The random thoughts of a sceptical activist

The trouble with leaflets

After the General Chiropractic Council ‘withdrew’ their What is Chiropractic? leaflet two weeks ago — as a result of a complaint by Simon Perry about its claims for childhood ailments — it took them a week to publish a new version on their website.

Simon sought advice from the ASA about this delay. They replied:

We’d normally expect an advertiser to implement the changes as soon as is ‘reasonably practicable’ (bearing in mind the time involved in printing new leaflets).

However, if it’s a leaflet on a website then it should be taken down as soon as possible.

Of course it takes a short while to get new leaflets printed, but there was no excuse for the delay in removing it from their website — they did not need to wait until a revised leaflet was available. Indeed, since the GCC had been discussing their leaflet with the ASA, they would have known that the ASA considered the wording to be misleading several weeks before the decision was made public. They should have withdrawn the leaflet then and not left it to continue to  mislead the public.

We now find out from disgruntled ex-chiropractor, Richard Lanigan, that the GCC have produced an amendment to the misleading leaflet that will be inserted into any leaflets sent out by the GCC. In an email/letter sent to GCC members, Paul Robinson, their Admin Assistant (Communications), stated:

…printed versions of the leaflet despatched by the GCC will contain an insert until our current stocks are used and we need to reprint. This approach is to ensure compatibility between the electronic and print versions.

Very sensible. There’s no point in wasting leaflets as long as they include the insert that corrects the misleading information.

However, they also say:

There should be no problem if you display or distribute any remaining stocks that you have of the current version, but if you do have any concerns we would be happy to send you a supply of the inserts.

So the GCC think it is OK for chiropractors to continue to display and distribute the leaflet — without the correcting inserts — that they have agreed with the ASA was misleading? I wonder what the ASA will have to say about that…

Yet another misleading chiropractic leaflet

Meanwhile, fellow sceptic and connoisseur of the espresso, Skeptic Barista, has today won an ASA adjudication against another leaflet used by chiropractors. Although the leaflet originates in the US, the publisher, chiropractor Tedd Koren of Koren Publications, distributes chiropractic publications all around the world including the UK. Read the post about it on his Skeptic Barista blog.

The misleading leaflet, Infants & Babies (cached pdf), made claims about chiropractic and childhood ailments:

For over a hundred years doctors of chiropractic have observed the often dramatic responses of infants to chiropractic care.

There seems to be no limit to the conditions that can respond to chiropractic care: colic, difficulty breastfeeding, Erb’s palsy (an arm is limp and undeveloped), torticollis (twisted neck), unbalanced face conditions that can respond to and skull development, foot inversion, “nervousness,” ear, nose and throat infections, allergies and -, sleep disorders, and projectile vomiting are just a sampling. All infants however, sick or well, need to have a healthy spine.

These claims are well referenced — fourteen in total and four for colic alone. But three of these four are in the BCA’s utterly demolished plethora. However, the one the BCA either didn’t know about or didn’t include because they didn’t think it would help their case was:

Vertebral subluxation and colic: a case study. Pluhar GR, Schobert PD. J of Chiropractic Research and Clinical Investigation, 1991;7:75-76.

From the abstract: A case study of a three-month-old female suffering from colic with resultant sleep interruption and appetite decrease is presented. Child received three adjustments with two weeks between adjustments (T-7 and upper cervical area were areas worked on.) Symptoms of colic were relieved within the above brief period.

Ah! A single case study. Colic that was relieved within just four weeks. That’s all. Not even a half-decent jot.

Defending the indefensible…and failing

Anyway, back to the ASA adjudication.

In their defence, Koren said that their:

…leaflets did not claim that chiropractic could treat any specific condition.

We’ve already seen how using woolly weasel words and making claims without looking as if they are making claims, just doesn’t wash with the ASA, who:

…considered that the claim “There seems to be no limit to the conditions which can respond to chiropractic care”, followed by a list of conditions, implied that chiropractic was efficacious as a treatment for those conditions.

That should come as no surprise to anyone who has even glanced at the ASA’s guidance and especially past adjudications. They added:

Furthermore, we noted the ad featured a testimonial about a baby, suffering from a variety of conditions, which claimed that “his health returned to normal” after chiropractic adjustments and considered that furthered the ads impression that chiropractic care would cure or alleviate those conditions.

So the ASA were concerned about the overall impression given by the leaflet as well as the actual words of the testimonial.

We considered that abstracts, case studies and references alone were not sufficient to demonstrate the efficacy of chiropractic in the treatment of the advertised conditions and therefore concluded the ad was likely to mislead.

This is getting a bit repetitive now: how long will chiropractors continue to make claims that fall foul of the very simple and straightforward guidance the ASA has, which — in case it isn’t yet clear — are there to protect the public?

Of course the ASA adjudicated against the leaflet:

On this point, the ad breached CAP Code clauses 3.1 (Substantiation), 7.1 (Truthfulness), and 50.1 (Health & beauty products and therapies).

Apply pressure here…

There are several other worrying things in this leaflet, including the subtle and not so subtle pressure put on new parents to get their baby started on a regime of life-long ‘chiropractic care’:

…there are six times in a baby’s first year when spinal examinations are especially important:

  • After the birth process.
  • When the baby starts to hold his/her head up.
  • When the baby sits up.
  • When the baby starts to crawl.
  • When the baby starts to stand.
  • When the baby starts to walk.

One wonders, what would have happened to this child if he never had spinal care? A life of antibiotics and other medicines? A life of continued sickness?

Surely too many children are born with subluxations that left uncorrected could hinder their health the rest of their lives.

Give your baby the best possible chance to have a healthy life. A simple checkup now might make a BIG difference  for your child(ren) for the rest of their lives.

But have you had your baby’s spine checked? How do you know if your child’s spine is healthy? An unhealthy spine can affect your child’s health for his/her entire life.

How well does this repeated badgering of parents, newly-born babe in arms, fit in with the GCC’s Code of Practice? It mandates:

C1.3 …Chiropractors must not encourage patients to become dependent on particular forms of care.

C1.6 …[Advertising] must not, in any way, abuse the trust of members of the public nor exploit their lack of experience or knowledge about either health or chiropractic matters. It must not put pressure on people to use chiropractic.

Shaken Baby Syndrome

Interestingly — but very worryingly — the advertiser made another claim that Skeptic Barista complained about: Shaken Baby Syndrome. The leaflet advises:

Any child who has been subjected to this rough behavior desperately needs a chiropractic checkup to prevent possible nerve damage.

No. The child desperately needs to be taken to a proper medical professional. Unbelievable.

Funnily enough, the ASA thought the same as most sensible people:

We considered that SBS was a serious condition, commonly associated with maltreatment, for which immediate medical advice should be sought. Because the ad targeted parents of very young children, and invited them to seek the advice of a chiropractor for SBS and other potentially serious conditions for children, we concluded the ad could discourage parents from seeking appropriate medical advice from a general medical practitioner.

Chiropractic is not a suitable treatment for SBS. Full stop.

Passing Muster

Why are chiropractors still making claims — whether for minor conditions or for more serious ones — that just do not pass muster with the ASA? They are doing this in leaflets, other advertising media (watch this space), which fall foul of the ASA and on their own websites. As many have said before, the ASA has no direct jurisdiction over claims made on advertisers’ own websites, but they still fall foul of the ASA’s CAP and adjudications because it is written into the GCC’s Code of Practice they all have to sign up to as a legal requirement for being given the privilege of calling themselves ‘chiropractors’.

In the case of the Koren leaflet, the ASA ruled:

The ad must not appear again in its current form. We advised Koren to consult the CAP Copy Advice team before making references to medical conditions in future.

The ASA’s Copy Advice Team are there to help advertisers keep within the guidance. Their service is free. It costs not a jot. Their website heralds:

Why gamble with the ASA?
All ads in the UK, wherever they appear, must be legal, decent, honest and truthful in line with the The British Code of Advertising, Sales Promotion and Direct Marketing (The CAP Code). The Copy Advice service is here to help you avoid breaking the rules and potential action by the Advertising Standards Authority by giving you free advice on your non-broadcast marketing communications before they are launched.

Why gamble with the ASA? Why indeed.

The GCC’s email/letter I mentioned at the start closes with:

Finally, you may find it helpful to sign-up to the Committee of Advertising Practice’s Copy Advice Team’s e-newsletter; the most recent version is attached below. Here’s a link to its webpage: http://copyadvice.co.uk

Do chiropractors not know by now what is and isn’t acceptable and what standard of evidence they need to hold before making claims? It’s good of the GCC to point them in the right direction. But aren’t they trying to shut the stable door long, long after the horse has bolted?

Instead of spending time printing new sales leaflets, do they not think that they could be weeding out those misleading claims their members are making and telling them what is — and what isn’t — misleading?

56 Responses to The trouble with leaflets

  • Great article! From the repeated straightforward common sense the ASA seems to come out with I can’t help thinking it would have been nice of some of the ASA folk had chosen different careers and gone into the legal profession!

  • [The baby especially requires chiropractic] “After the birth process”

    Un-f*!*ing-believable.

    Remember I had heard this before somewhere, but it still leaves me speechless.

    How Woo-crazed would a mother have to be to put her newborn in the hands of a chiro-quack for prodding and poking – and to PAY to have this done.

    Words fail me.

    Speaking as a relatively recent parent of two newborns I would have said they needed (i) mother (ii) milk (iii) warmth and (iv) sleep.

    If only I’d known what they needed was a good quack-cracking I could have had the Chiroquacktor waiting outside the delivery room along with the Aura Reader, the Reiki Master and the Medium.

  • The Skeptic Barista article appears to have vanished (pardon the oxymoron).

  • “Why gamble with the ASA? Why indeed.”

    Well, if your average Dr Chiro makes rubbish claims some people will probably believe them and he will make money. If–thankfully it isn’t such a big ‘if’ nowadays–someone reports his dosgy claims to the ASA then the ASA will tell him not to do it again. So he does it again, but in a slightly different format. Ad nauseam! So, it isn’t exactly a gamble, given whose favour the odds appear to be stacked in.

    Anyway, here’s a gem from
    http://mcc.chiroclinic.com.au/

    “…the story of a California woman who was given a 5 percent chance of ever pregnant, even with in vitro procedures and who became pregnant after chiropractic adjustments to her lower spine released subluxations.

    Really, all Karen Bulch wanted was a little neck-and-shoulders adjustment. But a month after wandering into chiropractor Mark Kimes’ Salina office, the 44-year-old Monterey woman was with child, something she had unsuccessfully been trying to accomplish for 4 years”

  • Nice article. Gives a great overview on how all these recent ASA ruings taken together show that the chiropractic profession in the UK is lacking any serious regulation.

  • The link to Skeptic Barista’s post is now working.

  • It’s worth remembering that the ASA guidance is there to protect the advertiser too. It’s no fun spending out a bucketload of your marketing budget on pamphlets, posters, commercials &c. if the ASA then turn around and order the ads to cease. That’s why it’s vital for advertisers to heed the advice given (and why I have so little sympathy for advertisers who ought to know better).

  • As a chiropractor, I totally agree and appreciate your analysis. It’s never appropriate to make an unscientific claim. If you’d care to take a moment to scan my practice website, http://www.mychirowalkin.com, I’d certainly welcome your comments and I WILL correct any inappropriate claims. Thanks!

  • I’m not going to defend Ted Koren, who I’m afraid is a nutcase.

    What I would say is that his preachings are distinctly at odds with the principles taught at the major institutions for chiropractic education in the UK, the Anglo-European College of Chiropractic and the Welsh Institute of Chiropractic. Have a look at their websites for a more realistic insight into modern chiropractic, as practiced by the vast majority of British chiropractors.

    It’s interesting that “disgruntled ex-chiropractor Richard Lanigan” has in the past been one of the most vocal proponents of Ted Koren and his beliefs. In fact he campaigned for Koren to be given a platform in the UK when the likes of the British Chiropractic Association were very uncomfortable with Koren spreading his particular brand of chiropractic philosophy. Lanigan is of course no longer on the register of chiropractors in the UK.

    Please do remember that the massive majority of UK chiropractors practice evidence based musculo-skeletal healthcare in a professional and ethical manner. Don’t be distracted by this material from a misguided American.

  • Bruce

    I have scanned your website but I can find little information of any kind on it, never mind any claims for chiropractic.

    However, I have no idea what rules and codes of practice you are bound by and it is completely irrelevant to my complaints.

    If you are concerned about any claims you are making (whatever they are), perhaps the Iowa Skpetics would be able to help you? They can be contacted at [email protected].

  • Wow, Bruce! Just some friendly advice and not, perhaps, what you were expecting but please, hire a professional web designer.

  • We all make mistakes David. My dad supports Spurs.
    I would like everybody to know chiropractic “woo” is still what I do. I just happen to agree with Simon Sings right to express his opinion in a newspaper even if I don’t agree with what he said.
    As for me being “disgruntled”? No more than anyone who campaigns to change their government, except I would not have been allowed to campaign while remaining on the chiropractic register. This is why the GCC has used private investigators, to try and entrap me into saying I was a chiropractor, then they could ask the police to arrest me, its happened to others. You guys may think that’s acceptable we are only quacks, I don’t.
    I have also pissed off the catholic church in Ireland by exposing their efforts to cover up the activities of infamous paedophile Fr Ronal Bennett, not to mention I am not allowed visit the US because of my activities in Cuba (Working as a chiropractor there). I got it from my mother she was the first person to make a protest in the Houses of Parliament on Tueday Feb 2nd 1972 days after the Bloody Sunday massacre.
    I am also a proud father of four healthy children,there must be a better word than “disgruntled”

  • David,

    I still see a lot of chiro claiming to cure cholic etc here in Europe.

    What are the modern chiros doing these days as opposed to, uh, traditional chiros?

    Why are you distancing yourselves from the Americans? Because of subluxations? If then, why? Or?

    It comes across a little like christians not believing in resurrection…

  • Seborgarsen,

    Good questions, thank you.

    “What are the modern chiros doing these days as opposed to, uh, traditional chiros?”

    If you look at the major chiropractic courses in the UK, the Anglo-European College of Chiropractic and the Welsh Institute of Chiropractic, the training is centred around the diagnosis and management of biomechanical disorders. Over many years of contact with the AECC, I can say that to my knowledge “subluxations” of the spine have no part in the principles taught there.

    “It comes across a little like christians not believing in resurrection”

    Chiropractic is not a religion, it is an evidence-based, scientifically supported method of managing musculo-skeletal disorders and their effects upon health.
    I wouldn’t class those who peddle the subluxation theory as traditionalists. I would class them as outdated.

    “Why are you distancing yourselves from the Americans? Because of subluxations? If then, why? Or?”

    I’m not distancing myself from the Americans per se. My point was that the ramblings of Ted Koren are a world removed from the chiropractic that I know and from the chiropractic that is taught at the above colleges.

    Chiropractic in the UK has been developing and maturing for many years. Unfortunately, there has been a growing number of imigrant chiropractors who have come to the UK and pushed unethical and unsupportable methods of practice and practice building. Tragically, some home-grown graduates have been sucked in as well. However, the GCC does not tolerate this sort of business, a case in point being that of Peter Proud who was removed from the Register for his methods back in 2006. There’s more weeding out to to, but thankfully some of these people have seen the signs and taken themselves off the Register voluntarily, to continue their practice under another name. A case in point being the “Oesteomyologists”.

  • On Friday 23 October 2009 at 13:09 David wrote: “If you look at the major chiropractic courses in the UK, the Anglo-European College of Chiropractic and the Welsh Institute of Chiropractic, the training is centred around the diagnosis and management of biomechanical disorders. Over many years of contact with the AECC, I can say that to my knowledge “subluxations” of the spine have no part in the principles taught there.”

    How do we know that “biomechanical disorders” isn’t just a more sciency sounding term for your mythical chiropractic “subluxations”?

    Isn’t it true that without their subluxation theory (in all its disguises) chiropractors are reduced to mere manipulative therapists practicing a *very limited* modality and competing in a marketplace already well-occupied by osteopaths, physiotherapists, sports trainers, some medical doctors, and others who are not nearly so mired in quackery?

    On Friday 23 October 2009 at 13:09 David wrote: “Chiropractic is not a religion…”

    Then please explain the following from the founder of chiropractic, D.D. Palmer:

    Quote
    “I occupy in chiropractic a similar position as did Mrs. Eddy in Christian Science. Mrs. Eddy claimed to receive her ideas from the other world and so do I…we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and others who have founded religions. I am the fountain head. I am the founder of chiropractic…”

    http://www.chiro.org/Plus/History/Persons/PalmerDD/PalmerDD's_Religion-of-Chiro.pdf

    On Friday 23 October 2009 at 13:09 David wrote: “[Chiropractic]…is an evidence-based, scientifically supported method of managing musculo-skeletal disorders and their effects upon health…”

    Absolute nonsense. And you know perfectly well that we’ve been through all of this already, very recently, in the comments section here:
    http://www.zenosblog.com/2009/10/i-get-anonymous-chiropractic-mail-i-do/

  • @ Blue Wode

    I don’t think that describing Osteopaths, physiotherapists and some medical doctors as ‘mere manipulative therapists’ is a particularly useful observation.

    Manual treatment is a hugely important part of health care and has an enormous part to play in the treatment of mechanical pain and dysfunction. ‘David’, & others whose comments I have seen, seem entirely content with their role within manual therapy.

    Judging by your reaction to comments on the subject, you seem to be uncomfortable with the possibility that chiropractic education does have a scientific basis. It may be easier to attack a caricature but the comments of ‘David’ and others seem to indicate that you may be entirely wrong about the training involved.

    “How do we know..?” – come on – you seem pretty resourceful. Your apparent unwillingness to objectively examine this training aspect is entirely at odds with the objectivity you demand from the target of your attack.

    It also appears from his comments that ‘David’ does not espouse any psudo-religious views so it seems a little churlish to use a 100 year old quote in response.

  • Blue Wode said:
    “How do we know that “biomechanical disorders” isn’t just a more sciency sounding term for your mythical chiropractic “subluxations”?”

    I don’t know how many times I have to say this. Neither I or any of my close colleagues use the term subluxation, except in the sense that you would find in Dorland’s Medical Dictionary. You can take it as read that we don’t have any euphemisms or synonyms for the concept of “subluxation” as you would describe it either.

    However, if you insist that as chiropractors we MUST be treating “subluxations” or we’re not actually “real” chiropractors,as you put it, then the term “biomechanical disorders” is probably a good enough definition. You see, we do treat problems of musculo-skeletal function, particularly with respect to the spine. One can use many differnet terms to describe that dysfunction and if you would like to use the word subluxation to define it then please do; I choose not to.

    Blue Wode said:
    “Isn’t it true that without their subluxation theory (in all its disguises) chiropractors are reduced to mere manipulative therapists practicing a *very limited* modality and competing in a marketplace already well-occupied by osteopaths, physiotherapists, sports trainers, some medical doctors, and others who are not nearly so mired in quackery?”

    Rubbish. I’ve been working as a chiropractor for over twenty years without “subluxations” forming any part of my practice. It is true that there is competition in the musculo-skeletal marketplace but chiropractors are extremely skilled managers of musculo-skeletal disorders. I have no idea why you should believe that our practice is “very limited”; we have the whole range of techniques available to us. Don’t forget, chiroprctic is about much more than manipulation; it’s the complete package that counts.

    Interestingly, physiotherapists only really took to manipulation when they realised that chiropractors were getting so much better results in the treatment of back pain. To this day, only a very small percentage of physiotherapists have the same depth of training in manipulation as chiropractors who are able to use it judiciously, safely and effectively.

    Blue Wode quoted D.D Palmer:
    “I occupy in chiropractic a similar position as did Mrs. Eddy in Christian Science. Mrs. Eddy claimed to receive her ideas from the other world and so do I…we must have a religious head, one who is the founder, as did Christ, Mohamed, Jo. Smith, Mrs. Eddy, Martin Luther and others who have founded religions. I am the fountain head. I am the founder of chiropractic…”

    Palmer was an interesting character but has nothing to do with today’s chiropractic in the UK. I have to say that I hadn’t read that quote before; he certainly had quite an ego didn’t he?

    Blue Wode said:
    “On Friday 23 October 2009 at 13:09 David wrote: “[Chiropractic]…is an evidence-based, scientifically supported method of managing musculo-skeletal disorders and their effects upon health…”

    Absolute nonsense. And you know perfectly well that we’ve been through all of this already, very recently”

    You know, it’s amazing how you think that you know so much more about chiropractic than
    I do. You certainly listed a good number of quotes and references in our last correspondence but mostly material that is irrelevant to how the majority of UK chiropractors practice and largely quotes from the likes of Edzard Ernst that are delivered with a deliberately dramatic and alarmist emphasis. I stand by what I say:

    Chiropractic is an evidence-based, scientifically supported method of managing musculo-skeletal disorders and their effects upon health.

    Before you feel compelled to repeat all your references, please bear in mind that spinal manipulation does not equal chiropracitc.

    Since you seem to enjoy arguing every point, I take it you agree that Ted Koren’s preachings bear no relation to chiropractic as taught at the AECC and WIOC? Also, that you would have to acknowledge that the GCC is working to maintain standards in the chiropractic profession?

  • On Saturday 24 October 2009 at 15:19 Jackie W wrote: “I don’t think that describing Osteopaths, physiotherapists and some medical doctors as ‘mere manipulative therapists’ is a particularly useful observation.”

    If you go back and read what I said you will see that I said that *chiropractors* would be reduced to mere manipulative therapists.

    On Saturday 24 October 2009 at 15:19 Jackie W wrote: “Manual treatment is a hugely important part of health care and has an enormous part to play in the treatment of mechanical pain and dysfunction.”

    Yes, and it can be provided by other therapists who do not, for the most part, resort to false claims.

    On Saturday 24 October 2009 at 15:19 Jackie W wrote: “Judging by your reaction to comments on the subject, you seem to be uncomfortable with the possibility that chiropractic education does have a scientific basis. It may be easier to attack a caricature but the comments of ‘David’ and others seem to indicate that you may be entirely wrong about the training involved.”

    If it is true that chiropractic education has a scientific basis, then four years and £40,000 is an incredible amount of time and money for someone to spend on a therapeutic intervention that offers so little of value, and that is associated with so much quackery. Indeed, here’s a summary of chiropractic that 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 Saturday 24 October 2009 at 15:19 Jackie W wrote: “It also appears from his comments that ‘David’ does not espouse any psudo-religious views so it seems a little churlish to use a 100 year old quote in response.”

    It is not churlish. My response was in context. The fact is that chiropractic is a healing system that is based on a mystical life-force that gets blocked by imaginary subluxations, that relies on anecdotal evidence, special pleading, the placebo effect, and subjective diagnoses – and a great many chiropractors in the UK continue to adhere to its cultish foundations. For example, in a 2007 survey, 76% of UK chiropractors deemed traditional chiropractic beliefs (chiropractic philosophy) to be important, and the 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. 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]

    I would also add that McTimoney chiropractors, who represent *at least a quarter* of all UK chiropractors, seem to have quite a quasi-religious approach to their provision of care. This is lifted from a current McTimoney prospectus:

    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

    It’s a very odd state of affairs 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.

  • On Saturday 24 October 2009 at 16:19 David wrote: “I don’t know how many times I have to say this. Neither I or any of my close colleagues use the term subluxation, except in the sense that you would find in Dorland’s Medical Dictionary. You can take it as read that we don’t have any euphemisms or synonyms for the concept of “subluxation” as you would describe it either.”

    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. Also, how many times do I have to keep producing the information that clearly suggests that you and your colleagues are in a minority in the way in which you choose to practice? (See the 2007 survey mentioned in my post above.)

    On Saturday 24 October 2009 at 16:19 David wrote: “I have no idea why you should believe that our practice is “very limited”; we have the whole range of techniques available to us. Don’t forget, chiroprctic is about much more than manipulation; it’s the complete package that counts.”

    That’s what worries me. Again, see the 2007 survey mentioned in my post above.

    On Saturday 24 October 2009 at 16:19 David wrote: “Interestingly, physiotherapists only really took to manipulation when they realised that chiropractors were getting so much better results in the treatment of back pain. To this day, only a very small percentage of physiotherapists have the same depth of training in manipulation as chiropractors who are able to use it judiciously, safely and effectively.”

    Chiropractors do not use spinal manipulation judiciously, safely and effectively. I would suggest that you, and other readers, put aside 42 minutes and watch the following video presentation by William Kinsinger, MD, in which he speaks about chiropractic to a class of graduating physiotherapists. (Dr Kinsinger is an anaesthiologist who, since 1990, has conducted investigations and research of the chiropractic industry. He is also associated with the Neck911 network, a volunteer organisation devoted to raising awareness of injuries associated with the practice of chiropractic):
    The Kinsinger Report on Chiropractic 2008
    http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv

    On Saturday 24 October 2009 at 16:19 David wrote: “Palmer was an interesting character but has nothing to do with today’s chiropractic in the UK.”

    That is not true. His influence is still very strong amongst UK chiropractors. (Ref. The 2007 survey mentioned in my previous post.)

    On Saturday 24 October 2009 at 16:19 David wrote: “You know, it’s amazing how you think that you know so much more about chiropractic than I do.”

    I would certainly seem to know more about the lack of evidence for chiropractic than you do – or that you are prepared to acknowledge.

    On Saturday 24 October 2009 at 16:19 David wrote: “You certainly listed a good number of quotes and references in our last correspondence but mostly material that is irrelevant to how the majority of UK chiropractors practice and largely quotes from the likes of Edzard Ernst that are delivered with a deliberately dramatic and alarmist emphasis. I stand by what I say: Chiropractic is an evidence-based, scientifically supported method of managing musculo-skeletal disorders and their effects upon health.”

    And I stand by what I say, and would once again draw your attention to the information provided by this quote:

    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

    BTW, I’m still disappointed that you have chosen not to answer the question I asked you at least twice on another blog post: “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?”

    Also, as you know, in an article in New Scientist in June of this year, 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. Do you know if there’s been any official response to his invitation yet?
    http://www.newscientist.com/article/mg20227140.100-open-letter-to-all-uk-chiropractors.html

    On Saturday 24 October 2009 at 16:19 David wrote: “Before you feel compelled to repeat all your references, please bear in mind that spinal manipulation does not equal chiropracitc.”

    I am acutely aware of that.

    On Saturday 24 October 2009 at 16:19 David wrote: “Since you seem to enjoy arguing every point, I take it you agree that Ted Koren’s preachings bear no relation to chiropractic as taught at the AECC and WIOC?”

    No, I don’t agree. For example, didn’t Richard Lanigan, one of Tedd Koren’s European distributors, lecture at the AECC in the not too distant past?

    On Saturday 24 October 2009 at 16:19 David wrote: “Also, that you would have to acknowledge that the GCC is working to maintain standards in the chiropractic profession?”

    Maintain standards? IMO, it’s hardly begun to set them.

  • David says: “Chiropractic is an evidence-based, scientifically supported method of managing musculo-skeletal disorders and their effects upon health.” (Saturday 24 October 2009 at 16:19)

    Where is this scientific evidence to be found? The BCA recently embarrassed themselves trying to support their “plethora” of evidence for pediatric chiro. Chiro is supported only for low-back pain of limited duration, and that is shaky and shows it is no more effective than standard treatments.

    I have looked at chiropractic “literature” and it is pathetic. Can you cite any high-quality studies showing the utility of chiro in anything other than low-back pain?

  • Jackie W says: “Judging by your reaction to comments on the subject, you seem to be uncomfortable with the possibility that chiropractic education does have a scientific basis. It may be easier to attack a caricature but the comments of ‘David’ and others seem to indicate that you may be entirely wrong about the training involved.” (Saturday 24 October 2009 at 15:19)

    Of course, those of us who have studied chiro (in my case, more than 30 years) are “uncomfortable” with the “scientific” nature of it because we know it is not scientific. Perhaps it is easy for you to interpret sincerity as fact-based; but, the bottom line is that chiro is a cult with grandiose therapeutic claims.

    You should educate yourself about the Brit. Chiro. Assoc. (BCA) VS Singh libel suite. The BCA cited pathetic “support” for their bogus, scientific claims. These people don’t know anything about health-care.

  • @ Blue Wode

    That stodgy quotational style of posting makes responding feel like trying to pass by a walrus on a narrow staircase – slow, awkward and more than a little unpleasant. I’m sure that’s part of the idea & certainly part of the charm.

    All I’m suggesting is that there is a little more even handedness applied here.

    Your reliance on a single survey undertaken at an institution you have no respect for is remarkable and hardly a plethora itself. Even repeatedly quoting it seems odd given that it holds a low ranking in the hierarchy of evidence and the even lower ranking in your opinion of its origin. Surely that part of your case isn’t teetering on such sliver?

    Similarly your use of the Singh / Ernst reference – I wasn’t asking for a summary of chiropractic – my point was about the content of the training & all you said on that was it’s a waste of time & money. That’s just an opinion – of course you have a perfect right to it but that’s all it is.

    @ JJM

    I’m just suggesting a bit more balance – why should your 30 years ‘studying chiro’ hold any more weight than the 20 years that ‘David’ has been studying chiro?

    It appears that pro chiropractic contributors can’t get away with an unsubstantiated assertion like ‘…because we know it’s not…‘- so why should you? ‘Because we know’ sounds suspiciously like a chiropractic defence that you wouldn’t stand for.

    And you can rest assured that I never confuse sincerity for being fact based. I’m sure your assertions are sincere I would never confuse them with being fact either.

    (NB – Sorry to keep referring to ‘David’ but there seems to be a distinct lack of other chiropractic contributors to refer to)

  • On Sunday 25 October 2009 at 08:39 Jackie W wrote: “Sorry to keep referring to ‘David’ but there seems to be a distinct lack of other chiropractic contributors to refer to”

    Perhaps because they’ve learnt that they would have trouble defending their arguments too?

  • Jackie W says: Sunday 25 October 2009 at 08:39 “@ JJM I’m just suggesting a bit more balance …”

    That’s your problem- when it comes to technical matters “balance” is meaningless. We are talking about facts. The facts are that chiro is a magical, pre-scientific notion conjured-up by a grocer and unsupported by science. It has no proven health benefits. Those are facts, you cannot argue them away. Reality is what remains when your beliefs differ.

    “Balance” is okay for philosophical notions such as the death penalty or slavery, where facts are less important than feelings.

  • @ Blue Wode

    How many more times are you going to trot out this 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.”

    It’s that sort of, quite frankly absurd statement, that epitomizes the prejudice that you, Simon Singh and Edzard Ernst evidently hold. Given the information that Ernst and Singh had available to them, they could easily have written something like:

    Chiropractic is a tried and tested treatment for which there is good evidence, especially in the management of neck pain, back pain and headaches. It’s effectiveness compares favourably with other treatments and although concerns have been raised about the safety of manipulation of the neck, the risks of serious side effects have been shown to be somewhere in the region of 1 in 2,000,000.

    If you feel it necessary to give alarmist warnings about the safety of interventions for musculo-skeletal conditions, then perhaps we should campaign for better information on over-the-counter NSAIDs. Something along the lines of:

    WARNING: This treatment carries the risk of heart attack and death. It has shown some evidence of benefit in the short-term relief of back pain but other treatments are more effective in the long term. There are an estimated 2,500 deaths in the UK each year from NSAID complications.

    As for the question that you feel is so important for me to answer, that is:
    “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?”

    There is already good evidence for the conditions that most chiropractors spend the vast majority of their time treating, that is neck pain and back pain. We do, of course also treat the complete range of other musculo-skeletal conditions and any evidence you find for the effectiveness of manual therapy can also be applied to chiropractic. With respect to non-mechanical conditions, remember that a lack of evidence does not mean a lack of effectiveness. Your implication that any therapy for which there is not yet good evidence must be ‘bogus’, is not valid.

    Justice Eady stated that the term ‘bogus’ suggested that treatments were being presented dishonestly. I am sure that those chiropractors who make claims for the management of childhood disorders are doing so with integrity and honesty and in that sense your question is immaterial.

    If chiropractors are making dishonest claims, then the GCC will take action.

    BTW, I love this quote of yours:

    “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.”

    This is lunacy. I’m now being told that because what we do is a sophisticated form of other non-contentious therapies, we’re not actually chiropractors at all! I’m sorry that the truth doesn’t fit with the image of chiropractic you like to portray.

  • @ JJM

    You said:

    “The facts are that chiro is a magical, pre-scientific notion conjured-up by a grocer and unsupported by science. It has no proven health benefits. Those are facts, you cannot argue them away. Reality is what remains when your beliefs differ.”

    The trouble with that statement is that your “facts” bear no relation to today’s chiropractic. Or even the chiropractic that I’ve been involved with for half a century.

  • @ Blue Wode

    You said:

    “On Sunday 25 October 2009 at 08:39 Jackie W wrote: “Sorry to keep referring to ‘David’ but there seems to be a distinct lack of other chiropractic contributors to refer to”

    Perhaps because they’ve learnt that they would have trouble defending their arguments too?”

    Or perhaps they recognise that there’s little point is trying to reason with unreasonable people.

  • On Sunday 25 October 2009 at 22:58 David wrote: “How many more times are you going to trot out this 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.”

    Quite a few more times, I expect.

    With regard to your concerns about NSAIDs, please remember that a true comparison would have to take into account the following:

    No prospective randomized trial conclusively demonstrates that chiropractic management reduces the incidence of serious NSAID complications, such as fatal gastrointestinal bleeding. NSAIDs taken at recommended doses for a short time are generally very low-risk for appropriately selected patients — particularly the relatively young not on corticosteriods, anticoagulants, alcohol or tobacco and without a history of ulcers or severe comorbid illness.

    Many patients continue to take NSAIDs while undergoing spinal manipulation. Moreover, spinal manipulation can frequently cause an exacerbation of pain, which might cause some patients to increase or initiate NSAID therapy. [Ernst E. Prospective investigations into the safety of spinal manipulation. Journal of Pain and Symptom Management, 21(3): 238-242, March 2001].

    Herbal recommendations seem to be common among DCs; some remedies have actions similar to NSAIDs, while others directly affect bleeding per se . A recent set of reports by the North American Spine Society includes an 18-page reference chart listing approximately 70 herbs with their uses, potential side effects, and (known) potential interactions.

    http://www.chirobase.org/18CND/03/03-03.html

    It’s also worth remembering that packets of NSAIDs contain patient information leaflets detailing risks. However, it is evident that not all chiropractors warn patients about the risks associated with their manipulative treatments. See here and here.

    I would also venture that because the rate of taking people taking NSAIDs is bound to be massively higher than those receiving spinal adjustments, then taking NSAIDs is likely to be far safer – and, in addition to that, they work. More here:

    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. 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

    On Sunday 25 October 2009 at 22:58 David wrote: “As for the question that you feel is so important for me to answer, that is: “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?” There is already good evidence for the conditions that most chiropractors spend the vast majority of their time treating, that is neck pain and back pain. …With respect to non-mechanical conditions, remember that a lack of evidence does not mean a lack of effectiveness. Your implication that any therapy for which there is not yet good evidence must be ‘bogus’, is not valid.”

    So, you’re saying that despite the fact that the risk/benefit profile for spinal manipulation is largely negative, you, and other chiropractors, are quite happy to take patients’ money for an intervention for which there are equally effective, cheaper, safer, and more convenient conventional options available, and that you don’t think it necessary to explain to patients that there is no evidence for cranioscaral therapy, applied kinesiology and the existence of chiropractic subluxations?

    On Sunday 25 October 2009 at 22:58 David wrote: If chiropractors are making dishonest claims, then the GCC will take action.

    Bearing in mind that the GCC has recently received over 600 complaints about its registrants, it seems to me that it is a reactive body, rather than a pro-active one. I blame that lack of efficiency on its (apparently deliberate) vague terminology.

    On Sunday 25 October 2009 at 22:58 David wrote: I’m now being told that because what we do is a sophisticated form of other non-contentious therapies, we’re not actually chiropractors at all!

    That is correct. It makes you a chiropractor in name only. As I have already said, if you are practising evidence based manual therapy, then you are not practicing real chiropractic – you are duplicating the services already provided by physiotherapists (and others) who work in healthcare arenas which are much less mired in quackery.

    David, it is plain to see from the above that you are fooling yourself. However, since you say that you’ve been involved with chiropractic for half a century, the defensive attitude that you have displayed here is entirely understandable to those of us who don’t have to rely on discredited practices in order to earn a decent living.

  • @ Blue Wode

    Well, I have to say that I was expecting something better than just another rehash of Edzard Ernst’s spin.

    You see, that’s the problem with your argument. You appear to be obsessed with presenting an entirely negative view of chiropractic, whatever the subject, context or evidence. It really is starting to look as if you’re completely blinded to the fact that chiropractic is a different profession from the one that you evidently want it to be.

    I’m sorry to have to tell you that I AM a chiropractor and that what I practice IS chiropractic, without a single subluxation in sight.

    I shall have to beg your pardon; I have been involved in chiropractic for only a quarter of a century, not half. A slip of the fingers. However, I am proud of the work that I do and have never once thought that I should have chosen a different path.

    Chiropractic has allowed me to help many thousands of people over the years. I have never advertised; virtually every one of our patients is referred to us by existing, satisfied patients or GPs, consultants and physiotherapists. I could have, and still could, do domething else more profitable but I’ll stick with this, thanks.

    Anyway, I’ll let you have the last word because I have other things to do.

  • @ Blue Wode

    You seem to be basing much of your belief that most Chiropractors in the UK practice

  • oops

    @ Blue Wode

    “The fact is that chiropractic is a healing system that is based on a mystical life-force that gets blocked by imaginary subluxations, that relies on anecdotal evidence, special pleading, the placebo effect, and subjective diagnoses – and a great many chiropractors in the UK continue to adhere to its cultish foundations. For example, in a 2007 survey, 76% of UK chiropractors deemed traditional chiropractic beliefs (chiropractic philosophy) to be important, and the 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. 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]”

    You seem to be basing your belief that most chiropractors practice this way based on a study that the authors in the conclusion state:

    “The results of this study are limited owing to the low number of participants, which prevents the findings being generalisable to the whole profession”

    In fact 249 questionaires were analysed, at that time there were 2240 chiropractors in the UK a sample of just over 11%.

    Not the sort of evidence I would expect someone like you to think worth making those conclusions with.

  • David

    I have little inclination to go through yet more chiropractic clinic websites and, unfortunately, I have not collected data on the numbers mentioning subluxations (although there are more than a few of them).

    However, McTimoney College of Chiropractic states in How Chiropractic Works [sic]:

    The nervous system is responsible for all body functions. The correct alignment of vertebrae in the spinal column is vital to maintain nerve pathways. Subluxations in the body can occur at any time. They may be related to accidents, sporting activities, household tasks, emotional and physical stress, even a bad mattress. Some causes are so subtle that changes can occur without the patient’s knowledge, as symptoms can take years to arise. Chiropractors believe that much ill health in adult life may be related to events such as accidents in childhood.

    Ignoring the other disconnects, subluxations seems to be a major part of any McTimoney student’s education.

    The AECC doesn’t explicitly mention ‘subluxations’ when describing what chiropractic is, but the word does crop up elsewhere on their website.

    The Welsh Institute of Chiropractic similarly seems to avoid that term.

    The British Chiropractic Association says:

    …a loss of proper function (movement) in the vertebrae, which some chiropractors call a subluxation, may interfere with the healthy working of your spine and the nerves that run through it.

    The General Chiropractic Council says:

    Q8. What is subluxation and can it do me harm?

    A8. A subluxation complex or ‘subluxation’ is the term used by chiropractors to describe a loss of function in the spine and nervous system due to a reduction in its normal motion or alignment and this can affect the quality of your life.

    The United Chiropractic Association says:

    In simplest terms, a subluxation (a.k.a. Vertebral Subluxation) is when one or more of the bones of your spine (vertebrae) move out of position and create pressure on, or irritate spinal nerves. Spinal nerves are the nerves that come out from between each of the bones in your spine. This pressure or irritation on the nerves then causes those nerves to malfunction and interfere with the signals traveling [sic] over those nerves.

    The Scottish Chiropractic Association says:

    Sometimes vertebrae can become misaligned or fixated causing interference with the mental impulses that travel between the brain and the rest of the body. Chiropractors refer to this as a vertebral subluxation. A subluxation can cause pain, imbalance, fatigue, lowered resistance to disease and a general decline in health.

    As a short cut to taking a random sample of chiro websites to see how many rely on subluxations, a simple Google search can be done to give an indication of the prevalence of that bothersome word. Try this Google search term:

    “chiropractic clinic” subluxation -sceptic -skeptic -singh site:.co.uk

    This will get rid of most sceptic websites that mention the Simon Singh case, yet it should find most chiropractic clinics that use the word. It is restricted to .co.uk sites to prevent the results being contaminated by results from other countries.

    The returned results seem to be mostly from actual chiropractic clinic websites and there are very few other sites. The total number of hits is 940, a sizeable proportion of the total UK chiropractic clinics websites.

    So, whether you personally avoid the term, it still seems a very widely used ‘explanation’ for chiropractic.

  • @ JJM

    The balance I’m talking about isn’t between fact & philosophy, it’s between what appears to be permissible as types of evidence used on both sides of this discussion.

    For example you cite your personal experience as evidence, which whilst it is interesting, holds little scientific weight. Pro chiro contributors don’t appear to get away with personal experience as evidence and so why should you?

    Blue Wode does the same thing with using his chiro survey but dismissing contradictory evidence of a similar level as flimsy. I just feel that if this is going to be a meaningful discussion then what’s good for the skeptical geese should be good for the chiropractic ganders.

    I entirely agree with you that facts & feeling should be mutually exclusive, but you still use emotionally charged language about magic grocers as a statement of fact, which seems polarizing and unhelpful, and is definitely less New Scientist & more Gerry Springer. Perhaps therein lies a philosophical discussion in itself – ‘Passionately dispassionate – the role of emotions in the modern scientific tirade’.

    Also JJM, I must say slavery is an incredibly crass choice as an example of a philosophical conundrum.

    @ Blue Wode

    You see – you’ve bored off the only chiropractic contributor on the blog..!

  • On Monday 26 October 2009 at 15:12 Rational wrote: “You seem to be basing your belief that most chiropractors practice this way based on a study that the authors in the conclusion state: “The results of this study are limited owing to the low number of participants, which prevents the findings being generalisable to the whole profession”. In fact 249 questionaires were analysed, at that time there were 2240 chiropractors in the UK a sample of just over 11%. Not the sort of evidence I would expect someone like you to think worth making those conclusions with.”

    Interestingly, another survey, this time of 1,418 active and semi-active UK chiropractors [Wilson FJH, A survey of chiropractors in the United Kingdom, European Journal of Chiropractic, 2003:50:185-198], appears to go some way towards supporting the findings of that 2007 survey of which you are so critical.

    The Wilson survey had a response rate of 58% (816), and its participants included members of the British Chiropractic Association (BCA) and Scottish Chiropractic Association (SCA), educated at accredited colleges, and members of the British Association for Applied Chiropractic (BAAC) and McTimoney Chiropractic Association (MCA), educated at unaccredited colleges but grandparented to practise in the UK. A strong majority considered organic or visceral conditions (69%) and the management of children (98%) to be within the scope of chiropractic practice. It’s also worth noting that 36% agreed that “chiropractors should be allowed to prescribe medication on a restricted basis (e.g. mild analgesics, NSAIDS and muscle relaxants).”

    That survey formed part of the World Federation of Chiropractic’s (WFC) ‘Abstracts of research relevant to identity, including past surveys and other research’. See page 13 here:
    http://www.wfc.org/Website/WFC/Library.nsf/CatalogByTitleLive/Survey%20Research%20Abstracts/$FILE/1125200311434.pdf

    As you will probably know, from July 2003 to June 2005, the WFC approached its member national associations, and others, for all past research relevant to the identity and role of the chiropractic profession (e.g., surveys and focus groups of the public and the profession, and demographic information concerning chiropractors and their patients). The research was gathered, collated, and summarised for use by the WFC’s Consultation Task Force, and others, in determining a public identity of the chiropractic profession. On 15th June 2005, the WFC, at its 8th Biennial Congress, unanimously agreed that chiropractors should be identified as “…spinal health care experts in the health care system…with emphasis on the relationship between the spine and the nervous system…”. However, veteran chiropractor, Samuel Homola, made the following observations on the new identity:

    “This definition fails to place proper limitations on chiropractors who use spinal adjustments to treat general health problems, plunging the profession deeper into pseudoscience and away from establishing an identity for chiropractors as back-pain specialists.”

    He also said the following, which I would say sums up the current position of chiropractors in the UK:

    The reasons for use of manipulation/mobilization by an evidence-based manual therapist are not the same as the reason for use of adjustment/manipulation by most chiropractors…As I warned in Bonesetting, Chiropractic and Cultism, if chiropractic fails to specialize in an appropriate manner, there may be no justification for the existence of chiropractic when there are an adequate number of physical therapists providing manipulative therapy.

    Samuel Homola, DC, Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor. Journal of Manual & Manipulative Therapy, Vol.14 No.2 (2006) E14-E18
    http://jmmtonline.com/documents/HomolaV14N2E.pdf

    Prophetic words?

  • This thread rocks! I’ve just read it all the way through.

    One thing I don’t understand about David (apart from the fact that he doesn’t seem to realise BW is wiping the floor with him) is, if he keeps insisting that “chiropractic is a tried and tested treatment for which there is good evidence, especially in the management of neck pain, back pain and headaches”, then why doesn’t he just cut the crap and provide references for this evidence so we can take a look at it? JJM asked him for it back at post no. 20, for crying out loud!

    Does he perhaps think that if he repeats that there is good evidence enough times we won’t notice that he isn’t actually providing a single jot?

    Jackie W @ JJM

    “For example you cite your personal experience as evidence, which whilst it is interesting, holds little scientific weight. Pro chiro contributors don’t appear to get away with personal experience as evidence and so why should you?”

    I have now read all of JJM’s posts several times looking for where he cites “personal experience as evidence” but I see he does nothing of the kind. I also note, Jackie, you are not bringing anything useful to this discussion but have resorted to making snide little comments about “stodgy” posting styles or being “bored off”. You might like to consider what your own posting style flags up to anyone reading this discussion. You appear to be even more out of your depth than David and I respectfully suggest you go away and learn how to construct a reasoned and supported argument, put some practise in and and be prepared to learn from your mistakes.

    I feel a blog post coming on…’chiropractic is crap’ perhaps.

  • Skepticat – Mioaw..!

    Now that’s what I’m talking about – that is not a stodgy style of post!

    I have no axe to grind here and thanks for your concern, but I got my scientific one length badge many years ago.

    I hope Blue Wode took the comment with the good humour it was intended. My intention was not to be snide so I apologise if anyone was offended. I do feel though that these discussion boards tend to fizzle out if the posts are over long, quotational & repetitive. Possibly the place for huge posts to discuss might be on one’s own blog..?

    Thanks for the style advice – I will endevour to apply a more critical view of my own posts. However, if I may make a respectful observation in response, you seem to have a penchant for telling people to go away / quack off etc. That’s not a particularly constructive basis for a dialogue. Perhaps it’s this ‘go away’ approach that may be responsible for the scarcity of comments on your own blog ;)

    “Of course, those of us who have studied chiro (in my case, more than 30 years)…” is citing personal experience & holds no more ( or just as much ) weight as ‘David’s’ Half / quarter of a century of studying chiro. I suggest that missing this was a simple mistake and I’m sure you are prepared to learn from it.

    ‘Chiropractic is crap’ – let it out girlfriend – that’ll tell em..!

  • Jackie, you may like to look again at what you wrote, how JJM responded and how you misinterpreted his response.

    Neither JJM nor anyone else has suggested that his 30 years of studying chiropractic carries any more or less weight than David’s 25 years. In post no. 33, you accuse JJM of citing personal experience as *evidence* but he does not do so. Try re-reading his sentence without the bit in parenthesis that you’ve latched on to. He’s simply putting his credentials on the table as somebody who has a good knowledge of what chiropractic is in direct response to your suggestion that BW “may be entirely wrong about the training involved”. Got it now?

    What JJM has done is point out is that there is no scientific support for chiropractic and he asks David – who claims there is such support – to provide it. David, it seems, has left the building.

    In post 22. you say “pro chiropractic contributors can’t get away with an unsubstantiated assertion like ‘…because we know it’s not…‘- so why should you?”

    You seem to be missing the point that it’s not what JJM or any other skeptic knows or doesn’t know that matters. What matters is whether there is *scientific evidence*. JJM claims there isn’t and David claims there is. The burden of proof is on David and all he has to do is point us to the evidence. I wonder why he doesn’t?

    I’m guessing it’s not only because he’s been bored off by Blue Wode’s tiresome habit of challenging every mendacious claim he makes, while carefully ensuring that BW’s own arguments are supported by all these irritating links and quotations. Because that’s not what people should do when chiropractics come to other people’s blogs and make demonstrably false claims on them, is it? You shouldn’t carefully demonstrate that they are false, oh no! What you should do is ignore these and just make idle chat or idiotic and unsupported comments that have no bearing on anything.

    Thanks for your encouragement for my blog post. ‘Chiropractic is crap’ is on its way.

    By the way, you seem to be a bit confused about my websites. My blog and my discussion forum are not one and the same. The vibrant, successful and very civil discussion forum I run can be found here:

    http://www.thinkhumanism.com/phpBB3/

    All are welcome but – as I suggested previously – you’d need to brush up on your skills. This is not about your “scientific one length badge” but about your critical thinking and debating skills. On this thread alone you have consistently misunderstood or misinterpreted just about every point that you’ve responded to.

    The entirely separate blog I write as a fun hobby is not intended to be a discussion forum. I want to help enlighten people about all the crap quacks and fundies come out with, not engage in some utterly frustrating and pointless dialogue with them where they come up with the usual unsupported or mendacious claims, contradict themselves and refuse to engage with the counter-arguments, much as David has done with BW.

    My skepticat writing style is intentional and knowing that it is successful in winding up the enemy is an added bonus, so I won’t be changing it. :-)

  • “David says:
    Saturday 24 October 2009 at 16:19 Since you seem to enjoy arguing every point, I take it you agree that Ted Koren’s preachings bear no relation to chiropractic as taught at the AECC and WIOC?”

    Hi David! I hope you might still be reading this occasionally. Can I follow up your point here? I recognise my limitations in not knowing exactly what is currently taught at AECC and WIOC, and that this is relevant to the discussion. Can you help me gain access to their teaching materials on non-musculo-skeletal disorders? You can PM me through the Bad Science forums. Your point is, of course, only a useful contribution if it is indeed possible to establish what is being taught!

  • @ Blue Wode

    Those are very interesting references – the survey results certainly add weight to the 2007 chiro survey. The final reference regarding the internal divisions within Chiropractic is also very interesting. It seems that perhaps there is a pattern of large chiropractic political bodies making decisions on direction and scope of practice that they seem to find impossible to implement on the ground. It seems that chiropractic cats are difficult to herd indeed – even for other chiropractors.

    The profession is clearly divided and it appears that those treating systemic illness using ‘subluxation theory’ will at some point divide from those pushing to be mechanistic ‘spinal health care experts’. There seems to be a certain inevitability about this process and it appears from the reference above and from some the previous chiro contributors that this process is under way. There is precedent for this type of split – Osteopathy split from chiropractic early in the 20th century and then there was a later calving off of McTimmony from the main body of chiropractic to do it’s own thing. In true Darwinian fashion, ultimately change is likely to be beneficial.

    The bigger picture is that manual therapy in general is young and has gone through enormous divisions and changes in a relatively short period of time and that the future is likely to encompass the best aspects of all manual treatment modalities. For that process to take on the best of all treatments, it will involve looking objectively at the content of the treatment protocols themselves – not necessarily the headline treatment provider. To exclude an entire profession out of hand potentially throws extremely useful concepts and skills out with the ‘subluxated’ bath water.

    There also appears to be great uncertainty amongst those outside the profession on the role & emphasis of philosophy in training – certainly in the UK – and in my opinion, it is probably prudent to reserve judgement and fully investigate this rather than just eviscerate the entire profession & then perform an autopsy only to find it was training decent clinicians after all.

    Its political leadership picked a ridiculous fight with a journalist – it’s fucked with the bull & it’s got the horns. Personally I think there is enough entrenched belief on both sides to suspect that ‘the truth’ is probably somewhere in the middle, and hopefully it won’t ultimately be decided in the law courts or on blogs like this. (With all due respect Zeno)

    @ Skepticat – MIAOW..!

    Well done – I’m glad you have a contrastingly vibrant, successful and civil blog – I’m sorry I’m not nearly geeky enough to distinguish between a blog & a discussion forum.

    You just seem a bit angry and rude – like you just want a fight more than you want a discussion – which is fair enough I guess. Everyone likes a good scrap now & then. The downside is that it normally ends up with trading insults, which may be what you enjoy but doesn’t move the debate on.

    I wish you luck in winding up enemies – that’s a very commendable aim. You seem very good at it and I’m sure you’ll find plenty out there on any subject you choose.

  • Well you know how it is, Jackie. What seems rude to one person, (like saying someone’s boring for example), is another person’s good humour. Geese and ganders, pots and kettles and all that. ;-)

  • @ Julio

    Fair point :)

  • On Monday 26 October 2009 at 16:36, Zeno said:

    “McTimoney College of Chiropractic states in How Chiropractic Works [sic]:

    ‘The nervous system is responsible for all body functions. The correct alignment of vertebrae in the spinal column is vital to maintain nerve pathways. Subluxations in the body can occur at any time. They may be related to accidents, sporting activities, household tasks, emotional and physical stress, even a bad mattress. Some causes are so subtle that changes can occur without the patient’s knowledge, as symptoms can take years to arise. Chiropractors believe that much ill health in adult life may be related to events such as accidents in childhood.’

    Ignoring the other disconnects, subluxations seems to be a major part of any McTimoney student’s education.

    The AECC doesn’t explicitly mention ’subluxations’ when describing what chiropractic is, but the word does crop up elsewhere on their website.

    The Welsh Institute of Chiropractic similarly seems to avoid that term.”

    Ah, the McTimoney problem…………

    You’ll have noticed that when I refer to chiropractic education in the UK I always refer to only the Anglo-European College of Chiropractic (AECC) and the Welsh Institute of Chiropractic (WIOC). To explain this I shall have to give you a little history of chiropractic in the UK.

    The reason there is regulation for the chiropractic profession in the UK is because chiropractors fought for it. And one of the main reasons they fought for it was because of the rise of the McTimoneys. The concern about the McTimoneys was that their course did not offer a high enough standard of education and that their philosophy represented an outdated model of chiropractic. The European Council on Chiropractic Education (ECCE) did not recognise the course and there were no countries which had regulation for chiropractic that would accept the McTimoney qualification as sufficient for licensure.

    Unfortunately, prospective students were largely unaware of these shortcomings and the course was becoming more popular, mainly because it was a shorter course and only part-time. This allowed students to maintain a full-time job while taking the course, something that the McTimoney College used to advertise as a positive aspect. It was inevitably also much cheaper to do but still gained you the title “chiropractor”.

    Something had to be done and the long campaign for regulation began.

    Unfortunately at this time, because of the nature of English law, all practitioners of chiropractic had equal rights precisely because there was no regulation. As a result of this it was judged that all practitioners should be allowed on the register when it opened, whatever their level of education. Minimum standards of education were only to be applied after the initial “grandfathering” period expired. The minimum standard expected from any course producing graduates after this time was that set by the ECCE in 1992, that being the year that the legislation was drawn up. All courses had a period of five years after the register opened to ensure that they met this minimum level.

    Interestingly, there is a clause I the current Code of Conduct that states:

    “Chiropractors must respect and encourage the skills and
    contributions which others bring to the care of patients.
    Specifically chiropractors:
    F1.1 must not discriminate against, or unjustly criticise, a colleague or other
    health professional.”

    The term “must not discriminate” produces some awkward moments for some in the profession when the legislation has come about in such a peculiarly British way.

    When it came to the GCC itself, every chiropractic association existing in England at the time of the GCC’s inception was to be given representation on the Council. This gave the McTimoney and McTimoney-Corley associations seats on the Council that would become responsible for policing chiropractic. There were many in the profession who felt that this situation had largely defeated the objective of having regulation at all. However, my understanding is that the government insisted that they would only support the application for registration if chiropractors showed a united front and accepted that everyone had equal rights. The carrot for those aspiring to the highest standards was the requirement for all courses to reach the internationally recognised level of education set by the ECCE.

    Unfortunately, there has been considerable doubt as to whether the McTimoney course has ever achieved this minimum standard. In fact, the GCC eventually reached the decision to recommend to the Privy Council that accreditation of the McTimoney course should be withdrawn. For reasons I can’t explain this action was averted by the McTimoney college, something that many found hard to believe. Subsequently, they submitted a revised set of courses to the GCC for consideration and these have since been evaluated. This is a quote from the conclusion of their latest assessment:

    “The Panel made the following recommendations:
    a. Review the learning portfolio for students to improve and enhance the emphasis on reflection on clinical outcome, patient management strategies and personal development.
    b. Review the website and the prospectus to ensure that they fully reflect the new programme(s) at Masters level and the College’s emphasis on evidence based Chiropractic care.
    c. Develop written guidelines for students on the use of patients in research projects.“

    Hopefully these recommendations will be met.

    Meanwhile, the AECC and WIOC have also striven to raise the standard of training they offer and are producing highly proficient practitioners of musculo-skeletal healthcare.

    It’s interesting to note that, in the study which Blue Wode likes to quote so often:

    (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]”

    the authors note that:

    “ Statistically significant ( p _ 0.001) differences in opinion were found between chiropractors from the four professional associations on issues influenced by philosophical belief”

    And in the discussion they comment that:

    “McTimoney and McTimoney—Corley chiropractors, [hold] philosophical traditions [that] have historically been strongly associated with the Palmer
    (vitalistic/organic) model of chiropractic.”

    They don’t actually give the breakdown of answers to each of the questions by association, but the suggestion is clear.

  • On Saturday 24 October 2009 at 20:12 JJM said

    “David says: “Chiropractic is an evidence-based, scientifically supported method of managing musculo-skeletal disorders and their effects upon health.” (Saturday 24 October 2009 at 16:19)

    Where is this scientific evidence to be found?”

    I’m truly sorry that I don’t have the time to go through the list of references that provide the evidence for Spinal Manipulative Therapy (SMT), let alone chiropractic, for the management of various musculo-skeletal conditions right now; I am short of time.

    However, for the moment, perhaps I can point you to Ernst and Canter’s paper, “A systematic review of systematic reviews of spinal manipulation”, where even they had to concede that there was evidence for the effectiveness of spinal manipulation in the treatment of neck pain, back pain, headaches and dizziness. http://jrsm.rsmjournals.com/cgi/reprint/99/4/192

    This is despite Ernst’s well known habit of presenting the facts in the most negative light possible. Remember also that spinal manipulation does not equal chiropractic, and that most of the studies that have been done try to compare only manipulation with other modalities. Chiropractic also involves massage, mobilization and exercise, together with lifestyle and postural advice; interventions that have in themselves proved to be helpful.

  • On Monday 26 October 2009 at 22:17, Blue Wode quoted “veteran chiropractor, Samuel Homola”

    “The reasons for use of manipulation/mobilization by an evidence-based manual therapist are not the same as the reason for use of adjustment/manipulation by most chiropractors…As I warned in Bonesetting, Chiropractic and Cultism, if chiropractic fails to specialize in an appropriate manner, there may be no justification for the existence of chiropractic when there are an adequate number of physical therapists providing manipulative therapy.” http://jmmtonline.com/documents/HomolaV14N2E.pdf

    I have to say that I agree with almost everything that Samuel Homola has to say. What you should bear mind though, is that he graduated from Lincoln College of Chiropractic in 1956. Lincoln College is a self-confessed “straight” college which doggedly adheres to outdated principles. The “revolution” that he forecasts will need to happen in chiropractic happened in the UK years ago.

    The AECC and WIOC are already supplying graduates to the
    “chiropractic profession [which] as a whole specializes in the physical treatment of back disorders…and earns reciprocity with other healing professions,
    under the guidance of medical science”

  • On Tuesday 27 October 2009 at 14:59, Skepticat said:

    “I’m guessing it’s not only because he’s been bored off by Blue Wode’s tiresome habit of challenging every mendacious claim he makes……………….”

    I’m afraid that your tone betrays your motives for engaging in this post. I’m not sure which part of my contributions you regard as “mendacious” but it seems to me that, despite your beratement of Jackie W, you have contributed nothing of substance yourself, only abuse.

  • On Tuesday 27 October 2009 at 16:35, Allo V Psycho said:

    “Can I follow up your point here? I recognise my limitations in not knowing exactly what is currently taught at AECC and WIOC, and that this is relevant to the discussion. Can you help me gain access to their teaching materials on non-musculo-skeletal disorders?”

    I’m afraid that I don’t have access to the actual teaching materials used at AECC or WIOC. My comments are based on what I know of the philosophy applied to the teaching offered at those institutions from my direct dealings with them and my contact with those involved.

    Sorry.

    Anyway, that really is going to have to be it from me for a while, so I’ll bow out now.

  • @David
    “I’m afraid that I don’t have access to the actual teaching materials used at AECC or WIOC. My comments are based on what I know of the philosophy applied to the teaching offered at those institutions from my direct dealings with them and my contact with those involved”

    So, you challenged Blue Wode to answer a question, knowing that he couldn’t access the information needed to answer it, and that you did not have access to the detailed information to answer it either?

    OK, if you have direct dealings with those involved, can you tell me how to get the information from them required to answer your challenge ? I’m sure support from you will help them agree to make it available, and if their philosophy is rational and evidence based, what objection could they have? I’m happy to share my own relevant teaching materials with them.

  • On Wednesday 28 October 2009 at 00:16 David wrote: “The reason there is regulation for the chiropractic profession in the UK is because chiropractors fought for it. And one of the main reasons they fought for it was because of the rise of the McTimoneys. The concern about the McTimoneys was that their course did not offer a high enough standard of education and that their philosophy represented an outdated model of chiropract…Unfortunately at this time, because of the nature of English law, all practitioners of chiropractic had equal rights precisely because there was no regulation. As a result of this it was judged that all practitioners should be allowed on the register when it opened, whatever their level of educati…When it came to the GCC itself, every chiropractic association existing in England at the time of the GCC’s inception was to be given representation on the Council. This gave the McTimoney and McTimoney-Corley associations seats on the Council that would become responsible for policing chiropractic. There were many in the profession who felt that this situation had largely defeated the objective of having regulation at all. However, my understanding is that the government insisted that they would only support the application for registration if chiropractors showed a united front and accepted that everyone had equal rights.”

    So what made the UK chiropractic industry continue to pursue statutory regulation when they knew that doing so would give McTimoney chiropractors seats on the council that would become responsible for policing chiropractic?

    On Wednesday 28 October 2009 at 00:16 David wrote: …the GCC eventually reached the decision to recommend to the Privy Council that accreditation of the McTimoney course should be withdrawn. For reasons I can’t explain this action was averted by the McTimoney college, something that many found hard to believe.”

    Could it have been undue influence from the McTimoney chiropractors who continue to have seats on the GCC?

    On Wednesday 28 October 2009 at 00:16 David wrote: …the AECC and WIOC have also striven to raise the standard of training they offer and are producing highly proficient practitioners of musculo-skeletal healthcare.”

    If that’s true, then why don’t Kenneth Vall DC, Principal of the AECC, and David Byfield DC, Head of the WIOC, issue a joint public statement confirming that their colleges do not train students in the vitalist/organic model of chiropractic, and that they do not believe that the chiropractic ‘subluxation’ is a real condition with known medical consequences?

    Is there anything to prevent them from making such a declaration?

    On Wednesday 28 October 2009 at 00:16 David wrote: ”Interestingly, there is a clause in the current Code of Conduct that states: “Chiropractors must respect and encourage the skills and contributions which others bring to the care of patients. Specifically chiropractors: F1.1 must not discriminate against, or unjustly criticise, a colleague or other health professional.”

    And interestingly, as I informed you in another blog post, clause E1.3 of your Code of Practice (p.21 in the pdf, p.18 of the actual document) says:

    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 Wednesday 28 October 2009 at 00:17 David wrote: ”Ernst and Canter’s paper, “A systematic review of systematic reviews of spinal manipulation”…they had to concede that there was evidence for the effectiveness of spinal manipulation in the treatment of neck pain, back pain, headaches and dizziness.”

    That’s true, but they also had to arrive at the following conclusion after taking into account a responsible risk/benefit profile for spinal manipulation…

    Spinal manipulation has been associated with frequent, mild adverse effects and with serious (probably) rare complications. Therefore the risk-benefit balance does not favour SM over other treatment options such as physiotherapeutic exercise. This statement is not in agreement with several national guidelines, for instance, for the treatment of back pain. We suggest that these guidelines be reconsidered in the light of the best available data.
    In conclusion, we have found no convincing evidence from systematic reviews to suggest that SM is a recommendable treatment option for any medical condition.

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

    Similarly, Ernst’s systematic review of adverse effects of spinal manipulation, which was published the following year (2007), determined the following:

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

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

    Don’t both of these reviews suggest, very strongly, that the regulation of chiropractic was premature? It’s something noted by Professor David Colquhoun in the New Zealand Medical Journal last year:

    Both the New Zealand and the UK governments have got themselves into an impossible position by giving official recognition to chiropractic before the evidence was in. Since the conventional manipulative treatments are cheaper, and may well be safer, and because they involve no quasi-religious ideas like ‘subluxation’ or ‘innate intelligence’, the only reasonable conclusion is that there is no need for chiropractic to exist at all. They do nothing they do that would not be done as well by medical practitioners and physiotherapists. What will governments do about that, I wonder?”

    http://dcscience.net/?p=253

    On Wednesday 28 October 2009 at 00:30 David wrote: ”I have to say that I agree with almost everything that Samuel Homola has to say…The “revolution” that he forecasts will need to happen in chiropractic happened in the UK years ago.

    No it didn’t. Take, for example, the comments made in the GCC’s Fitness to Practice Report 2007 (p.13) regarding a complaint it received against one of its registrants:

    The GCC’s expert witness advised that the discovery of subluxations (areas of vertebral restriction in the spinal joints) is commonplace to the point of universality in patients.

    http://www.gcc-uk.org/files/link_file/FITNESS_TO_PRACTISE_REPORT_2007_FINAL_FOR_WEBSITE.pdf

    Bearing in mind that an orthopaedic subluxation is an incomplete or partial dislocation of a joint which is frequently the result of trauma, and is a fairly severe abnormality which tends to occur in areas other than the spine (and, as such, is rarely treated by chiropractors), the above reference to ‘subluxations’ by the GCC’s “expert witness” can only relate to the imaginary ones only believed in by chiropractors.

    So, not really indicative of a ‘revolution’ is it?

    On Wednesday 28 October 2009 at 00:37 David wrote: ” @ Skepticat – I’m afraid that your tone betrays your motives for engaging in this post. I’m not sure which part of my contributions you regard as “mendacious” but it seems to me that, despite your beratement of Jackie W, you have contributed nothing of substance yourself, only abuse.

    It would appear that you have not read Skepticat’s latest blog post which was linked to in comment 40. For your convenience, here’s the link again:
    http://skepticat.wordpress.com/2009/10/27/chiropractic-is-crap/

  • In post 46, David said,

    “I’m afraid that your tone betrays your motives for engaging in this post. I’m not sure which part of my contributions you regard as “mendacious” but it seems to me that, despite your beratement of Jackie W, you have contributed nothing of substance yourself, only abuse.”

    Actually, what I contributed was a timely reminder that you hadn’t provided us with the scientific evidence for chiropractic. I also contributed some encouragement that you finally cut the crap and do so. But, in spite of coming back and postinging another 1500 words or so, you still have not done so.

    In post 44 David said,

    “I’m truly sorry that I don’t have the time to go through the list of references that provide the evidence for Spinal Manipulative Therapy (SMT), let alone chiropractic, for the management of various musculo-skeletal conditions right now; I am short of time.

    However, for the moment, perhaps I can point you to Ernst and Canter’s paper, “A systematic review of systematic reviews of spinal manipulation”, where even they had to concede that there was evidence for the effectiveness of spinal manipulation in the treatment of neck pain, back pain, headaches and dizziness. http://jrsm.rsmjournals.com/cgi/reprint/99/4/192

    Out of all the references you think provide evidence, you choose that one? OK, let’s have a look. Here are a couple of extracts from the paper:

    “…there are three systematic reviews of SM for headache.13–15 While Bronfort et al.13 concluded that SM is as effective as other interventions, the other two teams of reviewers14,15 did not find conclusive evidence in favour of SM. The evidence from the other systematic reviews of SM for non-spinal pain,16 dysmenorrhoea,17 infantile colic,18 asthma,19,20 cervicogenic dizziness and any condition21 is uniformly negative. Overall, the demonstrable benefit of SM seems to be minimal in the case of acute or chronic back pain; controversial in the case of headache; or absent for all other indications.

    “In conclusion, we have found no convincing evidence from systematic reviews to suggest that SM is a recommendable treatment option for any medical condition.

    In case it’s not absolutely clear I will stress that, contrary to what David claims, nowhere in the paper do the authors “concede that there was evidence for the effectiveness of spinal manipulation…”. In fact they conclude the very opposite:

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

    I’m thinking perhaps David doesn’t know what the word ‘mendacious’ means but asserting that a paper says the very opposite of what it does, in fact, say would seem to be as good an illustration of its meaning as anything else he’s said.

    David, I don’t know what kind of universe you inhabit, which leads you to describe comments challenging misinformation and bad arguments as ‘abuse’ but at least I don’t abuse the truth. :-(

  • Gah! Blue Wode’s excellent last post wasn’t there when I posted my comment above. It’s appearance was obviously delayed for some mysterious reason. Sorry for the repetition.

  • @ Skepticat Thank you for your kind words. I think my posts get temporarily caught up in the spam filter because of all the links I provide.

    BTW, the posts Skepticat is talking about can be found on page 1 of the comments here:
    http://www.zenosblog.com/2009/10/the-trouble-with-leaflets/comment-page-1/#comments

  • Blue Wode is right: probably because of the number of links, it had to wait for my approval, hence Skepticat did not see it until after she had submitted her comment.

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