The random thoughts of a sceptical activist

Chiro evidence for subluxations pwned — by chiros!

When the British Chiropractic Association published its ‘plethora‘ of 29 references they thought supported chiropractic for childhood conditions, it took just 24 hours for it to be utterly demolished by scientists and skeptics. Only 18 of these were relevant to chiropractic and childhood conditions.

Shortly after that, Fiona Godlee, Editor on the BMJ, commenting on an article by Prof Edzard Ernst, said:

But in response to our recent editorial by Evan Harris (doi:10.1136/bmj.b2254), the vice president of the BCA, Richard Brown, has now presented the evidence (doi:10.1136/bmj.b2782). He writes, “There is in fact substantial evidence for the BCA to have made claims that chiropractic can help various childhood conditions” and lists 18 references. Readers can decide for themselves whether or not they are convinced. Edzard Ernst is not (doi:10.1136/bmj.b2766). His demolition of the 18 references is, to my mind, complete.

This, presumably, was the best evidence the BCA could muster and it was left in tatters by those more knowledgeable about science and robust trials.

Chiro wars

There have always been uneasy tensions between the different chiropractic factions with the ‘straights’ at one extreme, sticking to the ‘true chiropractic philosophy of the vertebral subluxation complex’ (VSC) and the ‘mixers’ and ‘medipractors’ at the other end, more than happy to try to muscle in on non-chiropractic areas such as prescribing drugs.

The GCC’s declaration about the VSC being no more than an ‘historical concept’ that is:

…not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.

has upset many chiropractors who have been earning their livings from finding subluxations in their customers and correcting them with ‘specific yet gentle chiropractic adjustments’.

There is now even an organisation to protect and promote the beleaguered subluxation, the Foundation for Vertebral Subluxation (cached). I’ve mentioned them before, but we need to look more closely at them. They say (cached) they are:

Dedicated to the Founding Principles & Tenets of the Chiropractic Profession

The chiropractic profession is in the midst of deep and serious changes. These changes are taking place in the larger context of health care and an even larger socio-cultural worldview that is not necessarily congruent with the founding principles and tenets of the chiropractic profession.

In other cases some of the original premises of the chiropractic profession are being co-opted by others as they come to see the value in the niche that chiropractic has carved out for itself.

During this tumultuous time it is ever more important that the profession hold fast to its unique and distinguishing features for these are all we really have claim to.

Beyond holding ground already gained there is a sense of urgency that the profession must seriously advance itself in the area of vertebral subluxation. The identification and care for this pathophysiological process is uniquely chiropractic and through research, education, policy and service we must ensure that we remain at the forefront of its elucidation.

Not surprisingly, they talk a lot about attacks on the VSC (cached):

It is time for the subluxation based community to seriously engage in matters of policy that affect the profession. A small, rogue splinter group has sought to fundamentally alter the very substance of the chiropractic profession in just a short time period. It is time for the majority of the profession which identifies with a subluxation based approach to exert itself and formulate, develop and implement policies that are congruent and supportive of the foundational principles and tenets of the profession.

Concluding:

A sick and suffering humanity needs us and we need you to join us on this mission.

A call to arms!

By ‘small, rogue splinter group’, I assume they mean the BCA even though all the chiropractic training establishments in the UK have also deprecated the subluxation even if all the chiropractic trade associations don’t quite agree.

One of the Directors of this august body and defender of the subluxation is Matthew McCoy DC, MPH (Masters of Public Health, apparently). He has his own website, McCoy Press, dedicated to:

…publishing progressive, health related content that will help push the needed paradigm shift in health care in the right direction. We are about rational, thoughtful and progressive discussions on the current health care crisis.

No doubt as part of this ‘rational, thoughtful and progressive discussion’ was an article titled I Think Their Heads Rattle When They Shake Them (cached).

He appears to be referring to the GCC.

He continues his ‘rational, thoughtful and progressive discussion':

…just when you thought the General Chiropractic Council could not make more bizarre statements than they have already made – they provide more giggles and grins.

Scientism at its finest – or should I say worst since they can’t even seem to get the science right.

The bottom line is that the Golden Rule prevails here – He with the most gold – rules. And since the GCC has the gold in the way of the annual registration fees of the practicing chiropractors in the UK – they have the money to promote (ahem – enforce) their agenda.

However, McCoy highlights some correspondence (cached) between the GCC and an organisation called the Federation of Straight Chiropractors and Organisations (FSCO)

This correspondence is interesting.

They seem pretty convinced about the subluxation and its role in health, although geography obviously isn’t one their strong points:

The Federation of Straight Chiropractors and Organizations (FSCO) represents Doctors of Chiropractic whose objective in practice is the location, analysis and correction of vertebral subluxation for the betterment of health. We are writing at the request of our members internationally as well as those in the United States who are concerned with your recent position on the role of vertebral subluxation correction in chiropractic. Restricting the practice of chiropractic to the treatment of muscuioskeietai complains and physical therapy robs the public of a valuable health service (vertebral subluxation correction) and frankly duplicates the service of physical therapy in many instances.

Your most recent move to eliminate subluxation correction from the scope of practice in England [sic] is in direct conflict with the body of scientific literature as well as the standards of the chiropractic profession in virtually every other country chiropractors are licensed. Our concern is that the GCC has deviated from the standards our profession holds in the rest of the world, specifically in the United States. The Association of Chiropractic Colleges (ACC), Council for Chiropractic Education (CCE) as well as the National Board of Chiropractic Examiners (NBCE) all recognize vertebral subluxation as a vital component of our practice. In fact, our federal system of health care for senior citizens (Medicare) will not pay a submitted claim unless it is attached to a diagnosis of subluxation for the region of the spine being adjusted.

The aberrant effects of vertebral subluxation on health are well documented and inarguable. Attached to this document is a small sampling of literature demonstrating the effects of vertebral subluxation on physiology. To avoid any argument of bias associated with a particular journal or study design, we have included citations from both the chiropractic and medical literature. We ask that you consider the empirical evidence herein and make the appropriate changes to your position in a timely manner.

Our hopes are that after objective consideration of the facts presented the GCC will reconsider their position and that the people of England [sic] will have access to the service of vertebral subluxation correction.

Ah! Another…

Plethora!

This ‘small sampling of literature demonstrating the effects of vertebral subluxation on physiology’ consists of seven references. As ever, it is a ‘growing body of literature':

There is a growing body of literature that support the subluxation model, a sampling of which is provided below (1-7).

  1. Sato A, Swenson RS. Sympathetic nervous system response to mechanical stress of the spinal column in rats. Journal of Manipulative Physiological Therapeutics 1984; 7(3):141-7.
  2. Dishman R. Review of the literature supporting a scientific basis for the chiropractic subluxation complex. Journal of Manipulative and physiological Therapeutics 1985; 8(3):163-174).
  3. Mañno MJ, Langrell PM. A longitudinal assessment of chiropractic care using a survey of self-rated health wellness & quality of life: A preliminary study. Journal of Vertebral Subluxation Research 1999; 3(2):1-9.
  4. Bolton PS. Reflex effects of subluxation: the peripheral nervous system. Journal of Manipulative Physiological Therapeutics 2000; 23(2): 101-103.
  5. Budgell BS. Reflex effects of subluxation: the autonomic nervous system. Journal of Manipulative Physiological Therapeutics 2000; 23(2): 104-106.
  6. Bakris G, DickholtZ M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. Journal of Human Hypertension 2007;21 (5):347-52.
  7. McAllister W, Boone WR, Power K, Hart J, Xiong T, Westbrook M. Chiropractic Care and Changes in Physical State and SelfPercePt10n5 in Domains of Health among Public Safety Personnel A Longitudinal Follow up Study. Journal of Vertebral Subluxation Research 2009; [May 151: 1-11.

I assume this sample reflects the pinnacle of the research into the subluxation and representative of all the evidence — why would they provide any poor quality references?

For the avoidance of doubt

But before we look at the GCC’s response to this plethora, it’s worth noting what Margaret Coats says in her reply to the FSCO:

For avoidance of doubt, your attention is drawn in particular to the fact that both these documents are concerned with the level of clinical research evidence that is required in respect of advertised claims for chiropractic care in the UK. They do not focus on scope of practice.

For the avoidance of doubt, this is only to do with what chiropractors claim they can do and has nothing to do with what they actually do in practice.

Demolition

This is certainly another plethora that needs close examination. After all, there is always the possibility that there may, indeed, be good, persuasive evidence for the subluxation.

Do we need to gather the best minds in science to review all these references? Perhaps we need to call on the expertise of Prof Edzard Ernst?

No. These references have already been reviewed. The GCC got the Anglo-European College of Chiropractic, no less, to review them.

So, was this a whitewash, with chiropractors all agreeing amongst themselves about the mountain of evidence for the subluxation?

Not exactly. In fact, the best evidence put forward by the straight chiropractors was pwned. Utterly. By fellow chiropractors.

  1. …The major flaws in this paper render it a very poor paper, which should not have been published. This paper does not support the contention that the VSC has an effect on health and that the correction of this putative lesion can have an impact on health.
  2. …This study suggests that upper cervical manipulation may be an adjunctive treatment to medication for patients with mild hypertension, but does not address the concept of health promotion or wellness.
  3. …This paper does not support the contention that the VSC has an effect on health and that the correction of this putative lesion can have an impact on health.
  4. …This literature review can in no way be construed to support the concepts of the health and wellness benefits of correcting putative vertebral subluxations. Only well-conducted randomised controlled trials are able to test this concept.
  5. …This literature review can in no way be construed to support the concepts of the health and wellness benefits of correcting putative vertebral subluxations.
  6. …While this interesting study suggests force applied laterally to the spine may affect certain physiological parameters it does not support the concept that the putative vertebral subluxation complex has a health promoting effect. Only randomized controlled clinical trials are able to answer this question.
  7. …This is an interesting paper that presents possibilities and cannot be seen as adding support to the concept that correcting the vertebral subluxation complex has health promoting effects. Again, the only way to definitively show if the putative spinal lesion has health promoting effects and is as dangerous as some claim is through clinical trials using a randomized controlled design.

To steal the phrase from Fiona Godlee:

The demolition of the seven references is, to my mind, complete.

63 Responses to Chiro evidence for subluxations pwned — by chiros!

  • Thanks for another very interesting post, Zeno.

    I note that you’re careful to emphasise that Margaret Coats of the GCC said that the GCC was concerned with “the level of clinical research evidence that is required in respect of advertised claims for chiropractic care in the UK. They do not focus on scope of practice.”

    Doesn’t that mean that chiropractors will still be able to earn their livings from finding subluxations in their customers once they have their customers inside their clinics? Indeed, Harriet Hall MD highlighted that point quite recently in a post at Science Based Medicine:

    Unfortunately, they [GCC] define evidence-based care as

    “…clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners, including the individual chiropractor her/himself.” [emphasis added]

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

    (Source)

    Also, as I’ve pointed out before, it’s worthwhile reminding readers of the following comments which were made in the GCC’s Fitness to Practice Report 2007 (p.13 of the original document) 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.

    (Source)

    Furthermore, in 2004, the GCC claimed in a letter to the lobby group, Action for Victims of Chiropractic, that there was “scientific evidence” for the many interpretations of the word ‘subluxation’. See point 4 here.

    What happened to that “scientific evidence” is anyone’s guess.

    With regard to the all the chiropractic training establishments in the UK having deprecated the subluxation, I’m not entirely convinced that they have. Their apparent positions could quite easily be a smokescreen to allow them to carry on as before – after all, they have another 329 terms they can use for their mythical chiropractic subluxation.

  • “With regard to the all the chiropractic training establishments in the UK having deprecated the subluxation, I’m not entirely convinced that they have.”

    Yes – very confusing. Just last week I was arguing about this in the badscience forum and actually used a link to the cracklash article here precisely because it seemed suitably sceptical about these deprecation claims.

    Furthermore, when I followed the link from that article to the McTimoney college, I found this on their ‘site:

    http://www.mctimoney-college.ac.uk/page/20_How_Chiropractic_Works.html

    No deprecation there!

  • phayes

    There are still quite a few mentions of the ‘S’ word on their website. Oddly, the page you mentioned doesn’t show up in the Google search.

  • Zeno,
    Although I’m a chiropractor and have seen good and bad things, I’m wondering what your
    ultimate goal is here. You’re not going to make the profession go away. At best, you’re causing
    a little chaos. This will keep going back and forth until it fizzles out.
    How would you regulate what goes on or is said in a provider’s treatment room? Would you have
    the government tell people they could only visit a chiropractor for so many visits?
    You couldn’t possibly do that to a medical doctor.
    If some or many chiropractors are crazy to espouse the subluxation theory, how do you feel about
    medical doctors who aren’t atheists and who might even recommend prayer as therapuesis?
    Um, last I checked England is a geographic entity as is Scotland.
    Emory is a respected university as well so you can’t fault McCoy’s ( apparent) MPH.
    Part of your thorough investigation of chiropractic ought to include numerous visits to different types of chiropractors and then tell us what you think.

  • @Aethelred

    “Part of your thorough investigation of chiropractic ought to include numerous visits to different types of chiropractors and then tell us what you think.”

    That’s a good suggestion but unfortunately one needs deep pockets. We did visit one and I blogged about it here:

    http://www.skepticat.org/2010/03/inside-the-spine-wizards-den/

    A medical doctor who seriously recommends prayer is probably unfit to practise and should be struck off.

  • Aethelred

    …I’m a chiropractor and have seen good and bad things…

    I wonder what bad things you saw and whether you did anything about them?

    You’re not going to make the profession go away.

    But do you think it might be a bit better regulated once this is all over? Better, that is, in terms of the public being better protected.

    How would you regulate what goes on or is said in a provider’s treatment room?

    That’s one for the GCC to ponder. They’re supposed to be doing the regulation, after all, not me.

    If some or many chiropractors are crazy to espouse the subluxation theory…

    Crazy is your word, but it seems chiropractors can’t agree on whether or not it even exists.

    Um, last I checked England is a geographic entity as is Scotland.

    The GCC cover the UK, not just England.

    Emory is a respected university as well so you can’t fault McCoy’s ( apparent) MPH.

    I never said I did. I’m sure most readers here will know what DC stands for, but are probably unlikely to know what MPH stood for, other than Miles Per Hour.

    Part of your thorough investigation of chiropractic ought to include numerous visits to different types of chiropractors and then tell us what you think.

    Apart from the fact it’s never very clear what ‘type’ a chiropractor is, how would my personal anecdote affect the evidence — or lack of it — for particular chiropractic claims?

  • @zeno
    thing is that a chiropractor shouldn’t be claiming to treat any condition in the first place. That is the whole point of the subluxation concept. That was the genius of the theoretical concept (for which there is as of yet no scientific evidence as the research was… you guessed it; always looking at a specific symptomatology to be linked to a single and specific causality) The subluxation is really just a group term for anything or combination of things that cause dysfunction. The dysfunction can be locally, distally or globally. Removing the cause of dysfunction should then, in theory and when applied in the correct group of patients, result in natural recovery, by virtue of a reduction in stresses on the symptomatic structures. The correct group of patients is simply identified as that group of people in which it is likely to be of benefit i.e. not so much tissue destruction so as to render ambition of recovery unrealistic and neither absence of dysfunction rendering removal of absent cause of dysfunction pointless and unnecessary (as one would be able to expect natural recovery in such cases).
    So, if anything your complaints will have the effect of speeding up the polarisation of those who subscrobe to this view (chiropractors) vs those who don’t (medipractors) and the reorganisation of the management of these two professions. The GCC in theory should be looking after the former but is populated by the latter. Secondly the former should not be making claims, which they sometimes do, and should only be providing chiropractic care to the group of people for whom care is likely to be of benefit, which they don’t always do. Finally; the issue of causality: spinal dysfunction seems to not always be the (sole) cause of dysfunction but lots of people in the chiropractic and affiliated professions from either factions treat their patients as if it is. Consequently I believe the biggest problem to be the lack of clarity on this latter issue as the science and the recognition of efficacy is likely to ensue from elucidating it. Even the GCC fails to sometimes recognise the difference between a subluxation and a spinal subluxation at times, but treating the terms interchangeably is really quite misleading and allows for those who think that all causes of dysfunction are spinal in origin to continue in their wicked ways!
    Good effort though Zeno, you’ll be spinning circles around the profession for some time to go on the back of this! Enjoy
    Stefaan

  • Stefaan wrote: “…thing is that a chiropractor shouldn’t be claiming to treat any condition in the first place. That is the whole point of the subluxation concept. That was the genius of the theoretical concept (for which there is as of yet no scientific evidence as the research was… you guessed it; always looking at a specific symptomatology to be linked to a single and specific causality)”

    I assume that this ‘genius’ can only observed from a chiropractic point of view – i.e., it’s invariably a win-win situation for chiropractors in that they continue to profit from the theoretical subluxation concept at their customers’ – or rather, guinea pigs’ – expense. For how much longer do you think that chiropractors can get away with feasting on their dripping ‘philosophy’ roast whilst they wait, with apparent endless patience, for the evidence to appear? Clue: People are beginning to see through the ‘no jam today, jam to-morrow’ tactic.

    Stefaan wrote: “The subluxation is really just a group term for anything or combination of things that cause dysfunction. The dysfunction can be locally, distally or globally. Removing the cause of dysfunction should then, in theory and when applied in the correct group of patients, result in natural recovery, by virtue of a reduction in stresses on the symptomatic structures.”

    If identifying dysfunctions in the correct groups of customers is so important, then why do so many chiropractors recommend that asymptomatic customers, including whole families, sign up for regular chiropractic ‘wellness care’?

    Incidentally, if chiropractors’ provision of ‘wellness care’ really did work, then it would be reasonable to assume that chiropractors’ longevity would be on a par with that of medical doctors or, at the very least, the general population. However, according to a recent survey from the U.S. – which was conducted by a chiropractor – chiropractors’ life-spans are shorter than both:

    Two separate data sources were used to examine chiropractic mortality rates. One source used obituary notices from past issues of Dynamic Chiropractic from 1990 to mid-2003. The second source used biographies from Who Was Who in Chiropractic – A Necrology covering a ten year period from 1969–1979. The two sources yielded a mean age at death for chiropractors of 73.4 and 74.2 years respectively.

    The mean ages at death of chiropractors is below the national average of 76.9 years and is below their medical doctor counterparts of 81.5.

    Morgan, L. Does Chiropractic ‘Add Years to Life’? J Can Chiropr Assoc. 2004 September; 48(3): 217–224
    http://tinyurl.com/332qwpb

    Isn’t it about time that chiropractors called it a day with their quackery?

  • @Bluewode
    -what quackery my dear? Please be specific in what you feel is quackery, people might think you have a point!
    -the genius of chiropractic lies in that it distinguishes pain from problem, ie. the problem as you perceive it may be your symtpomatic display but clinicaly speaking, and more specifically in the chiropractic clinical encounter, the problem really is that which causes it. This distinguishment is what makes understanding holistic and vitalistic theories difficult to people who only perceive the problem to be their pain or symptom.
    It all really revolves around the question: do you think that the majority of injuries and pains chiropractors deal with are directly and uniquely linked to the action which set the pain off? ie. do you think that it is normal for a person to bend forwards and injure their back? Do you think the patient with back pain which is eased with orthotics only got the flat feet when they bent forwards and hurt their back? Do you not think that there are no predisposing factors? Because you know, wellness and maintenance care are all about snuffing the predisposing factors in the bud… cheap and easy, nothing else.
    Kind regards,
    Stefaan
    This is only the beginning

  • p.s on your little quirky “wellness” rhetoric the obvious flaw in deducing your conclusion from the research is this: a GP can treat themselves, a chiropractor cannot.
    To come to anything like a serious conclusion you will have to cross-reference those results with the percentage multi-practitioner practices… for starters!
    Regards,
    Stefaan

  • Stefaan wrote: “…what quackery my dear? Please be specific in what you feel is quackery…”

    Quackery as explained here:

    Quackery is not an all-or-nothing phenomenon. A practitioner may be scientific in many respects and only minimally involved in unscientific practices. Also, products and procedures can be useful for some purposes but worthless for others. For example…

    • Spinal manipulation may be effective for relief of appropriately selected cases of low back pain, but manipulation to correct chiropractic’s imaginary “subluxations” is quackery.

    Quackery entails the use of methods that are not scientifically accepted…

    Quackery can be broadly defined as “anything involving over promotion in the field of health.” This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters…

    Unproven methods are not necessarily quackery. Those consistent with established scientific concepts may be considered experimental. Legitimate researchers and practitioners do not promote unproven procedures in the marketplace but engage in responsible, properly-designed studies.

    http://www.quackwatch.com/01QuackeryRelatedTopics/quackdef.html

    As for your explanation of the ‘genius’ of chiropractic, you appear to be claiming that it distinguishes pain/symptoms from an underlying holistic/vitalistic cause. In that case, the ‘genius’ of the (real) chiropractic intervention – the correction of (mythical) subluxations – will almost certainly have nothing to do with successful outcomes (and can therefore safely be rendered obsolete). Indeed, David Byfield, Susan King and Peter McCarthy, who are chiropractic staff members at the University of Glamorgan, more or less admitted in the past that the successes derived from the chiropractic clinical encounter owed much to non-specific (placebo) effects:

    “…it has [also] been shown that patients are very pleased and satisfied with chiropractic care whether they get better or not….Furthermore, it has been said that chiropractic’s greatest contribution to health care has been the development of a solid doctor-patient relationship. So, let’s not kid ourselves. It may not be what we say…..but simply the way in which we say it that stimulates some measurable change in patient’s general health care status. Some studies support this view.”

    http://tinyurl.com/32odolf

    BTW, I’m puzzled by your defence of chiropractors’ longevity apparently being less than that of MDs and the general population. You say “GPs can treat themselves, a chiropractor cannot”. That simply doesn’t make sense. Surely if chiropractic was such a valuable addition to health care, then all chiropractors would ensure that they received regular chiropractic care in addition to being under the care of a GP?

  • @Blue Wode
    your rhetoric is baffling:
    “the correction of (mythical) subluxations – will almost certainly have nothing to do with successful outcomes (and can therefore safely be rendered obsolete)”
    Could you tell me why “the correction of subluxations will allmost certainly have nothing to do with successfull outcomes”? You seem to come to this conclusion because I “appear to be claiming that it distinguishes pain/symptoms from an underlying holistic/vitalistic cause”.
    Are you seriously proposing that giving orthotics to a patient with pes planus/cavus will have nothing to do with the successful outcome in back pain relief when a biomechanical causal link has been established on examination?
    Back to te quackery, the definition of quackery you quote is quite the valid one, but how, in your learned opinion does this in essence apply to the still theoretical subluxation model?
    Stefaan
    ps I like the way you emphasise part of my quotes to suit your purposes. Do read the rest of the material though so as to come to balanced view on the argument. It helps. No, really, it helps.

  • Stefaan, your last post is all over the place. I am unable to respond to it.

  • Tangled in your own delusory rhetoric? What don’t you understand? The question I asked you was clear enough and referenced your own statement so unles syou didn’t know what you were talking about it should be simple enough to answer.
    Good luck
    S

  • Stefaan

    I have to sympathise with Blue Wode. Your comments are – to be charitable – gobbledegook.

    By the way, whatever happened to your research project (http://www.zenosblog.com/2010/05/in-memoriam/comment-page-3/#comment-6240)? Did you see my last comment on it (http://www.zenosblog.com/2010/06/the-beginning-of-the-end/comment-page-1/#comment-6758).

    You said you were going to put it on your blog, but I can’t see anything there either. http://www.chiropractorswarwick.co.uk/index.php/blog/

  • @iaind what is the gobbledgook? Can you tell me what it is that is not clear? I have used quotation marks for quotes of his, the problem may be that I didn’t understand his sentence, but maybe you can elucidate as to why (blue wode quote:) “the correction of (mythical) subluxations – will almost certainly have nothing to do with successful outcomes (and can therefore safely be rendered obsolete)” and why he can deduce this from my appearing “to be claiming that it distinguishes pain/symptoms from an underlying holistic/vitalistic cause”? These are just quotes from his statements, the rhetoric of which is baffling as the two statements have nothing to do with one another but by the sequential nature of these phrases and the words linking these phrases to one another semantically he seems to be implying that they are. I would love to know how on earth he would come to said conclusion as it would be relevant to the weight and validity of his statement.
    And the study is in place. First lab is to be set up before the end of this year. I am sure you will find out about the results in due course. Decided to not publish study design at this stage, hope you will forgive me this but there was very little constructive (positive or negative) comment to the preliminary communications on these channels so didn’t bother.
    Stefaan

  • @steffan

    Did your proposed research undergo any form of independent ethical evaluation?

    You would also be very wise to explain your design before implementing it – it would be dreadful if you carried out your research only to find it impossible to draw conclusions from your results.

  • @Andrew Gilbey: Thanks for the guidance and help, all is under control
    @IainD: still keenly awaiting qualification for “gobbledgook” comment
    @Bluewode: yet another Bluewode #fail? Maybe there is more than empty atmospheric comments to the Bluewode phenomenon, but it is remaining elusive!
    This is only the beginning
    Stefaan

  • @Stefaan

    You’re most welcome

    In the meantime, here’s the abstract of a recently published article (Int J Clin Pract. 2010;64(10):1162-1165), which I’m sure that you’ll enjoy:

    Abstract
    Objective: The aim of this study was to summarise all cases in which chiropractic spinal manipulation was followed by death.
    Design: This study is a systematic review of case reports.
    Methods: Literature searches in four electronic databases with no restrictions of time or language.
    Main outcome measure: Death.
    Results: Twenty six fatalities were published in the medical literature and many more might have remained unpublished. The alleged pathology usually was a vascular accident involving the dissection of a vertebral artery.
    Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.

  • @Andrew Gilbey,
    I’m sure you’ll enjoy this:
    http://www.chiroaccess.com/Articles/Death-by-Chiropractic-Another-Misbegotten-Review.aspx?id=0000190
    26 deaths in 75 years.
    Nice One.

  • Every year 80.000 ill and terminally ill people visit Lourdes. 66 miracle recoveries have been recorded in the past 100 years. That’s approximately a 1/121.000 chance and considered statistically insignificant. How do the numbers in this study stack up? Not that convincing is it really?

    Evidence, plausibility and faith, not to mention evidence, plausibility and faith of causation are the problem with this (and some others, I must add) studies on the “death by chiropractic manipulation” topic. Are you getting caught out by your belief system? “But where is the evidence that it does any good?” I hear you say… and it is a very good point indeed. The evidence is there, just not in the form you wish to see it aka RCT’s. RCT’s are hard to design and expensive to run. This is why skin-care companies and pharmaceutical companies have the greatest reach in these levels of evidence. This of course, combined to the notion of mono-causation. But therein too lies a serious problem: the population group for which chiropractic care should be applied (according to chiropractic theory, although I concede that some chiropractors do not practice this, thereby confusing the issue) is not the self-limiting presentation, but rather the presentation which holds immovable but non=pathological dysfunction at it causal root. Immovable of course is held to be relative in this statement. The human body does not just grow an orthotic when flat-footed, but it can be artificially applied. Neither does the human body always reorganise dental occlusion to suit the purposes, and when it doesn’t one can resort to splint therapy. In my opinion, spinal manipulative therapy seems to similarly be able to artificially facilitate the restoration of joint movement resulting in alteration in muscular firing patterns. Improve movement patterns, results in a reduction of stress. A reduction in stress significant enough to be below the naturally occurring healing rate, should result in healing… I have no RCT evidence, but it sounds very plausible to me, and the clinical results seem to corroborate this plausibility.
    And now we are only talking about biomechanical influences and have not even touched on chemico-nutritional and psycho-emotional dysfunctional patterns… you may now agree I think that studying the “chiropractic paradigm” is no straight-forward matter.
    Besides that there is the issue of safety of alternatives (particularly when noting the argument held by some less informed people that back pain is “self-limiting”) As you now know that the symptomatic patient (as opposed to the asymptomatic patient-which is a big discussion by itself) accepted by the chiropractor should not be in the self-limiting population. Of course you are also aware that “self-limiting” cannot be a label given to a patient who has back pain one day which goes away the next, because you are ofcourse fully aware that it may recur the next… This is of course testimony to the human body’s ability to bypass and compensate for dysfunctional movement patterns, but also testimony of its limitations to doing so. In short there is only that much compensating that can be done.
    To make matters even more complicated for the observer of the phenomenon that is chronic and recurring back pain (and I am focusing on pain as that at leats can be considered a relatively reliable outcome measure) frequency, duration and nature of the pain are but a symptomisation of a dysfunction which is made to materialise more or less rapdily/intensly relative to the stresses the dysfunctional system is put under.
    In short; no there is no RCT-level evidence, and “it ain’t gonna happen” any day soon. But for very, very good reasons, hence my feeling slightly lackluster towards the hard-line sentiment held by many so-called skeptics that “RCT evidence is all”. It is of course true that it would really be the crowning jewel, but due to the technical challenges acquiring the data represent, I am sure you may now agree or at least give some consideration to the idea that it is really not that much of an argument.
    It is of course your choice whether or not you wish to entertain irrational arguments to support your belief systems or whether you are happy enough to be mentally flexible and making reasonable and plausible allowance…
    Stefaan Vossen

  • Stefaan, Thank you for clarifying the level of benefit from cervical spinal manipulation. So, according to even your own recount above of “benefit”, it is not shown to be above zero.
    Now, when you (try to) divide a number x, even a very small x, by approximately zero the resulting number q will be asymptotically high, as you may remember from your school maths. With a true zero it’s infinitely high, causing an ERROR message on your calculator. Thus in the risk/benefit calculation we are discussing, the risk is very unacceptably high, infinitely high. For me it’s a clear ERROR to wilfully expose another living creature to such a calculated risk. And the common chiropractic blind denials of any risks are incomprehensible.

  • Dear Olle,
    thank you for your response.
    Unfortunately you have made a few qualifying errors in your reading of my entries, the nature of which deny the validity of your concluding statement, at least in so far as being attributable on any basis provided by my comments.
    There are other problems with what I read to be the essence and nature of your rhetoric, chiefly amongst which is that lack of RCT evidence=no evidence. I think it should be clear, but will reiterate for your leisure that “there is evidence, just not the kind of evidence you (or I in fact) like”. If you happen to stand fast by the opinion that no RCT evidence= no evidence then I would suggest you question whether or not this rule stands fast for your opinion on all clinical interactions, or whether this is expression of bias on your behalf. Concluding that there is no RCT evidence is not the same as concluding that there is no evidence. Concluding that there is no evidence is not concluding that there is evidence to the contrary. If you are not comfortable with that, then you are unfortunately not cut out for clinical life and if that is your chosen profession, you need to rethink your suitability for the job.
    Secondly you (seem to) assume that risk is an absolute. You must do otherwise your mathematical rhetoric makes no sense to me. Sometimes people have dissecting vertebral arteries. Sometimes people with dissecting vertebral arteries have neck pain for a symptom. That means that there is a chance for a chiropractor to have a patient present to him/her with neck pain secondary to vertebral dissection syndromes. This patient may also have other problems in the neck which produce similar pains to those the patient reports or who over-shadow and confuse the pain caused by the dissecting artery. This may cause the clinician to confuse (errore human est) and treat with manipulative techniques which he/she has experienced to be effective in the past. This clinical choice is then latterly post-rationalised to be related in the event the dissecting artery causes further complications. This version of events is more likely than Prof Ernst’s and is more widely supported by the epidiomiological evidence, emphasised by the lack of pathomechanical relations between cervical manipulation and stroke.
    Finally it is, I think, important to remember that I feel it is perfectly acceptable to state to a prospective patient that I have no evidence for what I do, and there are risks associated to the tune of death and maiming, and then for the patient to decide what their view is on risk/benefit assessment. I do think that the freedom of the individual to choose is often negated in this debate and a discussion surrounding appropriate consent is more to the point in both technical and clinical terms. Unless you of course feel that the public cannot choose for themselves.
    Which is a tad condescending really. Maybe even arrogant. To be clear, my view is that it would be nice to be able to do the RCT’s, but as I explained above, it is in my opinion very complex and too little conscensus exists on basic biomechanical and chiropractic tenets to design and execute studies which would represent the whole issue. I understand your need to over-simplify the issue, but please be cautious in drawing your conclusion as they too are at risk of being simplistic.
    Ultimately your choice of words eg “the common chiropractic blind denials” shows me three things: you probably have too little information to your availability, you have no significant clinical experience, and lastly, act with bias for whatever motives.
    I understand and respect that these three observations may seem harsh-sounding but none are intended as disrespectful, just as observations. Not everybody is cut out to be a clinician and it takes a long time to acquire significant amounts of information.
    Kind regards,
    Stefaan Vossen
    This is only the beginning

  • Stefaan Vossen wrote: “I do think that the freedom of the individual to choose is often negated in this debate and a discussion surrounding appropriate consent is more to the point in both technical and clinical terms. Unless you of course feel that the public cannot choose for themselves.”

    With regard to chiropractic, let’s not forget that it is not uncommon for customers to be prevented from having the freedom to choose for themselves:

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

    CONCLUSION: Results from this survey suggest a patient’s autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk.
    http://tinyurl.com/6ajn5d

    Consent or submission? The practice of consent within UK chiropractic

    CONCLUSION: Results suggest that valid consent procedures are either poorly understood or selectively implemented by UK chiropractors.
    http://tinyurl.com/559ued

    BTW, I still fail to understand why any chiropractor would manipulate a customer’s neck when it is known that there are effective, safer, cheaper, and more convenient options available (e.g. exercise). I can’t help feeling that some chiropractors are putting their own interests ahead of their customers’interests when they resort to such a potentially lethal intervention. Whether the chiropractors’ interests are financial, emotional, or related to less time and effort being required (or all three) is anyone’s guess, but the fact remains that chiropractors who continue to use neck manipulation no longer have any excuses for not understanding why they leave themselves open to accusations of being unethical.

  • @Bluewode
    you throw some big words in there! Can you explain to me what your point is exactly about ethics? Ethical behaviour or action does require a fair few considerations. Considerations I have by and large covered above. Could you explain to me how, from the above considerations one could conclude that it would be unethical to provide treatment which has been experienced to be effective, cheap and low risk?
    I would also love some response to some comments I made to your address. It would further debate.
    Stefaan

  • ps. chiropractors are doctors of chiropractic and their “customers” are called patients
    pps. Blue wode quote “….the fact is…” it’s not fact, it is your opinion

  • Stefaan wrote: “Can you explain to me…”

    It has already been explained to you, several times, and not just by me. And you know it.

  • @Bluewode
    This is becoming more and more fun: my earlier question:
    Could you tell me why “the correction of subluxations will allmost certainly have nothing to do with successfull outcomes”? You seem to come to this conclusion because I “appear to be claiming that it distinguishes pain/symptoms from an underlying holistic/vitalistic cause”.
    No, I have not had anyone explain this to me. Please elucidate
    Whilst you’re at it could you explain your point bout ethics, you just made?
    Stefaan

  • another epic bluewode fail
    I don’t know why you bother, this “sceptic activism” seems to me to really be masking self-indulgent and half-witted cut’n paste-based verbal diarrhoea devoid of original or critical thought and without serious constructive purpose.
    You are of course entitled to spending your time whichever which way you choose and I thank you for giving me cause to think about how to respond to comments like yours. It is very useful.
    Stefaan Vossen

  • Stefaan

    I’ve indulged you on here long enough.

    Although I have little doubt that you just won’t be able to see it, your incessant ad hominems and slights are unnecessary and not welcome. You also continually ignore relevant points and simply do not engage with the arguments presented to you. Instead, you use up my server space frequently with what IainD rightly called ‘gobbledegook’.

    Visitors can make up their own minds about your conduct, style and depth of argument.

    I have no doubt you will feel that your behaviour on here has been nothing short of impeccable and that you believe that it is others who can’t engage with yourarguments‘. You are utterly wrong. Then again, perhaps you know full well what you are doing.

    Regardless, unless you start abiding by the rules of my blog, start behaving yourself and engaging properly, I will ban you from my blog.

  • Dear Zeno,
    I think that the reason for “that” post to have been denounced as “gobbledegook” is down to what I perceive to be a logical fallacy on behalf of those having incorrect or incomplete understanding of the “subluxation concept”. In consequence I repeatedly asked the authors to elucidate what the reasoning was to denounce the post as gobbledegook so as to be able to position my argument directly at this (what I believe to be) incorrect understanding of “the subluxation concept” and not waste anybody’s time. Such elucidation was not forthcoming.
    I, as a person and as a clinician, would be perfectly happy for any person to engage and determine the fallacy in the chiropractic subluxation concept. That the theory is as of yet not proven at RCT level, is clear. I have acknowledged that, and have also attempted to clarify over a number of posts the technical reasons for such a void in evidence. If the position you hold is that; in absence of RCT evidence the theory, regardless of plausibility should not be practised regardless of whether there is good reason for a lack of such RCT evidence or not, then I have nothing more to add. This would in my opinion be a surreal position, and I sincerely hope it is not the position you hold, as I have great respect and appreciation for your work.
    If on the other hand we can entertain a discussion about plausibility and hold a moderate position in regards to the challenges of clinical reality (including human fallacy) then it is my pleasure to contribute and appreciate your leniency towards some of my less erudite posts which express exasperation with what I perceive to be unwillingness to engage in constructive debate.
    My position is not that “chiropractic is right”. I think it is practised wrongly and badly by some and I am a critic in my own profession. Nor do I think “I am right” but I do have to weigh up the experience of significant improvements in significant population groups based on what I perceive to be plausible practice against the investments required to make it better still or scientifically proven.
    If I have failed to engage with points raised by some, then I must apologise as I did not do so willingly and would appreciate you raise these points so I can rectify the matter.
    Kind regards,
    Stefaan

  • Stefaan, I think what you’re trying to say is this:

    “I am a chiropractor and it is in my interest to try to validate the chiropractic ‘subluxation’. As it intrigues me that some of my patients manage to achieve significant improvements, would you, and others, please indulge me whilst I try to figure out the precise mechanism(s) for these outcomes.

    If the above summation is correct, I would urge you to have a slow read through this essay:

    Social and Judgmental Biases That Make Inert Treatments Seem to Work
    http://www.sram.org/0302/bias.html

  • @Blue Wode,
    not completely,although I am looking at outcomes of one way of approaching back pain versus those of another. Thereby, I guess, in a roundabout way identifying probable components of causation.
    What I am definitely trying to say is: why do you think that “the correction of (mythical) subluxations – will almost certainly have nothing to do with successful outcomes”? Do you think that all “subluxations” are spinal motion restrictions? Do you understand the term “subluxation” to be a clinical entity? Like a virus? Identifiable under the microscope or X-ray? You have been given plenty of reason to think this, as this is some of the crap that the chiropractic profession has tried to disseminate over the years. And I too think that this is non-sense. Which is why some time ago, you may remember, I asked you “what do you understand a subluxation to be?” I tried explaining that looking at chiropractic philosophy makes it clear that it does not allow for such nonsense. So too does it not allow for the concept of claiming to treat any condition. It can only claim to remove subluxations. And that, in essence, is only pursued in order to allow the “body to heal itself”. So, in true solipsistic fashion: if person was poorly, got de-subluxated and got better it is perceived to follow that poorli-ness was due to subluxation suppressing body’s ability to heal itself. I know the conclusion is rubbish (thank you for the links, but you may now realise that I am aware), but it seems logical to me that if a person has tended multiple practices, has been unresponsive to care, turns out to be flat-footed on the left side, causing internal rotation of the femur and anterior flexion of the ilium in consequence, then for that person to have recurring muscular low back pain almost seems unavoidable. To identify the subluxation (their unilateral pes planus), fix it (by referring to a good podiatrist), then it does indeed seem plausible that the body will indeed “fix itself”. There are subluxations of many origins. Finding the subluxation, fixing it and leaving the body to do the work is the chiropractor’s job description. This is “the genius” of chiropractic philosophy. Unfortunately not all chiropractors appreciate this, resulting in great confusion by observers like yourself. You are not wrong in my opinion to say that some of the claims and practices made by some chiropractors are unfounded and silly, but you are wrong to say that it has anything to do with “chiropractic”. It has to do with people.
    Regards,
    Stefaan Vossen
    This is only the beginning

  • Stefaan, thank you for your reply. All I can say is that I think you are spending a huge amount of time and energy on a wild goose chase. Good luck with it, anyway.

  • Blue Wode,
    do you have any good reasons to say it is a wild goose chase? It seems like you should do as you are spending a huge amount of time and energy on countering it. Should you have such reasons, I would love to know them so I can stop chasing the goose. National and international researchers seem to agree with me, but I would be most happy to not have to spend another minute on it if you can help.
    Stefaan

  • Stefaan wrote: “…do you have any good reasons to say it is a wild goose chase?”

    Didn’t you read the link I gave you?
    http://www.sram.org/0302/bias.html

    Stefaan wrote: “…you are spending a huge amount of time and energy on countering it.”

    That’s because I don’t like to see the trusting being taken advantage of by the deluded.

  • I refer you back to your own link:
    The test only fails on point c) in the case of chiropractic as I propose it to you, in that it has failed to provide conclusive RCT’s. I have explained to you that point c) is difficult to fulfil due to the inherent requirements of the testing procedure and the costs involved, though theoretically not impossible to approach. So chiropractic fulfils 3 out of 4 of the test but still you reject it out of hand. Seems dogmatic to me, but if you are happy and comfortable with that, then you should indeed spend your time helping the “trusting” to not be taken advantage of by the deluded” whilst I try and help the needing to get better.
    Stefaan Vossen

  • Stefaan wrote: “I try and help the needing to get better”

    Apparently whilst relying heavily on the following factors to produce positive outcomes:

    The low level of scientific literacy among the public at large

    An increase in anti-intellectualism and anti-scientific attitudes riding on the coat-tails of New Age mysticism

    Vigorous marketing of extravagant claims by the “alternative” medical community (including chiropractors)

    Inadequate media scrutiny

    Increasing social malaise and mistrust of traditional authority figures – the anti-doctor backlash

    Dislike of the delivery methods of scientific biomedicine (impersonal, not always tactile, etc.)

    Self-serving biases and demand characteristics (e.g. unwilling to admit to having experienced poor outcomes if a great deal of time and money has been invested)

    The disease/condition may have run its natural course

    Many diseases are cyclical

    Spontaneous remission

    The placebo effect (enhanced by touch in the case of chiropractic)

    Some allegedly cured symptoms were probably psychosomatic to begin with

    Symptomatic relief versus cure

    Misdiagnosis (by self or by a physician)

    Stefaan, I think it’s reasonable to request that you report back here only when you are able to produce convincing scientific evidence for ‘chiropractic’.

  • @BW
    “apparently” according to whom?
    Like I said before, all that seems to be lacking to convince you is RCT’s, but if you have a reliable and studied source that can indeed make a strong case that chiropractic only works because of the reasons you quote, then I will close my clinic tomorrow.
    I am not the only one who has to back up their statements with RCT’s to convince, surely?
    Stefaan

  • Stefaan wrote: ” “apparently” according to whom? ”

    David Byfield, Susan King and Peter McCarthy, chiropractic academic staff members at the University of Glamorgan (UK):

    “…it has [also] been shown that patients are very pleased and satisfied with chiropractic care whether they get better or not….Furthermore, it has been said that chiropractic’s greatest contribution to health care has been the development of a solid doctor-patient relationship. So, let’s not kid ourselves. It may not be what we say…..but simply the way in which we say it that stimulates some measurable change in patient’s general health care status. Some studies support this view.”

    http://tinyurl.com/32odolf

  • A letter? A letter in which they respond to a very sentimental and emotional outburst made earlier? A letter designed to moderate a very left wing position by emphasising some very right wing points? Points which are equal to saying “hang on boys and girls, let’s remind ourselves that all practices also involve placebo effects”. Are you suggesting that there are any practices which do NOT benefit at least in part of the placebo effect, any practices which do not have to come to this conclusion?
    Nobody here is denying that there is such a thing as a placebo effect and nobody is denying that it contributes to positive outcomes. But surely that is true for all practices, in fact, come to think of it,… this is true for all human interactions.
    I was expecting something heavier than confirmation that people within the chiropractic profession acknowledge the presence of the placebo effect. Because that’s all this is, right?
    Stefaan

  • Stefaan, you ask for sources, I provide them. I provide sources, you say they’re flawed in some way. Basically, I’m “damned if I do, damned if I don’t”. Play nice.

  • In my view you’re not damned either way, but do you not think that the source (a letter confirming knowledge that there is such a thing as placebo) does not match its use? (stating that I and my colleagues rely heavily on the points you quote from the letter)
    By the way, it is interesting to note that the first point in this letter contradicts observations in your sram.org source.
    I don’t disagree with you that it would be nice to have a clearer view on how much is placebo and how much is real and chiropractic-specific. That said, in the consideration of plausible theory and plentiful other evidence, combined to comprehensible difficulties with providing RCT evidence, I think it would not be unreasonable to ask for some restraint in the chiropractic-bashing. But I do think that there is occasional reason to bash individual chiropractors.
    That of course would be more truthful but libellous.
    Regards,
    Stefaan Vossen
    This is only the beginning

  • Stefaan wrote: “I think it would not be unreasonable to ask for some restraint in the chiropractic-bashing.”

    Stefaan, it has long been my observation that far more chiro-bashing takes place within the profession than from skeptics outside it. Indeed much of Zeno’s blogging, and Chiropractic Live’s ( http://www.chiropracticlive.com/ ) over the past year or so has highlighted just how prevalent that infighting is.

    Stefaan wrote: “I was expecting something heavier than confirmation that people within the chiropractic profession acknowledge the presence of the placebo effect.”

    What could be more damning than academics within your profession acknowledging the paucity of evidence for its techniques? As you probably know, for some time there have been a handful of US chiropractors who have dared to voice their concerns about chiropractic publicly, however, there are those in the UK who have also had their brave moments. For example, here’s what Edward Rothman – a senior lecturer at the UK’s Anglo European College of Chiropractic – had to say not so long ago about chiropractic manipulative therapy:

    Many of us whine, moan, and complain about the irrational, unethical, and stagnant state of chiropractic. NACM set out to make some changes but was not effective. Mainstream organizations, like the ACA, are made up of people without the intestinal fortitude to stand up to wacky technique gurus, DCs with fake PhDs, sleazy practice builders, and ridiculous “diagnostic” methodologies (subluxation station, sEMG scanning, etc). They are unwilling to admit that more than half of the schools in the States should be closed down and those left, undergo serious reform…

    I am not sure that anything can be done because it is my perception that there are very few rational chiropractors willing to leave, what I have termed, the ritual induced placebo of our manipulative techniques, the monotherapeutic nature of the profession, and the unethical practice building. Though I have argued with a PT on the other forum on behalf of the profession, I often wonder why — when physical therapists continue to improve their education, delving into differential diagnosis, and limited perscription rights, e.g., the new DPT programme.

    What does our profession do? We try to legislate to stop PTs from manipulating — further proof of our irrational behaviour, insisting on our monotherapeutic approach to treat everything. I am an American currently working at a chiropractic school in England. For me, AECC has been a little utopia because of the talented and dedicated people I work with. However, in the four years I have been in England, I have seen a change come over the profession there as more and more people take on American practice building methods and are attracted to irrational, illogical techniques and treatment pursuits, e.g., “occipito-sacral decompression in chiropractic paediatrics” (don’t even try to understand that one). Some of us can ban together and discuss these issues but will chiropractic/chiropractors ever change? What hope do we have of making the radical changes to the profession that is needed to attract rational scientific people into the field, considering the general state of the profession and the historical and current stance of the ACA?

    http://tinyurl.com/32l9o5e

    Hardly reassuring stuff, is it?

  • Dear Blue Wode,
    I don’t think it is damning for anyone to point out a paucity of evidence, let alone academics (that is after all what they work on). I believe I made those very comments to you on multiple occasions in this last blog alone, so am a touch surprised you seem to argue a point with the very point I make to you: there are no RCT’s but they are unlikely to emerge any day soon for technical reasons, rather than because the theory is inherently flawed. That in itself is a real shame as it would put discussions like these to bed sharpish, but it in itself does not really justify such strength of feeling. Paucity of evidence is not paucity of truth aka lack of evidence is not evidence of lacking…
    I have a great deal of respect for Ed Rothman, we have had many discussions in the past. I look forward to them in the future. I know, understand and share with him the occasional sense of desperation to some of the silliness of some within the profession. Show me one healthcare profession where such discussions and sentiments are not held… just one, please. You will find, I think, that intra-professional infighting is the rule, not the exception. In consequence, in-fighting cannot be held to be symptomatic of a diseased profession

    But that brings us back to square one and the only conclusions I can safely draw from your sources are: there is no RCT evidence and there is such a thing as placebo. But these are not denied by anyone. The conclusions you seem to draw from these sources on the other hand, I feel, lack in restraint and are far more colourful than the sources warrant. Sometimes I feel you are maybe doing exactly what you are accusing chiropractors of doing…
    Stefaan Vossen

  • Stefaan, methinks thou dost protest too much.

  • Hihi, good one!

    This is only the beginning

  • Zeno,

    First of all, i would like to thank you for your efforts. As a “real” medical doctor, not a doctor of crap(DC), it is quite obvious throughout the years that the cult of chiropractic has gained momentum and is trying to become more mainstream. Lets hope we don’t further contribute to this by wasting time commenting on the so called vsc or on this so called “profession” in general.

    Scientology a cult very similar to chiropractic practices, developed throughout the years by continuous attacks by sceptics and negative publicity. Definitely looking at the state of the profession in Canada and Australia for example, where they happen to be part of the national health care systems is quite scary, yet i can reassure you that spinal manipulation is now starting to be taught at an undergraduate level and that the normal PT degree is getting updated to that of a masters standard. Hence, its just a matter of time for quality research to emerge by physios. An excellent example of which is an article by

    James Dunning, Rushton A, The effects of cervical high-velocity low-amplitude thrust manipulation on resting
    electromyographic activity of the biceps brachii muscle, Manual Therapy (2008), doi:10.1016/j.math.2008.09.003

    Maybe we should send it to AK practitioners if only they could read!!!

    It is my hope and belief that research in the arena of manipulation will be totally owned by physios, and thats only when chiros will be out of a job and a profession. Actions by governments will then be taken.

  • @Hippocrates
    it truly is a real shame that such is you perception of the chiropractic management of back pain that you fail to see that the integration you speak of is in fact a by-product of the persistent existence of chiropractic, osteopathy and other manipulative management methods. The studies you speak of too are and will be a by-product of the work already done within the chiropractic and osteopathic profession.
    Shame of the bile but say that interdisciplinary respect is always a must in my opinion.
    Stefaan Vossen
    This is only the beginning

  • I have been following mainly the tweets these days and applaud some of what is going on.

    I have however just come across information that suggests Alan (Zeno) that when you complained about the chiropractors you requested that you remain anonymous so the chiropractors wouldn’t know who made the complaint but the regulator ignored your request and sent your name and address out anyway? I can’t believe it’s true as based on your high profile, why would you? Just letting you know what’s being said and they seem adamant it is true.

    I’m sure if it isn’t you will post. To suggest cowardice of a man of your stature and reputation which is they’re words not mine, they simply must not appreciate the work you do?

  • tzspense

    Anyone interested in the truth and spending more than a few seconds on my blog will find out that I did not request that I remain anonymous to the chiropractors I complained about.

  • tzspense: LMAO! Are you making that up?

  • Zeno,
    Can you tell me if you complained about any non-BCA members?

  • I suspect there were some non-BCA members.

  • Well, I would have thought you could be just a little more accurate. I suspect that very few indeed were non-BCA members. And is this important? Well, it seems to me your main bitch is about the BCA and unless you can tell me that a significant number of complaints were made against non-BCA members then I would have to say it proves my point.

  • Thanks for letting us know what you think and how you make up your mind.

    As I’ve said before, the BCA helpfully provided a list of their members and websites. None of the other trade bodies did.

  • So, as I said, your main issue is with BCA members then, yes or no.

  • I don’t think I can make this any clearer: the majority of complaints were about BCA members because the BCA made it easy to gather the websites of their members.

  • Oh…I see…I think. How do you mean they made it easy to gather the websites?

  • The BCA’s website had name, address and website details of its members. None of the other trade bodies supplied the website.

  • Ah, sorry, I see now, they provided you with a list. Yes, That makes it clearer to me thank you.

  • Cant any unjustifiable claims made by non-BCA members be cross referenced to the GCC list of registrants so that they too can be brought to task?

  • Feel free – but you don’t need to cross reference them to the GCC.

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