  • At 23:48 on 7th October, David wrote: “Of course there’s more research to be done and I know that the chiropractic profession will incorporate the results of good studies into its future protocols.”

    But hasn’t the research been done already? For example, in this month’s Dynamic Chiropractic there’s an article on the Foundation for Chiropractic Evidence and Research (FCER) which has decided on self-liquidation and filed for bankruptcy. In the article it states that:

    Quote:
    “Over the foundation’s history [more than 60 years], volunteers contributed more than 33,000 articles and helped fund over 152 randomized, controlled trials concerning chiropractic manipulation…”

    Interstingly, as the FCER is closing down, the Foundation for Chiropractic Progress (FCP) has received approximately $650,000 in pledges to help with its mission “To increase the public awareness of the benefits of chiropractic”.

    If, as you say, David, that “there’s more research to be done”, wouldn’t chiropractors be better channelling the FCP’s funds into research rather than marketing?

    In the meantime, for chiropractic in a nutshell, you really can’t do any better than the following:

    Quote:
    “WARNING: This treatment carries the risk of stroke or death if spinal manipulation is applied to the neck. Elsewhere on the spine, chiropractic therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo.”

    Having taking a thorough look at the evidence for chiropractic, the above is what Simon Singh and Edzard Ernst propose on p.285 of their recent book, ‘Trick or Treatment? Alternative Medicine on Trial’, that all chiropractors be compelled by law to disclose to their patients prior to treatment.

  • Edd
    You’re quite right that treating back pain is a complex, subtle and difficult matter. If there was a clear answer as to the best method of dealing with it, then everyone would be doing it.

    Becky,
    Thank you for your voice of support. Don’t be deterred, you did the right thing by seeing a chiropractor. All this business about asthma and colic shouldn’t blind people to the good work that the vast majority of chiropractors spend the vast majority of their time doing – successfully treating mussculoskeletal problems.

  • David said: “If the whole point of this is whether chiropractors abide by the rules or not, the GCC is the body to police that matter.”

    Well. The question needs to be asked whether, in view of the claims I have highlighted earlier, you really think the GCC is actually doing its job of protecting the public?

  • Blue wode,
    That’s a great quote, if you’re in the business of scare-mongering.

    Edzard Ernst often gets quoted on the basis of him being “the country’s first professor of complimentary and alternative medicine”. I can’t wait until there’s another one to help balance his views. There are professors in musculoskeletal medicine who hold rather different views from Ernst’s, but he seems to be the voice that people like to hear.

    No one claims that there are no risks involved in neck manipulation. However, the figures show that the risk of serious side effects is tiny. Also, the probability is that those who do suffer serious side effects are predisposed. The rest of the population (the massive majority) can be treated without concern. The research will hopefully identify those who are at risk so that they can be safeguarded and continue to benefit from excellent care.

    Zeno,
    Is the GCC doing its job? Yes it is.
    Is it doing it perfectly? Possibly not. However, like every other regulatory body, it will continue to improve and the public can continue to be confident the seeing a registered chiropractor is a good thing.

  • Of course, the other thing to mention is that alternatives to manual therapy include taking NSAIDs, which are proven to have a much higher risk rate than chiopractic and yet are available over the counter, without regulation……….

  • At 12.51 on 08 October, David wrote: “No one claims that there are no risks involved in neck manipulation. However, the figures show that the risk of serious side effects is tiny.”

    That might be so, but a responsible risk/benefit assessment does not favour using neck manipulation. The following is lifted from the most recent systematic review of adverse effects of spinal manipulation:

    Quote:
    “The effectiveness of spinal manipulation for most indications is less than convincing.5 A risk-benefit evaluation is therefore unlikely to generate positive results: with uncertain effectiveness and finite risks, the balance cannot be positive.

    -snip-

    The chiropractic profession tends to downplay the risks: ‘chiropractic services are safe’;60 ‘the healthy vertebral artery is not at risk from properly performed chiropractic manipulative procedures.’61 Others argue that ‘the occurrence of cerebrovascular accidents in the chiropractic population is 0.000008%’,62 that causality is not proven or even unlikely,61,63-66 that other interventions are more risky (see below),67 that the mechanical forces employed for spinal manipulation are too low to cause injury,68 or that there is a ploy from the medical establishment to sideline chiropractors.69-71 In the light of the evidence summarized above, such attitudes do not seem to be in the best interest of patients.

    It is, of course, important to present any risk-benefit assessment fairly and in the context of similar evaluations of alternative therapeutic options. One such option is drug therapy. The drugs in question—non-steroidal anti-inflammatory drugs (NSAIDs)—cause considerable problems, for example gastrointestinal and cardiovascular complications.72,73 Thus spinal manipulation could be preferable to drug therapy. But there are problems with this line of argument: the efficacy of NSAIDs is undoubted but that of spinal manipulation is not, and moreover, the adverse effects of NSAIDs are subject to post-marketing surveillance while those of spinal manipulation are not. Thus we are certain about the risks and benefits of the former and uncertain about those of the latter. Finally, it should be mentioned that other therapeutic options (e.g. exercise therapy or massage) have not been associated with significant risks at all.”

    http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

    At 12.51 on 08 October, David wrote: “Also, the probability is that those who do suffer serious side effects are predisposed. The research will hopefully identify those who are at risk so that they can be safeguarded and continue to benefit from excellent care.”

    And while the risks of serious side effects remain unknown, don’t chiropractors have an ethical duty to err on the side of caution and not use neck manipulation when there are equally effective, cheaper, more convenient, and safer options available?

    I would also add here that, bearing in mind that most chiropractors in the UK work in private practice and that many take an anti-vaccination stance, patients are exposed to other types of harms from chiropractic treatment. These would include:

    1. Decreased use of immunisation due to misinformation given to parents
    2. Psychologic harm related to unnecessary treatment
    3. Psychologic harm caused by exposure to false chiropractic beliefs about “subluxations”
    4. Financial harm due to unnecessary treatment

    At 12.51 on 08 October, David wrote: “There are professors in musculoskeletal medicine who hold rather different views from Ernst’s, but he seems to be the voice that people like to hear.”

    I suspect that Edzard Ernst is the voice that people like to hear because not only is he an impartial scientist, he is also the former Head of the Department of Physical and Rehabilitation Medicine at the University of Vienna’s Medical Faculty. As a consequence of the latter, not only is he very familiar with physical therapies, but he has also been trained in spinal manipulation and has applied it clinically.

  • David

    But the whole point is that NSAIDS have robust evidence that they work: chiropractic does not.

    And remember, as far as the GCC and ASA are concerned, the only evidence that counts is robust scientific evidence. The ASA have rules on what they will accept – and what they consider sub-standard evidence.

    Thanks goodness they have these high standards: it’s people’s health we are talking about here. To settle for such sub-standard ‘evidence’ is to put people’s health – and lives – at risk.

    If you think we need an alternative professor of AltMed, why doesn’t the AltMed industry sponsor one? But perhaps you are you forgetting Professor George Lewith, Professor of Health Research in the Complementary and Integrated Medicine Research Unit at the University of Southampton and Professor David Peters, Clinical Director, School of Integrated Health at the University of Westminster?

    Where are they when you need them? Why are they so quiet? Why aren’t they extolling the virtues of the evidence for chiropractic? Is it they are afraid their evidence just won’t stand up to scrutiny?

    But it’s nothing to do with personalities: it’s to do with the robustness of the evidence. And that is where chiropractic is so lacking.

    The GCC is registering chiropractors and taking their money for giving them the veneer of a professional medical service. But they are doing little to actually protect the public from misleading claims. Isn’t that what they should be doing?

  • Blue Wode,
    The passage you quote is, of course, from one of Ernst’s papers and I’m afraid that your assertion that he is an impartial scientist is questionable.

    On the evidence front, even the likes of Ernst and Singh have to acknowledge that there is good evidence for the effectiveness of spinal manipulative therapy for the treatment of neck pain, back pain and headaches. However, because that doesn’t fit with their anti-chiropractic stance, they qualify that concession with an alarmist reference to the tiny risks involved.

    The likes of the UKBEAM trial confirm the effectiveness of manipulation against other approaches for back pain. Do remember though, that chiropractic involves a great deal more than just manipulation. All my close colleagues treat using a combination of manipulation (where and when appropriate), mobilisation, massage, lifestyle advice and exercise. In other words, practising evidence based care.

    Chiropractors take their duties very seriously and, as part of that responsble approach, many were involved in a prospective trial to establish the risks of cervical manipulation. In the Thiel and Bolton study “Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey”, over 50,000 neck manipulations were monitored and there were no serious side effects recorded.

    As for your list of harmful effects of chiropractic:
    1) I do not know of one of my colleagues who advises against immunisastion. I certainly do not and my children have been vaccinated.
    2) Chiropractors do not treat unnecessarily. They are obligated to comply with the Code of Practice.
    3) As I have stated, I do not use the term subluxation with respect to spinal dysfunction. Chiropractors spend the vast majority of their time treating mechanical pain syndromes (successfully). Peddlars of the subluxation theory are being weeded out of the profession. Many are taking sanctuary under the title of “Osteomyologist”.
    4) See 2 above.

    Zeno,
    The modern chiropractor practices, first and foremost, evidence based care in the management of musculoskeletal disorders. There is plenty of robust evidence for this. One of the difficulties with measuring the risk of serious complications of what chiropractors do, is that it is so very small. The figures for NSAID induced side effects are much more easily measured. But don’t misunderstand me, for me there is no “them and us” and I do not take an anti-drug stance. My approach is to tackle mechanical pain syndromes in the only manner that can ever work, mechanically.

    I’m not going to battle on behalf of those who claim that they can treat non-mechanical disorders. What I will continue to do, is develop my skills so that I can carry on improving the safety and effectiveness of the treatment that I offer.

    Is that not professional?

  • This is probably not about Chiropractic’s like you David. It’s about a campaign to support Simon Singh. The hope is that any complaints that are upheld by the GCC can be used by Simon’s legal team to help his case. If it was about practitioners who use for example manipulation for colic, which as we have found out doesn’t have enough of an evidence base to support it, the far greater numbers of Osteopaths and Physios than chiropractics who advertise for this would be included in the raft of complaints by now. Anyone who is yet to google colic osteopathy or colic physiotherapy, should do so.
    I met a lady from Simon’s pr team last week. She also has just graduated as a nutritionist – the irony, the hypocrisy! She had some interesting things to say about his motivations for fighting this case with the BCA and Sense about Science (which she claimed they dreamt up).

  • I would caution that the following could be misread:
    “there is good evidence for the effectiveness of spinal manipulative therapy for the treatment of neck pain, back pain and headaches.”

    Good evidence for effectiveness is not evidence for good effectiveness.

  • At 17.34 on 08 October 2009 David wrote: “On the evidence front, even the likes of Ernst and Singh have to acknowledge that there is good evidence for the effectiveness of spinal manipulative therapy for the treatment of neck pain, back pain and headaches. However, because that doesn’t fit with their anti-chiropractic stance, they qualify that concession with an alarmist reference to the tiny risks involved.”

    David, I don’t think you’ve read my post correctly. Until the proper safety data are in, the risks of spinal manipulation outweigh the benefits – especially when there are other equally effective, cheaper, more convenient, and safer options available. And don’t forget that chiropractors are legally and ethically obliged to disclose that information to patients.

    At 17.34 on 08 October 2009 David wrote: “The likes of the UKBEAM trial confirm the effectiveness of manipulation against other approaches for back pain.”

    But the BEAM trial’s effects were:

    1. Not clinically significant
    [Tveito TH, Eriksen HR. United Kingdom back pain exercise and
    manipulation (UK BEAM) trial. Is manipulation the most cost
    effective addition to ‘‘best care’’? BMJ 2005; 330: 674.]

    2. Did not include 23–26% of the study population
    [Tillett R. United Kingdom back pain exercise and manipulation
    (UK BEAM) trial. What happened to participants who were not
    included in the analysis? BMJ 2005; 330: 674.]

    3. Had a design that couldn’t control for placebo and other non-specific effects.
    [Ernst E. United Kingdom back pain exercise and manipulation
    (UK BEAM) trial. Touch may have had non-specific effect, among
    other things. BMJ 2005; 330: 673–4.]

    At 17.34 on 08 October 2009 David wrote: “Do remember though, that chiropractic involves a great deal more than just manipulation.”

    Anything other than spinal manipulation (also known as ‘specific spinal adjustments’ to correct imaginary ‘subluxations’) is not real chiropractic and is available through other healthcare practitioners who are much less mired in quackery.

    At 17.34 on 08 October 2009 David wrote: “All my close colleagues treat using a combination of manipulation (where and when appropriate), mobilisation, massage, lifestyle advice and exercise. In other words, practising evidence based care.”

    One can only conclude that your close colleagues do not form part of the 76% of UK chiropractors who, in a 2007 survey, deemed traditional chiropractic beliefs (chiropractic philosophy) to be important. That same survey gives a figure of 63% for chiropractors who consider the fictitious ‘subluxation’ lesion to be central to chiropractic intervention. Interestingly, it also reveals that the responding chiropractors considered asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), as conditions that could benefit from chiropractic management (although opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive). As for childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma, they were perceived to benefit from chiropractic intervention by more than 50% of the respondents. You can read the results of the entire survey here:

    CAM Research Group

    [Ref. Aranka Pollentier and Jennifer M. Langworthy, The scope of chiropractic practice: A survey of chiropractors in the UK. Clinical Chiropractic, Volume 10, Issue 3, Pages 147-155. September 2007]

    Still on the subject of (the lack of) chiropractic evidence based care, I would be interested to know how chiropractors think it is possible for members of the public to determine which chiropractic treatments have scientific evidence supporting them, and which ones are bogus. It is a dilemma which is increasingly being referred to as the ‘bait and switch of unscientific medicine’.

    Quote:
    “Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine…someone may go to see a chiropractor and think they will be seeing a medical professional who will treat their musculoskeletal symptoms, but in reality they will see the practitioner of a cult philosophy of energy healing…The bait – claims that chiropractors are medical practitioners with expertise in the musculoskeletal system. The switch – practitioners of discredited pseudosciences that have nothing to do with the musculoskeletal system…A more subtle form of the bait and switch among chiropractors is the treatment of musculoskeletal symptoms with standard physical therapy or sports medicine practices under the name of chiropractic manipulation. Ironically, the more honest and scientific practitioners among chiropractors are most likely to commit this subtle deception. The problem comes not from the treatment itself but the claim that such treatments are ‘chiropractic’… But by doing so and calling it ‘chiropractic’ it legitimizes the pseudoscientific practices that are very common within the profession – like treating non-existent ‘subluxations’ in order to free up the flow of innate intelligence.”
    http://www.sciencebasedmedicine.org/?p=156

    At 17.34 on 08 October 2009 David wrote: “Chiropractors take their duties very seriously and, as part of that responsble approach, many were involved in a prospective trial to establish the risks of cervical manipulation. In the Thiel and Bolton study “Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey”, over 50,000 neck manipulations were monitored and there were no serious side effects recorded.”

    Professor Edzard Ernst questioned the integrity of the methodology used in that survey, and highlighted the very real problem of

    Quote:
    “…having to rely on the honesty of participating therapists [chiropractors] who could have a very strong interest in generating a reassuring yet unreliable picture about the safety of their intervention.”

    More here:
    http://www.medicinescomplete.com/journals/fact/current/fact1301a07g04r01.htm

    Interestingly, in their response, two of the survey’s authors, JE Bolton and HW Thiel, claimed that, in the UK alone, there were an estimated *four* million manipulations of the neck carried out by chiropractors each year. Yet, six months earlier, in October 2007, in a letter to the Journal of the Royal Society of Medicine, they claimed that the figure was “estimated to be well over *two* million cervical spine manipulations”. How that estimate could double in under 6 months is anyone’s guess, but it leaves them open to accusations that they may be trying to play down the risks.
    http://www.jrsm.org/cgi/content/full/100/7/330

    At 17.34 on 08 October 2009 David wrote: “I do not know of one of my colleagues who advises against immunisastion. I certainly do not and my children have been vaccinated.”

    That might be so, but only one out of 16 UK chiropractors who responded to this survey advised in favour of the MMR vaccination:
    http://www.dcscience.net/schmidt-ernst-vaccine-2003.pdf

    At 17.34 on 08 October 2009 David wrote: “Chiropractors do not treat unnecessarily. They are obligated to comply with the Code of Practice.”

    Apparently they do. See the survey of chiropractors in the UK (2007) linked to above.

    At 17.34 on 08 October 2009 David wrote: “As I have stated, I do not use the term subluxation with respect to spinal dysfunction. Chiropractors spend the vast majority of their time treating mechanical pain syndromes (successfully). Peddlars of the subluxation theory are being weeded out of the profession. Many are taking sanctuary under the title of “Osteomyologist”.”

    Well, it looks like there’s still a great deal of weeding out to be done. Once again, see the link to the 2007 survey of chiropractors in the UK above.

  • “I met a lady from Simon’s pr team last week. She also has just graduated as a nutritionist – the irony, the hypocrisy! She had some interesting things to say about his motivations for fighting this case with the BCA and Sense about Science (which she claimed they dreamt up).”

    This statement is not correct and I suspect no such lady exists. Simon does not even have a PR team. I am not aware of any person involved in the wider campaign with the background described.

    Jack of Kent

  • Thanks for that Jack.

    I think everyone reading that comment will have recognised it as the empty, malicious smear it is.

    You’re sounding desperate, ‘rational’.

  • Apologies – I did some fact checking with the host – apologies,the term “PR team” is inaccurate. The lady does exist, works with Simon, and in that role would be involved in his PR.

  • Blue Wode,
    “Until the proper safety data are in, the risks of spinal manipulation outweigh the benefits – especially when there are other equally effective, cheaper, more convenient, and safer options available.”

    What are we talking about here? We’ve established that there is a VERY small risk with upper cervical manipulation (so small that it’s proving hard to measure and is not a risk that applies to the vast majority of the population), but are you suggesting that there are substantial risks with manipulation in the low-back?

    The UKBEAM trial.
    Every trial can be criticised is some manner, but the criticisms you raise about this trial are very weak. You can’t get away from the fact that the best trials have all found that spinal manipulation is useful in the treatment of back pain.

    But don’t forget, chiropractic is about so much more than just manipulation, which is but one of the tools that can be used.

    You said: “Anything other than spinal manipulation (also known as ‘specific spinal adjustments’ to correct imaginary ‘subluxations’) is not real chiropractic and is available through other healthcare practitioners who are much less mired in quackery.”

    What an extraordinary statment. So now you’re telling me that I’m not a chiropractor! Well that’s funny, because that’s what it says on the certificate I was presented me with over two decades ago.

    What this neatly demonstrates is how ill-informed you are about chiropractic. If you were to take a look at either of the two main institutions that train chiropractors in the UK (the Anglo-European College of Chiropractic and the Welsh Institute of Chiropractic) you would find a very different model from the one that you seem to wish to portray.

    THe survey you quote is indeed worth reading and one of the facts that emerged was the differences in attitude between graduates of different courses. Notably, students of the McTimony-Corley course were the strongest adherents to outdated principles that are not taught in the intitutions named above. In fact, the McTimoney-Corley course has closed down, largely because it would never have been able to survive within the current legislative framework.

    Your argument regarding the value of the “Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey”,is typical of the prjudice demonstrated by the likes of Edzard Ernst and repeated by you:
    “Professor Edzard Ernst questioned the integrity of the methodology used in that survey, and highlighted the very real problem of
    Quote:
    “…having to rely on the honesty of participating therapists [chiropractors] who could have a very strong interest in generating a reassuring yet unreliable picture about the safety of their intervention.” ”

    This was a good study and if the biggest criticism you can level at it is to question the integrity of the participants, then you are on thin ice. It is inevitable that the data collection had to be done by the participants and for you to suggest that the reporting was anything other than completely honest in disingenuous. If you would like to fund an independent observer for another 50,000 chiropractic adjustments, you would be very welcome. I think they’d probably get a bit bored but I know that the data would be very similar.

  • Rational, do you feel able to share any of the interesting things that this lady has to say about Simon Singh’s motives?

  • Dear David,

    I often find it helpful in a discussion, to attempt to summarise areas of agreement. Do you agree (as it seems you do) that there is no substantive evidence that chiropractic can treat childhood asthma, otitis media, or colic?

    If you do agree that there is no such evidence, do you agree it is unfortunate that someone should be sued for saying that there is no such evidence?

    Finally, do you agree that it is best to focus on the evidence in a debate, rather than on ad hominem attacks on participants (including attacks on you, of course!)

    best wishes,

    Allo

  • Allo V Psycho,

    I personally do not run a paediatric orientated practice and have never intentionally treated infantile colic, otitis media or asthma. Although, interestingly I have observed an improvement in the asthma status of some children I’ve treated in the past. However, I have never promoted chiropractic as a treatment for these ailments because I feel that any response I’ve seen is difficult to explain or reproduce.

    There are many of my colleagues with a special interest in paediatrics who have done hundreds of hours of extra training and would be better placed to comment on the approach they take.

    With respect to the evidence, I have not scrutinised it very closely because it does not really relate to my practice. It seems to me though, that there is some evidence and that the debate is really over the robustness of that evidence.

    I have not entered this debate to fight the corner of those who promote their treatment for the conditions you have asked about. I have got involved because I object to the wholesale condemnation of chiropractic on the basis of this issue. The vast majority of chiropractors spend the vast majority of their time treating musculoskeletal conditions and to be honest, this issue is a red herring.

    The premise for the recent complaints made to the GCC about claims for chiropractic treatment is a smokescreen. I have seen many comments in blogs like this, where it has been people’s stated intention to ruin chiropractic and all chiropractors. Well, that would be doing a great disservice to to an honourable profession and its hundreds of thousands of grateful patients.

    Are you suggesting that I have made any ad hominem attacks in my postings? The difficulty here is that an awful lot of what is being said is indeed prejudiced. Many contributors to this and similar blogs have not been objective, even if they believe that they have been. I sincerely hope that none of my comments can be considered offensive because that is not my intention.

    My concern is that, so far, this has not been a debate but an unremitting damnation of chiropractic based on a false impression of what it is.

  • On Friday 09 October 2009 at 15:52 David wrote “We’ve established that there is a VERY small risk with upper cervical manipulation (so small that it’s proving hard to measure and is not a risk that applies to the vast majority of the population), but are you suggesting that there are substantial risks with manipulation in the low-back?”

    Not substantial risks, but according to a recent systematic review of adverse effects of spinal manipulation, mild to moderate adverse effects do occur in a large proportion (30-61%) of patients receiving spinal manipulation:

    Quote
    “…adverse effects are transient and non-serious but nevertheless seriously affect many patients. Risk-benefit evaluations of spinal manipulation must therefore account not just for serious complications but also for such adverse events.”
    Source

    It’s also worth noting that a systematic review in the journal ‘Spine’ earlier this year, which looked at the safety of chiropractic interventions, concluded that there was no robust data concerning the incidence or prevalence of adverse reactions after chiropractic, and that further investigations were *urgently* needed to assess definite conclusions regarding this issue: http://www.ncbi.nlm.nih.gov/pubmed/19444054

    So, currently, it seems that the bottom line is that, since other equally effective, more convenient, cheaper, and safer options are available, it would be unethical for chiropractors to administer any type of spinal manipulation to a patient unless that patient still consented to treatment after being informed of all other possible options.

    On Friday 09 October 2009 at 15:52 David wrote: “The UKBEAM trial: Every trial can be criticised is some manner, but the criticisms you raise about this trial are very weak. You can’t get away from the fact that the best trials have all found that spinal manipulation is useful in the treatment of back pain.”

    But you’re forgetting the crucial fact that the risk/benefit assessment for spinal manipulation is largely unfavourable. Take, for example, the studies included in the recent NICE guidelines:

    Quote
    “The guidelines considered ‘a total of seven RCTs on manipulation⁄mobilisation techniques’ for evaluating effectiveness. A Cochrane review included 39 RCTs. The methods section of the guidelines informs us that ‘articles not relevant to the subject in question were excluded’. It is unclear to me why so many RCTs of spinal manipulation were excluded from the NICE guidelines…A plethora of evidence on the risks of spinal manipulations (I estimate well over 500 articles) is available, and it is unclear why this was excluded…The risk of mild to moderate adverse effects is undisputed even by chiropractors: about 50%(!) of all patients suffer from such adverse effect after spinal manipulations. These effects (mostly local or referred pain) are usually gone after 1–2 days but, considering the very moderate benefit, they might already be enough to tilt the risk-benefit balance in the wrong direction. In addition, several hundred (I estimate 700) cases are on record of dramatic complications after spinal manipulation. Most frequently they are because of vertebral arterial dissection. Considering these adverse events, the risk-benefit balance would almost certainly fail to be positive. It is true, however, that the evidence as to a causal relationship is not entirely uniform. Yet applying the cautionary principle, one ought to err on the safe side and view these complications at least as possibly caused by spinal manipulations. So why were these risks not considered more seriously? The guideline gives the following reason: ‘The review focussed on evidence relevant to the treatment of low back pain, hence cervical manipulation was outside our inclusion criteria’. It is true that serious complications occur mostly (not exclusively) after upper spinal manipulation. So the guideline authors felt that they could be excluded. This assumes that a patient with lower back pain will not receive manipulations of the upper spine. This is clearly not always the case. Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them. And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment of spinal manipulation for back pain”.
    Source
    [Ref: Ernst, E. Spinal manipulation for the early management of persistent non-specific low back pain - a critique of the recent NICE guidelines, Int J Clin Pract, 18th August 2009. Reprints available from author]

    In addition to the above, in 2006 a systematic review of systematic reviews of spinal manipulation which was published in the Journal of the Royal Society of Medicine, it was concluded that there was no convincing evidence to suggest that spinal manipulation was a recommendable treatment option for any medical condition:
    http://www.jrsm.org/cgi/content/full/99/4/192

    On Friday 09 October 2009 at 15:52 David wrote “You said: “Anything other than spinal manipulation (also known as ‘specific spinal adjustments’ to correct imaginary ‘subluxations’) is not real chiropractic and is available through other healthcare practitioners who are much less mired in quackery.” What an extraordinary statment. So now you’re telling me that I’m not a chiropractor! Well that’s funny, because that’s what it says on the certificate I was presented me with over two decades ago.”

    Of course you’re *called* a chiropractor, but if you’re an evidence-based one then you’re not practicing REAL chiropractic.

    On Friday 09 October 2009 at 15:52 David wrote “If you were to take a look at either of the two main institutions that train chiropractors in the UK (the Anglo-European College of Chiropractic and the Welsh Institute of Chiropractic) you would find a very different model from the one that you seem to wish to portray.”

    Then why do around 60-70% of chiropractors in the UK still buy into subluxation theory?
    Source
    [Ref. Aranka Pollentier and Jennifer M. Langworthy, The scope of chiropractic practice: A survey of chiropractors in the UK. Clinical Chiropractic, Volume 10, Issue 3, Pages 147-155. September 2007]

    On Friday 09 October 2009 at 15:52 David wrote “The survey you quote is indeed worth reading and one of the facts that emerged was the differences in attitude between graduates of different courses. Notably, students of the McTimony-Corley course were the strongest adherents to outdated principles that are not taught in the intitutions named above. In fact, the McTimoney-Corley course has closed down, largely because it would never have been able to survive within the current legislative framework.”

    That may be the case, but the McTmoney College of Chiropractic is still going strong:
    http://www.mctimoney-college.ac.uk/

    BTW, notice the Meric Chart displayed on the wall in the photo in the above link. For those wishing to know more about it, here’s a close up of what the chart (misleadingly) conveys:
    http://www.cafeoflifepikespeak.com/merik_chart.htm

    It’s also worth remembering that the McTimoney College’s degrees, which include a great deal of pseudoscience, are, very disappointingly, underwritten by the University of Wales:
    http://www.quackometer.net/blog/2009/06/university-of-wales-is-responsible-for.html

    On the subject of the McTimoney College of Chiropractic, and the paucity of evidence for chiropractic interventions in general, I note that you still haven’t answered my question: How do chiropractors think it is possible for members of the public to determine which chiropractic treatments have scientific evidence supporting them, and which ones are bogus?

    As already pointed out, it’s a dilemma that’s increasingly being referred to as the ‘bait and switch of unscientific medicine’. Here’s a reminder:

    Quote
    “Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine…someone may go to see a chiropractor and think they will be seeing a medical professional who will treat their musculoskeletal symptoms, but in reality they will see the practitioner of a cult philosophy of energy healing…The bait – claims that chiropractors are medical practitioners with expertise in the musculoskeletal system. The switch – practitioners of discredited pseudosciences that have nothing to do with the musculoskeletal system.”
    http://www.sciencebasedmedicine.org/?p=156

    On Friday 09 October 2009 at 15:52 David wrote “Your argument regarding the value of the “Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey”, is typical of the prjudice demonstrated by the likes of Edzard Ernst and repeated by you…This was a good study and if the biggest criticism you can level at it is to question the integrity of the participants, then you are on thin ice. It is inevitable that the data collection had to be done by the participants and for you to suggest that the reporting was anything other than completely honest in disingenuous.”

    If you read the link I supplied, the following comments were also made:

    Quote
    “The sample of this survey was sizeable but not large enough to exclude rare events… The picture gets more complicated when considering the 698 treatment consultations of patients who failed to return for their next treatment. Theoretically some or most or all of these patients could have died of a stroke. Overlooking even one single serious adverse event would change the estimated incidence rates from this study quite dramatically. In my view, the most confusing aspect about the results of this survey is the fact that the incidence of minor adverse events is so low. Previous studies have repeatedly shown it to be around 50%. The discrepancy requires an explanation. There could be several but mine goes as follows: the participating chiropractors were highly self-selected. Thus they were sufficiently experienced to select low-risk patients (in violation of the protocol). This explains the low rate of minor adverse events and begs the question whether the incidence of serious adverse events is reliable.”
    http://www.medicinescomplete.com/journals/fact/current/fact1301a07g04r01.htm

    In addition to the above, it’s interesting that we still don’t know why two of the survey’s authors, JE Bolton and HW Thiel, claimed that in the UK alone there were an estimated *four* million manipulations of the neck carried out by chiropractors each year, and yet, six months earlier, in October 2007, in a letter to the Journal of the Royal Society of Medicine, they claimed that the figure was “estimated to be well over *two* million cervical spine manipulations”. http://www.jrsm.org/cgi/content/full/100/7/330

    On the subject of dishonesty, it’s interesting to note that a member of the public recently received a reply from the General Chiropractic Council (GCC) in response to a Freedom of Information Act Inquiry, and apparently the GCC avoided responding to almost every point in the inquiry. You can read more about it here:
    http://adventuresinnonsense.blogspot.com/2009/09/public-isnt-interested-in-why-gcc-is.html

    Why would that be?

    Also, as the words ‘manipulation’ and ‘subluxation’ in a chiropractic context have meanings that are different from the meanings in evidence-based literature, and the use of manipulation/mobilization by an evidence-based manual therapists are not the same as the reason for use of adjustment/manipulation by most chiropractors, why aren’t UK chiropractors, their associations, and their regulators, making clear the essential differences between scientific manual therapy and chiropractic philosophy? It’s very odd when you consider that the GCC’s Fitness To Practise Report (2007) states that all chiropractors must ensure that all the information they provide, or authorise others to provide on their behalf, is factual and verifiable, is not misleading or inaccurate in any way, does not abuse the trust of members of the public in any way, nor exploit their lack of experience or knowledge about either health or chiropractic matters, and does not put pressure on people to use chiropractic, for example by arousing ill-founded fear for their future health or suggesting that chiropractic can cure serious disease.

    Finally, are chiropractors aware that in June of this year, in an article in New Scientist, Edzard Ernst invited all UK chiropractors to stop the confusions, misunderstandings and animosities that arose during the recent debate about the effectiveness of chiropractic for non-spinal conditions such as asthma and otitis, and to state clearly where they stood? Because there doesn’t appear to have been any public response to it: http://www.newscientist.com/article/mg20227140.100-open-letter-to-all-uk-chiropractors.html

    In view of all the above, perhaps it’s not surprising that Professor Ernst wrote the following article in the Times back in May:

    Distrust me, I’m a chiropractor

  • Blue Wode,

    I wonder whether you would be kind enough to answer some questions for me.

    1. You are concerned about claims that some chiropractors have made about some of the conditions they believe chiropractic can help. How do you feel about the very similar claims that many osteopaths make and are you campaigning in the same vigorous manner to protect the public from this?

    2. You are concerned about the safety, and have doubts about the efficacy of, spinal manipulation as carried out by chiropractors. How do you feel about the spinal manipulation that is performed by osteopaths, physiotherapists, GPs and orthopaedic consultants on a daily basis and are you campaigning in the same vigorous manner to protect the public from this?

    3. You are concerned that some chiropractors practice according to a “subluxation” model that you feel has no scientific basis. How do you feel about the many GPs who practice homeopathy or acupuncture, and are you campaigning as vigorously to protect the public from this?

    4. Which would you rather see, a reformation of chiropractic or the end of chiropractic?

  • @ David

    I am pleased to answer you questions as follows:

    1. Yes, I am also very concerned about the claims made by osteopaths in the UK. Indeed, I am currently engaged in a lengthy debate with some osteopaths, and one of them is currently addressing my concerns via the General Osteopathic Council (which has yet to respond): http://www.skeptics.org.uk/forum/showthread.php?t=2452

    2. I am not so vocal about the safety aspects of spinal manipulation performed by osteopaths, physiotherapists, GPs and orthopaedic consultants on a daily basis because they, apparently, perform the procedure far more safely than chiropractors. See the graph in an article I wrote here:
    http://www.layscience.net/node/566

    3. I am not impressed by MDs who fail to adhere to their scientific training. By way of combating their drift towards pseudoscience I have, for the last six years, not only written to my MP, the NHS, and the Department of Health in an effort to have the issue properly addressed, but have also attempted to warn uninformed people of the lack of evidence for ‘alternative medicine’ through my anti-quackery website:
    http://www.ebm-first.com

    4. As reformed chiropractic would resemble/duplicate physiotherapy, I would like to see chiropractors re-trained and absorbed into the physiotherapy profession (osteopaths too).

    As I have answered all your questions, would you please answer the questions posed by Allo V Psycho and I in the posts above.

    Thank you.

  • David

    It was very good of Blue Wode to answer your questions but there was no need for him to do so.

    As I’ve said elsewhere, if you or anyone else has concerns about other treatments then please feel free to make appropriate complaints yourself.

    However, this is totally irrelevant to the questions of whether chiropractors are making claims that are against their Code of Practice and whether, in the light of that, they are being properly regulated.

    Now you have answers to your questions, can you address the questions Blue Wode (and others) have asked you?

  • David, why do you bother with these rather sad people? They have nothing better to do. You have.

  • Study reveals 29% of Bloggers are Losers!

    by Kamal El-Din

    Unconfirmed sources report that The Pew Research Center for the People & the Press will soon release a report on bloggers. The report called, “Bloggers are Losers”, concludes that 29% of people who write blogs are losers. The study also reveals that a much higher percentages of bloggers display traits that could be classified as ‘loser-like behaviors.’
    Scott Keeter, Associate Director of the center, described the study. “In the study we surveyed 1000 people who are self described bloggers. The bloggers filled out an extensive questionnaire and then were interviewed by Center researchers. I have to tell you, we loved working with this test group. They are very nice people. It is a shame that according to our findings a lot of the study participants are indeed losers.”

    In the study, researchers asked bloggers about their behaviors in four areas, personal relationships, work habits, political activism and hobbies. Because blogging is a complexes set of behaviors researchers point out that many of the behaviors cut across the four areas. Some of the more interesting results can be found below. For a complete summery of the report visit the web site of The Pew Research Center for the People & the Press

    34% of bloggers admit to calling in sick to stay home and work on their blog.
    45% of bloggers play video games regularly.

    11% of bloggers stated that on at least one occasion had they had passed up sex with a spouse or partner to work on their blog.

    76% of bloggers admit to working on their blogs at work.

    73% of bloggers admit too making up things to put in their blogs to make themselves look cool.

    82% of bloggers describe themselves as progressive.

    51% of bloggers stated that they have more friends on line that in real life.

    32% of bloggers admitted to linking too cool site to make them selves look cool.

    78% of bloggers are looking for a date on any given Friday night.

    Mitch Loveless, the self-described King of Blogging, admitted too engaging in some of the loser-like blogging behaviors. “I took part in the study and yes we bloggers do engage in some loser-like behaviors, but the Pew guys got it wrong. There is no way that 29% of us are losers. That’s bullshit and I’m going to blog all night to set the record straight! Sure we don’t go out as much, sure we don’t get laid very often and play lots of videos games online at all hours of the day and night, but that doesn’t make us losers!”

    In response to such pointed criticisms of the studies conclusions Scott Keeter said. “Yes, it does.”

  • Zeno, why bother to react to that gutless twat? S/he has nothing better to do. You have.

  • Dave try this.

    The secret of dealing with the know it all
    Being a ‘know-it-all’ is a form of bullying even if that is not the intention.

    The know-it-all has an opinion on everything regardless of whether they actually know anything about the subject or not. You know the type: something is self-evidently true purely because they happen to think it.

    Know-it-alls are bombastic, opinionated and bad at listening.

    What the know-it-all lacks is the humility to say: “I do not know enough about this to form a proper opinion”, or “You may be right because you have more experience in this area than I do”.

    Set on transmit not receive

    Know-it-alls are on set on ‘transmit’ most of the time. They are not up for receiving input from others. They want to be the ones giving out, transmitting their pearls of ‘wisdom’.

    What they don’t know isn’t worth knowing and when they do learn something well… according to them, they knew it already.

    The know-it-all may be a highly intelligent person but their know-it-all attitude makes them narrow minded and less and less able to learn as the years roll by.

    Putting you down without meaning to?

    The obvious solution seems to be to avoid the know it all as they have a great way of putting other people down by implication. In other words if they know everything then you know nothing. Or anything you do know you know because of them. That’s the way they can make you feel.

    Bad for self-esteem

    The know-it-all can damage your self-esteem because there is something compelling about certainty. The trouble is they can feel hard to deal with especially if they happen to be your boss or the person you live with.

    Being a know-it-all is a form of greed. Wanting to take all credit and direct all things at all times regardless of other people is like someone grabbing all the food at the table.

    The know-it-all may take on board other peoples’ ideas but then claim them as their own or say that ‘everyone knew that any way.’ They are in fact greedy over ownership of knowledge.

    Your ‘How to Deal with the Know It All’ hypnosis download will give you both tips and strategies and prime your unconscious mind to respond constructively to the know-it-all.

    Remember it’s not down to you to change the know-it-all, just to deal with them in ways which are more constructive and cause less conflict. You need to be able to remain calm and objective and remember that they do not know everything and that you, yourself, can contribute.

  • This is really what Zeno is all about.

    The need for power
    McClelland (1961), identified Power as one of three needs related to management behaviour, the other two being Achievement and Affiliation. Ironically, McClelland claims to have identified a strong power orientation amongst Psychologists! The need for Power is an urge to control others: to be able to influence them and make them do things which perhaps they would not have done if left to themselves. Along with this they accumulate the symbols and status of power and the prestige they consider to go along with it.

    McClelland identified four stages within the power orientation:

    1. Drawing inner strength from others – being a loyal follower and serving the power of other people;

    2. Strengthening oneself – beginning to play the power game, collecting symbols of status, one-upmanship, trying to dominate situations;

    3. Self-assertiveness – becoming more aggressive and trying to manipulate situations so as to use other people to achieve one’s own targets;

    4. Acting as an instrument of higher authority – identifying with some organisation or authority system and employing the methods learnt in stages 2 and 3 but now being able to claim formal legitimacy.

    Blake and Mouton (1964) would feature the kind of person who maximises this kind of approach as having the ‘Authority – Obedience’ style of management: concentrating on maximising production through the exercise of personal authority and power.

    This style of management is described by Chell (1987):

    ” such a leader combines a high concern for production with a low concern for people. He or she concentrates on maximising production by exercising power and authority, and achieving control over people by dictating what they should do and how they should do it. Typically he or she will ‘drive him – or herself and others’, investigate situations to ensure control and that others are not making mistakes; defend own ideas and opinions even though it may mean rejecting those of others; deal with conflict by either trying to cut it off or winning own position; make own decisions; is rarely influenced by others; and is not afraid to pinpoint other people’s weaknesses and failures.”

  • Fed Up, why do you bother copying and pasting random stuff? I recommend you go and look for a date.

  • I’m an outsider here but shouldn’t fed up’s comments be deleted? What do they have to do with the blog post? They are simply some form of hate speech.

    Thanks to David for the time in explaining and arguing his point of view as a chiropractor. It’s a pity more chiropractic supporters are as level headed in their approach.

    One comment on Chiropractic methods generally: if out of “manipulation, mobilisation, massage, lifestyle advice and exercise”, it turns out manipulation isn’t as effective as the other methods, where does that leave us? For example a lot of people won’t consider lifestyle, even though this might be the problem. Do chiropractors encourage these other methods by placebo?

    Chiropractors, I think, need to change from the inside and make sure that they use science and scientific proof and change their methods.

  • “It’s a pity more…” should read “It’s a pity more chiropractic supporters aren’t as level headed in their approach.” (Obviously!)

  • David said at
    Thursday 08 October 2009 at 07:54

    “Skepticat, I am not defending the term subluxation.”

    So, what makes you a chiropractor? I understand you have a certificate on your wall that says you are, but if the certificate said that the Institute of Astrologers had certified you as an astrologer, but you then turn up explaining how you fit gas boilers and that the Institute of Astrologers now only deals in the installation of gas boilers, I think you might appreciate that it is fair that you should be asked what the hell is going on.

    If you define ‘subluxations’ out of chiropractic then you are some sort of physiotherapist, but you are using a title under which it is fairly clear that a majority of your soi disant chiropractic colleagues claim they can treat asthma by cracking backs and counsel against vaccination because of a deeply wrong view of how biology works.

  • It’s not a real discussion without some random comments from someone like fed-up.

    Anyway – 29% of blog writers may well be losers, but what we need to really know is the base rate of being a loser. (And a good working definition of ‘loser’ too.) If the base rate for being a loser is, say, 47.3%, then it’s pretty cool (if ‘pretty cool’ is the opposite of being a loser loser) thing to be a blogger, is it not?

  • Blue Wode,

    You said: “I am not so vocal about the safety aspects of spinal manipulation performed by osteopaths, physiotherapists, GPs and orthopaedic consultants on a daily basis because they, apparently, perform the procedure far more safely than chiropractors.”

    I can introduce you to a local osteopath who manipulates more aggressively than any chiropractor I know, and another whose “manipulation” involves no discernible movement at all (he calls it cranial manipulation). I can introduce you to a couple of local GPs who manipulate in a very non-specific manner with little or no specialised training and often with poor results, in terms of effect and side-effect. There is also a local orthopaedic consultant who still practices manipulation of necks under general anaesthetic (how aggressive does a manipulation have to be before you need to anaesthetise your patient beforehand?).

    I do not accept that the manipulation done by chiropractors is more dangerous than that done by others. It looks to me as if your graph shows a higher incidence of side effects from chiropractic neck manipulation purely as a consequence of the fact that chiropractors perform much the greatest percentage of manipulations that are done. It does not suggest a greater incidence of adverse side effect per manipulation performed.

    By virtue of the extended training that chiropractors receive, and the practice they get, I believe that they are the people best placed to manipulate all areas of the spine.

    You say you are “not impressed by MDs who fail to adhere to their scientific training.” Yet you “would like to see chiropractors re-trained.”

    Remember, the majority of chiropractors spend all their time practicing evidence based care in the treatment of musculoskeletal disorders. Bearing this in mind, one could reasonably extrapolate your theory to suggest that ALL GPs should be retrained because a few practice theories that you’re not happy about.

    Your quote regarding the risks of spinal manipulation: “Not substantial risks, but according to a recent systematic review of adverse effects of spinal manipulation, mild to moderate adverse effects do occur in a large proportion (30-61%) of patients receiving spinal manipulation:”

    What the quote actually says, is only “mild” adverse effects. These mild adverse effects are akin to someone feeling a little sore or achy after having been to the gym and exercised. Mild and transient. Also, you should bear in mind that, by definition, the area being worked on will already have been uncomfortable; the very reason it was being treated in the first place.

    Your quote from this study: http://www.ncbi.nlm.nih.gov/pubmed/19444054 regarding the adverse effects of chiropractic reads: “further investigations were *urgently* needed to assess definite conclusions regarding this issue.” Of course, the sentence before your extract reads “There is no robust data concerning the incidence or prevalence of adverse reactions after chiropractic.” and even the figures quoted in this study suggest only a very low risk exists. What you’ve chosen to do is highlight and dramatise the word “urgent” in order to imply greater risk.

    With respect to your remarks about the McTimoney College, I’m afraid that I am unable to comment. As a registered chiropractor, I would draw your attention to clause F1.1 in the Code or Practice: “Specifically chiropractors: must not discriminate against, or unjustly criticise, a colleague or other
    health professional.”

    You said: “it’s interesting that we still don’t know why two of the survey’s authors, JE Bolton and HW Thiel, claimed that in the UK alone there were an estimated *four* million manipulations of the neck carried out by chiropractors each year, and yet, six months earlier, in October 2007, in a letter to the Journal of the Royal Society of Medicine, they claimed that the figure was “estimated to be well over *two* million cervical spine manipulations”.”

    This is a red herring. To infer that this apparent change is some sort of attempt to hide anything is ludicrous and would certainly qualify as an ad hominem attack. Both Dr Thiel and Professor Bolton are known to me personally and I can assure you that their integrity is beyond reproach. They certainly possess at least the same credibility as Professor Ernst, on whose writings you rely so much.

    Zeno,

    You said: “As I’ve said elsewhere, if you or anyone else has concerns about other treatments then please feel free to make appropriate complaints yourself.”

    I am not making complaints about the treatment offered by other disciplines. Largely because I believe that valid complaints should be lodged by those who have actually come to harm, or by their agent, rather than the vexatious complaints that have recently been made about chiropractors.

    Interestingly though, this is a quote from the Chartered Society of Physiotherapists website regarding the treatment of asthma:

    “How can physiotherapy help?
    Research has shown that breathing gently, calmly and slowly can help reduce some of the symptoms. Physiotherapists are highly skilled at supporting people with asthma by helping them to breathe in a more relaxed way. They can recommend breathing exercises, advise on physical activity, and explain how to manage wheezing and other symptoms, to contribute to your own recovery.”

    I’m pretty sure that chiropractors should be able to do that too…………….

    I can understand why you would rather I didn’t bring other disciplines into the debate though; it would distract readers’ attention from your objective which seems to be to prove the case against chiropractic in support of Simon Singh.

    Which brings me to the question that Allo V Psycho asked. I haven’t answered the question:

    “If you do agree [that there is no substantive evidence that chiropractic can treat childhood asthma, otitis media, or colic] do you agree it is unfortunate that someone should be sued for saying that there is no such evidence?”

    I’m not going back into the argument over how substantive the evidence is; I’ve already made my position clear on that. However, if, as I presume it is, this is a reference to the BCA suing Simon Singh for libel, the substance of the evidence is not the issue. As I understand it, the case was brought because Mr Singh made a statement of fact that suggested the BCA were deliberately promoting treatments that they knew to be invalid which they don’t.

  • Here is my favorite definition of “subluxation” from a chiro, who admits outright there is no real definition, but this is what she believes:

    All I can do is give you my definition of subluxation, which is most definitely different from Dorland’s or whatever medical dictionary you use. A chiropractic subluxation is an area of bony malposition which results in altered function, including muscular imbalance and decreased nerve flow. Here goes the neurology behind it: the zygapophyseal joints in the spine and the joints at the Atlanto-occipital and Atlanto-axial interfaces contain the largest concentration of proprioceptors and joint mechanoreceptors in the body. When these joints do not move properly (due to minor malposition), the normal proprioceptive input to the brain is reduced. This decrease in proprioception can result in a variety of cord-level and eventually cortical manifestations. Are you familiar with the Pain-Gate Theory? Pain fibers are only 10% of the afferent fibers coming into the cord at any given level, and their signals are overridden by the proprioceptive input from the body. When this proprioception is decreased, such as with subluxation, the CNS is free to perceive the pain. When subluxations are corrected, with specific chiropractic adjustments, the joint mechanoreceptors are able to fire again and “gate” out the pain. This is the reason for the sometimes-immediate pain relief experienced by chiropractic patients. However, since muscles and bones work together, repeated corrective adjustments are necessary until the bony misalignments stay corrected. This is where the old “once you go to a chiropractor, you always have to go” comes from. The body has to relearn proper position – it’s a training and adaptation process. A lot like rehab, just at a very specific and small area. Care should taper off as the body adapts and maintains the correction. You asked for a drink, and I turned on the fire hose — sorry about that, it’s just a complex issue, not easily “defined” in a short sweet sentence or two. That’s part of the problem with chiropractic, it’s difficult to define, which makes it seem unscientific. I prefer the neuro route, because it makes sense to my logical mind to draw out the pathways and reflexes, to know “why”. Others like to talk about “Innate Intelligence” and healing flow. Whatever works for them, I guess. Despite all of the many ways of explaining and practicing, I know that Chiropractic works. We are intricately designed creatures, and the body is capable of some miraculous things if it is free to function properly.

    She then went on to “clarify”:

    The neurology mentioned in my post, (…When these joints do not move properly (due to minor malposition), the normal proprioceptive input to the brain is reduced. This decrease in proprioception can result in a variety of cord-level and eventually cortical manifestations. ) indicates the ability of subluxation to affect the normal function of any part of the body subject to CNS control. The central integrative state of the patient most certainly affects their entire body function. Spinal wind-up, increased sympathetic activity, will affect vasomotor tone, GI secretion, etc. Proper physiological function of end organs depends on the brain’s ability to correctly stimulate and monitor that organ. This is where chiropractic affects viscera. Chiropractic philosophy is to locate and correct subluxation. IF the visceral dysfunction is related to the state of the CNS (afferentation, autonomic disturbances, segmental changes, etc.), and not some external force such as cigarette smoke or chemical exposure, it can be positively affected by removal of subluxation. (For example, adjustment of a spinal segment fires off muscle spindles and Golgi tendon organs, which synapse in the dorsal column, which: 1. monosynaptically inhibits the intermediolateral tract, inhibiting sympathetic activity, and 2. increases afferent input to the brainstem, cerebellum and cortex, thereby restoring proper autonomic balance and CNS function.) That said, adjusting a patient to “fix” visceral complaints, or even pain, is outside the basic chiropractic philosophy of subluxation correction. I can draw you the pathways that explain why chiropractic adjustments help with ear infections, vertigo, asthma, etc.. It goes back to the CNS controlling the function of every cell and tissue of the body and the widely-proven neurology is there to explain it.

    I am one of the few chiros who combines the “straight” philosophy of finding and correcting vertebral subluxation with an understanding of the neurological reasons “why” chiropractic works to let the body heal itself.

    ____________________________

    Sorry for the long post, but this is a sterling example of what we are up against. I e-mailed that to a neurologist friend for his opinion and his response was “hell if I know what she’s talking about.”

  • Hi David,

    When you say:

    “How can physiotherapy help?
    Research has shown that breathing gently, calmly and slowly can help reduce some of the symptoms. Physiotherapists are highly skilled at supporting people with asthma by helping them to breathe in a more relaxed way. They can recommend breathing exercises, advise on physical activity, and explain how to manage wheezing and other symptoms, to contribute to your own recovery.

    I’m pretty sure that chiropractors should be able to do that too…………….”

    If physiotherapists already do that, then why would chiropractors also want to do that?

  • BSM,

    You said: “If you define ’subluxations’ out of chiropractic then you are some sort of physiotherapist”

    No, I continue to be a chiropractor, advancing my skills and treatment through evidence-based care.

    Andrew Gilbey,

    You said: “If physiotherapists already do that, then why would chiropractors also want to do that?”

    I feel that diversity is a good thing. However, if you feel that it’s important to reduce the field of neuromusculoskeletal carre to one profession only, I suggest that your best bet would be to offer all physiotherapists some extra training and they can all become chiropractors.

    Let me just say that I have no objections to the work that physiotherapists do. I do, however have several friends who, having completed the physiotherapy training and worked in the field for some time, have gone on to do the extra training necessary to become a chiropractor.

    TomB,

    The principle of affecting central neurological function by affecting afferent nerve input is not a contentious issue.

  • On Monday 12 October 2009 at 00:26 David wrote: “I do not accept that the manipulation done by chiropractors is more dangerous than that done by others. It looks to me as if your graph shows a higher incidence of side effects from chiropractic neck manipulation purely as a consequence of the fact that chiropractors perform much the greatest percentage of manipulations that are done. It does not suggest a greater incidence of adverse side effect per manipulation performed.

    I disagree. Apparently the vast majority of neck manipulations done by chiropractors are unnecessary. Bearing in mind that around 60-70% of UK chiropractors admit to chiropractic philosophy (subluxation theory) being important to their practices, the following is lifted from a recent article by Samuel Homola, DC:

    When the RAND (Research and Development) organization published its review of the literature on cervical spine manipulation and mobilization in 1996, it concluded that only about 11.1% of reported indications for cervical spine manipulation were appropriate…Since about 90% of manipulation in the United States is done by chiropractors (1) who use spinal manipulation as a primary treatment for a variety of health problems, neck manipulation is more problematic among chiropractors than among physical therapists and other practitioners who use manipulation only occasionally in the treatment of selected musculoskeletal problems…Manipulation of the upper cervical spine should be reserved for carefully selected musculoskeletal problems that do not respond to such simple measures as time, massage, exercise, mobilization, longitudinal traction, or over-the-counter medication…There is evidence to indicate that cervical spine manipulation and/or mobilization may provide short-term pain relief and range of motion enhancement for persons with subacute or chronic neck pain.(1) There is no credible evidence, however, to indicate that neck manipulation is any more effective for relieving mechanical neck disorders than a number of other physical treatment modalities,(9) and it is clear that adverse reactions are more likely to occur following manipulation than mobilization.(10)…All things considered, manual rotation of the cervical spine beyond its normal range of movement is rarely justified. The neck should *never* be manipulated to correct an asymptomatic “chiropractic subluxation” or an undetectable “vertebral subluxation complex” for the alleged purpose of restoring or maintaining health or to relieve symptoms not located or originating in the neck. There is no evidence that such subluxations exist. When a painful, actual subluxation (partial dislocation) occurs, manipulation might occasionally be helpful but is most often contraindicated.(13) …A physical therapist trained in the use of both manipulation and mobilization for musculoskeletal problems would be less likely to use manipulation inappropriately than a chiropractor who routinely manipulates the spine for “the preservation and restoration of health.”(15)…According to the Association of Chiropractic Colleges (ACC), “Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.”15 Chiropractors who are guided by this vague paradigm (more of a belief than a theory) often manipulate the full spine of *every* patient for “subluxation correction.” Few chiropractors specialize in the care of back pain and other musculoskeletal problems, and only a few have renounced the chiropractic vertebral subluxation theory…Whatever the incidence of stroke per number of neck manipulations might be, this risk is greater *per patient* among chiropractic patients who may be manipulated many times for “health reasons” and who may be manipulated regularly for “maintenance care.” Chiropractors who renounce vertebral subluxation dogma and specialize in the care of back pain will use manipulation more appropriately. Unfortunately, there is no official or legal definition limiting chiropractors to treatment of musculoskeletal problems, making it difficult to find a properly limited chiropractor.(17)

    http://www.sciencebasedmedicine.org/?p=1037

    That hardly paints a reassuring picture, does it?

    On Monday 12 October 2009 at 00:26 David wrote: “By virtue of the extended training that chiropractors receive, and the practice they get, I believe that they are the people best placed to manipulate all areas of the spine.”

    But how can they be “best placed” when only a minority of them are committed to evidence based practice? Just to remind you, in a 2007 survey, 76% of UK chiropractors deemed traditional chiropractic beliefs (chiropractic philosophy) to be important and that same survey gave a figure of 63% for chiropractors who considered the fictitious ‘subluxation’ lesion to be central to chiropractic intervention. Interestingly, it also revealed that the responding chiropractors considered asthma (64%), gastro-intestinal complaints (61%) and pre-menstrual syndrome (PMS) (70%), as conditions that could benefit from chiropractic management (although opinions on the treatment of osteoporosis (43%), obesity (26%), hypertension (42%) and infertility (30%) were less conclusive). As for childhood musculoskeletal and muscular conditions, infantile colic, otitis media and asthma, they were perceived to benefit from chiropractic intervention by more than 50% of the respondents. The results of the entire survey can be read here:

    [Ref. Aranka Pollentier and Jennifer M. Langworthy, The scope of chiropractic practice: A survey of chiropractors in the UK. Clinical Chiropractic, Volume 10, Issue 3, Pages 147-155. September 2007]

    BTW, you still haven’t answered my question: How do chiropractors think it is possible for members of the public to determine which chiropractic treatments have scientific evidence supporting them, and which ones are bogus?

    On Monday 12 October 2009 at 00:26 David wrote: “Remember, the majority of chiropractors spend all their time practicing evidence based care in the treatment of musculoskeletal disorders. Bearing this in mind, one could reasonably extrapolate your theory to suggest that ALL GPs should be retrained because a few practice theories that you’re not happy about.”

    But it’s not “just a few” practice theories that blight the chiropractic industry in the UK (and elsewhere, for that matter). Once again, I refer you to the survey quoted above.

    On Monday 12 October 2009 at 00:26 David wrote: “Your quote regarding the risks of spinal manipulation: “Not substantial risks, but according to a recent systematic review of adverse effects of spinal manipulation, mild to moderate adverse effects do occur in a large proportion (30-61%) of patients receiving spinal manipulation:” What the quote actually says, is only “mild” adverse effects. These mild adverse effects are akin to someone feeling a little sore or achy after having been to the gym and exercised. Mild and transient. Also, you should bear in mind that, by definition, the area being worked on will already have been uncomfortable; the very reason it was being treated in the first place.”

    I’m not quite sure what your point is here. On the subject of spinal manipulation for back pain, did you read the following which was contained in another one of the quotes I gave?

    The risk of mild to moderate adverse effects is undisputed even by chiropractors: about 50%(!) of all patients suffer from such adverse effect after spinal manipulations. These effects (mostly local or referred pain) are usually gone after 1–2 days but, considering the very moderate benefit, they might already be enough to tilt the risk-benefit balance in the wrong direction. In addition, several hundred (I estimate 700) cases are on record of dramatic complications after spinal manipulation. Most frequently they are because of vertebral arterial dissection. Considering these adverse events, the risk-benefit balance would almost certainly fail to be positive. It is true, however, that the evidence as to a causal relationship is not entirely uniform. Yet applying the cautionary principle, one ought to err on the safe side and view these complications at least as possibly caused by spinal manipulations. So why were these risks not considered more seriously? The [NICE] guideline gives the following reason: ‘The review focussed on evidence relevant to the treatment of low back pain, hence cervical manipulation was outside our inclusion criteria’. It is true that serious complications occur mostly (not exclusively) after upper spinal manipulation. So the guideline authors felt that they could be excluded. This assumes that a patient with lower back pain will not receive manipulations of the upper spine. This is clearly not always the case. Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them. And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment of spinal manipulation for back pain.

    It’s pretty damning stuff.

    On Monday 12 October 2009 at 00:26 David wrote: “Your quote from this study: http://www.ncbi.nlm.nih.gov/pubmed/19444054 regarding the adverse effects of chiropractic reads: “further investigations were *urgently* needed to assess definite conclusions regarding this issue.” Of course, the sentence before your extract reads “There is no robust data concerning the incidence or prevalence of adverse reactions after chiropractic.” and even the figures quoted in this study suggest only a very low risk exists. What you’ve chosen to do is highlight and dramatise the word “urgent” in order to imply greater risk.”

    That is correct. As we know that complications related to chiropractic treatment are under-reported, in the interests of patient safety, until the data are in, shouldn’t chiropractors be erring on the side of cautioning and abandoning cervical manipulations as an intervention when there are equally effective, cheaper, more convenient, and safer options available?

    On Monday 12 October 2009 at 00:26 David wrote: “With respect to your remarks about the McTimoney College, I’m afraid that I am unable to comment. As a registered chiropractor, I would draw your attention to clause F1.1 in the Code or Practice: “Specifically chiropractors: must not discriminate against, or unjustly criticise, a colleague or other health professional.””

    And I would draw your attention to clause E1.3 in your Code of Practice (p.21 in the pdf, p.18 of the actual document):

    E1 Chiropractors must act quickly if either their own, or another healthcare worker’s conduct, health or performance may place patients or colleagues at risk. Specifically chiropractors…

    E1.3 must protect patients when they believe that the conduct, competence or health of another regulated healthcare practitioner (including a chiropractor) is a threat to patients. Before taking action, a chiropractor should do his/her best to verify the facts on which this belief is based. Then, if necessary, the chiropractor should report honestly to the
    practice principal/work colleagues of the other regulated healthcare practitioner (if s/he works with others) any concern about the conduct, competence or health of that healthcare practitioner. If the other person is a sole practitioner, or the practice principal/work colleagues of that other person have refused to take action, then a chiropractor must report his/her concerns to the relevant regulatory body.

    http://www.gcc-uk.org/files/link_file/COPSOP_Dec05_WEB(with_glossary)07Jan09.pdf

    On Monday 12 October 2009 at 00:26 David wrote: “You said: “it’s interesting that we still don’t know why two of the survey’s authors, JE Bolton and HW Thiel, claimed that in the UK alone there were an estimated *four* million manipulations of the neck carried out by chiropractors each year, and yet, six months earlier, in October 2007, in a letter to the Journal of the Royal Society of Medicine, they claimed that the figure was “estimated to be well over *two* million cervical spine manipulations”.” This is a red herring. To infer that this apparent change is some sort of attempt to hide anything is ludicrous and would certainly qualify as an ad hominem attack. Both Dr Thiel and Professor Bolton are known to me personally and I can assure you that their integrity is beyond reproach. They certainly possess at least the same credibility as Professor Ernst, on whose writings you rely so much.”

    Your vouching for the integrity of Dr Thiel and Professor Bolton is irrelevant. The fact remains that their estimate of the number of neck manipulations carried out in a year in the UK doubled in under 6 months, and that can only leave them open to accusations that they may be trying to play down the risks. Also, let’s not forget the other criticisms of their study:

    The sample of this survey was sizeable but not large enough to exclude rare events… The picture gets more complicated when considering the 698 treatment consultations of patients who failed to return for their next treatment. Theoretically some or most or all of these patients could have died of a stroke. Overlooking even one single serious adverse event would change the estimated incidence rates from this study quite dramatically. In my view, the most confusing aspect about the results of this survey is the fact that the incidence of minor adverse events is so low. Previous studies have repeatedly shown it to be around 50%. The discrepancy requires an explanation. There could be several but mine goes as follows: the participating chiropractors were highly self-selected. Thus they were sufficiently experienced to select low-risk patients (in violation of the protocol). This explains the low rate of minor adverse events and begs the question whether the incidence of serious adverse events is reliable.

    http://www.medicinescomplete.com/journals/fact/current/fact1301a07g04r01.htm

  • David said:
    Monday 12 October 2009 at 08:27
    “BSM,

    You said: “If you define ’subluxations’ out of chiropractic then you are some sort of physiotherapist”

    No, I continue to be a chiropractor, advancing my skills and treatment through evidence-based care.”

    David, I’m sorry to say that your repeated assertion of this carries very little weight until you address Blue Wode’s comments.

    That said, I am particularly disappointed to see you trying to deflect criticism by trying to dance around the issue.

    You said;

    “With respect to your remarks about the McTimoney College, I’m afraid that I am unable to comment. As a registered chiropractor, I would draw your attention to clause F1.1 in the Code or Practice: “Specifically chiropractors: must not discriminate against, or unjustly criticise, a colleague or other
    health professional.”

    It is pretty clear that criticism of chiropractic practice that is based on mythical subluxations is absolutely not “unjust” and, indeed, as Blue Wode has made clear to you, you are under an ethical obligation to do something about it.

    And to return to the issue of chiropractic beliefs, your definition of chiropractic as being independent of belief in ‘subluxations’ is obviously a minority view in chiropractic and without it I think most other people would wonder what you think chiropractic is.

  • Blue Wode,

    This is going to be my last posting on this issue because I have other things to do.

    You said: “Apparently the vast majority of neck manipulations done by chiropractors are unnecessary.”

    That is an opinion only, and one that is open to any amount of debate.

    Your quote: “When the RAND (Research and Development) organization published its review of the literature on cervical spine manipulation and mobilization in 1996, it concluded that only about 11.1% of reported indications for cervical spine manipulation were appropriate…”

    That’s a pretty random quote, the accuracy, relevence or significance of which I have been unable to verify. However, here’s another RAND organisation quote for you from 2001, five years later:

    “For half a century, the American Medical Association waged war against chiropractic, an intervention that relies on spinal adjustments to treat health problems. Chiropractors were regarded as the modern-day equivalent of snake-oil salesmen.

    Today, chiropractors are the third largest group of health care providers, after physicians and dentists, who treat patients directly. AMA policy now states that it is ethical for physicians not only to associate professionally with chiropractors but also to refer patients to them for diagnostic or therapeutic services.” http://www.rand.org/pubs/research_briefs/RB4539/

    You said: “Manipulation of the upper cervical spine should be reserved for carefully selected musculoskeletal problems that do not respond to such simple measures as time, massage, exercise, mobilization, longitudinal traction, or over-the-counter medication…”

    Chiropractors have the knowledge and skill to give treatment that is appropriate to the person and problem that they are treating. As I have said before, manipulation is only one of the tools that chiropractors have available to them. The others include, but are by no means limited to: massage, exercise, mobilization and longitudinal traction. Also, there is currently a consultation process to decide whether chiropractors should be given limited prescribing rights.

    The definition of chiropractic that you quote from the Association of Chiropractic Colleges, and the description of chiropractic practice you give, has nothing to do with how chiropractic is taught in the UK. I’m going to say for the last time: I do not and never have, used the term subluxation to describe dysfunction in the spine.

    Why don’t you try the definition of chiropractic given by the British Chiropractic Association:

    “Chiropractic is a primary health-care profession that specialises in the diagnosis, treatment and overall management of conditions that are due to problems with the joints, ligaments, tendons and nerves of the body, particularly those of the spine.

    Treatment consists of a wide range of manipulative techniques designed to improve the function of the joints, relieving pain and muscle spasm.”

    Your quote from Edzard Ernst regarding the prospective study of neck manipulation reads:

    “The sample of this survey was sizeable but not large enough to exclude rare events… The picture gets more complicated when considering the 698 treatment consultations of patients who failed to return for their next treatment. Theoretically some or most or all of these patients could have died of a stroke. Overlooking even one single serious adverse event would change the estimated incidence rates from this study quite dramatically. In my view, the most confusing aspect about the results of this survey is the fact that the incidence of minor adverse events is so low. Previous studies have repeatedly shown it to be around 50%. The discrepancy requires an explanation. There could be several but mine goes as follows: the participating chiropractors were highly self-selected. Thus they were sufficiently experienced to select low-risk patients (in violation of the protocol). This explains the low rate of minor adverse events and begs the question whether the incidence of serious adverse events is reliable.”

    The reply from the authors reads:

    “Ernst talks about ‘certainty’ in research studies and a sample size that was not large enough to exclude rare events. Just what is ‘large enough’ to achieve certainty? Choosing the worst risk estimate (˜2 per 10 000 treatment consultations), Ernst infers that this is a cumulative risk as well as for a patient instead of a single treatment. There is no evidence to suggest that the risk is cumulative and increases with repeated exposure. Even if this was the case, our design would have accounted for this by including not only the first but subsequent treatment consultations. Of course, Ernst is correct in saying that an adverse event could have occurred in those patients lost to follow-up. However, by any reckoning 1.4%, particularly in a sample of 50 000 treatments, is not only acceptable but, in our view, strengthens rather than weakens the credibility of the risk estimates. Ernst uses the difference in this study’s rate of a single minor side-effect with those reported in others to argue that the recruitment of chiropractors and patients was biased and therefore could have resulted in an underestimation of risk.

    When taking into account all minor side-effects observed in this study, this difference diminishes considerably. In endeavouring to provide research evidence and in debating its limitations, we should not lose sight of the bigger picture. In the UK alone, there is an estimated 4 million manipulations of the neck carried out by chiropractors each year. In the absence of any significant numbers of reported serious events (i.e. stroke or death), including those in which a causal link is based on extremely weak evidence, there can be little doubt that the risk is very low. In failing to find a serious event, the risk was estimated based on sample size. It can therefore be argued that this risk estimate is a conservative one, and that had it been possible to achieve a ‘large enough’ sample, we might then have been ‘certain’ of a very rare event.”

    Take your pick but, given Prof. Ernst’s unremitting negative attitude towards chiropractic, I know who I regard as the more objective.

    Anyway, we could carry on trading punches for ever. The point is this, chiropractic IS safe and effective and the research has shown as much for the treatment of many musculoskeletal disorders such as back pain, neck pain and headaches.

    It is true that there is a mixture of beliefs within chiropractic and you may consider that the research evidence for the treatment of some disorders is not yet good enough. However, that is not a justification for damning the whole profession.

  • David said;

    “Why don’t you try the definition of chiropractic given by the British Chiropractic Association:
    “Chiropractic is a primary health-care profession that specialises in the diagnosis, treatment and overall management of conditions that are due to problems with the joints, ligaments, tendons and nerves of the body, particularly those of the spine.”

    Funny you should cite the BCA, they take those asserted principles and claim that they form a basis for the treatment for a whole host of non-skeletal problems A claim for which there seems to be rather less than a jot of evidence that is what we have a problem with and why your attitude is a problem.

  • On Monday 12 October 2009 at 20:16 David wrote: “Your quote: “When the RAND (Research and Development) organization published its review of the literature on cervical spine manipulation and mobilization in 1996, it concluded that only about 11.1% of reported indications for cervical spine manipulation were appropriate…” That’s a pretty random quote, the accuracy, relevence or significance of which I have been unable to verify.”

    If you have been unable to verify the relevance or significance of the quote, then in the interests of patient safety, it must surely follow that you should err on the side of caution and not administer neck manipulations until you do.

    On Monday 12 October 2009 at 20:16 David wrote: “However, here’s another RAND organisation quote for you from 2001, five years later: “For half a century, the American Medical Association waged war against chiropractic, an intervention that relies on spinal adjustments to treat health problems. Chiropractors were regarded as the modern-day equivalent of snake-oil salesmen. Today, chiropractors are the third largest group of health care providers, after physicians and dentists, who treat patients directly. AMA policy now states that it is ethical for physicians not only to associate professionally with chiropractors but also to refer patients to them for diagnostic or therapeutic services.” http://www.rand.org/pubs/research_briefs/RB4539/

    Didn’t that ‘war’ waged by the American Medical Association end with the Wilk v AMA case? The upshot of it was as follows:

    Quote:
    “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

    As for chiropractors being the third largest group of health care providers, after physicians and dentists, that is a classic argumentum ad populum. Chiropractic largely owes its growth to relentless marketing and political lobbying. In other words, it seems that chiropractors have managed to dupe legislators, and the public, both of whom are generally not well-versed in scientific matters. However, in the US, at least, chiropractic’s future is not looking as bright as you might portray. Apparently 15% of DCs have quit the profession and there has been a 39% drop in chiroprictic education student enrolment from 1969-2002. In addition to that, while the use of CAM in general has increased, the largest decrease occurred for chiropractic (9.9% to 7.4%).
    Ref: The Future of Chiropractic Revisited: 2005 to 2015 Report & Online Poll http://www.altfutures.com/poll.asp

    On Monday 12 October 2009 at 20:16 David wrote: “You said: “Manipulation of the upper cervical spine should be reserved for carefully selected musculoskeletal problems that do not respond to such simple measures as time, massage, exercise, mobilization, longitudinal traction, or over-the-counter medication…” Chiropractors have the knowledge and skill to give treatment that is appropriate to the person and problem that they are treating. As I have said before, manipulation is only one of the tools that chiropractors have available to them. The others include, but are by no means limited to: massage, exercise, mobilization and longitudinal traction.”

    And as I’ve said before (see previous page of comments by scrolling to the bottom of this page), anything that isn’t a ‘specific spinal adjustment’ is not real chiropractic. Furthermore, as we have already learned, the vast majority of adjustments are likely to be contra-indicated by responsible risk/benefit assessments.

    On Monday 12 October 2009 at 20:16 David wrote: “Also, there is currently a consultation process to decide whether chiropractors should be given limited prescribing rights.”

    Presumably if they were given prescribing rights then that would mean that they would no longer be able to promote themselves as a natural alternative to drugs. For example the British Chiropractic Association’s website says “Chiropractic does not involve the use of any drugs or surgery”.
    http://www.chiropractic-uk.co.uk/default.aspx?m=3&mi=19&ms=9&title=What+is+chiropractic%3f

    On Monday 12 October 2009 at 20:16 David wrote: “The definition of chiropractic that you quote from the Association of Chiropractic Colleges, and the description of chiropractic practice you give, has nothing to do with how chiropractic is taught in the UK.”

    Nonsense. The McTimoney College of Chiropractic’s current prospectus for its Integrated Masters in Chiropractic (MChiro) says the following:

    Quote
    “By correctly training the hands as an instrument of our innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements). The basic principle of chiropractic is that disturbances of the nervous system, resulting from subluxation of the bones of the spine and other parts of the body, are a primary or contributory factor in the pathological process of many common human and animal ailments.”
    http://www.mctimoney-college.ac.uk/UserFiles/File/MChiro%20prospectus.pdf

    I would also venture that it would be very easy for chiropractors to treat patients based on their training/belief in “subluxation theory” while pretending they’d abandoned it.

    On Monday 12 October 2009 at 20:16 David wrote: “I’m going to say for the last time: I do not and never have, used the term subluxation to describe dysfunction in the spine.”

    Irrelevant. The use of the term ‘subluxation’ is widespread throughout the chiropractic industry in the UK. A Google UK search for ‘chiropractic’ and ‘subluxation’ confirms it.

    On Monday 12 October 2009 at 20:16 David wrote: “Why don’t you try the definition of chiropractic given by the British Chiropractic Association: “Chiropractic is a primary health-care profession that specialises in the diagnosis, treatment and overall management of conditions that are due to problems with the joints, ligaments, tendons and nerves of the body, particularly those of the spine. Treatment consists of a wide range of manipulative techniques designed to improve the function of the joints, relieving pain and muscle spasm.””

    IMO, that statement is vague to the point of being meaningless.

    On Monday 12 October 2009 at 20:16 David wrote: “The reply from the authors reads: “…In endeavouring to provide research evidence and in debating its limitations, we should not lose sight of the bigger picture. In the UK alone, there is an estimated 4 million manipulations of the neck carried out by chiropractors each year.”

    The fact remains that their estimate of the number of neck manipulations carried out in a year in the UK doubled in under 6 months, and that can only leave them open to accusations that they may be trying to play down the risks.

    On Monday 12 October 2009 at 20:16 David wrote: “In the absence of any significant numbers of reported serious events (i.e. stroke or death), including those in which a causal link is based on extremely weak evidence, there can be little doubt that the risk is very low.”

    But isn’t part of the “absence of any significant numbers of reported serious events” due to a Reporting and Learnings System http://www.cpirls.org/ only very recently having been implemented by the College of Chiropractors – and, even at that, not universally utilised? I also comment on it here:
    http://www.layscience.net/node/566

    The “absence of any significant numbers” could also be due to this:

    Quote
    “Patients who have delayed strokes may never see their chiropractor again, so chiropractors would naturally tend to underestimate the risk. Many of these diagnoses are missed because the vertebral arteries are not typically examined on autopsy.”
    http://www.sciencebasedmedicine.org/?p=94

    Also you mention that any causal link is “based on extremely weak evidence”. Isn’t it exactly that sort of evidence that, in many cases, chiropractors rely on to promote their services? It’s a point that’s addressed in paragraph 146 of the Statement of Claim of tetraplegic chiropractic victim, Sandra Nette. It asserts that many chiropractors, as well as their regulators and professional associations, seem to find it acceptable to promote anecdotal or weak evidence were it supports chiropractic treatment, but where similar, or more robust evidence suggests that serious complications can result form it, they are known to be quick to dismiss it. Paragraphs 85 and 193 of the Statement of Claim are also worth a read as they appear to very closely describe the way in which chiropractic is regulated in the UK:
    http://www.casewatch.org/mal/nette/claim.pdf

    On Monday 12 October 2009 at 20:16 David wrote: “Take your pick but, given Prof. Ernst’s unremitting negative attitude towards chiropractic, I know who I regard as the more objective.”

    And I know who I (and many others who like to follow what the science tells them) regard as the more impartial and safety conscious.

    On Monday 12 October 2009 at 20:16 David wrote: “The point is this, chiropractic IS safe and effective and the research has shown as much for the treatment of many musculoskeletal disorders such as back pain, neck pain and headaches.”

    The point is that the value of chiropractic continues to be questionable. Once again, I quote a summary of chiropractic which can be found on page 285 of Simon Singh and Edzard Ernst’s recent book, ‘Trick or Treatment? Alternative Medicine on Trial’:

    Quote:
    “WARNING: This treatment carries the risk of stroke or death if spinal manipulation is applied to the neck. Elsewhere on the spine, chiropractic therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo.”

    On Monday 12 October 2009 at 20:16 David wrote: “It is true that there is a mixture of beliefs within chiropractic and you may consider that the research evidence for the treatment of some disorders is not yet good enough. However, that is not a justification for damning the whole profession.”

    There is no place for beliefs in medicine. Further, after more than 100 years, most of the data are in for chiropractic, and, apart from some evidence of short-lived pain relief in a sub-group of low back pain sufferers (which can be provided by other therapists who are more evidence-based), there appears to be very little going for it, and a great deal going against it. Indeed, UK Skeptics sum it up very succinctly:

    Quote
    “A healing system that is based on a mystical life-force that gets blocked by imaginary subluxations, and that relies on anecdotal evidence, special pleading, the placebo effect, and subjective diagnoses is clearly an irrational concept no matter how much credence is given to it with qualifications and self-regulation.”
    http://www.ukskeptics.com/article.php?dir=articles&article=chiropractic.php

    BTW, it’s disappointing that you chose not to answer my question: “How do chiropractors think it is possible for members of the public to determine which chiropractic treatments have scientific evidence supporting them, and which ones are bogus?”

  • Blue Wode, it’s been nearly a week, I think you broke it. Chiroquacktors are amazingly fragile when subject to a bit of robust use. It’s a pattern seen in CAMsters everywhere. I think it’s a basic design flaw.

  • … but then again it was an amazingly dull post.

  • .., I am willing to try it, anything that can help me with my migraine.. :( It’s good to see a blog where we can see patients testimonies.. i am searching for it…

  • That is the better way, if you see a patients testimonies that is great that you got the right idea of doing the right purpose and don’t the wrong.

  • I see you’ve been doing the rounds of several other blogs that have been discussing chiropractic and trying to pretend you’re from the USA or Canada rather than your real location of the Philippines. (I’ve removed the spam links you gave to US chiro websites.)

    However, patient testimonies may be interesting, but, where people’s health is concerned, they are a very bad way to decide whether or not chiropractic works or is the best treatment for any condition. The best way is proper controlled and blinded trials. In all the good ones that have been done, chiropractic fares pretty badly.

  • Had a couple of these comments with links, too. Meh, you’d think that before pasting your links all over teh interweb you’d at least go to the effort of putting together a decent website…

  • This same individual, based in Manila in The Philippines has been littering a number of blogs with his/her nonsense, including Skepticat.com and LDBlog – Dr John Lloyd believes it is a blog commenting service, paid for, presumably, by a bunch of chiros or a chiro trade association in the US/Canada to promote chiropractic. They should demand a refund.

  • Ouch – so this is a ‘professional’ service? Sigh.

  • Its amazing people that have no knowledge of the chiropractic profession …continue to bad mouth it because of their ignorance…I guess they are mad because they are not educated ….and their life stink…..Chiropractic no longer needs to be proven….they are reconized primary care physicians….so that argument is over…..look at the MDs…according to the townsend letter review they are the leading cause of death in the US.(from Iatrogenic causes) 783,000 per year! and US surgeon General, General C. Everett Coop stated that ” 68% of all diagnoses in the US are wrong”
    So when people with no education and no facts and no experience want to talk badly about the chiropractic profession…..it is really a joke.
    Look at the allopathic profession …if 68% of the diagnosis are wrong according to the surgeon General…and 783,000 people die a year from Iatrogenic causes making it the leading cause of death in the USA…then complaining about Doctors of Chiropractic (especially with no research or statistical facts ) is just plain Ignorant!

  • Tim

    You’re completely wrong on several counts, but I’ll pick up on just a few and ignore most of your ill-informed diatribe.

    Why is you think that chiropractic ‘no longer needs to be proven’ and that the ‘argument is over’ when the Bronfort Report (written by chiropractors) came up with so little good evidence for so few of the conditions that many chiros claim to treat?

    How does the number of mis-diagnoses or even deaths allegedly caused by conventional medicine affect the dearth of evidence for chiropractic?

  • Can I just say that one good thing has come out of all this scrutiny and that is the public statement by the GCC and the Chiropractic Colleges that Subluxation is a historical concept with no evidence to support it. It was taught that way to me 19 years ago for 1 hour per week for 1 term of a 4 year degree in Chiropractic Contextual Studies (ie. putting chiropractic into the context of modern medicine). Sadly it is an all too convenient marketing tool that can be abused in private practice.

    One of the postives to come out of these blogs and the scrutiny chiropractic profession has brought on itself, is that it must move away from its stupid and outdated theories and look at an investigate plausible mechanisms by which manipulation might work. Hopefully it should broaden its scope to encompass techniques from other manual therapy professions where evidence dictates.

    It does annoy me somewhat the constant dearth of evidence tag. I have diagnosed a Burst Fracture, Type 2 Dens Fracture, Mets on several occasions, ABC C1, Cerebellar Tumour, (Referred to me by GP as Sciatica), Cervical Facet dislocation all of these patients had either been seen by their GP, or been to casualty, or indeed been x-rayed and missed. Most Chiropractors do a very worthwhile job, and whilst we cant claim to me more effective than any other manual therapy, except arguably for subacute back pain, we have not been shown to be be any worse either. If our diagnostic skills are up-to-scratch, we are indeed providing a worthwhile service.

  • Some chiropractors oppose vaccination and water fluoridation, which are common public health practices. Chiropractors’ attempts to establish a positive reputation for their public health role are also compromised by their reputation for recommending repetitive life-long chiropractic treatment.

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