Crticism of Chiropractic [Archive]

JJM

8th October 2009, 05:17 AM

There is an old thread in another subforum on this topic http://forums.randi.org/showthread.php?t=85436

I started this one because I think it is more appropriate in this subforum, and to provide a place to post on chiropractic, in general, outside of the thread on BCA vs. Singh. Also, I recently acquired an article featuring chiropractors critical of their business.

Jaroslaw P. Grod, DC, David Sikorski, DC, and Joseph C. Keating, Jr, PhD "Unsubstantiated Claims in Patient Brochures From the Largest State, Provincial, and National Chiropractic Associations and Research Agencies" Journal of Manipulative and Physiological Therapeutics Volume 24 • Number 8 • October 2001 pp. 514-19 Conclusion: The largest professional associations in the United States and Canada distribute patient brochures that make claims for the clinical art of chiropractic that are not currently justified by available scientific evidence or that are intrinsically untestable. These assertions are self-defeating because they reinforce an image of the chiropractic profession as functioning outside the boundaries of scientific behavior.That is straightforward. Since the publication is not readily available, I will quote some of the objections to claims:A prophylactic or health-maintaining effect of manipulation has not been experimentally demonstrated to date.

The value of “regular check-ups” by chiropractors is also unknown.

The effects, if any, of spinal subluxations upon athletic performance have not been scientifically validated.

The disease-producing and pathology-producing effects of subluxation-complex, if any, have not been demonstrated experimentally.

Adjusting has not been experimentally demonstrated to alter vertebral alignment or “nerve pressure”; such effects, if possible, have not been shown to influence neuritis.

Currently available experimental data do not justify any claims for the value of chiropractic care in populations of children.

The “causes of chronic pain” that may respond to manipulation have not been established.That article fits nicely with: "Improper Claims on Chiropractic College Web Sites" http://www.chirobase.org/03Edu/webclaims.html

When a chiro claims to have a chiropractic-subluxation free practice, one must ask why they spent so much time "studying" that fairy tale: Association of Chiro Colleges statement http://www.chirocolleges.org/paradigm_scope_practice.html Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.

Gord_in_Toronto

8th October 2009, 06:07 AM

The article is available online:
www.journalchiroed.com/2003/JCEFall2003 (http://www.journalchiroed.com/2003/JCEFall2003)Sikorski.pdf

The best thing about this study is that it was conducted by chiropractors. :D

Jeff Corey

8th October 2009, 06:12 AM

"The page cannot be found
The page you are looking for might have been removed, had its name changed, or is temporarily unavailable."

fls

8th October 2009, 06:17 AM

Fixed link.

http://www.journalchiroed.com/2003/JCEFall2003Sikorski.pdf

JJM

8th October 2009, 06:23 AM

The article is available online:
www.journalchiroed.com/2003/JCEFall2003 (http://www.journalchiroed.com/2003/JCEFall2003)Sikorski.pdf. ... :DThe link does not work. perhaps the period (full stop) at the end is the problem because I pasted the whole thing and it worked. Thanks, that was a different, and useful, article. ETA: fls fixed it.

"The page cannot be found ..."Thanks, I noted that and will look for its replacement.

ETA current link is now in my original post.

Gord_in_Toronto

8th October 2009, 06:36 AM

Fixed link.

http://www.journalchiroed.com/2003/JCEFall2003Sikorski.pdf

Thanks fls. I tried fixing it by cutting and repasting but that did not work. I figured someone smarter than me could make it work. :o

fls

8th October 2009, 06:53 AM

Thanks fls. I tried fixing it by cutting and repasting but that did not work. I figured someone smarter than me could make it work. :o

I'm just hoping for some geek cred.

Linda

Gord_in_Toronto

8th October 2009, 10:15 AM

I'm just hoping for some geek cred.

Linda

;)

JJM

8th October 2009, 11:20 AM

End of an Era: FCER Decides on Self-Liquidation http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54144

FCER is the Foundation for Chiropractic Education and Research. Founded in 1943, Over the foundation's history, volunteers contributed more than 33,000 articles and helped fund over 152 randomized, controlled trials concerning chiropractic manipulation ... So, why are chiros arguing, today, that they have no research that definitively supports their claims because of a lack of money? Even the claims to treat acute, low back pain are a bit shaky (according to the latest Cochrane review, which requires a subscription in most of the USA).

Blue Wode

8th October 2009, 01:13 PM

It's interesting to note that as the FCER is closing down, the Foundation for Chiropractic Progress (FCP) has received approximately $650,000 in pledges to help with its mission “To increase the public awareness of the benefits of chiropractic”.
http://www.chiro.org/wordpress/?p=1151

The words 'very few' seem to have been omitted from its mission statement.

jasonpatterson

8th October 2009, 01:49 PM

There are tons of chiropractors around here, and our local paper has a weekly Ask the Experts column that includes one. There was an ad yesterday in which the chiropractor was offering to treat mental disorders (anxiety and depression, specifically.) I am always amazed that this stuff is legal.

Blue Wode

9th October 2009, 02:33 AM

For those who may have missed it, at the end of last month Jeff Wagg wrote an interesting article looking at CAM practitioners and vaccination. It's accompanied by a short video of a questionable chiropractic presentation:

No Vaccine Against Greed
http://www.randi.org/site/index.php/swift-blog/724-no-vaccine-against-greed.html

Here's snippet from the article:
One of the things that's always puzzled me about the anti-vax movement is why people are motivated to rail against something with so much supportive evidence. Sure, there are legions of misinformed parents who think they're helping society by decrying the vaccination conspiracy, and there are certainly those that have experienced personal loss due to the very, very, rare negative side effects of vaccination. But Chiropractor Dr. Chad Rohlfsen [the chiropractor who features in the video] illustrates in abundance what I think might be the primary motive for anti-vaccine rhetoric, and that is pure, simple, banal greed.

Seems those assumptions may not be too far off the mark.

JJM

12th December 2009, 05:40 AM

Blue Wode

12th December 2009, 06:58 AM

There is news on chiropractic. Four of them went looking and could not find any evidence for the existence of the "subluxation" that is the centerpice of their work! This is news, despite the fact that we have known it for decades, because it is an admission from the chiros. http://www.sciencebasedmedicine.org/?p=3022

According to the Association of Chiropractic Colleges http://www.chirocolleges.org/paradigm_scope_practice.html

Don't be surprised if chiropractors claim in their defence that the authors only went looking for one type of subluxation...
Subluxation Synonyms and Metaphors
By P. L. Rome

The following 329 terms either relate to, are synonyms for, or have been used or cited in connection with describing a subluxation or aspects of a VSC. The use has been in chiropractic, medical and osteopathic papers. There are in fact 371 terms, including the 42 on the sacroiliac list.

Aberrant motion
(Ab)normal articular sensory input
Abnormal dysfunction
Abnormal fixation
Abnormal instantaneous axis of rotation
Abnormal mechanics
Abnormal motion or position
Abnormal muscle function
Abnormal nervous system function
Abnormal spinal function
Altered intervertebral mechanics
Altered joint structure and function
Altered nociceptive and proprioceptive input
Altered regional mechanics
Arthropathic
Abnormal function
(Ab)normal joint mechanics
Abnormal joint motion
Abnormal motion or position
Abnormal muscle function
Abnormalities of range of motion or coupling
Abnormal nervous system function
(Ab)normal regional sympathetic tone
Abnormal restrictive barrier in or around joints
Abnormal spinal function
(Ab)normal structural relationship
Acute joint locking
Acute locking
Adverse mechanical tension of the nervous system
Altered alignment
Altered joint motion
Altered nervous system movement
Altered physiological function
Apophyseal subluxation
Arthron (extremity joint subluxation -- see also "vertebron")
Articular derangement
Articular dyskinesia
Articular juxtaposition
Biomechanical distortion
Biomechanical impropriety
Biomechanical insult
Biomechanical stress
Blockage
Blocking
Bony displacement
Bony maladjustment
Bony lesion
Cervical joint dysfunction
Changes of the dynamic segment
"Changes of thoracic segments"
Chiropractic lesion
Compensatory structural subluxations
Comprehensive lesion
" ... compromise proper function"
Deconditioned syndromes
Deviation of the bodies
Errors of static or motor mechanics
Facet joint syndrome
Facet synovial impingement
Facilitated spinal system
Facilitated subluxation*
Functional pathology
Functional subluxation*
Chiropractic subluxation
Chiropractic subluxation complex
Comprehensive lesion
" ... compromise proper function."
Delayed instability
Deformation behaviour
Degenerative dynamic segment
Derangement
Derangement of the opposing joint surfaces
Discoradicular conflict
Disorder of the disc
Disrelationship of the facets
Displacement
Disturbance in the mechanico-dynamics
"(vertebrae) ... don't move enough, or they move too much."
Dynamic forceps
Dynamic segment
Dysarthric lesion
Dysarthrosis
Dysfunctional joint
Dysponesis
Dystopia
Dysfunctional segments
Engagement of the spinal segment in a pathologic reflex chain
Erratic movement of spinal articulations
Excursion (Conley) = ("Wandering from the usual path." -- Taber's)
Facet imbrication
Facet joint dysfunction
Facet syndrome
Facilitated segment
Facilitative lesion
Fanning of interspinous space
Fixation
Fixed vertebra
Focal tenderness
" ... force other joints to move too much."
Functional block
"(subluxations) ... force other joints to move too much."
Functional compromise
Functional deficit
Functional defects
Functional derangement
Functional and structural changes in the three joint complex
Functional disturbance
Functional impairments of motion
Functional spinal lesion
Functional subluxation*
Gravitational (im)balance of joints (with) reduced chronic, asymmetrical forces
Harmful dysfunction of the neuromusculoskeletal system
Hyperaemic subluxation
Hyperanteflexion sprain
Hypermobility
Hypopmobility
Hypokinetic aberration*
Impairment
(Im)properly direct(ed) coordinated, (in)harmonious motor programming
Inability of the segment to articulate about its new axis
Incomplete luxation
Incomprehensible pattern of symptoms and clinical findings when compared to with examination of mechanical lesions in the extremities
Instability of the posterior ligament complex
Interdiscal block
Internal joint derangement
Internal vertebral syndrome
Intersegmental instability
Intersegmental subluxation
Intervertebral blocking
Intervertebral disrelationship
Intervertebral dysfunction of the mobile segment
Intervertebral joint subluxation
Intervertebral obturations
Intervertebral subluxation
Joint bind
Joint disturbances
Joint dysfunction
Joint immobilization
Joint "instability"
Joint movement restriction
"Just short of a dislocation"
Kinesiopathology
Kinetic intersegmental subluxation
Kinetic subluxation
Lesion
Less than a locked dislocation
Ligatights
Localised/referred pain
Locked
Locking
Locked subluxation
Locks up and restricts motion
Lose their normal motion or position
Loss of elasticity
Loss of joint movement
Loss of juxtaposition
Loss of segmental mobility
Low back dysfunction
Malalignment
Maladjustment (of a vertebra)
Malposed vertebra
Mechanical interferences
Mechanical malfunctioning
Mechanically infringe
Manipulatable joint lesion
Manipulatable lesion (adjustable subluxation!)
Mechanical derangement
Mechanical disorder
Mechanical dysfunction
Mechanical instability
Mechanical irritation of the sympathetic ganglionic chain
Mechanical musculoskeletal dysfunction
Mechanico-neural interaction
Metameric dysfunction
Mild pubic diastasis
Minor derangement
Misalignment
Misalignment of the fibrocartilaginous joint
Motor unit derangement complex
Motion restriction
Movement restriction
Multisegmental spinal distortion
Musculoskeletal dysfunction
Myopathology
Nervous system impairment by the spine
Neuro-articular dysfunction*
Neuro-articular subluxation*
Neuro-articular syndrome*
Neurobiomechanical
Neuro-dysarthric
Neuro-dysarthrodynic
Neurological dysfunction
Neurodystrophy
Neurofunctional subluxation*
Neuro-mechanical lesion*
Neuromuscular unit
Neuromuscular dysfacilitation
Neuromuscular dysfunction
Neuropathology
Neuropathophysiology
Neurospinal condition
Neurospinal distortions
Neurostasis (Wilson)
Occult subluxation
Offset
Orthokinetics
Ortho-spondylo-dysarthrics
Osteological lesion
Osteopathic lesion
Osteopathic spinal lesion
Osteopathic spinal joint lesion
Pain and debility without recognisable pathology
Painful intervertebral dysfunction ("PID")
Painful minor intervertebral dysfunction ("PMID")
Palpable changes
Paravertebral subluxation
Partial dislocation
Partial or incomplete separation
Partial fixation
Partial luxation
Pathogenic interaction of spine and nervous system
Pathophysiological mechanics
Pathologically altered bradytrophic tissue
Pathologically altered dynamic segment
Pathomechanics
Pathophysiology
Perverted function
Physiologic displacement
Physiologic lock the motion segment
Positional dyskineria
Posterior facet dysfunction
Posterior joint dysfunction ("PJD" -- see "three-joint complex"!)
Posterior joint syndrome
Post-traumatic dysautonomic
Prespondylosis
Primary dysfunction
Primary fibromyalgic syndrome
Pseudosubluxation
Putative segmental instantaneous axis of rotation
Reflex dysfunction
Reduced mobility
Regional dysfunction
"Relative as absolute lack of space within the intervertebral foramen"
Residual displacement
Restricted motion
Restriction
Restriction of unisegmental mobility
Reversible with adjustment/manipulation
Sagittal translation (Conley)
Sectional subluxation
Segmental dysfunction
Segmental instability
Segmental movement restriction
Segmental vertebral hypomobility
Semiluxation
Simple joint and muscle dysfunction without tissue damage
Shear strain distribution
Slight luxation
Slightly luxated
Slightly misaligned vertebra
Soft tissue ankylosis
Somatic dysfunction
Spinal dysfunction
Spinal fixation
Spinal hypomobilities
Spinal irritation
Spinal joint blocking
Spinal joint complex
Spinal joint dysfunction
Spinal joint malfunction
Spinal kinesiology
Spinal lesion
Spinal mechanical dysfunction
Spinal pathophysiology
Spinal segmental facilitation
Spinal segmental instability
Spinal subluxation
Spine restriction
Spino-neural conflict
Spinostasis (Wilson)
Spondylodysarthric lesions
Sprain
Stable cervical injury of the spine (see also "instability" above)
Static intersegmental subluxation
Static subluxation
Strain
Strain distribution
Structural abnormalities
Structural derangement
Structural disrelationship
Structural intersegmental distortion
Structural lesions
"Stuck"
Subtle instability
Sub-luxation
Subluxation
Subluxation complex
Subluxation complex myopathy
Subluxation syndrome
Subluxes
Three joint complex
Tilting of the vertebral body
Tightened, deep, joint related structures
Total fixation
Translation
Unresolved mechanical tension or torsion
Unstable lumbar spine
Unstable subluxation
Vertebragenous syndromes
Vertebral derangement
Vertebral displacement
Vertebral dysfunction
Vertebral dyskinesia
Vertebral factor
Vertebral genesis
Vertebral induction
Vertebral lesion*
Vertebral pathology
Vertebral subluxation
Vertebral subluxation complex
Vertebral subluxation syndrome
Vertebrally diseased
Vertebroligamentous sprain strain
Vertebron (see also "arthron")
Wedged disc
Zygopophyseal pathophysiology

42 Terms for a Sacroiliac Subluxation

Abnormal pelvis biomechanics
Altered sacroiliac mechanics
Changed motor pattern (in muscles)
Change in relation
Displacement
Disturbed normal relationship
Distorting the normal mechanics
Downslips (see also "upslips")
Dysarthria
Dysarthric syndrome
" ... effect on body mechanics"
Instability of the pelvic joints
" ... irritation of the nerves is possible ... "
Joint binding
Joint dysfunction
Joint lesion
Joint motion restriction
Joint slip
Joint syndrome
Limitation of motion
Malposition
Malrotation
Mechanical dysfunction
Misplaced
Misplacement
Motions are restricted
Partial luxation
Primary dysfunction
Restrictions
Rotatory slips
Shear dysfunction
Shear mechanism
Slight luxation
Slip
Slipping sacroiliac joints
" ... stick at the limit of normal motion ..."
Strain
Strain and laxity
Tilts (anterior, posterior)
Upslips (see also "downslips")
Vertical slipping of the innominate on the sacrum

Synonyms
59 Synonyms or Metaphors for the "Spinal Adjustment"
Arthral alignment
Atlas therapy
Biokinetic remediation
Bone setting
Chiropractic manipulation
Chiropractic manipulative therapy
Corrective spinal care
Disengage
Diversified-type force application to release the segment at its articulation
Facet adjusting
Fix
Flexion distraction manipulation
Functional restoration
Gentle adjusting
Gently relieve the locked subluxation
High velocity facet adjusting
Human readjustments
Joint manipulation
Low force/amplitude manipulation
Manipulation
Manipulative surgery
Manipulative therapy
Manipulatory
Manual adjustment
Manual cavitation
Manual medicine
Manual reflex neurotherapy
Manual therapy
Manual treatment
Mechanical treatment of the nerve centres.
Mobilisation
Neuro-mechanical spinal chiropractic management
Neuromechanical correction*
Neurotherapeutic
Neurotherapy
Orthokinetics
Orthopedic orthokinetics
Osteopathic manipulative therapy
Osteopathic osteological adjustment
Physiatry
Physical medicine
Readjustment
Reconstructive measure
Reduced
Reduction
Reduction of dislocation
Release of intraarticular pressure
Replacement
Repositioning
Restoration of mobility
Slipped into place
Specific mobilization
Spinal adjustment
Spinal manipulative therapy
Spinal manual therapy
Spondylotherapy
"Springing the spine"
Vertebral adjustment*
Vertebral medicine

* Unreferenced

Reference

Rome PL. Usage of chiropractic terminology in the literature -- 296 ways to say "subluxation." Chiropractic Technique 1996;8:1-12.

Indeed, the UK chiropractic regulatory body, the General Chiropractic Council claims that there is scientific evidence for "the many interpretations" of 'subluxation':
http://209.85.229.132/search?q=cache:ulxx9xD3k3oJ:www.chirovictims.org.u k/images/Letter%2520to%2520GCC%252027.08.04.rtf+%22many+int erpretations%22+word+subluxation+action+victims+ch iro&cd=1&hl=en&ct=clnk&gl=uk

:boggled:

JJM

12th December 2009, 12:00 PM

@Blue Wode, that is a distressing list. However, it does not disentangle the cases where (for example) "spinal dysfunction" is offered as an alternative to "subluxation" which would have been found in the search. In other words, I think the terms would often have been linked ("the spinal dysfunction also known as the subluxation"). Also, we are talking about the "official" term of the ACC, if we deviate from that we deviate from their "paradigm."
'
But, yours is a good catch- we will have to be ready if it comes up.

Dogdoctor

12th December 2009, 12:52 PM

I am sure that even chiropractic schools cannot agree on how to accurately diagnose is a subluxation.

BillyJoe

12th December 2009, 03:26 PM

the General Chiropractic Council claims that there is scientific evidence for "the many interpretations" of 'subluxation'
However, it does not disentangle the cases where, for example...
You cats have such a dry sense of humour. :)

jhunter1163

12th December 2009, 03:42 PM

I used to work in a chiropractor's office. When there was no one around I used to read the various publications that the chiro subscribed to. There was (and is) an enormous amount of bickering and infighting among the leading lights of chiropractic about how to define a subluxation, how much "philosophy" to include in their training and public presentations, and on and on. It seemed disingenuous, to say the least, to be claiming to treat subluxations on the one hand while on the other bickering about how to define the term. If you don't have an objective definition of a subluxation, how can you possibly claim chiropractic is effective in treating it?

Blue Wode

28th January 2010, 12:31 PM

Could chiropractic be doomed in the UK?

That chiropractic can improve the spine and nervous system — whether or not they shun the dreaded ’subluxation’ word — is a universally held belief amongst chiropractors and central to their practice. Although there is no good independent evidence for the existence of subluxations — and some evidence that they don’t exist and do not have any effect on nerve function — there can be little doubt that, without such beliefs, chiropractic does not have a leg to stand on.

It is difficult to imagine how you could describe chiropractic without claiming it improves spine and nerve function.

So what would happen if these claims were undermined by, say, the ASA [Advertising Standards Authority] declaring that such claims have not been substantiated?

That is exactly what the ASA have said.

In my complaint, I doubted that the advertiser could justify the claims that chiropractic could improve the function of the spine and nervous system. The ASA have told me that they expect the advertiser to remove all the claims about conditions, serious or otherwise, not on their approved list and that:

This also applies to the claim that chiropractic is able to improve the function of the spine and nervous system, so we would expect the advertisers to also remove this claim.

A claim about improving the function of the spine or nervous system is treated just like a claim about colic or asthma: they are not on the list, therefore they are not allowed.

However, this is not something new or a new interpretation of their guidance:

…this has been the CAP/ASA position for some time. It is based on substantiation we have seen from the Chiropractic community, independent expert advice and previous adjudications.

A chiropractor making such a claim would be contrary to ASA guidance — and this has been the case for some time. And since ASA guidance forms an integral part of the GCC’s Code of Practice, it would seem that chiropractors are in a bit of a pickle.

http://www.zenosblog.com/2010/01/discover-chiropractic/

JJM

29th January 2010, 01:52 AM

Chiropractors question the existence of subluxations: http://www.sciencebasedmedicine.org/?p=3022

JJM

26th February 2010, 03:29 AM

Two new articles have just been published in the journal Chiropractic & Osteopathy which are relevant to this thread: ...

Commentary on the United Kingdom evidence report about the effectiveness of manual therapies
http://www.chiroandosteo.com/content/18/1/4

ETA. Page 77 of the pdf of the report says that it was funded by the GCC:
http://www.chiroandosteo.com/content/pdf/1746-1340-18-3.pdfThe first thing I noticed was the standard, chiro "bait and switch" ploy. That is probably why the report is titled "Effectiveness of manual therapies" rather than referring to "chiro therapies." You might think this is an evaluation of chiro practices; but it includes manipulation performed by PTs, masseurs, and reflexologists (and, probably, doctors).

The problem is that chiros usually claim superiority and different techniques from those employed by PTs and doctors. Moreover, it illustrates the chiro notion that they can substitute for PTs; for which they lack proper training. When chiros are not detecting and [I]adjusting "subluxations" they are trying to emulate other fields. Note that they often re-name and re-define "subluxation"; but it is all the same.

Mojo

26th February 2010, 03:47 AM

The first thing I noticed was the standard, chiro "bait and switch" ploy. That is probably why the report is titled "Effectiveness of manual therapies" [italics added] rather than referring to "chiro therapies." You might think this is an evaluation of chiro practices; but it includes manipulation performed by PTs, masseurs, and reflexologists (and, probably, doctors).

It doesn't always work (http://www.asa.org.uk/Complaints-and-ASA-action/Adjudications/2009/5/Dr-Carl-Irwin-and-Associates/TF_ADJ_46281.aspx): In relation to the chiropractic treatment of IBS we noted the evidence provided included a 2007 randomised controlled pilot study relating to osteopathy and another randomised controlled study where results involving the treatment of IBS with osteopathy were described as "promising"; we noted, however, that those studies referred to osteopathy, not chiropractic.

Blue Wode

27th February 2010, 06:21 AM

IMO, the General Chiropractic Council's (GCC) newly published report http://www.chiroandosteo.com/content/pdf/1746-1340-18-3.pdf doesn’t seem to have a great deal to do with ‘chiropractic’.

For example, the Background section on page 2 says that the report is “a summary of scientific evidence regarding the effectiveness of manual treatment…” The chiropractic ‘bait and switch’ http://www.dcscience.net/?p=1516 doesn’t seem to be addressed, nor do valid concerns about the apparent high frequency of under-reporting of serious complications http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

Page 15 is particularly interesting. It includes a look at the Hancock et al study (published in the Lancet in 2007), and states that: “Hancock et al found spinal mobilization in addition to medical care was no more effective than medical care alone at reducing the number of days until full recovery for acute LBP. This study had a low risk of bias.” Since the GCC report looks at the scientific evidence for manual therapy, it makes one wonder why, when the Lancet study was originally published, the GCC was up in arms about it, protesting that it didn’t address the effectiveness of ‘chiropractic’:
http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf

Indeed, both the GCC and the British Chiropractic Association (BCA) wrote to the Press Complaints Commission (PCC) in an attempt to elicit a public apology from three newspapers for saying that the study showed that chiropractic was ‘a waste of money’. See here
http://www.gcc-uk.org/files/page_file/Letter%20PCC%2020Nov07%20(Website).pdf

You can read about the BCA’s complaint, and the outcomes of both complaints, on pages 6 and 7 of the GCC’s March 2008 newsletter here:
http://www.gcc-uk.org/files/link_file/WEBSITE_GCCNews23.pdf

Now here's a summary of the Lancet study, with a link to its full text at the end of the quote…
Patients with acute low back pain receiving recommended first-line care do not recover more quickly with the addition of diclofenac or spinal manipulative therapy.

-snip-

The spinal manipulative therapy given in this trial included a range of low-velocity mobilisation and high-velocity manipulation techniques done by physiotherapists with postgraduate training in manipulative therapy. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal mobilisation is more effective than low-velocity spinal manipulation, or that the profession of the manipulator affects the effectiveness of treatment.

Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial Hancock MJ et al; Lancet:370:1638-43 (2007)
http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf

…and this is what the Consumer Health Digest newsletter, published by the National Council Against Health Fraud, had to say about the study:
Doubt cast on value of spinal manipulation and NSAIDS for acute back pain.

Australian researchers found that neither spinal manipulation or the drug diclofenac hastened recovery of acute low-back pain patients who had been properly counseled by their primary physician and prescribed paracetamol for pain relief. The study involved 240 patients who received either (a) diclofenac plus spinal manipulation, (b) diclofenac and sham spinal manipulation, (c) spinal manipulation and a placebo pill, or (d) sham manipulation plus a placebo pill. About half recovered within two weeks and nearly all recovered within three months.

[Hancock MJ and others. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomized controlled trial. Lancet 370:1638-1643, 2007]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=PubMed&Cmd=ShowDetailView&TermToSearch=17993364&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). Paracetamol is a pain-reliever marketed in the United States as acetominophen or Tylenol. An accompanying editorial noted:

**Systematic reviews had concluded that NSAIDS and spinal manipulation were more effective than placebos. However, the patients in the reviewed studies did not have optimum first-line care, and the apparent benefit was not large.

**Advice to remain active and prescription of paracetamol will be sufficient for most patients with acute low back pain.
[Koes BW. Evidence-based management of acute low back pain. Lancet 370:1595-1596, 2007]

http://www.ncahf.net/digest07/07-47.html

Page 73 of the GCC’s report is also interesting. It cites a systematic review of adverse events associated with paediatric spinal manipulation. However, that review failed to include the harms listed at the end of this summary:
Adverse events associated with chiropractic care of children. A systematic review has identified 34 cases in which spinal manipulation in children was associated with adverse events. [Vohra S. Adverse events associated with pediatric spinal manipulation: A systematic review. Pediatrics 119(1) January 2007, pp. e275-e283]

Fourteen of the cases involved "direct" events in which the treatment was followed by death, serious injury, symptoms requiring medical attention, or soreness. The rest involved "indirect" events in which appropriate diagnosis was delayed and/or inappropriate manipulation was done for serious medical conditions such as meningitis.

The reviewers commented that despite the fact that spinal manipulation is widely used on children, pediatric safety data are virtually nonexistent.

This type of review cannot determine how often adverse events occur. That would require a prospective study with active surveillance. The article did not consider harmful aspects of chiropractic care that are far more common than the reported events. These include (a) decreased use of immunization due to misinformation given to parents, (b) psychologic harm related to unnecessary treatment, (c) psychologic harm caused by exposure to false chiropractic beliefs about "subluxations," and (d) financial harm due to unnecessary treatment.

http://www.ncahf.org/digest07/07-14.html

The first harm (a) is a particular concern when you consider that only one out of 16 UK chiropractors who responded to this survey advised in favour of the MMR vaccination:
http://www.dcscience.net/schmidt-ernst-vaccine-2003.pdf

For those interested, there’s more discussion on the GCC report at Chirotalk http://chirotalk.proboards.com/index.cgi?action=display&board=evidence&thread=4685&page=1

and at Zeno’s blog http://www.zenosblog.com/2010/02/the-gccs-plethora/

Also, watch out for a Guardian article on it on Monday by Martin Robbins http://layscience.net/node/956

[NB. The information above also has some bearing on the GCC’s newly published revalidation document. You can read a scanned copy here: http://www.gcc-uk.org/files/page_file/C-170210-04a.pdf ]

Mojo

27th February 2010, 12:40 PM

Since the GCC report looks at the scientific evidence for manual therapy, it makes one wonder why, when the Lancet study was originally published, the GCC was up in arms about it, protesting that it didn’t address the effectiveness of ‘chiropractic’:

Did they still have promotion of chiropractic as part of their remit when they made the complaint?

Blue Wode

27th February 2010, 12:51 PM

Did they still have promotion of chiropractic as part of their remit when they made the complaint?

Yes, but remember that the Lancet study said this:
The spinal manipulative therapy given in this trial included a range of low-velocity mobilisation and high-velocity manipulation techniques done by physiotherapists with postgraduate training in manipulative therapy. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal mobilisation is more effective than low-velocity spinal manipulation, or that the profession of the manipulator affects the effectiveness of treatment.

Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial Hancock MJ et al; Lancet:370:1638-43 (2007)

http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf

Soapy Sam

27th February 2010, 09:36 PM

"The spinal manipulative therapy given in this trial included a range of low-velocity mobilisation and high-velocity manipulation techniques done by physiotherapists with postgraduate training in manipulative therapy. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal mobilisation is more effective than low-velocity spinal manipulation, or that the profession of the manipulator affects the effectiveness of treatment"

"Included" or the much misused "comprised"? If the trial therapy was only given by one profession, it's invalid to conclude that it makes no difference what profession applied it. I'm prepared to bet , were the same techniques of HV spine snapping applied by (say) marine commandos, the results might be rather different.
Seriously I don't follow the argument there, unless the second sentence "A systematic review..." bears no relation to the events decribed in the first sentence.
It's a bit opaque.

borealys

27th February 2010, 09:51 PM

Don't be surprised if chiropractors claim in their defence that the authors only went looking for one type of subluxation...

Well now, I only skimmed that list, but one item on it jumped out at me.

They're seriously claiming that dysarthria is a form of "sacroiliac subluxation"?

Dysarthria (http://www.answers.com/topic/dysarthria) is a motor speech disorder. Actually, it's a family of motor speech disorders, which can have numerous causes, absolutely none of which have anything to do with the sacroiliac joint. It's a head and neck disorder, for crying out loud! Couldn't they at least have blamed it on a subluxation a little higher up in the spinal column? :boggled:

Blue Wode

28th February 2010, 03:07 AM

"Included" or the much misused "comprised"? If the trial therapy was only given by one profession, it's invalid to conclude that it makes no difference what profession applied it. I'm prepared to bet , were the same techniques of HV spine snapping applied by (say) marine commandos, the results might be rather different.

Seriously I don't follow the argument there, unless the second sentence "A systematic review..." bears no relation to the events decribed in the first sentence.

It's a bit opaque.

Soapy, the problem centres on a lack of standardisation which allows confusion to prevail to chiropractors’ advantage. Spinal manipulation is not *real* chiropractic, but chiropractors will shout from the rooftops when a positive study for spinal manipulation is published. However, when a negative study for spinal manipulation appears, they are usually quick to condemn it as not being representative of ‘chiropractic’. Veteran chiropractor, Samuel Homola describes the problem in this article:
http://jmmtonline.com/documents/HomolaV14N2E.pdf

Snippet –
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. Only evidence-based chiropractors, who have renounced subluxation dogma, can be part of a team that would research the effects of manipulation without bias…

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. Many physical therapists are now using manipulation/mobilization techniques. Of the 209 physical therapy programs in the US, 111 now offer Doctor of Physical Therapy (DPT) degrees. Some of these programs have been opened to qualified chiropractors.

According to the American Physical Therapy Association, “…Physical therapy, by 2020, will be provided by physical therapists who are doctors of physical therapy and who may be board-certified specialists. Consumers will have direct access to physical therapists in all environments for patient/client management, prevention, and wellness services. Physical therapists will be practitioners of choice in patients’/clients’ health networks and will hold all privileges of autonomous practice…”

It matters little who does spinal manipulative therapy as long as it is appropriate and evidence-based. There can be cooperation between chiropractors and other practitioners of manual therapy if everyone works under the common denominator of science and if treatment methods are standardized.

It’s important to note that although the GCC’s report is on the effectiveness of *manual therapies*, it fails to make an explicit distinction between the type of manual therapy offered by chiropractors (with its pseudoscientific underpinnings) and that offered by other manual therapists who are much less mired in quackery (if at all).

fls

28th February 2010, 03:57 AM

Seriously I don't follow the argument there, unless the second sentence "A systematic review..." bears no relation to the events decribed in the first sentence.

This.

It's a statement made in reference to a different study (i.e. a systematic review).

Linda

DrFrankmeister

1st March 2010, 09:44 AM

JJM

I am responding to your comments drawn from Dr. Joe Keating's 2001 article:

1. A prophylactic or health-maintaining effect of manipulation has not been experimentally demonstrated to date.

I'd like to draw your attention to this article, published the year before Joe wrote his comments:
Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II
J Manipulative Physiol Ther 2000 (Jan); 23 (1): 10–19
Available in the LINKS Section of Chiro.Org

The important points from this article are:

A: The cost of health care for patients receiving MC in this study was far less than that for patients of similar age in the general population, despite the doubling of physician visits (chiropractic visits vs. medical visits). The greatest difference in health care costs with patients receiving maintenance care was in the areas of nursing care and, especially, hospital care. This reduced need for hospital and nursing home services has recently been corroborated by the research of Coulter et al. [Review the Coulter et al statistics]

B: Chiropractic patients receiving maintenance care, when compared with US citizens of the same age, spent only 31% of the national average for health care services and reported a 50% reduction in medical provider visits.

C: The health habits of patients receiving maintenance care were better overall than the general population, including decreased use of cigarettes and non-prescription drugs. Furthermore, 95.8% believed the care to be either “considerably” or “extremely” valuable.

2. The value of “regular check-ups” by chiropractors is also unknown.

The last article discusses "maintenance" (aka wellness, aka asymptomatic) care, and does find significant differences between chiropractic patients and their matched peers.

3. The disease-producing and pathology-producing effects of subluxation-complex, if any, have not been demonstrated experimentally.

I presume that you are not a doctor, so I'll keep these comments simple. The classic explanation of the subluxation complex is:

Kinesiopathology, or loss of alignment and/or motion irregularities (the 739 and 839 and the 737 ICD-9-CM codes), Neuropathology, which occur due to compressed or facilitated nerve tissue (the 722-24, 353 ICD-9-CM codes), Myopathology, or soft tissue changes due to muscle and ligament damage, involving spasm, muscle weakness/atrophy and development of myofascial disorders (the 728-29, 847 ICD-9-CM codes), Histopathology, or the pre and post inflammatory changes that result as sequela to the primary soft tissue damage, progressing from edema to congestion of tissue to eventual remodeling (the 719, 782 ICD-9-CM codes), and Pathophysiology, or the degeneration and/or fibrous tissue formation which are the inevitable outcomes of poor management of the other components (the 732-39, 723 ICD-9-CM codes).

There is significant (though unrelated) studies that demonstrate each of these processes. They are too extensive to list here, but much of this material is archived on the Chiro.Org website in the Research and LINKS Sections:

The LINKS and Research Section are both available at Chiro.Org

4. Adjusting has not been experimentally demonstrated to alter vertebral alignment or “nerve pressure”; such effects, if possible, have not been shown to influence neuritis.

You seem to be relying on relatively ancient chiropractic theories for your critique, because of the use of the term "nerve pressure". Chiropractic has been shown to reduce radiculopathy, and radiculopathy has been shown to evolve from irritated facet joints. Please refer to the Radiculopathy Page.
Available in the LINKS Section of Chiro.Org

5. Currently available experimental data do not justify any claims for the value of chiropractic care in populations of children.

Wrong! There has been negative results in trials on colic and asthma, but the results for low back pain, thoracic spine pain, neck pain, and headaches has been positive. I'd like to quote a passage from a newly published article:

"numerous claims made by chiropractors over the years, based on their clinical observations, have not stood up to critical analysis and the results of studies often suggest that these observations are due to placebo or the natural course of the disorder rather than the actual treatment. This has been true of a vast number of medical treatments. A recent Special Issue of The Spine Journal on Evidence Informed Management of Chronic Low Back Pain listed over 200 treatments currently being offered patients with low back pain, most of which are offered by medical physicians [3]. Of these, less than 10% have a reasonable body of support based on high quality clinical trials. The greatest research support was for therapies commonly used by chiropractors including the manual therapies, education and exercise."

"Commentary on the United Kingdom evidence report about the effectiveness of manual therapies"
Chiropractic & Osteopathy 2010 (Feb 25)

The conclusions from this extensive review are:

"Spinal manipulation/mobilization is effective in adults for: acute,
subacute, and chronic low back pain; migraine and cervicogenic headache;
cervicogenic dizziness; manipulation/mobilization is effective for several
extremity joint conditions; and thoracic manipulation/mobilization is
effective for acute/subacute neck pain. The evidence is inconclusive for
cervical manipulation/mobilization alone for neck pain of any duration,
and for manipulation/mobilization for mid back pain, sciatica,
tension-type headache, coccydynia, temporomandibular joint disorders,
fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal
manipulation is not effective for asthma and dysmenorrhea when compared to
sham manipulation, or for Stage 1 hypertension when added to an
antihypertensive diet. In children, the evidence is inconclusive regarding
the effectiveness for otitis media and enuresis, and it is not effective
for infantile colic and asthma when compared to sham manipulation. Massage
is effective in adults for chronic low back pain and chronic neck pain.
The evidence is inconclusive for knee osteoarthritis, fibromyalgia,
myofascial pain syndrome, migraine headache, and premenstrual syndrome. In
children, the evidence is inconclusive for asthma and infantile colic. "

"Effectiveness of manual therapies: the UK evidence report"
Chiropractic & Osteopathy 2010 (Feb 25)

This article, in particular, addresses the difference between clinical experience, opinion, and verifiable, reproducible, and measurable results in a clinical trial.

I understand that you (like myself) have opinions, but this study helps us to distinguish between our perhaps-biased opinions and the realities of scientific conclusions.

I certainly have issues with the asthma trials published in the past, primarily because they ignore the fact that both the placebo and active treatment groups improved in symptoms compared with controls. The conclusion was wrong, because it was based on the premise that the "placebo" had no effect.

Today researchers are becoming more aware of the "non-specific" effects of care generated by the "laying on of hands" and the sense of hope generated by the distinctly different way in which a chiropractor interacts with a patient. I have collected a variety of articles on this topic:
The Problem with Placebos/Shams
In Chiro.Org's Research Section

Our website (Chiro.Org) is devoted to collecting articles about chiropractic, from case studies through randomized trials. Over time, we will all better understand why chiropractic is so loved by clinicians and patients alike. Meanwhile, I see patients improve every day in my office when other forms of medical treatment had left them suffering. It is that joy I experience every day that helps he maintain my perspective when I read the negative comments posted on the anti-quack and science-buff nay-sayer websites.

I hope you will find these articles informative.

Warmly,

Frank M. Painter, D.C.
Frankp@chiro.org

P.S. This website prevented me from posting URLs to the pages I quoted above, but each section of the Chiro.Org website have their own Search Tools, so they can easily be found, if you are interested.

fls

1st March 2010, 11:56 AM

JJM

I am responding to your comments drawn from Dr. Joe Keating's 2001 article:

1. A prophylactic or health-maintaining effect of manipulation has not been experimentally demonstrated to date.

I'd like to draw your attention to this article, published the year before Joe wrote his comments:
Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II
J Manipulative Physiol Ther 2000 (Jan); 23 (1): 10–19
Available in the LINKS Section of Chiro.Org

The important points from this article are:

A: The cost of health care for patients receiving MC in this study was far less than that for patients of similar age in the general population, despite the doubling of physician visits (chiropractic visits vs. medical visits). The greatest difference in health care costs with patients receiving maintenance care was in the areas of nursing care and, especially, hospital care. This reduced need for hospital and nursing home services has recently been corroborated by the research of Coulter et al. [Review the Coulter et al statistics]

B: Chiropractic patients receiving maintenance care, when compared with US citizens of the same age, spent only 31% of the national average for health care services and reported a 50% reduction in medical provider visits.

C: The health habits of patients receiving maintenance care were better overall than the general population, including decreased use of cigarettes and non-prescription drugs. Furthermore, 95.8% believed the care to be either “considerably” or “extremely” valuable.

2. The value of “regular check-ups” by chiropractors is also unknown.

The last article discusses "maintenance" (aka wellness, aka asymptomatic) care, and does find significant differences between chiropractic patients and their matched peers.

The only conclusion which can be drawn from this study is that people who choose to visit a chiropractor tend to be quite different from the general population. It should be quite obvious that this group would tend not to include those who already are undergoing treatment and care related to medical conditions. If you exclude from your sample those people most likely to require hospital care, of course you will see a below average utilization of that care, even if you do nothing useful for them over the course of the next few years.

Also, you posted this study in response to the comment that "a prophylactic or health-maintaining effect of manipulation has not been experimentally demonstrated to date". This was an observational study, not an experimental study, so I have to wonder why you bring up something which cannot be considered a valid response.

3. The disease-producing and pathology-producing effects of subluxation-complex, if any, have not been demonstrated experimentally.

I presume that you are not a doctor, so I'll keep these comments simple. The classic explanation of the subluxation complex is:

Kinesiopathology, or loss of alignment and/or motion irregularities (the 739 and 839 and the 737 ICD-9-CM codes), Neuropathology, which occur due to compressed or facilitated nerve tissue (the 722-24, 353 ICD-9-CM codes), Myopathology, or soft tissue changes due to muscle and ligament damage, involving spasm, muscle weakness/atrophy and development of myofascial disorders (the 728-29, 847 ICD-9-CM codes), Histopathology, or the pre and post inflammatory changes that result as sequela to the primary soft tissue damage, progressing from edema to congestion of tissue to eventual remodeling (the 719, 782 ICD-9-CM codes), and Pathophysiology, or the degeneration and/or fibrous tissue formation which are the inevitable outcomes of poor management of the other components (the 732-39, 723 ICD-9-CM codes).

There is significant (though unrelated) studies that demonstrate each of these processes. They are too extensive to list here, but much of this material is archived on the Chiro.Org website in the Research and LINKS Sections:

The LINKS and Research Section are both available at Chiro.Org

I am a physician. You have simply listed established medical conditions without establishing any connection between them and something you call a 'subluxation complex'.

4. Adjusting has not been experimentally demonstrated to alter vertebral alignment or “nerve pressure”; such effects, if possible, have not been shown to influence neuritis.

You seem to be relying on relatively ancient chiropractic theories for your critique, because of the use of the term "nerve pressure". Chiropractic has been shown to reduce radiculopathy, and radiculopathy has been shown to evolve from irritated facet joints. Please refer to the Radiculopathy Page.
Available in the LINKS Section of Chiro.Org

Again, you reference observational, rather than experimental research. All this demonstrates is that many people with radiculopathy show improvement in their symptoms with conservative treatment - something we already knew. None of these studies allow you to conclude that chiropractic in general or treatment directed at something you call subluxation complexes, alters that outcome.

5. Currently available experimental data do not justify any claims for the value of chiropractic care in populations of children.

Wrong! There has been negative results in trials on colic and asthma, but the results for low back pain, thoracic spine pain, neck pain, and headaches has been positive. I'd like to quote a passage from a newly published article:

"numerous claims made by chiropractors over the years, based on their clinical observations, have not stood up to critical analysis and the results of studies often suggest that these observations are due to placebo or the natural course of the disorder rather than the actual treatment. This has been true of a vast number of medical treatments. A recent Special Issue of The Spine Journal on Evidence Informed Management of Chronic Low Back Pain listed over 200 treatments currently being offered patients with low back pain, most of which are offered by medical physicians [3]. Of these, less than 10% have a reasonable body of support based on high quality clinical trials. The greatest research support was for therapies commonly used by chiropractors including the manual therapies, education and exercise."

"Commentary on the United Kingdom evidence report about the effectiveness of manual therapies"
Chiropractic & Osteopathy 2010 (Feb 25)

The conclusions from this extensive review are:

"Spinal manipulation/mobilization is effective in adults for: acute,
subacute, and chronic low back pain; migraine and cervicogenic headache;
cervicogenic dizziness; manipulation/mobilization is effective for several
extremity joint conditions; and thoracic manipulation/mobilization is
effective for acute/subacute neck pain. The evidence is inconclusive for
cervical manipulation/mobilization alone for neck pain of any duration,
and for manipulation/mobilization for mid back pain, sciatica,
tension-type headache, coccydynia, temporomandibular joint disorders,
fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal
manipulation is not effective for asthma and dysmenorrhea when compared to
sham manipulation, or for Stage 1 hypertension when added to an
antihypertensive diet. In children, the evidence is inconclusive regarding
the effectiveness for otitis media and enuresis, and it is not effective
for infantile colic and asthma when compared to sham manipulation. Massage
is effective in adults for chronic low back pain and chronic neck pain.
The evidence is inconclusive for knee osteoarthritis, fibromyalgia,
myofascial pain syndrome, migraine headache, and premenstrual syndrome. In
children, the evidence is inconclusive for asthma and infantile colic. "

"Effectiveness of manual therapies: the UK evidence report"
Chiropractic & Osteopathy 2010 (Feb 25)

This evidence report does not support your assertion that the use of chiropractic in children is evidence-based. For one thing, that report was directed at manual therapies, not solely chiropractic therapies, so the included therapies are not directed at the idea of 'subluxation complexes'. And, more importantly, there were no uses in children that were supported by evidence.

This article, in particular, addresses the difference between clinical experience, opinion, and verifiable, reproducible, and measurable results in a clinical trial.

I understand that you (like myself) have opinions, but this study helps us to distinguish between our perhaps-biased opinions and the realities of scientific conclusions.

I certainly have issues with the asthma trials published in the past, primarily because they ignore the fact that both the placebo and active treatment groups improved in symptoms compared with controls. The conclusion was wrong, because it was based on the premise that the "placebo" had no effect.

Today researchers are becoming more aware of the "non-specific" effects of care generated by the "laying on of hands" and the sense of hope generated by the distinctly different way in which a chiropractor interacts with a patient. I have collected a variety of articles on this topic:
The Problem with Placebos/Shams
In Chiro.Org's Research Section

The effects attributed to placebo are fairly mundane. Most of the effects simply represent biases inherent in choosing a study population, such as regression to the mean, which means that those effects are present even if you do nothing. The remainder of the effects represent small, clinically insignificant changes in reports of subjective perceptions, with changes in pain the best established alteration. Even then, the average improvement tends to be below the threshold which is considered by patients to be clinically relevant.

http://content.nejm.org/cgi/content/short/344/21/1594

I appreciate the idea of taking an evidence-based, rather than opinion-based approach to chiropractic, but then I have to wonder why you failed to use an evidence-based approach when addressing the criticisms.

ETA: Just to be clear, I did go to chiro.org and look at the articles you referred to. Your directions were clear and the articles were easy to find. The JREF forum blocks links until you have 15 posts in order to block spammers from flooding the forum with links.

Linda

JJM

1st March 2010, 03:07 PM

There is little left for me to add.
JJM

I am responding to your comments drawn from Dr. Joe Keating's 2001 article: ...

4. Adjusting has not been experimentally demonstrated to alter vertebral alignment or “nerve pressure”; such effects, if possible, have not been shown to influence neuritis.

You seem to be relying on relatively ancient chiropractic theories for your critique, because of the use of the term "nerve pressure". ...A minor point: "nerve pressure" was Keating's term, not mine.
... "Commentary on the United Kingdom evidence report about the effectiveness of manual therapies"

http://www.chiroandosteo.com/content/18/1/3 [JJM]
"Effectiveness of manual therapies: the UK evidence report"
Chiropractic & Osteopathy 2010 (Feb 25) ...That review is not about chiropractic, and it is difficult to sort through all the original sources. However, it is clear that what counts for favorable evidence does not pass muster in scientific circles.

For example, they claim the evidence for chiro treatment of enuresis (bed wetting) is inconclusive but favorable. That is their summary of two papers: *Reed WR, Beavers S, Reddy SK, Kern G: Chiropractic management of
primary nocturnal enuresis. J Manipulative Physiol Ther 1994, 17: 596-600.

Leboeuf C, Brown P, Herman A, Leembruggen K, Walton D, Crisp TC:
Chiropractic care of children with nocturnal enuresis: a prospective
outcome study. J Manipulative Physiol Ther 1991, 14: 110-115.

The latter (1991) study was un-blinded and uncontrolled, and concluded that chiro did not work. The former (1994) was tiny, and the treatment and control groups were not closely matched; and the treatment and control groups were not statistically different after treatment. Maybe you can explain how this is interpreted as "inconclusive" and "favorable."

The review is rife with such over-enthusiastic interpretations of literature, and non-chiropractic references. Aside from low-back pain, there is little support for chiropractic.

Rolfe

1st March 2010, 03:40 PM

:popcorn1

Rolfe.

zeno2712

1st March 2010, 05:26 PM

I think I'll join you, Rolfe.

:popcorn1

BenBurch

1st March 2010, 06:05 PM

want some garlic butter for that popcorn?

Blue Wode

2nd March 2010, 01:25 AM

...they claim the evidence for chiro treatment of enuresis (bed wetting) is inconclusive but favorable. That is their summary of two papers: *Reed WR, Beavers S, Reddy SK, Kern G: Chiropractic management of
primary nocturnal enuresis. J Manipulative Physiol Ther 1994, 17: 596-600.

Leboeuf C, Brown P, Herman A, Leembruggen K, Walton D, Crisp TC:
Chiropractic care of children with nocturnal enuresis: a prospective
outcome study. J Manipulative Physiol Ther 1991, 14: 110-115.

The latter (1991) study was un-blinded and uncontrolled, and concluded that chiro did not work. The former (1994) was tiny, and the treatment and control groups were not closely matched; and the treatment and control groups were not statistically different after treatment. Maybe you can explain how this is interpreted as "inconclusive" and "favorable."

The review is rife with such over-enthusiastic interpretations of literature, and non-chiropractic references. Aside from low-back pain, there is little support for chiropractic.

Indeed. One has to wonder about the impartiality of the review. It’s worth noting that its lead author, Gert Bronfort, serves on NCCAM's National Advisory Council for Complementary and Alternative Medicine (NACCAM): http://nccam.nih.gov/about/naccam/roster.htm

For those not up to speed with NCCAM, this is what the Skeptics Dictionary recently had to say about it:
“We've been waiting for 16 years for the NIH to announce some major breakthrough in health care that has emerged from NCCAM. Unfortunately, most of the "alternative" research is driven by faith, hope, and ideology rather than science. As Dr. Wallace Sampson noted: the NCCAM "is the only entity in the NIH [among some 27 institutes and centers] devoted to an ideological approach to health”….. $2.5 billion spent, no alternative cures found…”

http://www.skepdic.com/NCCAM.html

This is also interesting:
“Dr. Bronfort was recently commissioned by the British General Chiropractic Council to report on the evidence for chiropractic care. The Council and the British Chiropractic Association (BCA) has come under intense public scrutiny and pending litigation due to a large number of false-advertising claims filed against field practitioners. The purpose of the report was to help sort out what can and cannot be claimed about the effectiveness of chiropractic care, particularly manual therapies. The report is expected to be published in a peer-review journal in late 2009 or early 2010.

Drs. Bronfort and Evans [a co-author of the GCC’s Evidence Report] were keynote speakers at the British Chiropractic Association Conference held in Wales, England, in October 2009.”

http://www.nwhealth.edu/nwtoday/research1109.html

Tell your friends.

Mojo

2nd March 2010, 02:49 AM

$2.5 billion spent, no alternative cures found…”

http://www.skepdic.com/NCCAM.html

Well, since "cures which cannot be demonstrated to work" is a pretty good working definition of what they've been asked to investigate...

DrFrankmeister

3rd March 2010, 12:11 PM

There's been an interesting collection of responses to my posting to JJM:

1. The most egregious comment was the claim by "blue wode" that NCCAM spent $2.5 billion (LOL!) in 17 years. That was the total budget of NIH for all 27 instuitutes. The first year (1993?) the total alt-med budget was #1 million. WOW! I'm not sure how much clinical research you've done, but most trials I've seen budgets for were in the range of 1/4 to 1/2 million each, so how far would a million go?

2. I truly appreciated Linda's response. Your first point that The only conclusion which can be drawn from this study is that people who choose to visit a chiropractor tend to be quite different from the general population. may or may not be true. And it is a prospective study.

As for your comments about the "subluxation complex", I didn't realize you expected me to "prove" it's existence. I'd prefer to leave that to the NIH and the research centers at our colleges.

Observational versus experimental: Until the mid 90's MDs were blocked by the AMA and various other named medical sociaties from teaching, or conducting research with my profession. We were blocked access to any federal grant money to do research, and in fact the first 5 or 6 million granted to my alma mater Palmer college (in the late 90's) was primarily devoted to improving the infrastructure for research, and for funding some students to complete PhD study in epidemiology and public health. This is NOT a complaint....it's just background. Any research published and conducted previous to that was 100% funded by our federally un-subsidized schools. This is unheard of in the medical world, paying out of your own pocket to fund research.

Even so, there has been some good work done, and there's plenty more to do.

As your comment "This evidence report does not support your assertion that the use of chiropractic in children is evidence-based. For one thing, that report was directed at manual therapies, not solely chiropractic therapies," I never said it was solely about chiropractic. Do you have compelling proof that neck pain, low back pain, or headaches in children is uniquely different than that experienced by aldults? I believe that was the point I was trying to make.

I'm happy you found the website easy to utilize. Sadly, many of our materials are abstract only, but any articles that offer free accsess are clearly marked.

I had to give up half my lunchbreak to type this, so that's it for now.

Warmly,

Frank M. Painter, D.C.
Frankp@chiro.org

Here_to_learn

3rd March 2010, 12:44 PM

Any research published and conducted previous to that was 100% funded by our federally un-subsidized schools. This is unheard of in the medical world, paying out of your own pocket to fund research.One would hope so - at least I would hope that it would be the other way around - the research to verify that something actually works would come before teaching students about it.

BenBurch

3rd March 2010, 12:55 PM

One would hope so - at least I would hope that it would be the other way around - the research to verify that something actually works would come before teaching students about it.

And still they have nothing honest to show for it.

Blue Wode

3rd March 2010, 01:21 PM

Blue Wode

4th March 2010, 03:27 AM

This is quite a revealing account of an undercover trip to a chiropractic clinic in the UK:
http://www.skepticat.org/2010/03/inside-the-spine-wizards-den/

IMO, it further justifies the heavy criticism that's repeatedly levelled at the chiropractic industry.

fls

4th March 2010, 06:14 AM

2. I truly appreciated Linda's response. Your first point that The only conclusion which can be drawn from this study is that people who choose to visit a chiropractor tend to be quite different from the general population. may or may not be true.

It may or may not be true, but epidemiology 101 would tell you that it would be very foolish to assume that it is not.

And it is a prospective study.

Yes, prospective studies are one type of observational study.

As for your comments about the "subluxation complex", I didn't realize you expected me to "prove" it's existence. I'd prefer to leave that to the NIH and the research centers at our colleges.

Isn't that the point? Without evidence that there even exists something called the "subluxation complex", how is it not quackery to offer treatment based on an idea which is increasingly contradicted by advances in medical knowledge?

Observational versus experimental: Until the mid 90's MDs were blocked by the AMA and various other named medical sociaties from teaching, or conducting research with my profession. We were blocked access to any federal grant money to do research, and in fact the first 5 or 6 million granted to my alma mater Palmer college (in the late 90's) was primarily devoted to improving the infrastructure for research, and for funding some students to complete PhD study in epidemiology and public health. This is NOT a complaint....it's just background. Any research published and conducted previous to that was 100% funded by our federally un-subsidized schools. This is unheard of in the medical world, paying out of your own pocket to fund research.

Chiropractic was thought up long before medicine established its own evidence base. And the availability of federal funds for research is a relatively recent addition. Chiropractic had similar opportunities to take the path that medicine took when it comes to introducing a science-based approach. I agree that they are now at a disadvantage because they chose not to do so. But if, as you say, funds are tight, wouldn't it make more sense to make good use of those funds through the performance of studies which provide useful results, instead of performing studies like the observational study you first referred to, where no useful conclusions can be drawn? And this still doesn't explain why reasonable research is performed only to be ignored (such as the research which fails to show that chiropractic is effective against most tested conditions).

Also, self-funding of medical research is common, as well as making uses of non-federal sources of funds (non-profits/foundations, institutional funds, commercial sources) which should also be readily available to chiropractic.

As your comment "This evidence report does not support your assertion that the use of chiropractic in children is evidence-based. For one thing, that report was directed at manual therapies, not solely chiropractic therapies," I never said it was solely about chiropractic. Do you have compelling proof that neck pain, low back pain, or headaches in children is uniquely different than that experienced by aldults? I believe that was the point I was trying to make.

It should be. Adults suffer from different conditions than children and the causes of back pain are different. Also there are substantial differences in anatomy and physiology between children and adults - for example, the extent of ossification of the bones differs.

And the point about manual therapies is that there is no justification for chiropractic as a 'profession' if it doesn't offer anything specific to chiropractic, but simply represent therapies that are available through already well-established professions. You don't need a whole new 'profession' to offer advice to quit smoking, for example. Without "subluxation complexes", chiropractic at best simply represents a hodge-podge of advice and therapy culled from other professions. At worst, it is redundant and depends upon the promotion of a non-scientific approach to health.

Linda

JJM

6th March 2010, 06:38 AM

... 1. The most egregious comment was the claim by "blue wode" that NCCAM spent $2.5 billion (LOL!) in 17 years. ...All the chiros had to do to get some of the money was write a grant proposal that could compete with faith-healing and homeopathy.

... We were blocked access to any federal grant money to do research, ...Not any longer.
Even so, there has been some good work done, and there's plenty more to do.Where is it published. After all, in your business job #1 should be finding the elusive subluxation. So far, we only know it fictional. http://www.sciencebasedmedicine.org/?p=3022

You did have a research fund http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54144 "Over the foundation's history, volunteers contributed more than 33,000 articles and helped fund over 152 randomized, controlled trials concerning chiropractic manipulation, as well as supported over 100 research fellowships leading to MS and/or PhD degrees." Yet, no evidence for the subluxation.

JJM

3rd May 2010, 03:27 PM

There is a good article on chiros' bogus pediatric claims here:
http://www.sciencebasedmedicine.org/?p=4950

BillyJoe

4th May 2010, 02:21 PM

...by a chiropractor!

Tomblvd

5th May 2010, 07:20 AM

As for your comments about the "subluxation complex", I didn't realize you expected me to "prove" it's existence. I'd prefer to leave that to the NIH and the research centers at our colleges.

Subluxation has been the absolute foundation of chiropractic since day one, and that was over one hundred years ago. It's been taught as fact in every chiro school in existence, and most chiros still toss the word around as a given.

Shouldn't anyone who looks at this without blinders on find the fact that chiropractic subluxations have yet to be proven very, very disturbing, at the least?

BillyJoe

8th May 2010, 02:13 AM

Subluxation has been the absolute foundation of chiropractic since day one, and that was over one hundred years ago...
...shouldn't anyone who looks at this without blinders on find the fact that chiropractic subluxations have yet to be proven

And there are now over a hundred definitions of "subluxation" in an attempt to obfuscate that fact.

Dorian Gray

8th May 2010, 03:17 PM

The way to test it:
Take 1000 people. Put them all to sleep. Perform chiropractic techniques on half of them (called 'chiros'), randomly, double blind. Do nothing for the other half (called 'sleepers'). Wake them all up. Tell half the sleepers and half the chiros that they received nothing. Tell the other half of the sleepers and the other half of the chiros that they received chiropractic treatment. Ascertain the results.

If all the chiros report feeling better, improved, more functional, more mobile, totally boingy in the chakra, or whatever, while all the sleepers report feeling simply rested, then chiropractic is an objective technique, is verifiably beneficial, and therefore is medicine.

However, if the half that are TOLD they received chiropractic treatment feel better, while the half that slept feel simply rested, then chiropractic is mind-over-matter, psychosomatic, mental, etc., is a subjective technique, and therefore is not medicine.

Dorian Gray

8th May 2010, 03:18 PM

Incidentally, is acupuncture a verified objective medicine? Or acupressure?

Gord_in_Toronto

8th May 2010, 04:30 PM

BillyJoe

9th May 2010, 06:33 AM

Incidentally, is acupuncture a verified objective medicine? Or acupressure?

No.

(But this thread is about chiropractic so I cannot elaborate without incurring the wrath of the anal retentives who keep our threads clean)

BJ

Blue Wode

15th May 2010, 11:16 AM

The chiropractic subluxation: 1895–12 May 2010
RIP

Obituary: The death of the subluxation
http://www.zenosblog.com/2010/05/obituary-the-death-of-the-subluxation/

UK General Chiropractic Council acknowledge that terms such as joint misalignment or dysfunction have the same meaning as subluxation. Simply using different terminology is not a get out clause:
http://skepticbarista.wordpress.com/2010/05/15/subluxations-we%e2%80%99ve-never-considered-the-research-part-2/

Delscottio

15th May 2010, 11:33 AM

So where does this leave them? Sports massages? They havent got much left really.

Blue Wode

15th May 2010, 11:53 AM

So where does this leave them? Sports massages? They havent got much left really.

It's interesting you should mention that. It was an issue that was highlighted back in 1976:
"If a chiropractor limited his practice to muscular conditions such as simple backaches, if he saw patients only on referral from medical doctors after medical diagnosis has been made, if he were not overly vigorous in his manipulations, if he consulted and referred to medical doctors when he couldn't handle a problem, and if he avoided the use of x-rays, his patients might be relatively safe. But he might not be able to earn a living."

http://www.chirobase.org/12Hx/hr76.html

In the UK, I suspect that chiropractors will be desperate to secure a large patient bank via NHS referrals now that they have NICE's dubious endorsement of their skills.
(See here for criticism of NICE's decision http://www.dcscience.net/?p=1516)

However, according to a flyer for a forthcoming chiropractic seminar in the UK, all is not well...
The aim of the meeting is to widen knowledge on issues around commissioning. A number of practitioners will have approached their local PCT only to be turned away. Our aim is to investigate ways of changing the PCT'S views, therefore improving the accountability and access to care for all patients, with musculoskeletal conditions especially back pain and, hopefully, create an environment where patients are seen in the appropriate place, by an appropriate person, for a particular condition and without a prolonged wait.

The NICE Guidelines are concerned with increasing the options GP's can give to patients, and improving the speed of access by increasing the amount and variety of treatment in the community. Little has happened since then. Investigating the inclusion of Chiropractors and Osteopaths into a possible Forum might bring a change to the current system.

http://www.colchiro.org.uk/gfx/uploads/textbox/AAA%20Event%20flyers/SEV100612%20Commissioning%20and%20Innovation%20-%20Are%20they%20synonymous,%20Taunton.pdf

I can't help thinking that they will have to reform under another name (so as to lose the quackery connotations of chiropractic) if they want to be accepted into mainstream healthcare.

Blue Wode

24th May 2010, 03:08 AM

I wonder what the chiropractic industry will make of this:

GUIDANCE ON CLAIMS MADE FOR THE
CHIROPRACTIC VERTEBRAL SUBLUXATION COMPLEX

The chiropractic vertebral subluxation complex is an historical
concept but it remains a theoretical model. It 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.

Chiropractors are reminded that

 they must make sure their own beliefs and values do not
prejudice the patients’ care (GCC Code of Practice section A3)

 they must provide evidence based care, which is 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
(GCC Standard of Proficiency section A2.3 and the glossary)

 any advertised claims for chiropractic care must be based only
on best research of the highest standard (GCC Guidance on
Advertising issued March 2010)

May 2010
General Chiropractic Council
44 Wicklow Street
LONDON WC1X 9HL
T: 020 7713 5155
enquiries@gcc-uk.org
www.gcc-uk.org

http://www.gcc-uk.org/files/page_file/guidance_on_claims_for_VSC_May_2010.pdf

Mojo

24th May 2010, 04:08 AM

"The preferences of the patient" constitutes evidence, does it?

BenBurch

24th May 2010, 04:18 AM

"The preferences of the patient" constitutes evidence, does it?

My back problems are cured by threesomes with cute 20-Somethings. I suppose this means I can get a prescription for that? ;)

zeno2712

25th May 2010, 01:14 AM

My take on it: In Memoriam (http://www.zenosblog.com/2010/05/in-memoriam/)

Lothian

25th May 2010, 02:20 AM

My back problems are cured by threesomes with cute 20-Somethings. I suppose this means I can get a prescription for that? ;)Even if you did what is the chance of you finding a Pharmacist who has 2 cute 20-Something rent boys in stock?

Incidentally the BCA’s last accounts were filed just over a year ago. I will keep an eye out for those ending Dec 09. Might make for some interesting reading.

Blue Wode

25th May 2010, 03:54 AM

My take on it: In Memoriam (http://www.zenosblog.com/2010/05/in-memoriam/)

Another interesting blog post here:

Born again, British Chiropractic Association joins skeptics “attack” on chiropractic
http://www.chiropracticlive.com/?p=697

ETA. It's obviously concerning the chiropractic trade in the US:

"...rumors are that the state regulatory bodies in the US are working on defining chiropractic in a whole new light."

http://researchupdate.mccoypress.net/2010/05/19/the-death-of-the-subluxation.aspx?ref=rss

BillyJoe

25th May 2010, 02:33 PM

"The preferences of the patient" constitutes evidence, does it?

To be fair, they are suggesting that "the preferences of the patient" be from the list of conditions with the "best available evidence from research".

...that would be back pain and....um...

Mojo

26th May 2010, 03:55 AM

To be fair, they are suggesting that "the preferences of the patient" be from the list of conditions with the "best available evidence from research".

I'm not suggesting that the preferences of the patient are not something that should be considered when deciding on a course of treatment, just that it isn't appropriate to include them in a paragraph defining "evidence based care". They are conflating two different things. What they should be advocating is providing evidence based care while also taking the patient's preferences into account.

Physiotherapist

27th May 2010, 03:59 AM

I think all the chiros should just stick to Sports Massage - seems to be all they can do now. They should go and re-train in sports massage or physiotherapy and be done with a do something useful.

Just had an altercation with one. Had a potential patient contact me with regard to treatment for a shoulder injury. Turns out they had seen a chiro some way out for rehab of this injury and the chiro had then suggested that they seek sports massage/physio for muscular work. I told the patient that I do my own assessment when I first see someone and the next thing I know I am then getting letters from this chiro telling me what kind of treatment he wants me to carry out on his patient.

Don't know where these quacks get off on thinking they are better trained than anyone else - I stopped short of saying that the profession had been completely discredited by Simon Singh's recent legal action.

Not sure what else to do short of refusing to treat the patient, but that would be a shame if they really need the treatment anyway.

steenkh

27th May 2010, 05:54 AM

Don't know where these quacks get off on thinking they are better trained than anyone else
Some of them are actually better trained than others. Two years ago I had pains in my calf that one doctor identified as a "small blood clot", and prescribed medicine, and another declared that it was rheumatism and would never go away. A chiropractor immediately noted a heavy swelling of my foot that was caused by a bycycle accident some months before, popped my toes, and did some quick pulling motions on the leg, after which the pain was gone forever, and the swelling was gone the next day.

None of the two doctors had looked at my foot, and I must admit that I had noticed the swelling, but did not connect it to my pain in the calf. I was just scared that it was a blood clot after all.

I do not think this chiropractor did anything that a physiotherapist could not have done, and she did not say any woo-woo stuff or mention displaced joint, or subluxations. I think that she is just a hell of a lot more experienced within her limited specialization than some doctors.

Mojo

27th May 2010, 06:03 AM

I stopped short of saying that the profession had been completely discredited by Simon Singh's recent legal action.

Point of order - it wasn't Simon's legal action, it was the BCA's. They were hoist with their own petard.

Cainkane1

27th May 2010, 06:06 AM

ectoplasm

27th May 2010, 06:39 AM

Blue Wode

27th May 2010, 06:40 AM

I speak with and associate with a Chiro and he says all he and his colleges do is comparable to brushing and flossing. This prevents tooth decay but if you get a cavity anyway you go to a dentist. In other words he can do what he can to prevent some diseases from happening but if you get sick with something outside his level of expertise he sends ypu to another doctor.

Here, in a nutshell, is a reminder of what chiropractic has to offer:
“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.”

The above quote is lifted from p.285 of the book, Trick or Treatment? Alternative Medicine on Trial , by Simon Singh and Professor Edzard Ernst. It's what they propose that all chiropractors be compelled by law to disclose to their patients prior to treatment.

Mojo

27th May 2010, 07:01 AM

I have trouble with this statement. What can they do to prevent disease from happening? Evidence please.

Well, if people have large amounts of cash in their wallets, and carry the wallet in a back pocket, they sit with one buttock higher than the other and cause strain on their spines. Chiropractic can help reduce this. ;)

BillyJoe

27th May 2010, 02:43 PM

Two years ago I had pains in my calf that one doctor identified as a "small blood clot", and prescribed medicine, and another declared that it was rheumatism and would never go away. A chiropractor immediately noted a heavy swelling of my foot that was caused by a bycycle accident some months before, popped my toes, and did some quick pulling motions on the leg, after which the pain was gone forever, and the swelling was gone the next day.

This doesn't sound right. You had pain in your calf. The doctor diagnosed a blood clot (presumably in your calf). He prescribed medicine. Later you state that your foot was swollen. This adds up to a Deep Vein Thrombosis. For this your doctor would have prescribed warfarin for three months with regular blood tests to guide the dose of warfarin. Is this what happened?

On the other hand, if the swelling was due to an accident some months before, how did that cause calf pain unless the foot was also painful - but how could that have been if you hadn't noticed the swelling - and caused you to limp hence straining the calf muscle.

And how could "popping the toes" and "quick pulling of the leg" (hey, there;s a joke there!) relieve foot swelling and, presumably, the calf pain? How long after that did the pain actually go away?

As for the doctor who diagnosed "rheumatism that would never go away", I would stay clear of him if your memory of his diagnosis and prognosis is correct.

But, then, what we have here is just an anecdote...

None of the two doctors had looked at my foot, and I must admit that I had noticed the swelling, but did not connect it to my pain in the calf. I was just scared that it was a blood clot after all.

I would have been too.
Maybe you just got lucky. :)

steenkh

27th May 2010, 11:24 PM

This doesn't sound right. You had pain in your calf. The doctor diagnosed a blood clot (presumably in your calf). He prescribed medicine. Later you state that your foot was swollen. This adds up to a Deep Vein Thrombosis. For this your doctor would have prescribed warfarin for three months with regular blood tests to guide the dose of warfarin. Is this what happened?
The first doctor prescribed some blood-thinning medicine called Magnyl (http://www.drugs.com/international/magnyl.html) (in a weak form called "Children's Magnyl"). It is a common medicine here, originally invented for its pain-killing effect, but now given to everybody in danger of blood clotting. It is recommended to take before air travel.

On the other hand, if the swelling was due to an accident some months before, how did that cause calf pain unless the foot was also painful - but how could that have been if you hadn't noticed the swelling - and caused you to limp hence straining the calf muscle.
Correct. I cannot explain it. I was limping since the accident, but the pain in the foot was soon gone. I only had pain in the calf when walking. Bicycling was OK.

And how could "popping the toes" and "quick pulling of the leg" (hey, there;s a joke there!) relieve foot swelling and, presumably, the calf pain? How long after that did the pain actually go away?
I have often thought that procedures like toe-popping and whatever chiros do has a slight anaesthetizing effect that might cause the muscles to relax. The leg-pulling manoeuvre is a bit difficult for me to describe, even in Danish. I was instructed to stand against a wall, facing the wall, and the chiro held my leg and made a sideways throwing motion.

Before the procedure I had been asked to raise my self to "stand on the toes", and I could not do it on my right foot. But I did not feel any pain. This was the point where I was asked to take off my socks and the swelling was noticed. After the treatment, I was able to "stand on the toes" almost equally well on both feet, and the pain in the calf was gone immediately.

Placebo is a very powerful thing :

As for the doctor who diagnosed "rheumatism that would never go away", I would stay clear of him if your memory of his diagnosis and prognosis is correct.
Actually, she did not actually give a firm diagnosis. She said something about "it could be a mild rheumatism", "these things happen", and "it might wear off in time", but "sometimes it never goes away", and at the time, I was rather satisfied, because she had been very firm that it was not a blood-clot. and she had actually examined me, whereas the other doctor (who is her husband) had only listened to my story, and had not bothered to look at the leg.

But, then, what we have here is just an anecdote...
Yes, it is my curse that I only ever experience anecdotes ;)

BillyJoe

29th May 2010, 06:48 AM

steenkh,

I don't know how effective Magnyl is as a prevention for DVT but, for the treatment of DVT, it's heparin, warfarin, or clexane (and a new one I can't remember the name of). DVT can be complicated by pulmonary embolism which can be lethal.
As I said, perhaps you were just lucky. :)

Also, see how your anecdote changed in the retelling here. In the first telling the doctor said "you have rheumatism and it will never go away". In the retelling the doctor said ""it could be a mild rheumatism...these things happen...it might wear off in time...sometimes it never goes away". But, what actually happened is anyone's guess, including your own. Over the two years since the event, there have probably been all those problems with memory including memory insertion, memory deletion, exaggeration, minimisation, and confusion of temporal order.

Also in regards to the treatment the chiroprcator gave you. I don't know what it was, but it definitely wasn't chiropractic treatment (at least how you remember it ;)). It sounds like he was just stretching you and your credulity. Not to mention your wallet :(

Yes, it is my curse that I only ever experience anecdotes

It is your curse that you can't accurately remember your experience.
But, dont feel bad, everyone is cursed.

fls

29th May 2010, 07:01 AM

The first doctor prescribed some blood-thinning medicine called Magnyl (http://www.drugs.com/international/magnyl.html) (in a weak form called "Children's Magnyl"). It is a common medicine here, originally invented for its pain-killing effect, but now given to everybody in danger of blood clotting. It is recommended to take before air travel.

Magnyl is aspirin. If you were given this for a 'blood clot', then it wasn't a DVT you were receiving treatment for, but a superficial thrombophlebitis, which does not put you at risk for a pulmonary embolism.

Correct. I cannot explain it. I was limping since the accident, but the pain in the foot was soon gone. I only had pain in the calf when walking. Bicycling was OK.

I have often thought that procedures like toe-popping and whatever chiros do has a slight anaesthetizing effect that might cause the muscles to relax. The leg-pulling manoeuvre is a bit difficult for me to describe, even in Danish. I was instructed to stand against a wall, facing the wall, and the chiro held my leg and made a sideways throwing motion.

Before the procedure I had been asked to raise my self to "stand on the toes", and I could not do it on my right foot. But I did not feel any pain. This was the point where I was asked to take off my socks and the swelling was noticed. After the treatment, I was able to "stand on the toes" almost equally well on both feet, and the pain in the calf was gone immediately.

Placebo is a very powerful thing :

Actually, she did not actually give a firm diagnosis. She said something about "it could be a mild rheumatism", "these things happen", and "it might wear off in time", but "sometimes it never goes away", and at the time, I was rather satisfied, because she had been very firm that it was not a blood-clot. and she had actually examined me, whereas the other doctor (who is her husband) had only listened to my story, and had not bothered to look at the leg.

Yes, it is my curse that I only ever experience anecdotes ;)

It is simply that anecdotes rarely contain sufficient information to determine whether anything unexpected happened, as is the case here.

Linda

steenkh

30th May 2010, 01:22 AM

Also, see how your anecdote changed in the retelling here. In the first telling the doctor said "you have rheumatism and it will never go away". In the retelling the doctor said ""it could be a mild rheumatism...these things happen...it might wear off in time...sometimes it never goes away".
My first version was how I interpreted the verdict on a pain that made it difficult for me to walk. The second version is presumably closer to the actual words.

But, what actually happened is anyone's guess, including your own. Over the two years since the event, there have probably been all those problems with memory including memory insertion, memory deletion, exaggeration, minimisation, and confusion of temporal order.
What is important here is that I did not get any treatment that helped me.

Also in regards to the treatment the chiroprcator gave you. I don't know what it was, but it definitely wasn't chiropractic treatment (at least how you remember it ;)). It sounds like he was just stretching you and your credulity. Not to mention your wallet :(
I will gladly accept having my credulity stretched any day and get rid of pain. I am well aware that it could be placebo effect, but then, the two visits to doctors did also not result in anything worth more than placebo. As for what is chiropractic treatment, I would rather leave that to chiropractors to decide.

It is your curse that you can't accurately remember your experience.
But, dont feel bad, everyone is cursed.
I know, hence the smiley.

steenkh

30th May 2010, 02:13 AM

Magnyl is aspirin. If you were given this for a 'blood clot', then it wasn't a DVT you were receiving treatment for, but a superficial thrombophlebitis, which does not put you at risk for a pulmonary embolism.
Wow, I did not even know that pulmonary embolism was a possible risk! I thought I was only at risk of losing my leg! :)

Thank you for the comment. The first doctor who gave this diagnosis did not, in my mind, regard it as very serious. As I told you, he did not even examine the leg. Perhaps that is why there was a complete absence of placebo effect on the pain. I have also been told that I was in error when I said that I was given children's magnyl, it was actually something called "Heart Magnyl", possibly marketed abroad under the Danish name "Hjertemagnyl". Apparently, it is stronger, but I do not know if it is stronger than normal Magnyl or Children's Magnyl.

It is simply that anecdotes rarely contain sufficient information to determine whether anything unexpected happened, as is the case here.

I know. I just wrote it in jest.

Physiotherapist

30th May 2010, 03:41 AM

If it is anything to go by, most chiros charge the earth for doing very little - 15 to 20 min appointments, so are raking it in.

Think I must have chosen to train in the wrong discipline then hey!!

BillyJoe

30th May 2010, 04:47 AM

Magnyl is aspirin. If you were given this for a 'blood clot', then it wasn't a DVT you were receiving treatment for, but a superficial thrombophlebitis, which does not put you at risk for a pulmonary embolism.

Didn't think of that.

Steenkh:
Did you have a localised red tender swelling on your leg?
(Do you have varicose veins?)

But, apparently, superficial thrombophlebitis has been associated with deep vein thrombosis; and it has been associated with pulmonary embolus without invovlement of the deep veins:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1281393/

So you may still have been lucky! :)

steenkh

30th May 2010, 05:01 AM

Did you have a localised red tender swelling on your leg?
(Do you have varicose veins?)
No, nothing was to be seen superficially. It could only be felt. And then of course there was the swelling of the foot that we did not notice.

In any case, I did not present my anecdote to discuss a possible diagnosis, but in order to show that it is not always the case that chiropractors are worthless and uneducated quacks. Simon Singh in his book more or less says the same thing about their traditional treatment, but adds that it is too dangerous to be preferred over other similarly effective treatments.

BillyJoe

30th May 2010, 05:34 AM

No, nothing was to be seen superficially. It could only be felt. And then of course there was the swelling of the foot that we did not notice.

I'm still going for DVT. :D

In any case, I did not present my anecdote to discuss a possible diagnosis, but in order to show that it is not always the case that chiropractors are worthless and uneducated quacks. Especially when they don't actually use chiropractic treatment...
...as in your case ;)

Simon Singh in his book more or less says the same thing about their traditional treatment, but adds that it is too dangerous to be preferred over other similarly effective treatments.Yeah, about as good as a massage but a fair bit riskier if applied to the neck.

Another anecdote:
My wife once had a chiropractic adjustment to her neck and suffered what she interpreted as a brief episode of quadriplegia. For a moment there she thought she'd be spending the rest of her life in a wheelchair. But maybe she overreacted because she did this behind my back knowing my views on alternative medicine.
But, then again, that is only the way I remember it, and it was about a decade ago, so I think we can all perhaps disregard that anecdote as well. :)

BillyJoe

30th May 2010, 05:51 AM

In any case, I did not present my anecdote to discuss a possible diagnosis...

No, we're just trying to get something useful out of your anecdote. :D

fls

30th May 2010, 07:13 AM

Didn't think of that.

Steenkh:
Did you have a localised red tender swelling on your leg?
(Do you have varicose veins?)

But, apparently, superficial thrombophlebitis has been associated with deep vein thrombosis; and it has been associated with pulmonary embolus without invovlement of the deep veins:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1281393/

So you may still have been lucky! :)

Yes, saphenous vein thrombosis is more worrisome, but that is not what he described. He also didn't really describe superficial thrombophlebitis - that's just what it looks like the first doctor was trying to diagnose.

The story is more consistent with a cyst, such as a popliteal cyst, interfering with the function of the gastrocnemius. Sometimes manipulation can reduce the cyst, although since it's likely to recur, it's not usually the treatment of choice. But some people are lucky.

Linda

zeno2712

31st May 2010, 02:09 AM

Well, if people have large amounts of cash in their wallets, and carry the wallet in a back pocket, they sit with one buttock higher than the other and cause strain on their spines. Chiropractic can help reduce this. ;)
Brilliant! :D

JJM

17th July 2010, 12:04 PM

If one searches on google for chiropractic, chirobase and skepdic (both critical of chiro) come up on the first page. It has been suggested that that can be changed by logging on to a google account and clicking on the blue stars associated with each site http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54777

I suppose we can work against them by logging on and clicking on the stars next to chirobase and skepdic. The procedure is described in the site to which I linked.

Gord_in_Toronto

17th July 2010, 08:17 PM

Google does not like attempts to "game the system". Whether they would care about this, I don't know.

JJM

18th July 2010, 04:37 AM

Google does not like attempts to "game the system". Whether they would care about this, I don't know.If they detect it, and block it, that will be fine; as long as they get both.

JJM

22nd July 2010, 10:22 AM

Another thing one can do is link chiro terms to skepdic and chirobase on one's own web page. http://jdc325.posterous.com/ahh-the-chiropractors-want-to-play

Blue Wode

3rd October 2010, 12:11 AM

Science Based Medicine has just published an interesting new article by Samuel Homola, DC, regarding the fictitious subluxation lesion:

Chiropractic Vertebral Subluxations: Science vs. Pseudoscience
http://www.sciencebasedmedicine.org/?p=6839

“Unlike the mysterious, undetectable and asymptomatic chiropractic ‘vertebral subluxation complex’ alleged to be a cause of disease, a real vertebral subluxation, that is, an orthopedic subluxation, can be a cause of mechanical and neuromusculoskeletal symptoms but has never been associated with organic disease…

A largely ignored landmark review of the literature by a Ph.D. and a chiropractor (Nansel and Szlazak), published in 1995, concluded that there is not a single appropriately controlled study to indicate that any dysfunction in structures of the spinal column is a cause of organic disease…

Unfortunately, the chiropractic profession in the United States continues to be defined by subluxation theory. Too few chiropractors are willing to ‘step out of line’ and announce that the theory (more accurately defined as a belief) is scientifically indefensible and should be dumped… the British Chiropractic Association advised its members to “refrain from making any reference to Vertebral Subluxation Complex in media to which their patients or the general public may have access,” adding that “this advice has no bearing on scope of practice”…

Without some identifying label or degree that distinguishes science-based chiropractors from subluxation-based chiropractors, medical physicians will continue to be reluctant to refer a patient to a chiropractor, lest they deliver a patient into the hands of a pseudoscientific practitioner whose philosophy embraces an anti-medical approach and endangers the patient...

It seems likely that subluxation-based chiropractic, like homeopathy and other belief systems, will be perpetuated to some degree by true believers…

Because the chiropractic profession seems unwilling to abandon these discredited concepts, reform of the state chiropractic practice acts to eliminate subluxation-based chiropractic practice may be the only viable solution to the perpetration of unscientific and unproved healthcare practices…

Good science-based chiropractors who do not subscribe to the vertebral subluxation theory and who use manipulation appropriately can offer a service of value. Unfortunately, such chiropractors are not easy to find.”

Despite the above, chiropractors still seem to be on a subluxation wild goose chase:

The great subluxation debate: a centrist's perspective

Christopher J. Good DC, MAEd, Professor, University of Bridgeport College of Chiropractic, Bridgeport, CT 06604

ABSTRACT

Objective
This commentary describes the debate and some of the associated issues involving the subluxation construct.

Discussion
The long-standing debate regarding the chiropractic subluxation has created substantial controversy within the profession. Currently, this phenomenon can be compared with a country with a 2-party system that has a large silent majority sitting between the 2 factions. It is argued that the position held by those in the middle (the centrists) may be the most rational view when considering all of the available evidence. It is also suggested that the subluxation construct is similar to the Santa Claus construct in that both have a factual basis as well as social utility. Ultimately, the centrists must become proactive if they want to protect the profession and further advance the evidence in regard to the subluxation. They must not only engage in the debate, but fund the research that will investigate various aspects of the subluxation and then help disseminate this evidence to fellow doctors of chiropractic, other practitioners, health care policy makers, and society at large.

Conclusion
The role of subluxation in chiropractic practice, the progression of this debate, and the future of the profession will be directly determined by the role that centrists choose to play.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B9HD4-512N9HK-1&_user=10&_coverDate=09%2F21%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=324e669837df4a009c06b6e16c00b773&searchtype=a

JJM

3rd October 2010, 06:42 AM

This Conclusion
The role of subluxation in chiropractic practice, the progression of this debate, and the future of the profession will be directly determined by the role that centrists choose to play.

http://www.sciencedirect.com/science...3&searchtype=a (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B9HD4-512N9HK-1&_user=10&_coverDate=09%2F21%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=324e669837df4a009c06b6e16c00b773&searchtype=a)is particularly rich. One would hope the progression would depend on the evidence.

Blue Wode

13th October 2010, 01:25 PM

More criticism of chiropractic in the media:

Researchers advise parents not to take children to chiropractors
http://www.infonews.co.nz/news.cfm?id=59215

Medical researchers Professor Shaun Holt and Andrew Gilbey have issued a strong warning against parents taking their children to see a chiropractor for any reason. Many chiropractic practices and organizations, in New Zealand and overseas, advocate routine spinal manipulation in infants and children, for conditions ranging from ear infections, colic and asthma to ADHD and even cancer.

"There is no plausible explanation why high-velocity manipulation of the spine can help children with these medical conditions, it is an extraordinary claim" said Professor Holt. "Given that this is a multibillion dollar industry, the lack of good research that has been undertaken is staggering. There is also evidence that many chiropractors advise against routine childhood immunizations, which is irresponsible.”

Andrew Gilbey said that “there are some serious safety concerns related to the unnecessary use of x-rays and the manipulation of childrens’ spines and so we advise parents to instead consult their family doctor who has been trained to recognize and treat a wide range of medical problems. In Canada, an undercover researcher reported that 4 out of 5 chiropractors found serious problems with the spine of a child and said that these required urgent chiropractic treatment, whereas an experienced paediatric orthopedic surgeon who also examined the girl found her to be perfectly healthy.”

Holt and Gilbey's advice echoes similar warnings issued by paediatricians overseas. The Australian Medical Association has stated that chiropractic care for children is a waste of money and inappropriate. They advise parents who are worried about any aspect of their children's health to consult a medical doctor.

Seems the message is slowly getting through. :)

JJM

3rd November 2010, 02:56 PM

Blue Wode

4th November 2010, 07:08 AM

Blue Wode notified me that there is a new report that strongly associates stroke (by bilateral vertebral artery dissection) with chiro http://tinyurl.com/2uden4f

It concerns a young woman who had a clear MRI of her arteries immediately before a stroke due to chiropractic manipulation.

Thank you for that, JJM.

Readers might also be interested to know that chiropractic is currently being heavily criticised at two other sources:

Subluxations: WHO said what...
http://skepticbarista.wordpress.com/2010/10/24/subluxations-who-said-what/

Chiropractors at War with their Regulator, the GCC
http://www.quackometer.net/blog/2010/11/chiropractors-at-war-with-their-regulator-the-gcc.html

Blue Wode

18th December 2010, 05:34 AM

Mojo

18th December 2010, 06:30 AM

We've had an interesting definition of the chiropractic subluxation advanced by a chiropractor over on the Quackometer blog (http://www.quackometer.net/blog/2010/11/chiropractors-at-war-with-their-regulator-the-gcc.html) (see posts dated 17th December, currently just above the bottom of the page).

Eos of the Eons

18th December 2010, 09:16 AM

More criticism of chiropractic in the media:

Researchers advise parents not to take children to chiropractors
http://www.infonews.co.nz/news.cfm?id=59215

Seems the message is slowly getting through. :)
Meh, chiros will just say they are getting bashed for being "competition" to, well, science based medicine... Chiros are victims doncha know (in a way they are, as they got a very expensive bogus education that is really useless except for getting to call themselves a doctor and being taught some really good marketing).

Blue Wode

19th December 2010, 04:47 AM

Readers may be interested to know that chiropractic professor, Stephen Perle, has attacked a recent paper by Professor Edzard Ernst:

'The self-importance of being Ernst'
http://smperle.blogspot.com/2010/12/self-importance-of-being-ernst.html

The paper in question is this one:

Ernst E. Deaths after chiropractic: a review of published cases. Int J Clin Pract. 2010 Jul;64(8):1162-5.
http://mcdanielchiro.com/clients/4846/documents/Deaths_After_Chiropractic_...pdf

(Note – Table 1. in the above link is published twice)

ETA. As I have all the relevant papers, I've left four comments on Prof. Perle's blog, but they've yet to be published.

It’s been over 24 hours and my comments still haven’t appeared on Professor Stephen Perle’s blog, so in the interests of public debate I am posting them here:

Stephen Perle wrote:

“In the results section of the paper he [Professor Ernst] has a paragraph that is, to say the least, very interesting when one thinks of the purpose. Herein he describes "the testimony of the chiropractor Preston Long for a court in Connecticut recently listed the family names of nine victims." Ernst cites this with: "Presentation by Dr Preston Long DC to State of Connecticut. Connecticut State Board of Chiropractic Examiners. Hartford Connecticut. 25 October 2009. There was never a hearing before the State Board of Chiropractic Examiners on October 25, 2009. The hearing was in January of 2010 and because Long did not appear to under oath attest to his pre-submitted testimony it was, in accord with the procedural rules in CT not accepted and thus not part of the public record. One wonders how does Ernst get this document when it was not public. I have a copy as I was on the witness list and these pre-submitted testimony documents I was told were not to be made public until the board hearing.”

My comment:

If you read the ‘Methods’ section of Professor Ernst’s original paper he said that “several experts were also contacted for further data”. Perhaps that is how he managed to see Preston Long’s document.

Stephen Perle wrote:

“What is the common feature of Ernst's citation of these deaths whose information or rather misinformation was obtained from a web site and the deaths reported by Long? Neither of these data sources were from the scientific literature. In his reply to our letter Ernst says "These cases were, however, merely added for completeness and not included in my total number of 26 cases reported in my review." Completeness? So adding people who didn't die after chiropractic spinal manipulation and weren't in the scientific literature adds completeness to a review of the scientific literature?”

My comment:

Note that Professor Ernst said in his Introduction that:
“A responsible approach to serious therapeutic risks, however, requires an open discussion of the facts. In this review I aimed to provide the basis for such a discussion by summarising all fatalities which occurred after chiropractic spinal manipulation and were published in the medical literature.”

Note that he didn’t say he would *exclusively* look at the scientific literature. Indeed, in the Methods section he was more specific, informing us that:
“Electronic searches were conducted in the following electronic databases: Medline, Embase, AMED, Cochrane Library (September 2009)… In addition, our own departmental files and the bibliographies of the articles thus located were searched. Several experts were also contacted for further data. Case reports were included if they provided information on human patients who had died after receiving one or more treatments from a chiropractor.”

He goes on to say that many other fatalities seemed to have remained unpublished and gives examples of the testimony of Preston Long DC (whom it is likely that he contacted personally) which listed the family names of nine victims. Dr Long also stated that ‘many others are unknown hidden behind legal agreements of silence’. Professor Ernst then cites ‘names’ of further North American fatalities from the website http://www.whatstheharm.com

Stephen Perle wrote:

“Wenban has detailed the commonality of wrongly ascribing adverse events of manipulation to the care of doctor’s of chiropractic.”

My comment:

As Professor Ernst says in his response to Whedon et al, his original review contests that with good references. He also says he can not reasonably be expected to know of the ‘personal correspondence’ that Wenban and Bennett cited and asserts that the small discrepancies in numbers (about which they argue) are almost irrelevant.

Stephen Perle wrote:

“Ernst says Cassidy's study has been repeatedly criticized for being flawed. The key word is repeatedly. This obviously repeatedly means more than once, which means that there must be more than one reference cited for that criticism. In fact, I think most would agree that repeatedly probably means many more than one. Well there is only one reference cited and what is that: Ernst E. Vascular accidents after chiropractic spinal manipulation: myth or reality? Perfusion 2010; 23: 73–4. No it can't be the only criticism in the scientific literature (not the blogosphere mind you - this is science we are talking about here) that Ernst can find is his own (now you get the idea about the title for the blog).”

My comment

Professor Ernst did not qualify where the study had been repeatedly criticised. [He did not imply that it had been repeatedly criticised in the scientific literature.] Further, if you’re going to discount the blogosphere, then your blog post here should not, in any way, be taken seriously by the scientific community.

Stephen Perle wrote:

“Now to his critique. I won't reproduce it here…”

My comment

Why not? For anyone wishing to read it, there’s a link to the full text of it in the chiropractic section of my website at http://www.ebm-first.com/chiropractic/risks/1604-vascular-accidents-after-chiropractic-spinal-manipulation-myth-or-reality.html

It really is quite revealing.

BTW, I think readers should be told that Dohos and Tragiannidis, of the Aristotle University of Thessaloniki’s Medical School in Greece, wrote to the International Journal of Clinical Practice in support of Ernst’s paper:
“…we agree with Professor Ernst on the following points

Vascular accidents after upper spinal manipulation can cause severe vertebral artery dissections;
Numerous deaths have been associated with chiropractic neck manipulations;
Many other cases are unknown behind legal agreements of silence

Therefore the risks of chiropractic neck manipulations by far outweigh their benefits.”

Ref: Critique of review of deaths after chiropractic, 3. Dokos C, Tragiannidis A. [I]Int J Clin Pract. 2011 Jan;65(1):103-4.

I also think readers should be made aware of the following in the US:

"The National Quality Forum lists 28 ‘never events’ healthcare mistakes that should never happen and need to be reported. Death or serious disability from spinal manipulation is listed as no.16. But chiropractors do not have to report this because they have a loophole. The National Quality Forum demands it of clinics and hospitals but no reporting is mandated for individual doctor's offices where 99% of spinal manipulation is done. Chiropractors generally do not practise in hospitals or clinics."

Ref: Britt Harwe, open letter to the Editor, Focus on Alternative and Complementary Therapies, Volume 15, Issue 1, pages 87-88, March 2010.

Also, with regard to Stephen Perle’s criticism of one of Professor Ernst’s critiques:

...let's look at his cited critique

Ernst E. Vascular accidents after chiropractic spinal manipulation: myth or reality? Perfusion 2010; 23: 73–4.

Don't search too hard for this in PubMed. It's not there. The journal name is wrong. I know newbies sometimes get their citations wrong especially when they don't know the journal too well. Here is the proper citation.

Ernst E. Vascular accidents after chiropractic spinal manipulation: Myth or reality? Verlag Perfusion GmbH. 2010;23:73-4.

What do I know about http://www.verlag-perfusion.de/html/Perfusion.htm
If you look at their web site you'll see it is a German publication and the first editor listed is...Ernst. So I guess he's unfamiliar with the proper name for the journal.

...someone at Twitter has just pointed out that Professor Perle apparently can't seem to distinguish between a journal title and the name of a publisher.

Blue Wode

25th February 2011, 04:32 PM

I am sure that JJM and the JREF moderators will not mind my posting the following here in the interests of public debate and as a permanent reference resource.

On 23rd February a chiropractic podcaster, Brett L. Kinsler*, tweeted that he had booked American Chiropractic Association Vice President, Keith Overland, and chiropractic stroke researcher, J. David Cassidy, for his On The Other Hand podcast, and invited people to send in their questions for them.

*In addition to being a podcaster, Dr. Kinsler describes himself as a skeptical chiropractor and blogger who “separates crap from credible in chiropractic, altmed and health”.

Podcast: http://ontheotherhand.podbean.com/
Twitter: http://twitter.com/#!/BrettKinsler
Web: http://www.rochesterchiro.com

Dr Kinsler has kindly agreed to ask chiropractor stroke researcher, J. David Cassidy, one of my questions which is:

Why, after having admitted that he had manipulated the neck of a woman and caused a stroke (http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html ), did Cassidy change his mind that he hadn’t caused a stroke (http://www.youtube.com/watch?v=xkZQlrQMJ-k&feature=youtu.be )?

NB. Although he cited a study which he co-authored [Cassidy JD, Boyle E, Cote P et al. Risk of vertebrobasilar stroke and chiropractic care: results of a populatin-based case-control and case-crossover study. Spine 2009;33(4S):S176-S183] which apparently demonstrated that patients suffering from headache and neck pain were no more likely to suffer from a stroke following a visit to a chiropractor than they are after a visit to a family medical physician, the study clearly stated “our results should be interpreted cautiously …we have not ruled out neck manipulation as a possible cause of some vertebrobasilar artery stroke.”
http://www.chirowatch.com/Stroke/2010%20Vascular%20accidents%20after%20chiroSM%20-%20myth%20or%20reality.pdf

The other questions which I would like answered (which are lifted from an assortment of comments and questions I have read over the past three years) are as follows:

(1) The study (cited above) did not report the presenting complaint or whether neck manipulation was performed, so it was really meaningless. What if patients with early stroke symptoms are more likely to see a medical doctor than a chiropractor, and what if some of the patients had no pre-existing symptoms but saw a chiropractor for health maintenance and had strokes as a result? Does Cassidy agree that the data would look the same? If not, why not?

NB. The authors’ speculation that patients who saw chiropractors were already having a stroke is in no way supported by the data. And of course, chiropractors seeing a patient with stroke symptoms should have recognised them and sent the patient to a hospital. If they can't recognise stroke symptoms, they are likely doing neck manipulations on these already vulnerable patients, which can't be good. We have plenty of smoking gun cases where a patient with no headache or neck pain got neck manipulation and collapsed on the table with torn vertebral arteries. Chiropractors would have us believe that they would have collapsed anyway without manipulation, but they can't offer any supporting data. The very fact that they try to defend these cases with rationalisations and speculations rather than data just shows how far they are from science-based thinking.

(2) Does Cassidy agree that (i) non-hospitalised stroke cases, (ii) transient cerebral ischaemia, (iii) stroke patients residing in long-term care facilities, and (iv) patients not covered by the Ontario Health Insurance Plan or patients not reimbursed for consulting a chiropractor - who were all excluded from the analyses - could have had a significant influence on the results? If not, why not?

(3) Sub-analysis of Cassidy’s study shows that the odds ratio for a stroke within one day of chiropractic is 12.0 compared to 3.1 for the 30-day index period. As most strokes associated with chiropractic occur soon after treatment, does Cassidy agree that this suggests that the study’s 30-day index period may have weakened an already weak signal? If not, why not?

NB. In real medicine, it takes less data than this to bring a drug under scrutiny to decide if the benefits are worth the potential risks of a therapy.

(4) Most strokes occur spontaneously and relate to the elderly population. Cassidy’s analyses included all age groups. Would he agree this might have further diluted the weak signal? If not, why not?

NB. Sub-analysis of his data confirms that the odds ratios for patients below the age of 45 years are consistently higher than those for patients beyond that age.

(5) Cassidy et al took their evidence for a stroke from discharge notes. Such notes are notoriously unreliable and no data were provided to show how accurate these data were. Does Cassidy agree that this may even be more relevant for the verebrobasilar strokes, the type of stroke relevant in relation to chiropractic neck manipulation? If not, why not?

(6) Is Cassidy aware of the following (in the US), and will he take an active part in ensuring that the loophole is removed in the interests of patient safety?

"The National Quality Forum lists 28 ‘never events’ healthcare mistakes that should never happen and need to be reported. Death or serious disability from spinal manipulation is listed as no.16. But chiropractors do not have to report this because they have a loophole. The National Quality Forum demands it of clinics and hospitals but no reporting is mandated for individual doctor's offices where 99% of spinal manipulation is done. Chiropractors generally do not practise in hospitals or clinics."

Ref: Britt Harwe, open letter to the Editor, Focus on Alternative and Complementary Therapies, Volume 15, Issue 1, pages 87-88, March 2010.

If anyone has any more questions for Dr Kinsler's two guests, please add them. I’ll be posting the podcast here as soon as it’s available online.

JJM

26th February 2011, 11:48 AM

Blue Wode, that is an excellent post. Anyone who is interested can also find criticism of Cassidy's "Spine" article here http://www.sciencebasedmedicine.org/ and search for Cassidy. Especially follow the the post by Mark Crislip.

zeno2712

26th February 2011, 05:42 PM

Very interesting questions and I hope they are fully answered.

Blue Wode

13th March 2011, 03:04 AM

Mojo

13th March 2011, 03:55 AM

Chiropractor, Brett Kinsler, host of On The Other Hand podcast, has announced that the audio file of his interview with chiropractor and stroke researcher, Dr David Cassidy, has become damaged and he will have to reschedule another interview. See here:
http://twitter.com/#!/BrettKinsler

In the meantime, interested readers can listen to Dr Kinsler’s January 2011 interview with Professor Edzard Ernst via this link:
http://www.ebm-first.com/images/files/BRETT%20KINSLER%20INTERVIEWS%20EDZARD%20ERNST.pdf

In it, Professor Ernst defends himself against accusations of bias in his research, particularly in relation to his critical assessments of chiropractic. (For those who are not able to spare an uninterrupted 45 minutes to listen to the interview, the above link also contains a transcription of it.)

I like the response to the first question: KINSLER That chair position in the Department of Complementary Medicine that was set up by Sir Maurice Laing, who was a builder - whose wife, I believe, was helped by alternative medicine during a serious illness - and he wanted to set up this university chair to promote scientific investigation of alternative medicine. He was probably looking for positive proof, I would think, in alternative medicine.
ERNST No, he wasn’t that stupid. He actually was very clever, and he always told me that whatever this field needs, it needs critical assessment.

Blue Wode

17th March 2011, 06:36 AM

In today's Australian press:
MEDICAL experts have called on Canberra to shut down a university chiropractic clinic aimed at children amid claims the theories behind the practice are "no better than witchcraft" and using it on children is akin to child abuse.

More than half a dozen experts, many of them professors with international reputations, have written to voice concerns about the clinic at Melbourne's RMIT University, warning that chiropractic treatments for children's conditions are useless, at best, and "may well cause serious harm".

More...
http://www.theaustralian.com.au/news/health-science/experts-demand-roxon-shut-uni-clinic/story-e6frg8y6-1226023550529

Good to see more people taking a stand. For more on chiropractic 'paediatrics', see here:
http://www.ebm-first.com/chiropractic/treating-children.html

Blue Wode

26th March 2011, 03:45 AM

zeno2712

27th March 2011, 04:34 AM

In today's Australian press:

Good to see more people taking a stand. For more on chiropractic 'paediatrics', see here:
http://www.ebm-first.com/chiropractic/treating-children.html
More about Loretta's campaign from the Australian Skeptics (http://www.skeptics.com.au/latest/announcements/featured-announcement/call-to-close-rmit-chiro-clinic/).

Blue Wode

27th March 2011, 07:37 AM

Full transcript of Brett Kinsler's interview with chiropractic researcher, J. David Cassidy, DC, in which it is claimed that there is no increased risk of stroke with chiropractic:
http://www.ebm-first.com/images/files/BRETT-KINSLER-INTERVIEWS-J-DAVID-CASSIDY.pdf

More about the risks of chiropractic treatment here:
http://www.ebm-first.com/chiropractic/risks.html

Emet

27th March 2011, 09:25 AM

In the meantime, interested readers can listen to Dr Kinsler’s January 2011 interview with Professor Edzard Ernst via this link:
http://www.ebm-first.com/images/files/BRETT%20KINSLER%20INTERVIEWS%20EDZARD%20ERNST.pdf

In it, Professor Ernst defends himself against accusations of bias in his research, particularly in relation to his critical assessments of chiropractic. (For those who are not able to spare an uninterrupted 45 minutes to listen to the interview, the above link also contains a transcription of it.)

Hi Blue Wode. It was great to read the transcript first. When I decided to listen to the podcast, it was even better. :D

Kinsler has a nice speaking voice. ;)

Other than that, what a clown. The postscript was... absurd. :boggled:

I'll have to decompress for a while before I attempt to read any more.

Thanks for all of your efforts. Well done.

Blue Wode

29th March 2011, 06:01 AM

Readers might also be interested in listenting to JD Cassidy’s testimony from the Connecticut informed consent hearings in 2010 in which he discussed his chiropractic stroke study:
http://www.ctn.state.ct.us/webstream.asp?odID=5079&odTitle=State%20Board%20of%20Chiropractic%20Examin ers%20Hearing%20on%20Informed%20Consent%20for%20Ch iropractic%20Procedures%20-%20Day%204%20Morning%20Session&caption=true

[2hrs 50 mins]

And still on the subject of criticism of chiropractic, this is the 20-page document which has just been submitted to the Australian Federal Health Minister requesting closure of Melbourne's RMIT University's Chiropractic Paediatric Clinic:
http://www.skeptics.com.au/wordpress/wp-content/uploads/RMIT-clinic-review.pdf

It's well worth a read.

Blue Wode

8th April 2011, 12:38 PM

This Monday, 11th April, Brett Kinsler DC, will be conducting a podcast interview with a “responsible” doctor of chiropractic in Australia who is calling for investigation of the paediatric clinic at Royal Melbourne Institute of Technology (see my previous post above). I have suggested that he ask the following four questions:

1. Has there ever been a study conducted to examine potentially damaging psychological effects in children resulting from them experiencing monthly (or even weekly) chiropractic treatment(s) for 'subluxations', 'leg-length inequalities', 'energy imbalances', or other delusional concepts?

2. A 2009 survey of chiropractors and parents of chiropractic pediatric patients, conducted by the International Chiropractic Pediatric Association http://www.ncbi.nlm.nih.gov/pubmed/19733815 indicated that the primary reason for chiropractic care of children was ‘wellness care’ (Alcantara 2009).

Has any good study ever demonstrated that chiropractors can do anything to generally help a child’s body heal itself or optimise their health?

3. In 2008, the Chiropractors Registration Board of Victoria proposed chiropractic standards that attack core beliefs and practices of subluxation-based chiropractic. The draft document, which was intended to apply to children up to the age of about 13, stated that "Non-indicated, unreliable and invalid diagnostic tools, instruments or methods and unnecessary diagnostic imaging procedures are to be avoided."
http://www.ncahf.org/digest09/09-05.html

It specified:

(i) Routine radiographic examination and re-examination of pediatric patients is not recommended without clear clinical justification. X-ray examinations should not be performed solely for the detection of biomechanical disorders of the spine, such as vertebral subluxations, postural analysis or for the monitoring of spinal curves or posture, unless for monitoring progressive scoliosis;
(ii) The use of . . . surface electromyography (SEMG) or thermography, is not considered appropriate in the diagnosis of childhood conditions;
(iii) There is currently an overwhelming lack of good quality scientific evidence to support the use of spinal manipulation in the treatment of most "Type O" conditions.

"Type O" stands for organic/visceral disorders (diseases) as opposed to "type M" (musculoskeletal/biomechanical disorders). SEMG and thermography have no legitimate diagnostic value, but many subluxation-based chiropractors use them to sell patients long courses of unnecessary treatment.

Whatever became of that draft document?

4. In 2010, a review of possible adverse events in children treated by manual therapy (B. Kim Humphreys, Chiropractic & Osteopathy) concluded that “There is currently insufficient research evidence related to adverse events and manual therapy.”
http://7thspace.com/headlines/346476/possible_adverse_events_in_children_treated_by_man ual_therapy_a_review.html

With hardly any scientific evidence to support the use of chiropractic treatment for children, and a largely unknown complication rate, how can a responsible risk/benefit assessment ever be favourable?

If anyone has any more questions which they think should be asked, please post them.

zeno2712

10th April 2011, 03:26 AM

Excellent questions, Blue Wode.

catsmate1

20th April 2011, 11:20 AM

BillyJoe

21st April 2011, 01:29 PM

Bump. Anyone know anything about this site (http://www.dna-activation-power.com/index) ? Some German chiroquack and his misaligned DNA scam?
Warning: site uses pops and "please don't leave" message boxes.

Before you download that site, Pharyngula has the low down here (http://scienceblogs.com/pharyngula/2011/04/chiropractic_will_fix_your_jun.php)
After that, I'm sure you won't want to bother.

Delscottio

21st April 2011, 02:50 PM

Before you download that site, Pharyngula has the low down here (http://scienceblogs.com/pharyngula/2011/04/chiropractic_will_fix_your_jun.php)
After that, I'm sure you won't want to bother.

I got as far as "Spiritual DNA" and gave up, anyone else manage better? I presume the rest was more utter junk?

catsmate1

22nd April 2011, 01:36 PM

I got as far as "Spiritual DNA" and gave up, anyone else manage better? I presume the rest was more utter junk?
Yip.
Planetary grid distortions of the 3470 BC "Babble-on" Massacre caused mutation in the human DNA template that shortened human life span, blocked higher sensory perception, caused loss of race memory, and scrambled our original language patterns, which are built upon DNA fire letter sequencing. Our race has been amnesiac, dying young, and "babbling on" in rhetorical conflict ever since. This historical event was recorded as the biblical "Tower of Babel" story.

Blue Wode

13th May 2011, 04:24 AM

Here is the transcript of the interview (conducted on 7th May 2011) between US chiropractor, Brett Kinsler, and responsible, skeptical, Australian chiropractor, John Reggars, who admits he’s “as mad as hell” regarding the large fundamentalist chiropractor element in the chiropractic profession and the claims they make, particularly in relation to treating children:

The crossroads of science vs. subluxation
http://www.ebm-first.com/chiropractic/various-concerns/1938-the-crossroads-of-science-vs-subluxation.html

For more background see: http://static.rbi.com.au/common/contentmanagement/AusDoc/pdf/AD_001_002_MAY13_11.pdf

Unfortunately, John Reggars seems to be wrong about the UK General Chiropractic Council’s (GCC) position statement on the ‘Vertebral Subluxation Complex’ (VSC). The part of the GCC’s position statement that said
“It [VSC] is not supported by any clinical research evidence that will allow a claim to be made that it is the cause of disease or health concerns”

had the words “health concerns” deleted in August 2010 following pressure from the largely fundamentalist group, the Alliance of UK Chiropractors (AUKC). See here:
http://www.gcc-uk.org/files/link_file/Guidance_on_claims_made_for_the_chiropractic_VSC_1 8August10.pdf

Reggars also says
“…the British Chiropractic Association issued a joint statement at that point in time as well and said that “for many years the BCA has not supported the concept of the Vertebral Subluxation Complex”, which I thought was very interesting."

Well, it is interesting to note that the British Chiropractic Association appears to be working collaboratively with the Alliance of UK Chiropractors (AUKC). For example, the BCA’s President, Richard Brown, recently co-signed a letter of no confidence in the GCC along with the AUKC leadership:
http://adventuresinnonsense.blogspot.com/2010/11/chiropractic-trade-organisations-launch.html

One has to assume that he did this whilst being fully aware of a survey of the AUKC’s members which produced the following results:

88.2% felt that chiropractic should remain drug-free and that chiropractors should not pursue prescribing rights
82.9% felt that the Vertebral Subluxation was NOT an historical concept
95.4% thought that Philosophy should be taught in the Chiropractic Colleges
90.5% had found that in their experience Chiropractic was effective for conditions outside those mentioned in the Bronfort Report
83.9% answered NO to the question “Do you have confidence in the GCC to regulate the profession?”

Ref: http://tinyurl.com/36y3qwm

(It’s interesting to note that despite the 88.2% of the AUKC membership wanting chiropractic to remain drug-free, the BCA is currently seeking prescribing rights for its members.)

In addition to the above, Richard Brown wrote the following at the end of last year:
"The BCA opposes restricting the scope of practice of chiropractors...[it] supports equality of opportunity and diversity and indeed it has been this rich diversity that has given the chiropractic profession its colour and vibrancy for nearly 85 years.”

http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1524-chiropractic-towards-new-horizons.html

That doesn't seem to me to be representative of an association that claims it "has not supported the concept of the Vertebral Subluxation Complex" for many years.

With regard to fundamentalist, subluxation-based chiropractors, regulation does seem to be pretty much useless, not least due to the GCC being reactive rather than proactive. Significantly, the GCC’s guidance on claims made for the chiropractic VSC state that
The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease

yet chiropractors can still, during their unmonitored clinical encounters with trusting patients, provide care based on the ‘preferences of the patient’ and the 'expertise' of chiropractor. See:
http://www.gcc-uk.org/files/link_file/Guidance_on_claims_made_for_the_chiropractic_VSC_1 8August10.pdf

That effectively allows “in my experience” and “the patient likes it” to be considered along with evidence – all of which subtly condones the dubious practices of fundamentalist, subluxation-based chiropractors. (It’s also worth mentioning that it includes permitting them to put patients’ lives at risk by subjecting them to treatments that carry an unacceptable risk/benefit profile.)

IMO, this is an utterly unacceptable state of affairs for any health profession, let alone one that’s regulated by statute. I'm not sure what can be done about it.

Blue Wode

13th May 2011, 08:07 AM

BCA President, Richard Brown, has responded to my similar comments on Professor Edzard Ernst’s blog at Pulse:
http://www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4129401&c=2

@ Blue Wode
The BCA was invited to join the Alliance of UK Chiropractors (AUKC) but declined on the grounds that we felt a number of their values and tenets were unsupportable. There is therefore no allegiance as you claim. That said, it is correct that the four UK chiropractic associations worked collaboratively to represent the views of UK chiropractic profession in their correspondence with the General Chiropractic Council. This has led to a better mutual understanding of the relative positions of the regulator and the regulated.

From the BCA's perspective, we condone neither exaggerated marketing claims nor inappropriate use of x-rays. The legislation is clear and the BCA has issued guidance to its membership in these areas. It strongly condemns unethical practice and in 2009 set out its current vision, values and identity in a statement that was accepted by the membership.

Have you contacted either the Anglo-European College of Chiropractic or the Welsh Institute of Chiropractic and find out at first hand how UK chiropractors are being educated? There is a good deal of historical dogma being portrayed as being representative of chiropractic in the UK, and while some may retain outdated views, modern chiropractic has moved on and utilises a package of care, not simply a unidimensional approach. Manual therapy, including spinal manipulation, exercise prescription, therapeutic and lifestyle advice, myofascial dry needling and a strong biopsychosocial approach is entirely consistent with the NICE guidelines for back pain and is what BCA members are delivering. There are many examples of collaborative care with other healthcare professionals, so the characterisation that this blog attempts to make is neither in the best interests of healthcare nor of patients, who ought to be provided the opportunity to make choices informed by objective information, not flawed assumptons.

This is my reply (currently awaiting publication):

@ Richard Brown
Modern chiropractic may have moved on, but historical chiropractic continues to thrive both in the UK and abroad. With that in mind, apart from issuing statements that the BCA strongly condemns unethical practice, what have you and other BCA members done over the last 10 years to ensure that those chiropractors who behave unethically are disciplined? As skeptical Australian chiropractor, John Reggars, said within the last week when asked about what could be done to help the chiropractic profession advance:

“…it starts with reporting colleagues. There’s been this culture within the chiropractic profession, and I’m not sure whether it is the same in other professions, where people are reluctant to report colleagues for misbehaviour… professional transgressions such…false and misleading advertising, over-servicing…”

http://www.ebm-first.com/images/files/BRETT-KINSLER-INTERVIEWS-JOHN-REGGARS-DC.pdf

BTW, I don’t see any point in contacting either the Anglo-European College of Chiropractic or the Welsh Institute of Chiropractic to “find out at first hand how UK chiropractors are being educated”. FYI, a British neuroscientist recently wrote to the Welsh Institute of Chiropractic (WIOC), University of Glamorgan, to express his concerns about the claims and information available (or not, in some cases) on its official website. He requested clarification as to the website’s accuracy/intent. You can read his letter here:
http://sciencedigestive.blogspot.com/2010/06/email-to-university-of-glamorgan.html

Apparently the WIOC’s reply, which hasn’t been published, was wholly evasive in that it sent a run down of the modules taught, but not what was actually in them.

One wonders if the WIOC has something to hide.