Thanks for more intriguing revelations, Zeno. I’m glad to see the GCC’s recent statement (“there is no clinical research base to support claims that the chiropractic vertebral subluxation complex is the cause of disease or health concerns”) being aired again, because I would remind readers that in 2004, Margaret Coats, CEO of the GCC, claimed that there was “scientific evidence” for the *many* interpretations of the word ‘subluxation’. See point 4 here. What happened to that scientific evidence remains a mystery. Reply
Zeno is surprisingly quick and adamanant (again- see obituaries) in his interpretation of the word “historical” to mean “just an historical concept, consigned to the history books as an outdated and irrelevant concept that explains absolutely nothing and based on no evidence whatsoever; something dreamed up 120 years ago by a magnetic therapy salesman”. I think Zeno may need to rethink his interpretation of the word historical rather than eat too much popcorn… It could ofcourse also just mean “someone came up with it in the past, recorded it and now we’ve moved on (even if we have done so without producing much evidence)”. A little like most scientific processes really… someone says something, and the next one either disproves it or improves on it until the day breaks that a workable and testable format arises… Good luck with it all zeno Kind regards, Stefaan Vossen This is only the beginning Reply
“What a hornet’s nest we stirred up, with the GCC eventually acknowledging that chiropractic had to be based on proper evidence and not on wishful thinking.” Dear Zeno, I know this goes dead against this seemingly hermetic view of the world you hold, but Chiropractic doesn’t “have to be based on proper evidence” and is in fact allowed to include plenty of wishful thinking…that is after all what the vast majority of most healthcare interventions are based on. Whatever you and your compadres/madres think. What does however have to be based on proper evidence is claims made by chiropractors as they have to be vetted and approved by the ASA’s rules. And the GCC has to play by those rules, and make sure that we play by those rules too. If your efforts were directed any further than enforcing ASA rules in regards to “claims chiropractors made”, then I am afraid to say you still have some work to do… maybe you could set up a study to assess whether or not you can find any scietific evidence that the chiropractic subluxation theory doesn’t work? Ah, but you’ll have to work out what that theory really is first… Stefaan Reply
Stefaan wrote: “…[chiropractic] is in fact allowed to include plenty of wishful thinking…that is after all what the vast majority of most healthcare interventions are based on. Whatever you and your compadres/madres think.” Nonsense. Bearing in mind that the General Medical Council’s rules have always stated that MDs’ “information must be factual and verifiable”… QUOTE “Good Medical Practice: Providing and publishing information about your services 1. 60. If you publish information about your medical services, you must make sure the information is factual and verifiable. 2. 61. You must not make unjustifiable claims about the quality or outcomes of your services in any information you provide to patients. It must not offer guarantees of cures, nor exploit patients’ vulnerability or lack of medical knowledge. 3. 62. You must not put pressure on people to use a service, for example by arousing ill-founded fears for their future health.” http://www.gmc-uk.org/guidance/good_medical_practice/probity_information_about_services.asp …it is clear that as much as 80% of modern medicine is evidence based: http://www.theness.com/neurologicablog/?p=51 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314867/pdf/15160706.pdf (pp4-5) http://www.dcscience.net/garrow-evidence-bmj.pdf http://www.bmj.com/cgi/eletters/335/7623/736-a#178246 Reply
“Many synonyms… exist for this theoretical model… Chiropractors specialize in locating…” I like that bit. It sounds like being trained to find (theoretical) spirits in (theoretically) haunted houses. Only some people are able to (theoretically) do it properly. Reply
@Blue Wode “Nonsense. Bearing in mind that the General Medical Council’s rules have always stated that MDs’ “information must be factual and verifiable” How does that make it nonsense for a clinician to acknowledge that a)less than 20% of medical practices meet EBM standards b)the clinician looks at what is in front of him/her, formulates a theory and then hopes it all works out to at least seem correct. Post -rationalisation and all that… Information, yes, that should be factual and verifiable as it says in the GCC statement and the GMC statement you’re quoting alike, but that has nothing to do with the working model, and certainly nothing to do with the rest of my statement which clearly refers to the interventions, and NOT to “information”. You may wish to think that the two are the same, but that is where you couldn’t be more wrong… Concept, working model, information,… three different things. That is where your lack of clinical experience is letting you down. Stefaan Vossen This is only the beginning Reply
Stefaan Vossen wrote: “Information, yes, that should be factual and verifiable as it says in the GCC statement and the GMC statement you’re quoting alike, but that has nothing to do with the working model, and certainly nothing to do with the rest of my statement which clearly refers to the interventions, and NOT to “information”. But Section B2.7 of your Code of Practice requires that you [chiropractors] “…must offer enough *information* to patients for them to take the decision to consent or not. If the patient is not offered as much *information* as they reasonably need to make their decision, and in a form they can understand, their consent may not be valid.” A related footnote explains that this would include “… *information* on the benefits and risks of the proposed method of assessment or care and any alternative methods.” It begs the question, what sort of information are you giving patients about the interventions you are using? Could it be that you are twisting Section A2.3 of the GCC’s Standard of Proficiency, which states clearly that “Chiropractors’ provision of care must be evidence based”, to allow “in my experience” and “the patient likes it” to be considered along with evidence, effectively negating the whole point of evidence-based medicine? See here: http://www.sciencebasedmedicine.org/?p=5339 Reply
@Bluewode ps 80% is possibly a little adventurous, particularly if we start taking into account the placebo effect of being in a medicalised environment…. I know this is mischief but the point still stands: EBM is EBM, RCT’s are RCT’s and EBM includes amongst others RCT’s logic and common sense. Chiropractors apply primarily the two latter on a broad and in-depth knowledge-base of anatomy, neurology and physiology amongst others. The fact that there isn’t much in terms of RCT support does not by any stretch of the imagination mean that chiropractic practice is not evidence based… unless you still think we’re talking about cancer and asthma and tetanus and not like most chiropractors in this country: backpain, or unless you think that EBM = “RCT-based medicine” (trust me Steve’s account of EBM certainly takes a broader view). I don’t think you have got your research base on chiropractic sussed out… or chiropractic in fact, come to think of it. Stefaan Reply
@ Stefaan You’re not making yourself clear to me. Are you saying that you base your evidence on your clinical experience, i.e. what you see with your own eyes? Reply
@BW how do you deduce from what I am writing that I “base my evidence” on my clinical experience? Evidence is evidence, clinical experience is clinical experience… What is this evidence you refer to in your statement for? The evidence I base my information for patient-discussion on? Or is it my evidence required by the ASA for advertised claims? Stefaan Reply
Stefaan “@BW how do you deduce from what I am writing that I “base my evidence” on my clinical experience?” It looks to me like Blue Wode is *asking* you what you base your evidence on and he’s not made the assumption you jumped to. Reply
@IainD my evidence to base what on? As I stated in my response to BW, that is the question. What assumption did I jump to? Reply
Thank you, IainD, for clarifying my previous comment. @ Stefaan Vossen I don’t find it easy to comprehend your comments. Interestingly, Zeno highlighted a very pertinent question made by Christopher Kent, President of the Foundation for Verebral Subluxation: Quote “Are we a profession with a clearly defined mission or are we a profession simply seeking some niche which offers access to a slice of the health care pie?” I think that gets near to the hub of the issue, i.e., are chiropractors evidence-based or anecdote-based? They cannot be all things to all people. Whether claims are advertised, or made in a clinical setting (upon which, it follows, treatment will be administered), one would expect them to be backed up with good, scientific evidence and a favourable risk/benefit profile. Reply
Stefaan “@IainD my evidence to base what on? As I stated in my response to BW, that is the question. What assumption did I jump to?” Eh? I assume you’re just confused, but, as I said in my last comment, you said: ““@BW how do you deduce from what I am writing that I “base my evidence” on my clinical experience?”” But Blue Wode did not say that he deduced that you based your evidence on your clinical experience – he *asked* you if you did. It was a question, not a statement. The question he asked was: “Are you saying that you base your evidence on your clinical experience, i.e. what you see with your own eyes?” Reply
@Blue Wode I am having some trouble understanding you too, I guess we are cross wires at the moment. That said I do think that the fetish held here for RCT’s is disproportionate and not representative of clinical reality (in any healthcare field), in the same way as equating the GCC’s statement to anything but an agreement that the vertebral subluxation concept is an historical, but still valid theoretical model which is lacking in RCT-evidence. The other thing we (you and me) seem to be getting crossed is the idea of what this subluxation concept is… what do you understand it to be? Stefaan Reply
Stefaan, have you contacted the GCC about what they really mean the chiropractic subluxation to be? As far as my understanding of the chiropractic subluxation goes, I get the distinct impression that it’s whatever chiropractors want it to be. Reply
Blue wode rightly asks “What happened to that scientific evidence remains a mystery”. The GCC Chief Executive Margaret Coats also wrote to me claiming “The GCC subluxation was based on the WHO definition and 160 people, including experts and national authorities and professional and NGO’s, in over 54 countries had reviewed this document prior to publication” So its fair to say the GCC is not a reliable source of information for a debate on subluxation and to quote from them only undermines any discussion questioning the existence of subluxations which are documented both in the medical and chiropractic literature. The medical profession recognise subluxation in relation to hypermobility of a spinal joint so presumably dysfunction also applies to hypo mobility of a joint or am I mistaken?? The question sceptics have every right to ask; what is the scientific evidence for the theory behind “vertebral subluxation complex” and sadly I would have to hold up my hands and say, not a lot. Before sceptics get too excited I would qualify that by saying the anatomical and physiological principles are there to make subluxation theory a legitimate hypothesis for scientific investigation and I would be delighted if chiropractic researchers put some of their resources into subluxation theory rather than the more profitable area of back pain. In the mean time my clients and I will just have to rely on anecdotes, not a perfect situation, but if they are happy with that so am I, we are where we are. Having said that the president of the British Chiropractic Association Richard Brown has this week come out in agreement with the skeptic view of “subluxation”. As his “plethora of evidence” was rubished last year. I dont suppose traditional chiropractors should be too worried by anyone now trying to claim that Richard Brown is a reliable source because it suits a particular point of view. I believe thats called “confirmation bias” The medical profession were making dodgy claims in 1998, perhaps they have cleaned up their act, better than the BCA did, http://ukpmc.ac.uk/articles/PMC1113581 Reply
@Blue Wode I think you’ll find the GCC fairly non-judgmental on this topic, but by all means ask them. I would love to know what you personally understand it to be though. Having looked into the topic so extensively I would expect you to be quite knowledgable on what it is you critique. It would just make conversing without cross-wires so much easier. Reply
ps I think it can be quite releveant when asking for “the scientific evidence” for me to ask the question: scientific evidence for what?” And if your answer is “the subluxation theory”, the I do, indeed want to know what your understanding of this theory is, as depending on your interpretation/understanding of it it will be easy/difficult/impossible to provide you with information/evidence. Kind regards, Stefaan Reply
@BW Another BlueWode #fail? You know, you are only feeding the suspicions of malice in avoiding constructive debate… Maybe that is just not your goal, that could be true of course. That does of course make you a heckler, rather than a skeptic. Reply