Chiropractic medicine. [Archive]

scepticat

6th November 2007, 11:15 PM

It is easy to put down chiropractic medicine. And certainly there are an embarrassing number of quacks in the field. And much of the published information is loopy at best. The problem is that many "sceptics" go too far and claim it is never useful under any circumstances.

But the far greater problem is that doctors don't offer anything better. With a doctor, it's either surgery or painkillers. Many doctors for whatever reason have a poor knowledge concerning the back. On the contrary, the intricate knowledge of some chiropractic practitioners is astounding. (Doctors generally are ill prepared to answer questions they don't expect you to ask.)

There are a number of studies attempting to claim that chiropractic is useless, however the majority of these are poorly constructed and incomplete or flawed in a number of ways.

Certainly a lot of the negative ideas surrounding chiropractic can be assigned to practitioners within the field who have no ethical standards and tell people without problems to keep coming, or attempt to tell asymptomatic people that they need treatment anyway. Additionally, many chiropractic practitioners tend to put down doctors and make claims that are without merit. However this latter part is certainly true of both sides.

a_unique_person

6th November 2007, 11:37 PM

Physical therapy is a recognised field of medical science, and it doesn't rely on 'woo' to explain itself.

autumn1971

6th November 2007, 11:43 PM

scepticat, the problem with chiropractic is that it has never had even an ounce of evidence for its most basic claims. Chiropratic is simply a brand of snake oil from early in the last century. Even when it was first advanced, its methodology was roundly criticised by actual scientists, as well as actual people with the ability to make logical conclusions. Never has chiropractic advanced a single idea which would promote it to the status of "as yet undetermined". It has wallowed in the idiocy of its founder, and has relied on the fact that "massage makes me feel good" to advance its position.
If you can give anyone a scientific and testable example of a "subluxation" or whatever they call it, you are very likely in line for a Nobel Prize.

JoeTheJuggler

6th November 2007, 11:48 PM

There is no such thing as "chiropractic medicine".

Chiropractic is not medicine.

Doctors of chiropractic or chiropractic physicians are not medical doctors and have not attended medical school (unless they did so in addition to their "training" in chiropractic).

Chiropractic theory was invented from whole cloth (i.e. it is not an outgrowth of any field of medicine or science) by an Iowa grocer.

athon

6th November 2007, 11:49 PM

Physical therapy is a recognised field of medical science, and it doesn't rely on 'woo' to explain itself.

This is my gripe as well.

There is no such thing as 'alternative' medicine. There is medicine. Full stop. That's it. Within medicine there are specialties and options available for practitioners to choose from.

If somebody has a problem with their spine, what is the point of seeing a chiropractor over a back specialist? So many people think they are synonymous (much like naturopath = homeopath). I don't get it.

Sure, today in most cases chiro's are little more than another name for a physiotherapist who focuses on your spine, with few selling the woo that the philosophy came from. So why not become a back specialist then? What distinguishes the two if not the woo philosophy?

Athon

autumn1971

6th November 2007, 11:50 PM

arthwollipot

6th November 2007, 11:56 PM

The problem is that many "sceptics" go too far and claim it is never useful under any circumstances.

I found chiropractic to be useful for a very limited range of neck and back problems. My chiropractor never once spouted any claims about chiropractic beyond that range.

However, as others have suggested, the origin of chiropractic betrays its reliance on totally nonscientific principles (subluxations being the cause of everything from haemorrhoids to cancer).

I stopped getting chiropractic for my neck when I realised that each visit was in effect forcing me into the next visit. And they were somewhat expensive. Michael Shermer has written about this "addiction" to chiropractic in Why People Believe Weird Things. The more you have your back manipulated, the more it tends to go "out" and the more you have to have your back manipulated.

I no longer get chiro, and I don't recommend it to anyone else. There is always the chance that someone may come to rely on chiropractic at the expense of proper medicine.

JoeTheJuggler

6th November 2007, 11:58 PM

Wait, I just noticed that you claim that "Many doctors for whatever reason have a poor knowledge concerning the back".

My wife is studying to be a nurse, and I can attest that the level of knowledge required, vis-a-vis the back, is frakking enormous. Nurses are required to know every vessel and nerve in the areas which may require needle-sticking, and my assumption is that doctors are aware of this as well. Where the hell is your docmentation that even ONE chiroprator is more knowledgable in the area of the spine than even the most idiotic neurosurgeon?

Well said.

When I worked as an interpreter for the Deaf, one of my last clients was an Occupational Therapy student. OT school is part of medical school. Even they had gross anatomy and had to learn the spine in great detail. In particular, they focused on spinal cord and other nerve injuries. They'd have to know, for example, if a patient had a spinal cord injury at a certain level, which muscles would still work and therefore what motions would still be possible--in great detail.

And these were OT students!

Ryokan

7th November 2007, 02:46 AM

Chiropractic medicine

Oxymoron.

circuit_bent

7th November 2007, 02:58 AM

I was stupid enough to go to a chiropractor when I injured my back at the gym. It was actually positioned inside the gym so it would have a steady stream of people with pulled muscles and sore backs etc..
Looking back, I was a fool. He used to try and elicit a 'crack' from my back at various points and if it could be heard, that was regarded as a succesful attempt. It seemed plausible at the time.
Nothing really helped and the benefit was no greater than that of a massage. To make things worse though, he finished off after a couple of months by directing me to an acupuncturist who used needles that carried current and painfully made my muscles convulse. I was encouraged to take the highest setting that could be endured.
It was insane, the machine was even covered in dust and looked like it was from the 1960's. Oh, and have these traditional roots as well for $25 dollars. Usually $35 but you have a 'good face'. Urghhh! Shoot me!!!

I left in the most pain I had ever experienced in my life and I was in agony for at least a few days.

Don't use chiropractors or get acupuncture. Run away.

Acleron

7th November 2007, 03:08 AM

It appears that chiropractice can also be dangerous.

See this post by JJM (http://forums.randi.org/showthread.php?postid=3089718#post3089718)

JJM

7th November 2007, 04:08 AM

{snip} Does anyone have any scientific evidence against chiropractic medicine?The more important question is whether anyone has evidence for chiro. The answer is that the best evidence shows chiro is as effective as less expensive methods (e.g., massage) for low back pain and some kinds of headache. Although, if your chiro snaps your neck for the headache it can be lethal.
{snip} But the far greater problem is that doctors don't offer anything better. With a doctor, it's either surgery or painkillers.Whether you know it or not, this is pure, chiro propaganda. Real doctors also prescribe physical therapy, diet and exercise for back trouble.
Many doctors for whatever reason have a poor knowledge concerning the back.More propaganda. Many medical specialties don't require such knowledge. Chiros don't know anything about the back that medical specialists don't know.
On the contrary, the intricate knowledge of some chiropractic practitioners is astounding.It may appear so to the lay public.
{snip} There are a number of studies attempting to claim that chiropractic is useless, however the majority of these are poorly constructed and incomplete or flawed in a number of ways.More propaganda. As I said, the best studies show it is an expensive massage (by someone with delusions of medical grandeur). More to the point, there is no indication in the medical literature that it is superior for any indication, or that it is even effective for any of their claims for treatment of any visceral disease.

{snip}

Blue Wode

7th November 2007, 06:39 AM

Here is the most up-to-date scientific study on spinal manipulation:

A systematic review of systematic reviews of spinal manipulation

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

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

And here is the most up-to-date scientific study on complications associated with spinal manipulation:

Adverse effects of spinal manipulation: a systematic review

CONCLUSIONS: Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.

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

And here is the most up-to-date scientific study on complications associated with paediatric spinal manipulation:

Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review

CONCLUSIONS. Serious adverse events may be associated with pediatric spinal manipulation; neither causation nor incidence rates can be inferred from observational data. Conduct of a prospective population-based active surveillance study is required to properly assess the possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients.

http://pediatrics.aappublications.org/cgi/content/abstract/119/1/e275

Note what the National Council Against Health Fraud had to say about the paediatric study:

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

[My Bold]

How many people knowing the above facts (and they have an ethical and legal right to be informed of them) would still go to a chiropractor?

Certainly a lot of the negative ideas surrounding chiropractic can be assigned to practitioners within the field who have no ethical standards

To help you understand that this would appear to apply to the majority of chiropractors, I suggest that you read these two recent threads (both are three pages long):

MSNBC/Self article: dangers of chiropractic
http://forums.randi.org/showthread.php?t=85046&highlight=chiropractic

Chiropractic Woo?
http://forums.randi.org/showthread.php?t=85436&highlight=chiropractic

JJM

7th November 2007, 07:22 AM

There is a survey of chiros by chiros that is hard to get; but it is summarized here:
http://www.chiroweb.com/archives/21/12/19.html

They think it shows great unity in the beliefs of the cult members. What it really shows is the prevalence of bizarre beliefs that they hold. For example, 94% offer regular adjustments, I guess they make the other 6% look bad.

Spindrift

7th November 2007, 07:42 AM

Saw this site on a commercial. Not sure if it was a PSA or a paid ad.

http://www.chiropracticstroke.com/

JJM

7th November 2007, 08:37 AM

Saw this site on a commercial. Not sure if it was a PSA or a paid ad.

http://www.chiropracticstroke.com/It is a paid ad, and the chiros are not happy about it. The group started with a billboard a couple years ago. However, the owners were deluged with calls from chiroquacks and took it down, quickly. A year ago they put the message on the sides of some municipal buses. This time, the telephone campaign was ineffective because the city has rules that any legitimate sign stays up as long as the client pays for it.

Mr. Scott

7th November 2007, 08:57 AM

The chiropractic field is riddled with worthless woo, as exemplified in the following news story from 2006:

Chiropractor claims to travel through time (http://www.msnbc.msn.com/id/12208638/)

COLUMBUS, Ohio - A chiropractor who claims he can treat anyone by reaching back in time to when an injury occurred has attracted the attention of state regulators.

The Ohio State Chiropractic Board, in a notice of hearing, has accused James Burda of Athens of being "unable to practice chiropractic according to acceptable and prevailing standards of care due to mental illness, specifically, Delusional Disorder, Grandiose Type."

Burda denied that he is mentally ill. He said he possesses a skill he discovered by accident while driving six years ago.

"My foot hurt and, knowing anatomy, I went ahead and I told it to realign and my pain went away," Burda said Thursday.

Burda calls his treatment "Bahlaqeem."

Phytotherapist

8th November 2007, 06:59 PM

I've never been treated by a chiropractor and I never referred (and never will) a single patient to them. I always refer patients with muscular and skeletal problems to orthopaedic specialists.

15 years ago I met an American chiropractor mainly practising manipulation of the backbone. He sees an average of 30-40 people each day and refers many of them to me for, sometimes serious, medical problems. Almost all of his clients belong to the upper-middle class and pay 100-120 EUR for a single treatment. To be honest, I must say that all the patients he refers to me are more than satisfied with his "treatments" and none of them has had any side-effect from his "treatments".

An excellent orthopaedic specialist (friend of mine) and I went to visit him and we've been the whole working day in his practice where he "visited" and "treated" 32 clients. We were allowed to ask questions to him and to his clients.

I'm often discussing with this orthopaedic specialist (friend of mine) and with one of the best orthopaedic surgeons, whether chiropractic works or not, whether it is useful or not and, we haven't got a clear-cut answer yet.

How can any of you, that know little or nothing about medicine or chiropractic, be so sure that chiropractic doesn't work (or works)? By the way, Americans are, by far, the best chiropractors in Italy and there hasn't been a single case of malpractice reported.

Jeff Corey

8th November 2007, 07:07 PM

One word. Subluxations.

Jeff Corey

8th November 2007, 07:20 PM

How can any of you, that know little or nothing about medicine or chiropractic, be so sure that chiropractic doesn't work .
What an assumption. How can you, with no worthwhile training whatsoever, assume we know nothing about medicine or chiroquacktic? Do you really know what they think "subluxations" are and what they supposedly cause?

zenotter

8th November 2007, 07:22 PM

I've heard of something called network chiropractic that doesn't involve snapping adjustments, rather waves of healing energy that have a byproduct of spinal alignment for the client. Too woo for me.

I started visiting a regular chiropractor several years ago after a car accident. I wouldn't consider him woo at all, though I think he's a raw foodie vegetarian. (More power to him; I couldn't do that for long.)

Now I go occasionally and mainly for the A.R.T.* they offer. The LMTs who work on me have a way more successful time getting the kinks worked out of my upper back and neck with this technique as compared to regular massage. The occasional adjustment afterwards always seems to help, probably because I'm iced afterwards. It's not a snap-only place.

*A.R.T. = Active Release Technique; www(dot)activerelease(dot)com.

Rodney

8th November 2007, 07:38 PM

How can any of you, that know little or nothing about medicine or chiropractic, be so sure that chiropractic doesn't work (or works)?
Careful now, Phytotherapist. If medical geniuses like Randi and Shermer say it doesn't work, then how can you -- a mere medical specialist -- even consider that it could possibly work? I hereby order you to do penance by reading all the past chiropractic threads on this forum. ;)

Jeff Corey

8th November 2007, 07:47 PM

Careful now, Phytotherapist. If medical geniuses like Randi and Shermer say it doesn't work, then how can you -- a mere medical specialist -- even consider that it could possibly work? I hereby order you to do penance by reading all the past chiropractic threads on this forum. ;)
A "mere medical specialist"? He's a herbalist, and may know less scientific medicine than you do.
Maybe you can tell me about subluxations causing diabetes and cancer.

Acleron

8th November 2007, 08:07 PM

A "mere medical specialist"? He's a herbalist, and may know less scientific medicine than you do.
Maybe you can tell me about subluxations causing diabetes and cancer.

Jeff Corey beat me to it.

A phytotherapist is a herbalist in a new guise. Strange how they need to change the name to protect the innocent, sorry guilty.

arthwollipot

8th November 2007, 09:21 PM

How can any of you, that know little or nothing about medicine or chiropractic, be so sure that chiropractic doesn't work (or works)?

Ahem.

Here is the most up-to-date scientific study on spinal manipulation:

A systematic review of systematic reviews of spinal manipulation

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

http://www.jrsm.org/cgi/content/abstract/99/4/192 (http://www.jrsm.org/cgi/content/abstract/99/4/192)

And here is the most up-to-date scientific study on complications associated with spinal manipulation:

Adverse effects of spinal manipulation: a systematic review

CONCLUSIONS: Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.

http://www.jrsm.org/cgi/content/abstract/100/7/330 (http://www.jrsm.org/cgi/content/abstract/100/7/330)

And here is the most up-to-date scientific study on complications associated with paediatric spinal manipulation:

Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review

CONCLUSIONS. Serious adverse events may be associated with pediatric spinal manipulation; neither causation nor incidence rates can be inferred from observational data. Conduct of a prospective population-based active surveillance study is required to properly assess the possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients.

http://pediatrics.aappublications.or...act/119/1/e275 (http://pediatrics.aappublications.org/cgi/content/abstract/119/1/e275)

Note what the National Council Against Health Fraud had to say about the paediatric study:

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

[My Bold]

How many people knowing the above facts (and they have an ethical and legal right to be informed of them) would still go to a chiropractor?

To help you understand that this would appear to apply to the majority of chiropractors, I suggest that you read these two recent threads (both are three pages long):

MSNBC/Self article: dangers of chiropractic
http://forums.randi.org/showthread.php?t=85046&highlight=chiropractic

Chiropractic Woo?
http://forums.randi.org/showthread.php?t=85436&highlight=chiropractic

Jeff Corey

8th November 2007, 10:00 PM

Jeff Corey beat me to it.

A phytotherapist is a herbalist in a new guise. Strange how they need to change the name to protect the innocent, sorry guilty.

I'm sorry I can't figure out how to post the Gary Larson cartoon, "A wolf in sheep's clothing".
But you get the idea. They have to change the name to protect the guilty.

Physiotherapist

9th November 2007, 01:43 AM

Don't jump to conclusions and make massive assumptions about somebody's screen name!!

Why don't you look back over previous threads and posts and you will see that as well as being a Phytotherapist/herbalist, he is in fact a fully qualified medical practitioner who is Italian and lives and practices in Italy.

Blue Wode

9th November 2007, 03:04 AM

In today’s news:

'Painkillers and a walk are best for back pain'
http://www.timesonline.co.uk/tol/news/uk/health/article2836326.ece

The best treatment for acute lower back pain is a painkiller plus normal activity, a trial in Australia has shown.

Fancier treatments such as spinal manipulation, or the use of an anti-inflammatory drug, did nothing to speed recovery, say Mark Hancock, of the Back Pain Research Group at the University of Sydney, and colleagues.

-snip-

In a commentary in the medical journal The Lancet, Dr Bart Koes, of Erasmus University Medical Center in Rotterdam, says that the findings may have wider implications.

“The important message is that the management of acute low back pain in primary care (advice and prescription of paracetemol) is sufficient for most patients.”

Edzard Ernst, Professor of Complementary Medicine at Peninsula Medical School, Exeter, said: “The study seems to impressively confirm what has been known for some time, even some of the more enlightened guidelines include advice along those lines.”

Dr Stuart Derbyshire, senior lecturer in the School of Psychology and an expert in pain at the University of Birmingham, said: “For most people, providing simple care and advice should guide the patient through their acute phase of pain and allow them to return to normal life when that acute phase is over. It is reassuring that this appears to have happened in The Lancet study.”

JJM

9th November 2007, 04:48 AM

{snip}

15 years ago I met an American chiropractor mainly practising manipulation of the backbone. He sees an average of 30-40 people each day and refers many of them to me for, sometimes serious, medical problems. Almost all of his clients belong to the upper-middle class and pay 100-120 EUR for a single treatment. To be honest, I must say that all the patients he refers to me are more than satisfied with his "treatments" and none of them has had any side-effect from his "treatments".

An excellent orthopaedic specialist (friend of mine) and I went to visit him and we've been the whole working day in his practice where he "visited" and "treated" 32 clients. We were allowed to ask questions to him and to his clients.This is an anecdote- it proves nothing. Once a chiro is licensed to practice, they can do whatever they please- there is little, actual, quality control. You may have seen one of the few that realizes his limits, or you may not have recognized his quackery.
{snip}

How can any of you, that know little or nothing about medicine or chiropractic, be so sure that chiropractic doesn't work (or works)? By the way, Americans are, by far, the best chiropractors in Italy and there hasn't been a single case of malpractice reported.Post #2 in this thread leads to plenty of expert analysis that you should read (www.chirobase.org (http://www.chirobase.org/)) before you ask if we have any basis for our opinions. That web-site is a sub-site of www.quackwatch.org (http://www.quackwatch.org/), which is run by Stephen Barrett (MD) who has studied chiropractors for more than 35 years After studying the literature, if you have any unanswered questions I am sure we can help you.

JJM

9th November 2007, 06:19 AM

Chiropractic is based on two silly notions. One is Innate Intelligence (life force) which is rarely discussed because it is embarrassing. The other is the subluxation, to which they desperately cling because, without it, they are merely masseurs.

Subluxation is a medical term referring to a dislocated joint, the chiros used to say they could find them in the spine. They could even see them in x-rays, until they were asked to read unlabeled x-rays and were forced to admit they could not see anything. So, rather than admit the (invisible) subluxations do not exist, they defined a chiro subluxation as anything they could pretend to fix.
http://www.chirocolleges.org/paradigm_scope.html
Chiropractic is Concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.
A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.
A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.

The subluxation "pinches" a nerve exiting the spine and, thus, interferes with nerve signals going to and from the visceral organs- resulting in disease. This is treated with a chiro adjustment of the spine. At Chirobase, search for Crelin and read his experiments showing that even if pinched nerves existed, chiros could not adjust them.

There is a further problem with chiro notions that is rarely mentioned- most visceral organs function normally with no connection to the spine. Ask any doctor, transplanted organs are not connected to the spine. Chiros deny these facts, one even pointed me to this article on heart reinnervation after transplant.
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=10528745&dopt=Abstract
Too bad he did not read his own reference; because it supports my assertion. The article describes people who average two years post-transplant with no reinnervation. It also includes people averaging four years post-op who have slight reinnervation. A cardiologist at Harvard confirmed, for me, that heart reinnervation is slow and of little consequence.

The bottom line- the subluxation cannot be demonstrated, pinched nerves cannot be adjusted, and the nerves are not even necessary.

Nick73

9th November 2007, 06:31 AM

Are there different types of chiropractic?

I only ask because in the UK it has a veneer of respectability. One of the Universities wher I studied had a chiropractic degree (w3.glam.ac.uk/coursedetails/685/130), and have since developed a chiropractic clinic (w3.hesas.glam.ac.uk/facilities/chiropractic/) that runs under the auspices fo the University. (Is it a coincidence that the same University is reported to be one of the most financially stable (at least of the new Universities) in the UK?) When I was there I never really paid any attention to it. However in recent years I have (obviously) become more interested in skepticism and critical thinking.

I can still remember the complete shock I felt the first time I went to quackwatch and found long reference to chiropractic medicine. I was amazed because the Degree status of the discipline stops people (including myself) questioning it s efficacy too much. (It is a practical example of argument from authority I suppose. "It must work because we have a degree about it"). I particularly remember it getting up everyones nose because the third year undergraduates insisted on everyone refering to them as Doctor

So my question is are there diferent varieties of chiropractic, and hence Im confusing the two or is it all the same area? Or in other words is my old Uni fleecing the good people of Wales or is theres a different 'brand' of Chiro?

Ill give you an example, Kinesiology, in my field is the biomechanical analyses of movement and forces in the performance of some motor skill. I was surprised to find references to Applied Kinesiology in quackwatch, but despite the similarities of name this refers to a woo belief (similar to choiro i believe....but have been wrong before).

PS i have to put W3 instead of www as I have less than 15 post...my bad:rolleyes:

Jeff Corey

9th November 2007, 07:09 AM

Cuddles

9th November 2007, 07:20 AM

Are there different types of chiropractic?

Yes and no. Technically, chiropractic refers only to the beliefs and practice described by JJM - life force, non-existant subluxations and denial of germ theory. However, it has come to be mean basically massage with a different name. It's a problem, because massage and physical therapy are perfectly valid therapies and many chiropracters are actually qualified in real medicine and practice as such with no mention of the woo. This makes it a problem to argue against chiropractic in general because a lot of the time it is actually useful. The woos manage to hide behind the physiotherapists and can get away with their quackery because no-one can quite pin them down.

It's sort of similar to homeopathy. Very few people actually understand what homeopathy is, and a huge amount of stuff that is called homeopathic is actually no such thing. A lot of it is herbal, which has it's own problems, but in some cases could actually have an effect, and some is simply medicine with a label saying homeopathic. This makes it hard to argue with sometimes because when someone claims that a homeopathic remedy worked, it's entirely possible it did, it just wasn't actually homeopathic.

JJM

9th November 2007, 07:49 AM

Are there different types of chiropractic? {snip}Yes, but ... They are a cult, united around DD Palmer's subluxation notion; their schools and organizations would have you believe they are all equivalent. After that, just about anything goes. Someone has observed that chiros agree on little except opposition to criticism.

There are "straights" who only adjust the spine, and "mixers" who freely incorporate other quackery. Each chiro has his/her way of detecting subluxations, and that still includes x-ray in some cases. Then, some only "adjust" the neck (in one case, a woman with a bruised tail-bone had a stroke after the chiro adjusted her neck!). Some chiros concentrate on the other end, while trying to avoid sex-abuse charges.

In addition to the diversity of "diagnosis" and where to treat, they have over 100 methods of adjustment. At their centennial celebration in 1995, one senior chiro observed that there is no clinical proof for the effectiveness of any of those methods.

There are a small number (ca. 5%) who continue to practice under chiro licensure; but who reject subluxations. These people try to work within evidence-based therapy, much like physical therapists. However, I don't know if they are that well educated. Also, PTs work under doctors' orders and do not diagnose; whereas these guys do their own diagnosis as if they had medical knowledge and experience.

I hope that answers your question, if not I'll try to answer other questions. I should note that I have very little info specific to chiros in Britain. However, if they believe in subluxations they cannot be better than those in North America.

JJM

9th November 2007, 08:54 AM

Yes and no.I almost wrote that while you posted.
{snip} [M]any chiropracters are actually qualified in real medicine and practice as such with no mention of the woo.I must dispute the word "many." According to the survey I cited previously, only 12% eschew the subluxation, and 94% believe a regular back adjustment is beneficial. And, as I cited (after you posted) only around 5% practice evidence-based therapy (that is the enrollment in the American Association of Chiropractic Medicine- much reviled by mainstream chiros).
This makes it a problem to argue against chiropractic in general because a lot of the time it is actually useful. The woos manage to hide behind the physiotherapists and can get away with their quackery because no-one can quite pin them down. {snip}It is easy to argue against chiropractic in general, their own survey shows the prevalence of woo. However, it is difficult to know what any, individual chiro practices.

Fnord

9th November 2007, 09:10 AM

Shouldn't this thread be split into two separate threads, one named "Chiropractic" and the other named "Medicine"?

I mean ... they are two completely different subjects, after all ...

Blue Wode

9th November 2007, 12:07 PM

Chiropractic is based on two silly notions. One is Innate Intelligence (life force) which is rarely discussed because it is embarrassing.

…even although the members of two chiropractic organisations in the UK still buy into it:

United Chiropractic Association:
Vitalism: We ascribe to the idea that all living organisms are sustained by an innate intelligence, which is both different from and greater than physical and chemical forces. Further we believe innate intelligence is an expression of universal intelligence.

-snip-

We recognize that interference to innate intelligence (Subluxation) diminishes healing capacity, with an alteration in the dynamic interrelationship between mental, physical and social aspects of the whole person.

http://www.united-chiropractic.org/modules/content/index.php?id=4

McTimoney Chiropractic Association:
By correctly training the hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements).

http://www.mctimoney-chiropractic.org/mca_objectives.htm

The other is the subluxation, to which they desperately cling because, without it, they are merely masseurs.

...and like the two organisations already mentioned, here are another two UK chiropractic organisations whose members are apparently desperate not to be viewed as merely masseurs:

British Chiropractic Association:
As you go through life, a loss of proper function (movement) in the vertebrae, which some chiropractors call a subluxation, may interfere with the healthy working of your spine and the nerves that run through it. This may affect your body’s natural ability to recover from injury and you may find yourself increasingly unwell, unable to shake off apparently minor aches, pains and even some illness.

http://www.chiropractic-uk.co.uk/gfx/uploads/textbox/Servicing%20your%20spine.pdf

Scottish Chiropractic Association (see under ‘What problems can be helped?’):
Chiropractors are able to examine and evaluate a child's spine to determine if they can help problems such as colic, asthma, bedwetting, eczema and sleeping difficulties. Chiropractors advise that a child's spine be checked for subluxations and postural distortions before any symptoms are even present.

http://www.sca-chiropractic.org/index2.htm

in the UK it [chiropractic] has a veneer of respectability. One of the Universities wher I studied had a chiropractic degree (w3.glam.ac.uk/coursedetails/685/130), and have since developed a chiropractic clinic (w3.hesas.glam.ac.uk/facilities/chiropractic/) that runs under the auspices fo the University.

In the UK, the chiropractic regulatory body, the General Chiropractic Council (GCC), is responsible for the accreditation of all chiropractic degrees in the UK. For some eye-opening information on the GCC, and a revealing look at the deceptive behavior of the chiropractic “profession” in general in the UK, I suggest that you read this page:
http://forums.randi.org/showthread.php?t=85046&page=2

For a great summary of the chiropractic educational and regulatory situation in the UK see the end of this article:
http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php

I can still remember the complete shock I felt the first time I went to quackwatch and found long reference to chiropractic medicine. I was amazed because the Degree status of the discipline stops people (including myself) questioning it s efficacy too much. (It is a practical example of argument from authority I suppose. "It must work because we have a degree about it").
[My bold]

It would seem that that’s exactly what the chiropractic profession banks on.

I particularly remember it getting up everyones nose because the third year undergraduates insisted on everyone refering to them as Doctor

Chiropractors are not permitted to call themselves “doctors (of chiropractic)” until after they have graduated.

Kinesiology, in my field is the biomechanical analyses of movement and forces in the performance of some motor skill. I was surprised to find references to Applied Kinesiology in quackwatch, but despite the similarities of name this refers to a woo belief

Yes, there is absolutely no scientific evidence for Applied Kinnesiology, however, the GCC finds it an acceptable practice despite its Code of Ethics and Standard of Proficiency requiring that “chiropractors’ provision of care must be evidence based”. For verification of this, see one of the more recent GCC letters published on this page of the Action for Victims of Chiropractic website:
http://www.chirovictims.org.uk/victims/news.html

many chiropracters are actually qualified in real medicine

Would you please provide the evidence to support that claim.

JoeTheJuggler

9th November 2007, 05:14 PM

And, as I cited (after you posted) only around 5% practice evidence-based therapy (that is the enrollment in the American Association of Chiropractic Medicine- much reviled by mainstream chiros).

I can't imagine they're exactly embraced by the mainstream medical community either.

Acleron

9th November 2007, 06:22 PM

I can't imagine they're exactly embraced by the mainstream medical community either.

Not embraced but more insidiously, accepted.

tsig

9th November 2007, 07:44 PM

tsig

9th November 2007, 07:49 PM

JoeTheJuggler

10th November 2007, 12:04 AM

Not embraced but more insidiously, accepted.

That's a darn shame.

My mom is a long retired P.T., and when I was growing up, for a long time I thought the correct term was "chiroquackter".

zenotter

10th November 2007, 01:37 AM

Teh teck is to get the money to release from the wallet.
True that with teh s ucking of teh money. A.R.T. is helpful when I have a fibromyalgia flare (mainly due to changing weather) but that massage modality is for soft tissue conditions and doesn't appear to be strict chiropractic although it's offered by my chiropractor. I don't think a lot of chirocrackers offer it, but I could be mistaken.

I've also mentioned to him that basic yoga "cracks" me enough to keep me limber and he flipped out a little, advising that I could injure myself unknowingly. He's all for yoga but not for self-adjustments. That was my tip-off to "something's not quite right here" since my neck and lower back crack quite well on their own, quite often.

Maybe I'll sue myself for malpractice. ;)

Eos of the Eons

10th November 2007, 09:57 AM

http://www.news.com.au/heraldsun/story/0,21985,22732746-2862,00.html

http://www.guardian.co.uk/science/2007/nov/09/medicalresearch (http://www.guardian.co.uk/science/2007/nov/09/medicalresearch)
For most people, providing simple care and advice should guide the patient through their acute phase of pain and allow them to return to normal life when that acute phase is over. It is reassuring that this appears to have happened in the Lancet study."
There's really nothing to chiroquacktic except the usual placebo effect. A nice hot bath will do more with less risk of damage.

Phytotherapist

10th November 2007, 10:17 AM

Tsig - If you don't believe a single word it is your problem.The fact is that Americans working in Italy are quite excellent Chiropractors. It could't be otherwise because they work here on the edge of law: Chiropractic is considered here a medical act and only medically qualified practitioners are allowed to practice. American Chiropractors are "tolerated" because they never caused any problem to their clients. Moreover, some of them are working in clinics or hospitals alongside with doctors as part of group practices. Many football (soccer)teams have a Chiropractor in their medical team and many stars are regularly visiting them for "treatment".

I don't understand: why I should be a Chiropractor? I'm practising Integrated Medicine (Mainstream, Nutritional and Phytotherapy) as well as Aesthetic Surgery and I'm quite happy with my work and with my life.

Radrook

10th November 2007, 10:28 AM

I was suffering from persistent gastrointestinal distress. Dietary restrictions along with vertebral adjustments seem to have cured me in less than a week.

However, the rest of my experiences with chiropractors resulted in slipped disk symptoms accompanied by previously absent sciatica. This happened after I was-informed that collecting the fee from my insurance was proving difficult.

At another I acquired shoulder discomfort after just one adjustment. There was also the painful application of heat pads which threatened serious burns forcing me to call out repeatedly chiropractor assistant in the next room who was joking and conversing with someone. Annoyed at my interruptions, he seemed unable or unwilling to reduce the heat.

Another Chiropractor claimed not to need X-ray machines. He simply looked you over and Voila, he knew exactly what the problem was. Additionally, he would adjust nothing. He would simply tap the neck and other areas lightly claiming that the touch of a hand is a very powerful thing. He later admitted that he was essentially experimenting with the people in the low-income neighborhood and that he had been involved in lawsuits based on his unorthodox approach.

Eos of the Eons

10th November 2007, 10:42 AM

Tsig - It could't be otherwise because they work here on the edge of law: Chiropractic is considered here a medical act and only medically qualified practitioners are allowed to practice. American Chiropractors are "tolerated" because they never caused any problem to their clients.

They are tolerated because years ago a political chiro buddy made it legal. They cause considerable problems to their clients... like STROKES. But, since they are not MDs they don't have acknowledge these risks or do anything about informed consents.

Radrook

10th November 2007, 10:53 AM

I agree. There certainly is danger involved. There are numerous cases in which patients are misdiagnosed-treated, and suffer the dire consequences.That's why a person should first seek a diagnosis from a regular doctor before seeking chiropractic treatment.

Excerpt:

Injured patients!

A 58-year-old woman consulted a chiropractor for low back and left hip pain. The chiropractor performed a cursory physical exam and x-rayed only her lumbar spine. Diagnosing "lumbar nerve pressure syndrome," he manipulated her low back area with her left leg flexed. The patient's problem was actually a fractured hip. Manipulation disturbed the fracture and made normal healing impossible. As a result, the patient required surgical implantation of an artificial joint.

A 38-year-old man who consulted a chiropractor for low back pain was * x-rayed, examined briefly, and treated with spinal manipulation. Despite three months of treatment, his pain persisted and he consulted a second chiropractor who treated him in a similar fashion. When his pain persisted, he went to a medical doctor who ordered tests that led to a diagnosis of Hodgkin's disease. The patient's pain had been caused by swollen lymph glands. It disappeared with treatment of his underlying disease.

A 58-year-old man with back pain became paralyzed from the waist down after spinal manipulation by a chiropractor. Unknown to the chiropractor, the patient's spine had been weakened by metastatic bladder cancer. The chiropractor's evaluation did not include a medical history, an orthopedic evaluation, or a urinalysis. An x-ray film was taken but was of such poor quality that it was diagnostically useless.

A 50-year-old man required surgery for a prolapsed lumbar disc that was ruptured by chiropractic treatment. Careful orthopedic evaluation would have indicated that what the patient needed at the time of his chiropractic visit was not manipulation but bed rest and traction.

A 63-year-old woman who relied on a chiropractor to treat her for neck pain, headaches, nausea, and dizziness died as a result of a brain hemorrhage. Unsuspected by the chiropractor, her symptoms were caused by high blood pressure in urgent need of medical management.

A 55-year-old man who consulted a chiropractor for pain in his midback, chest, and left shoulder was told that his pain was "nerve pressure" from a spinal subluxation. His problem was actually a heart attack requiring immediate hospitalization.

By: Peter J. Modde, D.C.

http://www.chirobase.org/01General/modde.html

The truly amazing thing is how this is allowed to go on unabated. Certainly some type of restriction in terms of diagnosis and treatment should be required.

JJM

10th November 2007, 10:55 AM

{snip} The fact is that Americans working in Italy are quite excellent Chiropractors.Compared to what? You said you have only met one. True, there are a small number of chiros who try to practice evidence-based therapies. Do you suppose they are the only ones who move to your country?
{snip} Many football (soccer)teams have a Chiropractor in their medical team and many stars are regularly visiting them for "treatment".That is true here, too. However, although athletes rely on their bodies, they are not particularly sophisticated about quackery.

I suspect you don't know what mainstream chiro entails.
{snip}

Blue Wode

10th November 2007, 12:35 PM

Here’s another press report on the study published in the Lancet:

Chiropractors 'are waste of money'
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/11/09/nback109.xml

Note the misleading comments from Tony Metcalfe, president of the British Chiropractic Association:
The BCA was, however, encouraged to see that no participants reported serious adverse reactions associated with spinal manipulation therapy, which further reinforces the fact that spinal manipulation is safe.

It is not “a fact” that spinal manipulation is safe. Once again, here are the conclusions of the most recent scientific study on the subject:

Adverse effects of spinal manipulation: a systematic review

Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.

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

More from Mr Metcalfe:
When it comes to back pain, there is no single treatment that has been researched more than chiropractic, and the results speak volumes.

And supported by the study in the Lancet, here’s what those (not cherry-picked) results have said:

The value of chiropractic

Back pain is by far the condition most frequently treated by chiropractors. The Cochrane review of spinal manipulation for back pain summarised 39 clinical trials.1 The authors’ conclusions were very clear: ‘There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.’

A Cochrane review of spinal manipulation and mobilisation for mechanical neck disorders evaluated 33 clinical trials.2 The authors found that, combined with exercise, these approaches were promising, but ‘the evidence did not favour manipulation and/or mobilisation done alone or in combination with various other physical medicine agents; when compared to one another, neither was superior.’2

Another Cochrane review summarised the available trials of chiropractic treatment for asthma.3 The authors found only two such studies and ‘neither trial found significant differences between chiropractic spinal manipulation and a sham manoeuvre on any of the outcomes measured.’ Finally, a Cochrane review assessed five trials of spinal manipulation for dysmenorrhoea.4 The authors concluded that ‘there is no evidence to suggest that spinal manipulation is effective in the treatment’ of this condition.

Any discussion of therapeutic value would be incomplete if it excluded adverse effects. Most chiropractors recognise that manipulation of the upper spine may lead to a stroke, which can be fatal. However, they are adamant that such dramatic complications are extremely rare. In its current promotional literature, the UK General Chiropractic Council does not mention serious risks at all and only states that ‘it is normal to experience some reaction to treatment, including temporary increase in discomfort, stiffness or tiredness for a day or so.’5 On the other hand, the same brochure also informs us that before treatment starts chiropractors should explain clearly to patients ‘the probability of risks associated with your condition and proposed treatment.’5

No Cochrane review is available specifically on the safety of spinal manipulation. An authoritative (non-Cochrane) systematic review of this area included 295 complications after spinal manipulation.6 The authors concluded that ‘referral for spinal manipulative therapy should not be made to practitioners applying rotary cervical manipulation.’6 Based on these findings and more recent data as well, a US forensic examiner advised that ‘the public should be informed that chiropractic manipulation is the number one reason for people suffering stroke under the age of 45.’7

http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm

A systematic review of systematic reviews of spinal manipulation

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

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

Hardly anything for chiropractors to shout about.

The fact is that Americans working in Italy are quite excellent Chiropractors. It could't be otherwise because they work here on the edge of law: Chiropractic is considered here a medical act and only medically qualified practitioners are allowed to practice.

Presumably these chiropractors gained their qualifications in America where, as recently as 2004, 89.8% of chiropractors thought that the chiropractic ‘adjustment’ shouldn’t be limited to musculoskeletal conditions, and more than 75% endorsed the vertebral subluxation concept, as well as the subluxation being a significant contributing factor in many visceral ailments. In addition to that, they endorsed the teaching of a relationship between spinal subluxation and visceral health.

[McDonald W, Durkin K, Iseman S, et al, How Chiropractors Think and Practice: The Survey of North American Chiropractors, Seminars in Integrative Medicine, Vol.2 Issue 3, 2004, pp92-98.]

There's really nothing to chiroquacktic except the usual placebo effect. A nice hot bath will do more with less risk of damage.

This is what it seems to be rapidly boiling down to. This fact sheet from UK Skeptics sums it up very well:
http://www.skeptics.org.uk/factsheets/Chiropractic.pdf

What I’d like to know is why aren’t more skeptical bloggers highlighting the problems with chiropractic?

Eos of the Eons

10th November 2007, 01:15 PM

Particularly since they are so miseducated that they are some of the biggest purveyors of antivaccine misinformation.

Acleron

10th November 2007, 05:02 PM

What I’d like to know is why aren’t more skeptical bloggers highlighting the problems with chiropractic?

Give them their due, there are only so many dragons one person can slay.

I emailed badscience to inform him of the chiropractic that had started appearing on a channel 5 program and his response, quite rightly, was start a blog yourself. I have neither the writing skills or the education to take on such a wide subject, but I'll support anyone who does.

Blue Wode

11th November 2007, 03:37 AM

Particularly since they are so miseducated that they are some of the biggest purveyors of antivaccine misinformation.

Absolutely, Eos.

For example, how many people know that an elected member of the General Chiropractic Council, Richard Lanigan, (who serves on its Health Committee which considers complaints against chiropractors relating to their mental or physical health - see here http://www.gcc-uk.org/page.cfm?page_id=9#3 ), is a blatant anti-vaxer?

Regarding the GCC’s members’ interests list, under ‘non-pecuniary interests declared’ Mr Lanigan has put “campaign of awareness of adverse events from vaccinations”, and under ‘direct pecuniary interests declared’ he has put “European distributor for Koren publication patient education materials”.

A link to that information could previously be found here
http://test.gcc-uk.org/files/link_file/Direct%20Indirect%20and%20non%20pecuniary%20intere sts%20July%2007.pdf
but it now appears to have been removed (fortunately I have it on hard copy). However, if you look at the end of the home page of his highly dubious ‘vaccination’ website, it says:

Thanks go to Tedd Koren, DC, who has contributed much to the content of this site.

http://www.vaccination.co.uk/

So it’s wholly evident that he is in cahoots with Mr Koren.

For those not familiar with Tedd Koren, DC, he is a notorious anti-vaccination chiropractic lecturer, researcher and publisher who lives in Pennsylvania, USA.

Here is a sample of his website material:
http://www.korenpublications.com/kp/category/vaccine-information

Phytotherapist

11th November 2007, 02:53 PM

JJM - American Chiropractors working in Italy are quite excellent compared to other Italian and foreign Chiropractors. I met 4 American Chiropractors and I can say that they are very well prepared in the anatomy and physiology of the Muscl-Skel system. I can also say that I met a few American Ortopaedic MDs and Physiotherapists and I, and an ortopaedic specialist friend of mine, were very impressed with their skills. I'm sure, although I have not the monopoly of truth, that American Ortopaedic doctors and physiotherapists are, on average, far better than European Ortopaedics and Physiotherapists. In Europe, in my opinion, UK Ortopaedics, Physiotherapists (and Chiropractors) are the best. In all other fields of Medicine e.g. Cardiology, Oncology etc. US and European doctors are, more or less, at the same level (on average).

My opinion is that there is no "alternative Medicine" like there is no alternative tax lawyer that can help me to avoid paying taxes. All that works and is good for the patient must be mainstream. We are discussing Chiropractic without considering the role of good or bad practitioners.

One more thing: I had a lively discussion with this American Chiropractor about the American cars. He claims that European and Japanese cars are better than American cars. I'm convinced that this is not true. Can anyone tell me why Americans tend to overestimate the quality of foreign goods?

JoeEllison

11th November 2007, 02:56 PM

It is easy to put down chiropractic medicine.

Yes, fraudulent pseudoscience IS easy to put down! :cool:

JJM

11th November 2007, 04:06 PM

JJM - American Chiropractors working in Italy are quite excellent compared to other Italian and foreign Chiropractors. I met 4 American Chiropractors and I can say that they are very well prepared in the anatomy and physiology of the Muscl-Skel system.You described meeting one; it was my mistake to think that was all you knew. However, I still doubt you know what chiropractic is.
{snip} My opinion is that there is no "alternative Medicine" like there is no alternative tax lawyer that can help me to avoid paying taxes. All that works and is good for the patient must be mainstream. We are discussing Chiropractic without considering the role of good or bad practitioners.You are right, there is no "alternative medicine" (AM) in the scientific view. AM is a marketing term, used by proponents, that has come into popular use in the USA to make quackery sound nice. Other such terms are "Complementary" "Integrative" and "Holistic," to name a few. Herbs, homeopathy, reiki, acupuncture and chiropractic are all AM. Another way to describe AM is- methods that are largely unproven (or, disproven); many such methods are also irrational.

In the case of chiropractors, "good" practitioners would be those who retain the designation of "chiropractor" but do not practice it. These are people who try to work as masseurs, or physical therapists (PT). One can only hope that, when trying to replace a PT, they are adequately prepared; there is little quality control on their education. Most especially, they are not properly trained in diagnosis; I don't know how one learns that by oneself.

It would help if you would explain what you think chiropractic is. You could just refer us to a web-site that encompasses your understanding.
{snip}

arthwollipot

11th November 2007, 10:52 PM

My opinion is that there is no "alternative Medicine" like there is no alternative tax lawyer that can help me to avoid paying taxes.

"Alternative medicine" is simply a shorthand way of saying "medicine that hasn't been proved to work".

Blue Wode

12th November 2007, 02:31 AM

Re: 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
http://www.medpagetoday.com/Geriatrics/PainManagement/tb/7307

Peter Dixon, Chairman of the UK General Chiropractic Council (GCC), has just issued a statement in which he declares that the GCC is appalled by press reports that ‘chiropractic is a waste of time and money’. He goes on to say:

Chiropractors provide an evidence-based approach based on European-wide guidelines compiled by multidisciplinary teams of experts who reviewed all relevant research.

The main treatments of chiropractic have been shown consistently in reviews to be more effective than the treatments to which they have been compared. Chiropractic intervention is safe, effective and cost-effective in reducing referral to secondary care.

http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf

Note the total absence of scientific references in support of Mr Dixon’s claims.

Regards guidelines, here’s what Professor Edzard Ernst has to say about them:

And what about national guidelines? Chiropractors argue that their approach must be safe and effective, not least because the official guidelines on the treatment of back pain recommend using chiropractic. However, this is true only for some, but by no means all, countries. Secondly, guidelines are well known to be influenced by the people who serve on the panel that develops them. Cochrane reviews, on the other hand, are generally considered to be objective and rigorous. Writing about the importance of systematic reviews for health care in the Lancet, Sir Ian Chalmers stated, ‘I challenge decision makers within those spheres who continue to frustrate efforts to promote this form of research to come out from behind their closed doors and defend their attitudes and policies in public. There is now plenty of evidence to show how patients are suffering unnecessarily as a result of their persuasive influence.’10

The Value of Chiropractic
http://www.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm

fls

12th November 2007, 05:54 AM

"Alternative medicine" is simply a shorthand way of saying "medicine that hasn't been proved to work".

I don't think that's the case. There are many treatments that haven't been proved to work that aren't called alternative - any drug in development, novel surgeries, extensions of rehabilitation techniques, etc., etc. Physicians and medical researchers are always trying new things, such as extending established treatments to novel uses or trying to come up with novel therapies, but we don't call what they do 'alternative'. It's simply normal/conventional medicine.

I think 'alternative medicine' is something else. It is therapies that are used despite the fact that have already been demonstrated to be ineffective or are highly likely to be ineffective. What is different about them is the attitude towards evidence, not the absolute amount of evidence. In the case of using herbals, what is 'alternative' is not the idea that plants can contain useful medicinal properties. It is the idea that a long tradition of subjective evaluation and observation is a useful way of gathering reliable knowledge. Our scientific evaluation of plant extracts has led us to discover that the traditional use of these extracts was wholly inadequate when it came to discovering which uses were ineffective and which uses were effective in situations any more complicated than symptom relief (or generation in the case of things like laxatives and purgatives). The same goes for harm.

Those herbalists who treat the body of knowledge derived from traditional uses of plants and/or scientific information that is preliminary at best, as though it has enough accuracy and reliability to guide the use of these plants in the prevention and treatment of disease, are practicing 'alternative medicine' because we have already demonstrated that this assumption is false. The ratio of useful information to useless information is very low. The inability to discover when you are wrong is a demonstrably ineffective way to make progress.

Hence my signature.

Linda

ETA: I admit that I got my threads a little mixed-up, but my point applies to any 'alternative medicine', including Chiropractic.

Mashuna

12th November 2007, 07:31 AM

One more thing: I had a lively discussion with this American Chiropractor about the American cars. He claims that European and Japanese cars are better than American cars. I'm convinced that this is not true. Can anyone tell me why Americans tend to overestimate the quality of foreign goods?

Personally, I think he's right. European and Japanese cars generally are better than American cars. Although it all depends on your definition of 'better', and you can certainly pick a good American car and compare it to a bad European car.

Although I see you're based in Italy - I've never driven Italian cars, but have had good experiences with German and Japanese cars, bad experiences with American.

Here endeth the derail.

Phytotherapist

12th November 2007, 06:25 PM

JJm - The one I metioned allowed me to see the whole working day his "treatments" and to ask questions. Of course I don't know what Chiropractic is otherwise I would be a Chiropractor. I just try to understand how much it is effective compared to conventional treatments (only for pain treatment). I don't think Chiropractic could be beneficial for Dysmenorrhoea, Allergies, Stress, Insomnia etc.

I have a few leaflets in Italian advertising Chiropractic (written by the American Chiropractors working here). I'll try to translate it in English: * Chiropractic is third among health professions after Medicine and Dentistry and is rapidly growing. * More than 50,000 Chiropractors in USA treat more than 2,000,000 people each day (it means about 40 a day). * More than 90% of insurance companies (in USA) cover expenses for chiropractic treatment. * More than 17 Universities in USA offer chiropractic courses. These Universities are authorized and recognized by the Federal Government and by all 50 States. * Universities teaching chiropractic are similar to Medical Schools. 11 chiropractic and 22 Medical school were compared which show that chiropractic students must attend 4,485 hours compared to 4,248 hours for students in Medicine. Here are the hours by subject for chiropractors (in brackets for MDs). Anatomy 520 (508), Physiology 420 (326), Pathology 205 (401), Chemistry 300 (326), Bacteriology 130 (114), Diagnosis 420 (324), Neurology 320 (112), Radiology 217 (148), Psychiatry 65 (144), Obstetrics 65 (148), Orthopaedics 225 (156). Total: 2,887 (2,706). I have the copy of their Course Syllabus which is very similar to ours (MDs). I'd like to know whether the above is correct or not.

There is an excellent Clinic in my region (near Venice) with an Orthopaedic specialist, a Physiotherapist and a Chiropractor (American of course), working together on the same patients: the Orthopaedic specialist makes the correct diagnosis and prescribes the treatment carried out by the Physiotherapist and the Chiropractor (manipulations). Why would they need the help of the chiropractor if chiropractic is always less effective in pain treatment than conventional treatment? There are many more questions on this issue and this is why I don't have a definitive opinion on Chiropractic. The line that separates conventional Medicine from quack "medicine" (if it is quack than it's not medicine) is not so obvious. Please forgive my English!

fls

12th November 2007, 08:19 PM

They why is chiropractic separate from medicine or physiotherapy?

Linda

Eos of the Eons

12th November 2007, 10:23 PM

Just look at the crazy education chiros get compared to people who actually learn how the body really works.

http://www.rebuildyourback.com/chiropractic/school.php (http://www.rebuildyourback.com/chiropractic/school.php)

Blue Wode

13th November 2007, 04:36 AM

The British Chiropractic Association has now issued a statement rebutting the findings of the study published in this week’s Lancet. See latest media release here:
http://www.chiropractic-uk.co.uk/default.aspx?m=5&mi=21&title=Media+Area

Its ‘Notes to Editors’ section, in which it continues to tout the Meade Trial in support of chiropractic, is a particular disgrace:

Parallels can be drawn from this study with the results of the Meade Trial (1990) BMJ 2nd June 1990, Vol.300 – pages 1431-1437, Low back pain of mechanical origin: randomised comparison of chiropractic ad hospital outpatient treatment which compared chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin and found that “chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management” (physiotherapy). These findings were endorsed by the follow-up Meade trial published in BMJ Vol.311 on 5 August 1995 which further indicated that “those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals” (physiotherapy).

Here’s what the British Chiropractic Association fails to mention:

From 1991
Effectiveness of chiropractic and physiotherapy in the treatment of low back pain: a critical discussion of the British Randomized Clinical Trial

The results are difficult to extrapolate, because only a small portion of the eligible patients participated, and chiropractic seems to be clearly superior only in the subgroup originally presenting to a chiropractic clinic. We conclude that it is premature to draw conclusions about the long-term effectiveness of chiropractic based on the results of this study alone.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1833493

From 1995
Results were clinically trivial

EDITOR,--T W Meade and colleagues have provided further data from their study comparing chiropractic with hospital physiotherapy.1 Unfortunately, their report is far from convincing. The "headline" advantage of chiropractic over hospital management at three years (29%) sounds impressive but refers to an improvement of three points on the 100 point Oswestry scale, or one and a half responses on the questionnaire. This difference may be statistically significant but is clinically trivial.

In their original article the authors noted that chiropractic was 50% more expensive,2 and in the latest report they note that the chiropractic group had more treatments in the long term. The measured improvement does not seem to support such an expenditure.

The design of the study was criticised after the first paper was published.3 The patients initially presenting to a chiropractor were self selected on the basis that they believed that chiropractic would be effective (as they were expecting to pay for treatment). It is interesting that only the patients referred by chiropractors showed a significant advantage for chiropractic. Those initially recruited in hospital practice showed no significant difference. The study compares private practice with NHS treatment, with all the implications for environmental and personal factors that this brings. The follow up rate (70% and 77%) is inadequate and would preclude publication in some journals.4 Analysis by intention to treat does not obviate this deficiency. Important variables such as psychological disturbance are not addressed, although these are noted to have a greater impact on results than does treatment.5

It is disappointing that in the five years between the reports these and the other criticisms that were raised were not more fully addressed. Despite the acclamation of the first report in the popular media, I do not think that this study has advanced our understanding of the treatment of back pain in any useful way.

http://bmj.bmjjournals.com/cgi/content/full/311/7015/1302

From 1998
“Chiropractors often cite the trial of the UK Medical Research Council in defence. They say it favoured chiropractic over physiotherapy. This trial, however, is much misinterpreted as both its treatment groups received spinal manipulation." Professor Edzard Ernst, The London Independent

http://findarticles.com/p/articles/mi_qn4158/is_19981208/ai_n14204324/pg_1

Where is the integrity of this profession?

JJM

13th November 2007, 06:07 AM

{snip} Of course I don't know what Chiropractic is {snip}Then, you should not be promoting it. Perhaps the person you watched did not really practice it. The second post in this series directed you to a place where you can learn the facts.
{snip} Chiropractic is third among health professions after Medicine and Dentistry and is rapidly growing.A fallacious appeal to popularity.
{snip} More than 90% of insurance companies (in USA) cover expenses for chiropractic treatment.That is because they are required to do so by law. Legislators are not informed on health care, and readily pass legislation that does not spend tax dollars.
More than 17 Universities in USA offer chiropractic courses.Not "universities." They are stand-alone colleges. Respectable universities have rejected chiro affiliation.
Universities teaching chiropractic are similar to Medical Schools. {snip}This is chiro propaganda/wishful-thinking. It is not a question of how many hours chiros spend in school, what matters is what they are really taught. They spend a lot of time on the basics of their cult, regardless of the title or description of the course. Their clinical experience before being licensed to practice is laughable. I think Eos has addressed this.
{snip} I'd like to know whether the above is correct or not.It is not- see the literature.
{snip} Why would they need the help of the chiropractor if chiropractic is always less effective in pain treatment than conventional treatment? {snip}Chiro is not less effective in low-back pain and certain headaches- it is as effective as (less expensive) massage. Why would a doctor hire a chiro (?) some doctors don't understand the nonsense.

JJM

13th November 2007, 06:10 AM

{snip} Where is the integrity of this profession?It is not a profession, it is a cult. Thanks for the useful references.

Phytotherapist

13th November 2007, 03:25 PM

Mashuana - On the other hand I had bad experiences with German cars (Mercedes S, Volkswagen Golf, Porsche Cayenne)and Japanese cars (Mazda5) and good experiences with American cars (Grand Cherokee 4.7 and Chrysler 300 C CRD Touring). Top Italian cars (Ferrari, Maserati and Lamborghini) are also good.
I had a Porsche Cayenne that was unpractical inside, very hard to drive and very uncomfortable. On the other hand, Grand Cherokee is spacious, very comfortable and I could drive it the whole day without getting tired. It is also incredibly capable off-road and costs 50% less than Cayenne.

More American cars (Ford, GM and Chrysler) are sold in Ialy than Japanese. This means that Italians think that American cars are better than Japanese cars (which are also very uncomfortable). I know that people after buying Japanese cars are often reluctant to admit the error but the fact is that only few of them buy again a Japanese car.

I'm not promoting American cars as I'm not promoting Chiropractic. I just say that the world is not only black and white, that there are many quacks (not you!) on this thread that know nothing about Medicine (and life) and their words have the effect of strenghtening "alternative" quacks.

fls

13th November 2007, 04:09 PM

I'm not promoting American cars as I'm not promoting Chiropractic. I just say that the world is not only black and white, that there are many quacks (not you!) on this thread that know nothing about Medicine (and life) and their words have the effect of strenghtening "alternative" quacks.

I realize that you are referring to people like me with your characterization, but your statement that our words strengthen alternative quacks is interesting. Can you elaborate on what you mean by that? I'm interested in your insights on this issue.

Linda

JJM

14th November 2007, 07:49 AM

{snip} The line that separates conventional Medicine from quack "medicine" (if it is quack than it's not medicine) is not so obvious. {snip}
{snip} I just say that the world is not only black and white, {snip}These statements are too vague to use. They remind me of the quack plea to realize that we don't know everything; therefore, we should allow anything.

In the case of chiropractic, it is unarguably quackery. If the chiropractor you observed was practicing evidence-based medicine, he was not practicing chiropractic.

Phytotherapist

15th November 2007, 06:25 PM

Fls - I wasn't referring at people like you although I don't share some of your ideas. I would elaborate but my English is not good enough. My feeling is (I may be wrong) that they (quacks) are growing faster and faster all the time. I have many theories on this subject but I'm afraid I'm unable to explain it correctly.

athon

15th November 2007, 06:50 PM

They why is chiropractic separate from medicine or physiotherapy?

Linda

I think this question needs repeating. The arguments in favour of chiropracty always focus on its similarities with physiotherapy or liken it to a back specialist, ignoring its roots in pseudoscience. Which is fine...except if it's no different to a back specialist (trained in medicine), then why chiropracty? What benefit does it offer over physio?

Athon

Jeff Corey

15th November 2007, 07:02 PM

... there are many quacks (not you!) on this thread that know nothing about Medicine (and life) and their words have the effect of strenghtening "alternative" quacks.
That sounds like you are describing yourself.

Blue Wode

17th November 2007, 02:51 AM

Hot on the heels of the Hancock et al study on spinal manipulation in the Lancet comes this article from Edzard Ernst:

Spinal manipulation: are the benefits worth the risks?
E. Ernst, Expert Review of Neurotherapeutics, November 2007, Vol. 7, No. 11, Pages 1451-1452
http://www.future-drugs.com/doi/full/10.1586/14737175.7.11.1451?cookieSet=1

This is interesting:
…the early chiropractic literature provides ample evidence for the fact that chiropractic was not originally meant as a treatment for musculoskeletal problems, but as a cure for any human condition [1].

To understand this seemingly bizarre claim a little better, one should glance at the concepts that underlie chiropractic. Palmer was convinced that he had discovered a law of nature. In his view, all human illness and disease were caused by the blockage of the 'innate intelligence’ through vertebral malalignments or subluxations. Therefore, all conditions could and should be treated with adjustments of these abnormalities, in other words, spinal manipulation. This would restore the flow of the innate intelligence and, in turn, would cure whatever condition the patient was suffering from [1].

It seems obvious to any critical evaluator that these concepts are little more than fantasy: there is no evidence for any innate intelligence, and there is no reason to assume that adjusting malalignments of vertebra (if they at all exist) are the cause of disease or illness…

And yet the McTimoney College of Chiropractic course in the UK apparently instructs its students in the following:

By correctly training the hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements).

http://www.mctimoney-chiropractic.org/mca_objectives.htm

Incredibly, that course (which has produced 500 practising chiropractors) is validated by the University of Wales as a BSc (Hons) Chiropractic degree:
http://www.mctimoney-college.ac.uk/cofc.htm

Even more bewildering is that the UK General Chiropractic Council stipulates in its Code of Practice and Standard of Proficiency that chiropractors’ provision of care must be evidence based. See section A2.3 of the Standard of Proficiency here:
http://www.gcc-uk.org/files/link_file/COPSOP_8Dec05.pdf

:boggled:

Acleron

17th November 2007, 04:06 AM

Hypocrisy, inability to think logically and credulous acceptance of invalidated treatment modes are all characteristics of purveyors of woo, so I don't find it incredible or bewildering that the Chiropractic Council issues such statements or that it is taught in universities.

I just find it so damned depressing. :(

Blue Wode

29th November 2007, 04:35 AM

Following on from the Hancock study which was published this month in the Lancet…

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

…here’s a newly-published study which seems to support the findings of that study:

‘Nonspecific Low Back Pain and Return to Work’
American Family Physician
15th November 2007
http://www.aafp.org/afp/20071115/1497.html

Interestingly, no mention is made of ‘chiropractic’. As for spinal manipulation, it was mentioned once in a brief list of “treatments for which evidence of effectiveness is unclear”.

ETA: Here’s the very latest from Ernst:

Spinal manipulation: are the benefits worth the risks?
http://www.ukskeptics.com/documents/spinal_manipulation_benefits_risks.pdf

zenotter

1st December 2007, 01:10 PM

I think this question needs repeating. The arguments in favour of chiropracty always focus on its similarities with physiotherapy or liken it to a back specialist, ignoring its roots in pseudoscience. Which is fine...except if it's no different to a back specialist (trained in medicine), then why chiropracty? What benefit does it offer over physio?

Athon
At least where I live, chiro offices seem to be way more accessible for people to travel to (the Starbucks of alternative wellness services, with one on each corner) compared with actually making an appointment at a hospital. I had physical therapy at a hospital after a car accident, which helped about as much as adjustments with my chiropractor back then. Both emphasized proper posture, adequate stretching/exercise, and all the common sense self-care things, anyway.

I think I've had a fortunate experience with finding a chiropractor's office that's not woo at all. Still, the only reason I go there nowadays is for the specialized massage (A.R.T.) that happens to be offered. I get so much benefit from that, plus my cost is way less than it would be otherwise since my health insurance covers appts with chiropractors. :)

Blue Wode

7th December 2007, 04:21 AM

I think I've had a fortunate experience with finding a chiropractor's office that's not woo at all.

It would seem that you have considering that around 90% of chiropractors in the USA buy into the Palmer’s original subluxation theory, and four chiropractic associations here in the UK appear to support it.

Regards the one aspect of chiropractic that has been supported by a small amount of evidence (spinal manipulative therapy for low back pain), here’s an update from this week’s Consumer Health Digest newsletter published by the National Council Against Health Fraud:

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 antiinflammatory 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

Full Text of the Hancock et al study here:
http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf

Interestingly, the chiropractic profession in the UK is currently up in arms about the study, including its regulatory body which is protesting that it doesn’t address the effectiveness of ‘chiropractic’.

http://www.gcc-uk.org/files/page_file/LANCET%20Australian%20study%20statement9Nov07.pdf

It has even written to the Press Complaints Commission in an attempt to elicit a public apology from three newspapers for saying that chiropractic is ‘a waste of money’,

http://www.gcc-uk.org/files/page_file/Letter%20PCC%2020Nov07%20(Website).pdf

and despite the emerging lack of evidence for spinal manipulation it is currently actively promoting chiropractic as a career:
http://www.gcc-uk.org/files/page_file/CAREERS%20LEAFLET%20FINAL%20FOR%20WEBSITE30Nov07.p df

Could the chiropractic PR machine be taking lessons from the homeopathy community?

simonmaal

7th December 2007, 06:00 AM

Not only is chiropractic nonsense, it can be dangerous for two reasons. First, ham-fisted manipulation can cause injury and secondly (and more significantly), consulting a chiropractor can cause a person to forego proper medical care.

Blue Wode

24th February 2008, 08:55 AM

From today’s CBS news, ‘Risk of chiropractic treatment’:
Britt Harwe hasn't eaten a meal in 15 years. She survives on nutritional drinks poured directly into her stomach through a feeding tube.

"If I try to swallow, it goes into my lungs, I aspirate," said Britt.

She says it's the result of suffering a stroke during a visit to her chiropractor.

"I slumped over to the left and he helped me straighten out and I couldn't really focus. I couldn't talk," said Britt. The chiropractor had just finished adjusting her neck.

More…
http://cbs3.com:80/health/Risk.of.Chiropractic.2.661491.html

(Don’t forget to watch the accompanying 2-minute video)

Note that at the end of the article the following study is cited in support of there being “no link between chiropractic treatment and stroke”:

Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study
http://spinejournal.com/pt/re/spine/abstract.00007632-200802151-00019.htm;jsessionid=HBKd4R87BwpL66BG7vBC4hLQ5Lp1T QTRbJsblzrB1J72hvhd3hNM!1253064403!181195628!8091!-1?index=1&database=ppvovft&results=1&count=10&searchid=1&nav=search

However, according to this letter from Sharon Mathiason, a mother whose daughter died following chiropractic neck manipulation, it appears that the study’s lead author, David Cassidy (DC), was discredited as a researcher some time ago:
This new "study" itself is a review of billing records. No patient charts or tests were examined. There was no new scientific data. The authors took 819 strokes and then used billing records to see who had seen a doctor in the past year and who had seen a chiropractor. Considering that billing payments were very limited for chiropractors in Ontario and now thank God have been completely eliminated, this is a very poor record of the actual number of visits to a chiropractor. Did the scientists not realize this simple statistical fact?

Of course, the strokes caused by the chiropractors happened in their offices while none happened in the office of the doctors. Where did they tell us that? According to the logic of this study, if my daughter Laurie or anyone else saw your medical doctor in January and then had a stroke in December after having a neck manipulation, it did not count against the chiropractor. Almost everyone has seen their doctor within a year. You would get the same result if she had stopped at McDonald’s to buy a hamburger and then went to the chiropractor.

The Globe and Mail [a newspaper in which the study was recently featured] is also negligent in not identifying the principal author, David Cassidy, as a chiropractor, one who has been sued in Saskatchewan, in 1999, by his research assistant for falsifying data, and one whose work is stated in the New England Journal of Medicine as "all of the study’s authors conclusions are completely invalidated by their methods".

David Cassidy, before he was dismissed from the University of Saskatchewan,was called as an "expert" witness by the Chiropractic Association of Saskatchewan (CAS) at my daughter’s inquest.

In the Globe and Mail article co-author David Cassidy is quoted "Has it ever happened that a chiropractor has caused a stroke? I can’t say it’s never happened. But if it’s happening, it’s not happening at a greater risk than when it is at a GP office". Well guess what, chiropractor David Cassidy admitted on the stand into the death of my daughter they he had manipulated the neck of a woman and caused a stroke, a very severe one called Wallenberg’s syndrome. Did he say it never happened because this poor woman also saw her doctor in the past year? I doubt if he has ever seen a patient coming out of a doctor's office having a stroke after a neck manipulation.

More…
http://www.chirowatch.com/Chiro-strokes/gm080120stroke.html

(Scroll down the link a little to locate the letter)

For those interested, a new critical evaluation of chiropractic by Professor Edzard Ernst has just been published in the Journal of Pain and Symptom Management. Here’s part of the abstract:
Chiropractic is rooted in mystical concepts. This led to an internal conflict within the chiropractic profession, which continues today.

-snip-

With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition.

Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence.

Its cost-effectiveness has not been demonstrated beyond reasonable doubt.

The concepts of chiropractic are not based on solid science and its therapeutic value has not been demonstrated beyond reasonable doubt.

More…
http://www.ncbi.nlm.nih.gov/pubmed/18280103?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

arthwollipot

25th February 2008, 06:08 PM

One more for the "What's the harm" site?

Blue Wode

27th February 2008, 07:06 AM

One more for the "What's the harm" site?

Good idea. I'll let them know about this thread, not least because the Victims of Chiropractic Abuse (VOCA) campaign seems to be growing:

This "Chiropractors Accused" Fox News segment (approx. 10 minutes) http://www.myfoxdc.com/myfox/MyFox/pages/sidebar_video.jsp?contentId=5888684&version=1&locale=EN-US
is related to VOCA's latest press release below.

The three television reports follow a recent opinion column in the Hartford Courant (February 15, 2008, No Sense Resisting Database) that called for the chiropractic industry to drop its defensive posture and support legislative proposals by Victims of Chiropractic Abuse (VOCA) to help patients learn more about the risks of chiropractic treatment through Informed Consent laws.

The Fox 25 story can be viewed online by going to:
http://www.myfoxboston.com/myfox/pages/Home/Detail?contentId=5869524&version=1&locale=EN-US&layoutCode=VSTY&pageId=1.1.1

The CBS 3 story can be viewed online by going to:
http://cbs3.com/health/Risk.of.Chiropractic.2.661491.html

The WBZ News story can be viewed online by going to: http://wbztv.com/specialreports/chiropractor.and.strokes.2.659998.html

More…
http://www.prweb.com/releases/2008/2/prweb722453.htm

Just to underscore VOCA's concerns, here’s a recent study which looked at chiropractic consent procedures…

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

OBJECTIVE: This study explores the implementation of consent procedures in a sample of chiropractors in the United Kingdom (UK) and the United States (US) and how well they satisfy the core ethical principles of autonomy, veracity, justice, nonmaleficence, and beneficence.

Journal of manipulative and physiological therapeutics, 2007 Jul-Aug;30(6):419-31.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

…and here's its conclusions:
Results from this survey suggest a patient's autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk. Practitioners felt that a serious adverse event occurred so infrequently that this, coupled with a lack of convincing evidence regarding the risk associated with certain treatment, rendered the routine discussion of major risk unnecessary.

Go VOCA.

kev

27th February 2008, 09:42 AM

When it comes to chiropractic, I have mixed feelings. In no way do I believe any claim about chiropractic being useful for "curing" illness or disease. When they talk about "energy" or "pathways", the warning bells chime. And, I don't contest the fact that scientific study does not adequately support chiropractic.

However, I also have personexperience that leads me to believe that there is at least limited value to chiropractic. Once, or perhaps twice per year, I will be lifting something that I should have known better than attempting. Usually I lift something heavy, try to turn while I am doing it, and essentially feel as though someone shoved an icepick into my lower back and hip area.

LITERALLY, I am completely laid out on the floor. It has been so bad that I have been immobile - only able to lie flat on my back, needing to crawl or roll to the bathroom. When this occurs, my wife puts me in the back seat of the car and drives me to the chiropractor. He cracks/twists my lower spine and I LITERALLY walk out the door. Generally I am still sore for a few days, and may need to go one or two more times. But, in a matter of minutes, I am transformed from agony to relatively normal.

I have tried doctors etc. in these instances, and have always been give some sort of heavy dose of ibuprofin or equivalent and told to, essentially, rest until it gets better.

I know it is only anectdotal, and my personal experience, but for acute back problems due to twisting/lifting/exertion - chiropractic has given me instant improvement, and traditional medicine has not. These are not situations where I feel "kinda bad" and then feel "a little better." This is "I can't move" to "I am almost fine."

Are there any studies that suggest any relevance to using spinal adjustment in these situations of acute injury vs. the more chronic/ keep coming back forever/keep the 'energy" flowing chiropractic that seems very flawed?

JJM

27th February 2008, 10:17 AM

{snip} Are there any studies that suggest any relevance to using spinal adjustment in these situations of acute injury vs. the more chronic/ keep coming back forever/keep the 'energy" flowing chiropractic that seems very flawed?Kev, you can poke around http://www.chirobase.org/ a bit. It is a subsidiary of www.quackwatch.org which is the best single source of info about quackery on the Net. I believe there is an article on "What a rational chiro can do for you."

In short, what you describe sounds reasonable; however, real health-care professionals (PTs, osteopaths, physiatrists) can do it, too. You can rest assured that there is nothing chiros know (that is true) that health professionals do not know.

What separates chiros from masseurs is that chiros spend a lot of time learning about nonexistent subluxations (and a life-force they call innate intelligence).

If your curiosity is not satisfied by chirobase, you can contact the author(s) there; or try, here, again. Good luck.

zeusbheld

27th February 2008, 10:55 AM

i'm not worried about a proper diagnosis for my upper back problems, as i've been to MDs and chiros of all stripes and the x-rays are pretty obvious and they all seem to agree. second opinion? i've gotten about six, and that's just the MDs.

i was born with a twisted spine which leads to muscle spasms between my shoulders and neck problems. i've been to some damn good physios and good and bad chiros--really though i've found that "popping" the spine into place is a good short-term solution for a spine-induced muscle spasm, and have had poor results from all physios (including some of new york's reputed best).

that said, suxluxation theory is all fecal matter dropped from male bovines as far as i can tell.

my chiro here in bangkok is essentially a physiotherapist, he does all the local jocks and doesn't spout BS theory about colds and stuff. he works on getting my spine back to mobility, and has a team of phsyios doing deep-tissue massage (you can do that cheaply here in bangers) and pops my spine where it's out of whack and that's all, in as few visits as possible. usually 2 or 3. 6 to 12 months between incidents, probably far fewer if i got off my lazy buttocks and exercised. never once has he mentioned all that suxluxation crap. i've never asked though as my heart might break once he started talking that.

the moral of the story is: even if they're wrong, sometimes they can be useful.

JJM

27th February 2008, 11:58 AM

{snip} the moral of the story is: even if they're wrong, sometimes they can be useful.I appreciate you reinforcing my point. As I said, I think there is an article at chirobase that explains what a rational chiro can do for you. Samuel Homola, DC, runs that site; I know he has such a chapter in his book Inside Chiropractic. I should also point out that approximately 5% of chiros recognize the fictional aspects of their education, and eschew them.

Blue Wode

27th February 2008, 12:56 PM

Here are Samuel Homola’s guides to good chiropractic practice:

What a Rational Chiropractor Can Do for You
http://www.chirobase.org/07Strategy/goodchiro.html

Finding A Good Chiropractor
http://archfami.ama-assn.org/cgi/content/full/7/1/20

This also from Samuel Homola:

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 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 degrees (DPT). 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…”

More…
http://jmmtonline.com/documents/HomolaV14N2E.pdf

This is good too (although it's not by Samuel Homola):

Appropriate chiropractic practice

Choosing a chiropractor can be difficult because, according to several large surveys many chiropractors are involved in unscientific practices . If you decide to consult one, start with a telephone interview in which you explore the chiropractor's attitudes and practice methods.

Good signs

Practice limited to conservative treatment of back pain and other musculoskeletal problems.
Recommendation from your medical doctor.
Membership in the National Association for Chiropractic Medicine or the Canadian Academy of Manipulative Therapists (CAMT); however, the number of chiropractors who belong to these groups is small. CAMT's "orthopractic guidelines" describe a science-based approach to manipulative therapy.
In addition to manual manipulation or stretching of tight muscles or joints, science-based chiropractors commonly use heat or ice packs, ultrasound treatment (not diagnosis), and other modalities similar to those of physical therapists. They may also recommend a home exercise program.
For most conditions that chiropractic care can help, significant improvement should occur within a few visits.

Avoid Chiropractors

advertising about "danger signals indicating the need for chiropractic care
making claims about curing diseases
trying to get patients to sign contracts for lengthy treatment, promote regular "preventive" adjustments
using scare tactics
disparaging scientific medical treatment or preventive measures such as immunization or fluoridation
who claim to diagnose or treat "subluxations," or who have literature promoting "nerve interference" as an underlying cause of disease
who suggest that chiropractic might help nearly every type of health problem
routinely performing or ordering x-ray examinations of all patients, particularly full spine X rays.
Avoid chiropractors who "prescribe" dietary supplements, homeopathic products, or herbal products for the treatment of disease or who sell any of these products in their offices. For dietary advice, the best sources are physicians and registered dietitians.
who offer any of the listed "Useless (for the patient) gadgets and tests". In addition other dubious tests and/ or procedures include:

o body fat analysis
o computerized "nutrient deficiency" testing
o computerized range-of-motion analysis
o cytotoxic testing, electrodermal testing
o Functional Intracellular Analysis (FIA)
o herbal crystallization analysis
o blood cell analysis (also called nutritional blood analysis or Hemaview)
o testing with a Nervo-Scope
o Nutrabalance, NUTRI-SPEC
o pendulum divination
o reflexology
o saliva testing

This list is by no means inclusive. The viewer is directed to quackwatch for a comprehensive review of dubious chiropractic (and medical) devices and procedures.

More…
http://your-doctor.com/patient_info/alternative_remedies/various_therapy/chiropractic.html#11

It’s worth remembering that currently around 90% of chiropractors in the USA think that spinal manipulation should not be limited to musculoskeletal conditions and all four chiropractic organisations in the UK - and their regulators - continue to believe in chiropractic ‘subluxations’.

arthwollipot

27th February 2008, 07:50 PM

However, I also have personexperience that leads me to believe that there is at least limited value to chiropractic.I agree. I have also found that chiropractic is useful in a limited domain of neck and back problems that I have had.

humber

27th February 2008, 10:43 PM

...
LITERALLY, I am completely laid out on the floor. It has been so bad that I have been immobile - only able to lie flat on my back, needing to crawl or roll to the bathroom. When this occurs, my wife puts me in the back seat of the car and drives me to the chiropractor. He cracks/twists my lower spine and I LITERALLY walk out the door. Generally I am still sore for a few days, and may need to go one or two more times. But, in a matter of minutes, I am transformed from agony to relatively normal.

I have tried doctors etc. in these instances, and have always been give some sort of heavy dose of ibuprofin or equivalent and told to, essentially, rest until it gets better.

It is always difficult to deny personal experience such as this. Perhaps the manipulation has an analgesic effect, reducing the pain.
A friend of mine has a similar problem, and uses a chiropractor. He is never cured, but returns at regular intervals, giving each visit a glowing report.

I too had a lower back spasm, did the recommended exercises to strengthen the muscles so the damage could be healed before I "pulled" it a gain. It has long gone.

zeusbheld

28th February 2008, 01:43 AM

It is always difficult to deny personal experience such as this. Perhaps the manipulation has an analgesic effect, reducing the pain.

i think its' simpler than that, in many cases. when i have upper back or neck pain, my spine actually is out of whack (one can feel it to the touch). the spasming muscles are working to hold the ship together, but when the spine goes back home they relax within a day. in my case i don't think it's a nerve thing at all, but rather, musculoskeletal.

I too had a lower back spasm, did the recommended exercises to strengthen the muscles so the damage could be healed before I "pulled" it a gain. It has long gone.

that is a very important point. doing relevant stretching and strengthening exercises is FAR more important in the long run. chiro is a short-term solution, and most good ones i've been to (same as most physios) advise you to get relevant exercise.

JoeEllison

28th February 2008, 01:49 AM

It is always difficult to deny personal experience such as this. Perhaps the manipulation has an analgesic effect, reducing the pain.
A friend of mine has a similar problem, and uses a chiropractor. He is never cured, but returns at regular intervals, giving each visit a glowing report.

I too had a lower back spasm, did the recommended exercises to strengthen the muscles so the damage could be healed before I "pulled" it a gain. It has long gone.

That's the thing, isn't it? Reality-based treatment will include a recommendation to stretch and strengthen the muscles in your back, unless there is an underlying injury that requires more serious treatment. Chiropractic nonsense will insist on "treating" the problem with woo-tainted back rubs that require repeat visits.

Blue Wode

28th February 2008, 03:17 AM

Reality-based treatment will include a recommendation to stretch and strengthen the muscles in your back, unless there is an underlying injury that requires more serious treatment. Chiropractic nonsense will insist on "treating" the problem with woo-tainted back rubs that require repeat visits.

Exactly.

Those endless repeat visits which are recommended by many chiropractors usually amount to little more than the financial exploitation of their patients.

If chiropractors didn’t (deliberately) create patient dependency, their ability to earn a good living would rapidly diminish. That’s why the vast majority of them treat infants and young children despite there seldom being any medical reason for them to do so, and despite the non-existence of chiropractic paediatric safety data. This exploitation also extends to their pushing of bogus concepts like “family wellness care” where whole (usually asymptomatic) families are encouraged to adopt the ‘chiropractic lifestyle’.

For those who’d like to learn more, John Jackson of UK Skeptics captured the all the problems with chiropractic in this excellent article:

http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php

This is its conclusion:
Chiropractic is a pseudoscientific approach to health care. The thinking behind it has no basis in fact, and even after more than a century, its core belief, the subluxation, cannot be shown to exist; even though it is a scientifically testable theory.

Some of the beliefs, such as the anti-vaccination stance, actually go against scientific evidence, medical opinion and government policy. Opposing germ theory exposes the 19th century thinking that Chiropractic is based upon.

Chiropractic is not one technique that can treat one class of illness or disease. It is promoted as a panacea and an all-encompassing preventative measure to be used from the moment we are born onwards.

A healing system that is based on a mystical life-force that gets blocked by imaginary subluxations, and that relies on anecdotal evidence; special pleading; the placebo effect; and subjective diagnoses is clearly an irrational concept: no matter how much credence is given to it with qualifications and self-regulation.

JJM

28th February 2008, 03:25 AM

I agree. I have also found that chiropractic is useful in a limited domain of neck and back problems that I have had.If you let a chiro work on your neck, there is the possibility of complications that will leave you seriously dead. There is nothing they can do there that cannot be done more safely. The information is at chirobase, the problem is a stroke caused by snapping your neck.

JJM

28th February 2008, 03:27 AM

i think its' simpler than that, in many cases. when i have upper back or neck pain, my spine actually is out of whack (one can feel it to the touch). the spasming muscles are working to hold the ship together, but when the spine goes back home they relax within a day. in my case i don't think it's a nerve thing at all, but rather, musculoskeletal. {snip}A chiro cannot actually change the configuration of your spine. The experiments showing that were done by an anatomy professor named Crelin- the paper is available at chirobase.

zeusbheld

28th February 2008, 04:23 AM

A chiro cannot actually change the configuration of your spine. The experiments showing that were done by an anatomy professor named Crelin- the paper is available at chirobase.

not what i'm saying. let me clarify: what i am saying is that i have a bit of a twist in my spine. the diagnosis by (good) chiropractors i've been to and (good) physicians i've been to has been IDENTICAL, at least in terms of how they explained it to me. chiro doesn't "fix" this problem, nor can an MD. it's just there. i'm stuck with it.

however, i have found that producing a certain kind of "pop" (movement, not sound. the sound is cool but easier had by cracking knuckles) between my shoulder blades a) relaxes the muscle very quickly (a day or two to normal) and b) i can feel by running my hand on the little bumps in my back (my spine) that that particular vertebra isn't in an odd position, the little lump is no longer off to the side.

i am not saying my spine configuration is "changed" AT ALL perhaps i wasn't clear on that. just that when things are out of whack, the adjustment performed by a chiropractor has been 100 percent effective every time in giving me relief from back pain and muscle spasms. i haven't gone that often, but the problem has existed for over 15 years and was initially diagnosed by an MD.

if i were to speculate as to what the exact mechanism is for that particular adjustment, i would say the pressure applied to the muscle on either side allows the vertebra to return to its slightly less torqued position, and once there, it stays, and the muscle stops trying to hold it in place and the spasm ends. but that's speculation on my part.

i have also said consistently from my first post that problems like that need to be addressed long-term through sensible exercise, and that such an 'adjustment' is a short term solution.

zeusbheld

28th February 2008, 04:40 AM

zeusbheld

28th February 2008, 04:50 AM

chirobase is great btw. everyone with back problems should read it.

my favorite article i've read there so far is "Placebos, Nocebos, and Chiropractic Adjustment." (http://www.chirobase.org/01General/placebo.html)

Blue Wode

28th February 2008, 06:16 AM

That's the thing, isn't it? Reality-based treatment will include a recommendation to stretch and strengthen the muscles in your back, unless there is an underlying injury that requires more serious treatment. Chiropractic nonsense will insist on "treating" the problem with woo-tainted back rubs that require repeat visits.
[My bold]
*if* no claims other than the obvious musculoskeletal ones any physio might make are made, then i fail to see how a back rub is tactitly "woo-tainted" solely by virtue of taking place in a chiropractor's office.

-snip-

...back rubs are not the problem with chiro, are they? the problem is that suxluxations are allegedly responsible for everything from allergies to myopia to discolored voodoo auras.

By his use of the word ‘nonsense’, I assumed that Joe Ellison was inferring that excessive back manipulations/mobilisations could be deemed to be woo-related (i.e. not evidence based).

not insignificantly, when going to an MD for back problems, one also needs to choose the practitioner VERY carefully. not only are there plenty of mediocre doctors and physios, but many of THEM are interested in nothing quite so much as you using their services until your insurance runs out and your bank account is dry.

Not universally so. Here in the UK most GPs and physios work for the NHS and are on fixed salaries. On the other hand, nearly all chiropractors in the UK work in private practice.

also MDs in my experience tend to over-prescribe medications, especially pain killers. (i find that muscle relaxers help significantly, but pain killers dont' make my back stop hurting any faster, just make it easier on me while i wait for the spasms to subside).

Perhaps clinical experience has shown GPs that painkillers are the best treatment. Indeed, the results of this recent scientific study indicates that advising patients to remain active and prescribing them paracetamol is the best course of action:
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 antiinflammatory 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

More from the full text of the Hancock study:
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.

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

my personal bottom line is i'm not interested in any chiro selling anything but a finite program of short-term relief, and anywhere i'd go had better be physio-oriented and not make any voodoo-claims. voodoo claims are pretty easy to spot.

Easy to spot for whom?

once that hurdle is cleared,

Can you suggest a source that members of the general public could use to help them clear that hurdle (and, if you can, would most of them know it exists)?

i look for a place where professional and high-level amateur athletes go. yeah, they get sucked in by voodoo too (who can forget Patrick Ewing with friggin' magnets on his knees),

although “voodoo claims are pretty easy to spot”?

but in my experience once the voodoo hurdle's cleared athletes tend to flock to the best physios.

But what about your Average Joe? How does he go about sorting the wheat from the chaff?

zeusbheld

28th February 2008, 08:03 AM

By his use of the word ‘nonsense’, I assumed that Joe Ellison was inferring that excessive back manipulations/mobilisations could be deemed to be woo-related (i.e. not evidence based).

agree and at no point have disagreed.

Not universally so. Here in the UK most GPs and physios work for the NHS and are on fixed salaries. On the other hand, nearly all chiropractors in the UK work in private practice.

there is no NHS in the US or Thailand, and it is common in both countries. i suspect if chiros had to work in NHS on fixed salaries it'd stop being such a glamorous cash cow. definitely looks like one can't go too far wrong by avoiding ALL chiros in the UK. and most elsewhere.

Perhaps clinical experience has shown GPs that painkillers are the best treatment. Indeed, the results of this recent scientific study indicates that advising patients to remain active and prescribing them paracetamol is the best course of action:
fair enough, but just following the link and reading the abstract, i was talking about chronic upper back pain and muscle spasms whereas the study was talking about acute lower back pain, so it's not apples-to-apples.

as far as a general trend toward over-prescribing goes, antibiotics are the best thing to look at. not to digress too much but most MDs would agree that over-prescribing antibiotics is a bad idea in principle. yet (short version) it happens quite often, at least in the US or Thailand. however, if you want to discuss over-prescribing start a thread 'n' let me know, as it's not what this thread's about.

Easy to spot for whom?
look at the list you quoted above. anyone making those claims listed under "avoid" is likely to be making more than one of those claims. also, pretty much anyone who uses the word "subluxation," in my opinion.

'chirobase,' which you also cited, also has good advice.

i think anyone who reads the sources you cited then talks to the chiro before hiring them should be able to tell the difference. these people are NOT subtle.

Can you suggest a source that members of the general public could use to help them clear that hurdle (and, if you can, would most of them know it exists)?
you already did suggest a resource, and no, most of them would not know it exists. is supect most are aware of the existence of google, i'd imagine. however, most of them probably don't put any thought or care into researching their MDs either.

although “voodoo claims are pretty easy to spot”?
*if* you do your homework. if you don't do your homework, you might end up with a bad MD too.

But what about your Average Joe? How does he go about sorting the wheat from the chaff?
if the "average Joe" can't get off his average hindquarters and do some basic homework before choosing ANY healthcare practitioner, then average Joe has no one but himself to blame. google is readily available in public libraries in most countries.

well you tried hard to lead me to whatever conclusion you were trying to lead me to, sorry if i never arrived. your line of argument seems a bit odd. what are you really arguing here? i don't think that we're in disagreement that some chiros are good but most are bad. if i'm wrong, it seems odd you'd cite chirobase, for starters. are you arguing that chiro should be outlawed? (disagree) or regulated? (agree) if not why should it matter if Joe sixpack, who can access google same as i do, does his homework?

JJM

28th February 2008, 09:18 AM

not what i'm saying. let me clarify: {snip}Very good. A lot of chiros continue to argue that they actually change spinal alignment. I find it humorous that they argue the Crelin paper is too old, as if research had an expiration date. (Which is ironic because they continue to cite DD Palmer, and he died way before 1973.)

Blue Wode

28th February 2008, 09:45 AM

well you tried hard to lead me to whatever conclusion you were trying to lead me to, sorry if i never arrived.

Actually, you did:
definitely looks like one can't go too far wrong by avoiding ALL chiros in the UK. and most elsewhere.

your line of argument seems a bit odd. what are you really arguing here? i don't think that we're in disagreement that some chiros are good but most are bad. if i'm wrong, it seems odd you'd cite chirobase, for starters. are you arguing that chiro should be outlawed? (disagree) or regulated? (agree)

I don’t think there’s a need for chiropractors when physiotherapists can provide the same type of service with much less likelihood that their patients will be ensnared by quackery.

With regard to regulation, chiropractic has been regulated by statute in the UK since 2001 and it hasn’t made much difference to the way in which the chiropractic 'profession' conducts itself since the four main professional chiropractic organisations all continue to buy into chiropractic subluxation theory, and several of these organisations' members now serve on the regulatory body's committees.

why should it matter if Joe sixpack, who can access google same as i do, does his homework?

Because the public should be able to trust the information that health professionals give them without having to resort to Google.

Interestingly, here’s what the UK regulatory body, the General Chiropractic Council, has to say on the subject…

The trust that the public places in chiropractors can be abused in a variety of ways.

It may be through marketing activities that exploit the public even before they become patients.

Or it may be by using strategies designed to lock patients into treatment plans that are excessive in both frequency and duration. Such treatment plans are exploitative, leading patients to believe they are more seriously ill than they are and thereby promoting undue dependence on chiropractic care.

Any abuse of trust or exploitation of lack of knowledge undermines the foundation of respect for the profession. It is particularly damaging when a conduct hearing exposes a complete lack of clinical justification for recommended treatment.

When a patient consents to treatment/care, it is essential that the plan of care is developed in discussion with the patient to ensure that

it helps the patient to improve her/his own health and actively participate in her/his own care
it has aims that are consistent with the patient’s identified health and health needs, and anticipated changes in those health needs
it is kept under continuous review by the chiropractor and modified appropriately, in line with the patient’s changing health and health needs

All chiropractors must ensure that all the information they provide, or authorise others to provide on their behalf

is factual and verifiable
is not to be misleading or inaccurate in any way
does not, in any way, abuse the trust of members of the public nor exploit their lack of experience or knowledge about either health or chiropractic matters
does not put pressure on people to use chiropractic, for example by arousing ill-founded fear for their future health or suggesting that chiropractic can cure serious disease

See page 5 here:
http://www.gcc-uk.org/files/link_file/F2P2005_6.pdf

Unfortunately, they seem to be little more than pretty words.

JJM

28th February 2008, 10:11 AM

{snip} *if* no claims other than the obvious musculoskeletal ones any physio might make are made, then i fail to see how a back rub is tactitly "woo-tainted" solely by virtue of taking place in a chiropractor's office.The problem with chiros who eschew the nonsense is- you still don't know what they are really competent at. Some people call them "PTs with delusions of grandeur;" but the standard chiro education focuses so much on quackery that I doubt they are technically as capable as PTs. Some are, however they behave just like the ones who are not.

A chiro can graduate and get a license to practice without ever seeing a sick person! Not so for PTs. And PTs learn when to refer back to a doctor, chiros may not. Furthermore, chiros can graduate without learning to take usable xrays, or to read good xrays, or when to take xrays. Sometimes, the first symptom of a cancer is joint pain, which can be missed by a chiro even though it is visible on a good xray read by a competent radiologist.

in fact, having been to MDs, physios and chiros for the same problem, i can say with some conviction (still just opinion, obviously) that a good back rub is a good back rub, regardless of whether you get it in an MD's office or a chiro's office. {snip}That is my point- generally, there is no reason to go to someone who's training is suspect (DC). If you have found a competent DC for your purposes, you are are beating the odds; their own surveys suggest they only represent around 5% of the business.

BTW- Lack of appropriate capitalization of words in posts is strongly associated with chiros. You seem like a rational person, if you are going to write more on the topic you should probably be more careful.

zeusbheld

28th February 2008, 10:18 AM

Actually, you did:

oh. well then. problem solved. for the UK anyway.

I don’t think there’s a need for chiropractors when physiotherapists can provide the same type of service with much less likelihood that their patients will be ensnared by quackery.

fair enough, but you're in the UK. i'm not nor have i ever been. the situations are not comparable. for one, as i pointed out, neither the US nor Thailand have an NHS at this point.

i don't think, in either case, banning chiropractors would be the way to go. although perhaps the good ones could pass a test and be re-labeled "spinal manipulation physio" or something like that.

can't speak to the UK but banning them in the rest of the world would throw out a few babies with the bathwater--for my particular problem, most physios don't know what to do and are too much the generalists. i couldn't endorse banning them without chiros being replaced by physiotherapists who specialize in spinal manipulation.

With regard to regulation, chiropractic has been regulated by statute in the UK since 2001 and it hasn’t made much difference to the way in which the chiropractic 'profession' conducts itself since the four main professional chiropractic organisations all continue to buy into chiropractic subluxation theory, and several of these organisation’s members now serve on the regulatory body's committees.

in other words the inmates are minding the asylum. regulation of their claims would have to come from outside chiropractic in order to work.

Because the public should be able to trust the information that health professionals give them without having to resort to Google.

forgetting chiro and just looking at medicine for a minute: that'd be great in a perfect world but in practice one can go very, very wrong with an MD. and MDs are tightly regulated. among other ill-advised behaviors, many people plunge into major surgical interventions without benefit of even a second opinion.

in short, regardless of how good the info that health professionals give them is, Joe sixpack NEEDS to resort to Google and NEEDS to be involved in his own healthcare (arguably Josephine does even more).

Interestingly, here’s what the UK regulatory body, the General Chiropractic Council, has to say on the subject…

Unfortunately, they seem to be little more than pretty words.

perhaps rather than banning outright or repurposing them, make it so that chiro can't take on a new patient without a referral from an MD or at least a phsyio.

zeusbheld

28th February 2008, 10:28 AM

The problem with chiros who eschew the nonsense is- you still don't know what they are really competent at. Some people call them "PTs with delusions of grandeur;" but the standard chiro education focuses so much on quackery that I doubt they are technically as capable as PTs. Some are, however they behave just like the ones who are not.

A chiro can graduate and get a license to practice without ever seeing a sick person! Not so for PTs. And PTs learn when to refer back to a doctor, chiros may not. Furthermore, chiros can graduate without learning to take usable xrays, or to read good xrays, or when to take xrays. Sometimes, the first symptom of a cancer is joint pain, which can be missed by a chiro even though it is visible on a good xray read by a competent radiologist.

That is my point- generally, there is no reason to go to someone who's training is suspect (DC). If you have found a competent DC for your purposes, you are are beating the odds; their own surveys suggest they only represent around 5% of the business.

the problem with that is most physios that i've been to do not specialize, and i've been to some very reputable physios who just plain aren't very good at any sort of upper back work. if i had found a physio in new york who could have done the trick, i would have stuck to physios. as it was, an MD referred me to a physio who referred me to a (rational) chiro.

on further reflection i definitely be in favor of banning chiro if and only if in its place a clearly differentiated spinal manipulation specialization in physiotherapy were created.

BTW- Lack of appropriate capitalization of words in posts is strongly associated with chiros. You seem like a rational person, if you are going to write more on the topic you should probably be more careful.

BTW- pedantry is strongly associated with dogma. don't give up your day job for comedy any time soon.

Blue Wode

28th February 2008, 10:33 AM

in short, regardless of how good the info that health professionals give them is, Joe sixpack NEEDS to resort to Google and NEEDS to be involved in his own healthcare (arguably Josephine does even more).

But how will they know that the information they find via Google is reliable?

perhaps rather than banning outright or repurposing them, make it so that chiro can't take on a new patient without a referral from an MD or at least a phsyio.

It would be nice to see that being made compulsory.

zeusbheld

28th February 2008, 10:46 AM

But how will they know that the information they find via Google is reliable?
how does one know that ANY information is reliable? no matter how trustworthy the source one must approach with caution, and check sources against each other wherever possible.

in some major US cities (New York, definitely) there are databases of doctor ratings one can subscribe to. also with MDs checking their credentials, number and type of specialtizations, what they've published, and their malpractice record are also worthwhile.

It would be nice to see that being made compulsory.
incidentally my insurers would not pay for chiro if no referral from an MD. (referral chains like mine were OK). do people in the UK have to pay for chiro out of pocket or is there some sort of insurance reimbursement?

anyway, long-term, i'd rather they be made to either quit or train properly as physios.

Rolfe

28th February 2008, 10:55 AM

Most people in Britain have no health insurance as it isn't necessary - the NHS takes care of us. So, as there's no chiropracitic on the NHS, if you want that, pay up.

There are policies avaliable, mostly for people who want the option to go private if they find themselves with a wait for treatment, but I have seen one advertised recently that seemed to be promoting itself as covering extras - like private physiotherapy, but I woudn't swear it didn't mention woo stuff.

Rolfe.

zeusbheld

28th February 2008, 11:16 AM

Most people in Britain have no health insurance as it isn't necessary - the NHS takes care of us. So, as there's no chiropracitic on the NHS, if you want that, pay up.

just checking if i'm understanding this correctly: phsyios are covered by NHS, but chiros are not? and does NHS allow you to choose your MDs and physios? in other words, if your'e not satisfied with your physio, you can go to a different one? if indeed one can, i don't understand how chiros survive in the UK. :eek:

Blue Wode

28th February 2008, 11:22 AM

i don't understand how chiros survive in the UK. :eek:

From post #93:
Those endless repeat visits which are recommended by many chiropractors usually amount to little more than the financial exploitation of their patients.

If chiropractors didn’t (deliberately) create patient dependency, their ability to earn a good living would rapidly diminish. That’s why the vast majority of them treat infants and young children despite there seldom being any medical reason for them to do so, and despite the non-existence of chiropractic paediatric safety data. This exploitation also extends to their pushing of bogus concepts like “family wellness care” where whole (usually asymptomatic) families are encouraged to adopt the ‘chiropractic lifestyle’.

JJM

28th February 2008, 11:48 AM

{snip} BTW- pedantry is strongly associated with dogma. don't give up your day job for comedy any time soon.I am serious. I have debated this with many chiros online, and some of them claim to be neutral, or, even, MDs; but the lack of capitalization gives them away. I don't sense that you are a chiro. In fact, it does not matter- we deal in facts and the source does not matter. However, if someone is inclined to be prejudiced, you might be summarily dismissed.

You wrote "pedantry is strongly associated with dogma." I have no idea what that means.

Blue Wode

28th February 2008, 11:58 AM

just checking if i'm understanding this correctly: phsyios are covered by NHS, but chiros are not? and does NHS allow you to choose your MDs and physios? in other words, if your'e not satisfied with your physio, you can go to a different one?

Yes to all three questions.

on further reflection i definitely be in favor of banning chiro if and only if in its place a clearly differentiated spinal manipulation specialization in physiotherapy were created.

As Samual Homola said, that will probably be in place in the US by 2020. Hopefully, by then, the treatments offered by chiropractors in the UK will have been properly defined and limited to evidence-based manual therapy. Indeed, I believe that one or two reformist (rational) chiropractors would like to get rid of the name 'chiropractor' and be known as 'musculoskeletal specialists'.

zeusbheld

28th February 2008, 12:01 PM

I am serious. I have debated this with many chiros online, and some of them claim to be neutral, or, even, MDs; but the lack of capitalization gives them away. I don't sense that you are a chiro.

i am most definitely not a chiro. or an MD.

In fact, it does not matter- we deal in facts and the source does not matter. However, if someone is inclined to be prejudiced, you might be summarily dismissed.

if someone is inclined to be prejudiced, i'm inclined to summarily dismiss *them.*

You wrote "pedantry is strongly associated with dogma." I have no idea what that means.

people inclined to read pedantically are generally not reading at all, as they are "inclined to be prejudiced" and tend to be merely looking for the opportunity to demonstrate that they already know everything. and very, very few of them have anywhere near the command of the English language they imagine themselves to.

robinson

28th February 2008, 12:51 PM

So true.

JJM

28th February 2008, 01:50 PM

{snip} people inclined to read pedantically are generally not reading at all, as they are "inclined to be prejudiced" and tend to be merely looking for the opportunity to demonstrate that they already know everything. and very, very few of them have anywhere near the command of the English language they imagine themselves to.I have been following chiro-quackery for 30 years. I may be biased; but you certainly can't call it prejudice any longer.

of course, i may not have anywhere near the command of the english language ...

zeusbheld

28th February 2008, 02:07 PM

I have been following chiro-quackery for 30 years. I may be biased; but you certainly can't call it prejudice any longer.

of course, i may not have anywhere near the command of the english language ...

or the memory, apaparently. predjudice was *your* word.

given your commitment to reason, you are no doubt aware that while all cats are mammals, it does not imply all mammals are cats. shall we get back on topic now, or split more hairs over my nasty irreverence toward capital letters?

JJM

28th February 2008, 02:48 PM

or the memory {snip}Quite. You've run rings round my logic ... it's time for the penguin atop your TV-set to explode ...

Rolfe

28th February 2008, 04:26 PM

just checking if i'm understanding this correctly: phsyios are covered by NHS, but chiros are not? and does NHS allow you to choose your MDs and physios? in other words, if your'e not satisfied with your physio, you can go to a different one? if indeed one can, i don't understand how chiros survive in the UK. :eek:

Basically yes. Chiropactors are very firmly part of "alternative medicine" here. They have no pseudo-medical qualifications and nobody is likely to call them "Dr." Alternative medicine has very very limited penetration into the NHS (see separate thread), and chiropractic not at all.

People go to them for much the same reasons as they go to any alternative quack. Either their conventional treatment isn't really doing it for them and they think they'll try unconventional, or the NHS system has imposed a wait on them, which they decide to circumvent by going private. At that point, when you're out of the system, the distinction between kosher and not can get a bit blurred.

Personal example. In December my mother fell and injured her shoulder. I took her to the GP at once. GP confirmed nothing apparently broken, probably just bruised, prescription for painkillers. But she also said, if it's not getting better in a week, go to Casualty. That means, show up at the Accident and Emergency department of the hospital, where x-rays are available. (All that is totally free.)

Well, it wasn't getting better, but we happen to live in a rural village some distance from the nearest hospital. I didn't fancy carting an elderly lady all that way to sit in a waiting room for an couple of hours possibly, only to go away with a sling and more painkillers (as I was pretty certain it wasn't broken). So we waited more like six weeks, and still it wasn't better.

By this time we could hardly show up at A&E, yes it's an emergency she fell back before Christmas.... So I'd have had to take her back to the GP, who would have had to get a referral appointment for her with an orthopaedic consultant, again a trip to the city and the hospital, all for probably something which wouldn't show up on x-ray. Then what? Probably physiotherapy at this stage. Which might all have entailed a wait for treatment, and again probably driving her to the hospital multiple times.

It's just the way the system works. Great for a major injury, but a pest for a minor one which isn't resolving. And physiotherapy is notoriously badly served in the NHS, they just don't have enough staff, they need more funding. If we'd been broke then we'd just have jumped through the hoops and she'd have been treated in the end, but we're not.

So I decided to cut out the middle-man. I knew it was a physiotherapy case, so I looked through the local phone book and picked out a properly qualified physiotherapist who advertised house calls. I wondered if she'd see her without an x-ray but fortunately she did. She agreed that an x-ray was probably unnecessary, and decided it was supraspinous tendonitis. She's been coming every two weeks, doing some infra-red treatment and giving Mum a series of exercises, which are gradually doing the trick. £35 a pop. Fine by me, especially for the house calls part, never mind the instant availability.

But this is where people can get suckered into woo. There were two or three "massage therapists" in that book, including one doing the infamous cranial osteopathy, and they looked quite dodgy to me. I also pass a chiropractor's establishment on the way into the city so I know they exist. I knew what to look for and got the proper physio. She came to see Mum on her way home from her part-time work in the city for the NHS. But if I hadn't known, Mum could just as easily ended up with the woo massage or the chiro, or heaven help us, an acupuncturist.

There's a fair bit of scope scratching round the edges like this. Especially when there is a wait time to get proper physiotherapy on the NHS. But really, chiropractors in Britain are in the Outer Darkness.

Rolfe.

arthwollipot

28th February 2008, 07:30 PM

Those endless repeat visits which are recommended by many chiropractors usually amount to little more than the financial exploitation of their patients.The best description of this was from Michael Shermer's book Why People Believe Weird Things. He said that the more he saw the chiropractor, the more his back would go "out" and the more he'd have to go and see the chiropractor. Once he stopped seeing the chiropractor, his back stopped going "out", and he didn't need them any more.

zeusbheld

28th February 2008, 11:55 PM

The best description of this was from Michael Shermer's book Why People Believe Weird Things. He said that the more he saw the chiropractor, the more his back would go "out" and the more he'd have to go and see the chiropractor. Once he stopped seeing the chiropractor, his back stopped going "out", and he didn't need them any more.

i should be so lucky. for me, the more i exercise properly the less likely my back is to go 'out,' that's about THE only treatment long term. exercise is about the ONLY thing that i've noticed to actually have the kind of positive knock-on effects often attributed to new-agey crap. (for example, is tai chi adjusting your chi flow? no. it's a good safe low-impact workout).

a question about the NHS: can you go outside the plan and get a proper MD if your'e in a hurry and in the mood to burn a stack of cash? if so are MDs working outside the NHS better, on average, or worse, or do they also work for the NHS?

a question about physios in the US: do they specialize? i'm used to going into an MDs office and seeing degree and certificates for specialties on the wall; i don't recall seeing anything like this in a physio's office (which doesn't mean it wasn't there). for me, and people like me who have used chiros for the only thing they're good for, it would be useful to know how to spot a physio who'd be good at legit spinal manipulation.

arthwollipot

29th February 2008, 12:16 AM

(for example, is tai chi adjusting your chi flow? no. it's a good safe low-impact workout).I did tai chi for a while too, but had to stop because of work commitments. And I totally agree with your assessment of it.

Of course, I had to ignore a lot of woo from the instructor in order to enjoy it, but that wasn't hard.

Blue Wode

29th February 2008, 04:53 AM

a question about the NHS: can you go outside the plan and get a proper MD if your'e in a hurry and in the mood to burn a stack of cash?

Yes, there are a few private clinics where you can see a GP pretty quickly, but you'd definitely need that stack of cash.

if so are MDs working outside the NHS better, on average, or worse, or do they also work for the NHS?

Probably about the same. There are quite a few MDs involved in (often part-time) private healthcare looking after the 6 million or so of our 60 million population who have private health insurance. The main benefits of private health insurance here are that you’re seen more quickly and usually enjoy a plusher, less impersonal treatment environment.

a question about physios in the US: do they specialize? i'm used to going into an MDs office and seeing degree and certificates for specialties on the wall; i don't recall seeing anything like this in a physio's office (which doesn't mean it wasn't there). for me, and people like me who have used chiros for the only thing they're good for, it would be useful to know how to spot a physio who'd be good at legit spinal manipulation.

It would probably be a good idea to contact the Amercian Physical Therapy Association about that:
http://www.apta.org//AM/Template.cfm?Section=&WebsiteKey=

Rolfe

29th February 2008, 09:19 AM

a question about the NHS: can you go outside the plan and get a proper MD if your'e in a hurry and in the mood to burn a stack of cash? if so are MDs working outside the NHS better, on average, or worse, or do they also work for the NHS?

Actually, there is no such thing as an "MD" in Britain. Well, it's a very exalted academic award, sometimes honorary I think. The basic medical qualification is MBChB, not actually a doctorate. We just call them doctor because they like it. Then the ones who advance to become surgeons revert to "Mr." for historical reasons.

Every doctor in the NHS is "proper". The question of how and when to go outside the NHS is quite a complicated one though.

Virtually nobody uses a private GP. When you need to see a GP on the NHS you can. You don't have to wait for urgent matters, and really serious urgent matters will get you an NHS ambulance taking you right to the A&E department of the hospital. The only time I've encountered private GPs is in big London rail terminuses, where they cater to the communters with problems not serious enough for them to take time off work and see their own home GP (mostly it will be the rich city types living many miles away in the leafy countryside who use this service). And I gather there are a few private GPs in London who mainly serve rich expatriates such as Arab tycoons, who possibly don't qualify for the NHS and may be too snobbish to use it if they did.

I have no reason to believe the medical standards of the private GPs would be any different from their NHS colleagues, although I'd be a bit wary of a possible tendency to over-investigate and over-service if they are paid by procedures carried out.

However, many people requiring surgery do choose to go private, in order to avoid a wait for treatment on the NHS. This will either be funded by an insurance policy they have taken out against this eventuality (not that expensive, because the insurance company knows that most of their client's healthcare and all emergency treatment will still be taken care of by the NHS), or self-funded.

Someone doing that may well find themselves being operated on by their original NHS consultant, just at a private hospital and much sooner. If you're shopping for elective surgery, the main trick is to find out what your chosen surgeon's NHS position is. All the good ones have prestigious NHS appointments - they're allowed to have their own private practices as well. Avoid anyone without NHS connections, as they could well be substandard, is the advice.

The final category is non-essential surgery such as cosmetic surgery. That is all private of course, and there are clinics pretty much touting for business. Again, the word is to avoid these like the plague and go privately to the best NHS consultant in the appropriate field. It will probably cost you more, but you get what you pay for.

Rolfe.

Blue Wode

1st March 2008, 01:46 AM

Chiropactors are very firmly part of "alternative medicine" here.

Although chiropractors don’t seem to think so. This from Peter Dixon, Chairman of the General Chiropractic Council (GCC), in the GCC’s response to the May 2006 article in The Times, ‘NHS told to abandon alternative medicine’:
The inclusion of the chiropractic profession in today’s coverage of the heart-felt letter circulated by Professor Baum and his colleagues seems to be based on the wholly inaccurate impression that chiropractors practice ‘alternative’ medicine. Time has moved on. Let’s all please move with it and give credit to a health profession that, given half a chance, could provide care that could be of real benefit to NHS patients.

http://www.gcc-uk.org/files/link_file/THE%20TIMES%20re%20joint%20letter%2023MAY06.pdf

For more disingenuous PR from the GCC see its archives here,
http://www.gcc-uk.org/page.cfm?page_id=182

and its FAQs page here:
http://www.gcc-uk.org/page.cfm?page_id=6

nobody is likely to call them "Dr."

Well, chiropractors certainly like to call themselves “Dr” much of the time. Just take a look under ‘Chiropractors’ in the Yellow Pages and you’ll see how the public could be easily fooled into thinking that chiropractors are MDs (or MBChBs). Interestingly, UK Skeptics have highlighted the problem in its ‘Dangers of chiropractic’ section:
Many people wrongly assume that chiropractors are part of the medical community. They are not: they are part of the alternative medicine industry. Unlike many other alternative practitioners, chiropractors are thought by many to be medically qualified doctors and as such people may place as much trust in their advice as they would in that of qualified doctor.

http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php

I think it should also be mentioned here that although one sCAM establishment, The Royal London Homoeopathic Hospital, looks like it could be on its way out, another, ‘The Royal College of Chiropractors’, looks like it could be on its way in…
5 June 2007 - Towards a Royal Charter: College Council attends House of Lords Reception

College Council members attended a reception organised by Baroness Jean Corston at the House of Lords today. Guests included key figures from the Commons and the Lords keen to hear more about the College and its pursuit of a Royal Charter. Baroness Corston welcomed those present and highlighted the importance of a united chiropractic profession. Tim Jay, College President, explained the value of a Charter to the public and profession. Small group discussions followed enabling MPs and Peers to ask questions of Council members. It was clear there is significant support for the chiropractic profession and the College's pursuit of the Royal Charter. The Council intends to approach the Privy Council later this year to re-open discussions.

http://www.colchiro.org.uk/default.aspx?m=39&mi=202&ms=0

(That link also suggests that the Rt Hon Kevin Barron MP, Chair of the Commons Health Select Committee, is a woo to watch)

For those wishing to object to the proposed Royal Charter for the College of Chiropractors, simply follow the procedure outlined in this link:
Formal applications for Charters are published, to allow other interested individuals or organisations to comment or to lodge counter-petitions. Because the process of Petitioning for a Charter is thus a public one, and can also be expensive in terms of the preparation of the formal documents, this Office encourages institutions to have taken soundings among other bodies who may have an interest, in order to minimise the risk of a counter-petition. Any proposal which is rendered controversial by a counter-petition is unlikely to succeed.

http://www.privy-council.org.uk/output/Page45.asp

zeusbheld

1st March 2008, 02:17 AM

For those wishing to object to the proposed Royal Charter for the College of Chiropractors, simply follow the procedure outlined in this link:

i'd imagine objecting is only open to citizens of the UK?

Physiotherapist

1st March 2008, 03:48 AM

The primary medical qualification in the UK is not just MBChB. If you go to London University, then it would be MBBS. If you go to Cambridge, then you would get MB BChir. If you went to Oxford then you would get MB BCh and so on an so forth. Scottish universities award MBChB to their graduates, I believe, as do some other universities in the UK.

In the UK, students can do A levels and go straight to med school following A levels. This is an undergraduate degree and takes 5 to 6 years to complete. However, there are now graduate entry to medicine programmes that have been developed for people who already have good degrees. These courses take 4 years to complete and are similar to the MD programs in the States, where you have to get a BS first and then go through med school for 4 years, then going through Internship, Residency and Attending posts. These are similar to House Officer, Senior House Officer, Registrar, Senior Registrar and Consultant posts.

There are a lot of private GP services around in the London area that are becoming more popular. BUPA have private GP's. You can pay for a consultation with them even if you don't have BUPA health insurance. A lot of complementary therapy practices have GP's who work with them. The Wren Clinic in London being a good example. There are MediCentre's on the London stations that provide private GP services - walk in clinics that are popular.

I don't use my GP a lot and have not had cause to, but a few years ago now I did and he was absolutely hopeless and I walked out in disgust. A colleague of mine happened to tell me about a great GP that she had seen who worked for BUPA. I rang and got an appointment and payed myself, not having BUPA health insurance. I think I saw him a couple of times and he was great and helped me sort out my problem. The cost was not prohibitive by any means - I think at the time it was £60, but I got a 30 min and then a 15 min consultation for that. Well worth the cost over and above my NHS GP who gave me 5 mins worth of time and then did nothing.

Money well spent I would say.

Blue Wode

1st March 2008, 05:17 AM

For those wishing to object to the proposed Royal Charter for the College of Chiropractors, simply follow the procedure outlined in this link:
Formal applications for Charters are published, to allow other interested individuals or organisations to comment or to lodge counter-petitions. Because the process of Petitioning for a Charter is thus a public one, and can also be expensive in terms of the preparation of the formal documents, this Office encourages institutions to have taken soundings among other bodies who may have an interest, in order to minimise the risk of a counter-petition. Any proposal which is rendered controversial by a counter-petition is unlikely to succeed.

http://www.privy-council.org.uk/output/Page45.asp

i'd imagine objecting is only open to citizens of the UK?

Good question. I'll contact the Privy Council about that and post its reply.

Rolfe

1st March 2008, 05:41 AM

Physiotherapist, regardless of the initials, it all stands for "Bachelor of Medicine and Bachelor of Surgery". I know some people abbreviate it differently. The graduate programmes still don't award their graduates "MD" degrees, and the fact that the graduates already had degrees on entry has little bearing on their training from them on.

I lived in the south east of England for 25 years. I know there are some private GPs about. Very, very few people use them. But the fact remains that people are not tied into the NHS system if they don't want to be, and have a bit of spare money. Best of both worlds, which the Merikans can't seem to get their heads around.

Rolfe.

Lilith

1st March 2008, 07:11 AM

I often advise people to stay away from chiropractors, and could bore you with some examples over the past 30 yrs, but prefer to bore you instead with what happened to me when I visited a chiropractor 20 yrs ago - and why I stopped.

In my early 20's, and after years of telling people (including my mother) to not "do it", I took a challenge from an acquaintance who is a chiropractor. I have had ongoing TMJ pain (including jaw deviation when opening, clenching, teeth cracking, and, over the last 15 years, crowns placed over cracked molars from the clenching) and pain in my shoulder joint, trapezius, sternocleidomastoid, and masseter muscles on one side of my body. Back when it first began, the docs didn't recommend anything for me. But this chiropractor would tell me from time to time that he could help me. After about a year of this, I said ok. I let him treat me for about a month - including neck "adjustments" and electrical muscle stim. After about two sessions, I had such freedom from pain - I commented, "I didn't realize how much pain I was in until it was removed." It felt sooooo good. I continued letting him "adjust" me for several months before I decided that, as good as I felt, I wasn't completely comfortable with having my neck snapped again and again.

A few years later, in grad school, I spent some time in a lab in a neurology department, and when I mentioned this experience to them I was told to never, ever, ever allow a chiropractor to adjust my neck for fear of stroke. And even though it had been years since I'd had an "adjustment", I was quite blue to know that I would never again experience that total freedom from my pain and stiffness in my jaw.

I now get an occaisonal massage, asking them to focus on the neck and upper back, but the nice effects are short-lived. The most recent massage I had was from a practicing chiropractor, and it was by far the best massage I've had in some time.

So, my experience tells me that the chiropractic treatment by the first chiropractor did something to alleviate my pain and stop my clenching for a while, even though the TMJ joint still deviated upon opening the jaw. I now think that there are a few good chiropractors out there, but that they are the minority. But even these chiropractors are playing with fire if they continue to adjust necks.

As for my continuing TMJ (and other joint) issues, I live with it. You learn to ignore it for the most part - impossible at times. I can often be caught rubbing that side of my face, or stretching my jaw muscles, or asking my beau to massage my neck on that side. Perhaps it's better to not get relief from it, if the relief is only temporary (!).

Ok - you can wake up now ...

zeusbheld

1st March 2008, 10:18 AM

this has been an interesting thread.

i've gone from being "i don't care what they say coz some of them do good work" to "get rid of them except as a subset of physios, and then keep only the ones that aren't wearing tinfoil hats". God bless evidence (Ah merkins CAN do irony, albeit ham-handedly).

a forum FOR skeptics is perhaps the one place where i'm not a troll. <snif> i wuv you guys.

zenotter

2nd March 2008, 09:43 PM

I still have to say I love my chiropractor because he's not woo and he and his team give the best specialized massage-like treatment (Active Release Technique). He refers people to medical doctors, has been working with medical doctors in treating patients with frozen shoulder syndrome, has worked with people on soft tissue and other non-spine-cracking issues, and promotes a healthy lifestyle (plenty of veggies and fruits and moderate exercise) more than anything else. He's good enough for olympic athletes so he's good enough for me. :)

Blue Wode

3rd March 2008, 03:32 AM

I still have to say I love my chiropractor because he's not woo and he and his team give the best specialized massage-like treatment (Active Release Technique).

In other words, you seem to be one of the lucky ones who has managed to find one of the 5-10% of chiropractors in the US who lean towards more rational treatment approaches. Indeed, it sounds like your chiropractor practices physiotherapy and not ‘chiropractic’.

I’m interested to know if you deliberately looked for a rational chiropractor and, if so, how did you know to do so?

i've gone from being "i don't care what they say coz some of them do good work" to "get rid of them except as a subset of physios, and then keep only the ones that aren't wearing tinfoil hats". God bless evidence

I suspect that many people would reach a similar conclusion if they were given access to accurate information about chiropractic.

For the benefit of any drive-by readers wanting to learn more, see here
http://www.ukskeptics.com/documents/spinal_manipulation_benefits_risks.pdf

and here:
http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php

zeusbheld

3rd March 2008, 04:23 AM

I suspect that many people would reach a similar conclusion if they were given access to accurate information about chiropractic.

heheh. well obviously *i* would agree with that pretty much by definition.

that said, like zenotter, i have seen rational chiros that were very helpful for my particular chronic upper back problem, and i did outline in broad strokes how to tell 'em apart.

Blue Wode

3rd March 2008, 06:25 AM

From the highly respected veteran chiropractor, Samuel Homola, in the January 2008 issue of Skeptical Enquirer:
It is generally agreed that chiropractic may be a useful approach in alleviating pain for a very limited set of disorders associated with the back or spine.

However, many skeptics are concerned that chiropractic is being applied to disorders for which it is an inappropriate intervention and for which solid evidence of its efficacy is lacking.

If this is the case, then several unfortunate consequences might result. Patients might be harmed by the treatment itself, they might waste their time and money, or they might be deterred from seeking effective treatments.

Skeptics fear that chiropractors and their representatives may often promise too much and create expectations that chiropractic can cure or heal medical problems for which it is ill suited.

More…
http://www.encyclopedia.com/doc/1G1-174102078.html

zenotter

3rd March 2008, 10:14 PM

I lucked out with finding mine. I had gotten a referral to a woo-one after a car accident, but put off going there because I didn't feel like being "muscle-tested" with vials of whatnot. I went to the local Whole Foods and had a chair massage from a therapist I'd not seen there before. She was realllly, really good, and we started talking about physical therapies since the car accident had happened the month prior. She mentioned that she worked with a chiropractor who was really good and took various forms of insurance, and I later found that their office happened to be 15 minutes from my workplace. The rest is great history. :)

I made an appointment with the chiropractor, not ever having been to a chiropractor before, but since the chair massage helped me to move better than the physical therapy I was doing at a nearby hospital, I took a chance and went. I'm still glad I did. The specialized massage has helped immensely with my fibromyalgia spasms and muscle tightness, and I know I need to get in better shape since those will ease up if I do but the massage still gets out the deep tissue knots that regular sports massage can't even touch.

I did try the other guy out though, and learned that I was apparently low on selenium and molybdenum. It was kind of a weird experience, too. I'm all for natural approaches, but within reason, and the whole "take care of yourself by eating right and moving around a bit" has worked the best so far.

Blue Wode

4th March 2008, 03:02 PM

Zenotter, thank you for your reply. That was, indeed, a lucky find. I’m glad it has helped you.

i'd imagine objecting is only open to citizens of the UK?

Zeus, I have just received a reply from the Privy Council and, having asked if contesting an application for a Royal Charter was confined to citizens of the UK, it would appear that anyone, anywhere, can contest an application - see answer (1) from the Privy Council below:

1. Representations may be made by anyone about the granting of a Royal Charter to this Office.

2. The formal application for Charters are published in the London Gazette.

[London Gazette: http://www.gazettes-online.co.uk/home.aspx?geotype=London ]

3. Representations about a Charter need to be made, in writing, to this Office.

So, for the benefit of drive-by readers, here are the details you need if you wish to counter-petition the UK College of Chiropractors' application for a Royal Charter...

Latest status of the application (petition):
5 June 2007 - Towards a Royal Charter: College Council attends House of Lords Reception

College Council members attended a reception organised by Baroness Jean Corston at the House of Lords today. Guests included key figures from the Commons and the Lords keen to hear more about the College and its pursuit of a Royal Charter. Baroness Corston welcomed those present and highlighted the importance of a united chiropractic profession. Tim Jay, College President, explained the value of a Charter to the public and profession. Small group discussions followed enabling MPs and Peers to ask questions of Council members. It was clear there is significant support for the chiropractic profession and the College's pursuit of the Royal Charter. The Council intends to approach the Privy Council later this year to re-open discussions.

http://www.colchiro.org.uk/default.aspx?m=39&mi=202&ms=0

Email contact for the counter-petitioning procedure given via this link:
Formal applications for Charters are published, to allow other interested individuals or organisations to comment or to lodge counter-petitions. Because the process of Petitioning for a Charter is thus a public one, and can also be expensive in terms of the preparation of the formal documents, this Office encourages institutions to have taken soundings among other bodies who may have an interest, in order to minimise the risk of a counter-petition. Any proposal which is rendered controversial by a counter-petition is unlikely to succeed.

http://www.privy-council.org.uk/output/Page45.asp

As far as I know, a formal application has yet to be published in the London Gazette.

Acleron

4th March 2008, 05:43 PM

As far as I know, a formal application has yet to be published in the London Gazette.

Is that for a petition or counter petition?

Blue Wode

5th March 2008, 12:10 AM

As far as I know, a formal application has yet to be published in the London Gazette.

Is that for a petition or counter petition?

It’s for the petition (application) from the College of Chiropractors.

As I understand it, when it’s published in the London Gazette other interested individuals or organisations can then comment or lodge counter-petitions.

You have to wonder why the Privy Council doesn’t publish the petition on its website. It would be so much easier to find. Anyway, I’ll try to keep track of the College of Chiropractors’ progress with the petition and post any updates here.

zenotter

5th March 2008, 09:37 PM

Zenotter, thank you for your reply. That was, indeed, a lucky find. I’m glad it has helped you.

You're very welcome. I'm fortunate to be in such good care. Sad that the vast majority of chiropractors don't seem to be the same way.

Blue Wode

9th March 2008, 07:11 AM

Well worth viewing:

The Kinsinger Report on Chiropractic (approx. 42 mins)
http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv

This presentation was included in the curriculum of the course PHTH 7990 “Advanced Spinal Manipulation for Physical Therapy Students” for physical therapy students taught by Dave Johnson, PT, PhD, Clinical Assistant Professor, Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center (OUHSC). It was also included in the continuing education program “Spinal Manipulation: 5th Annual Update for Physical Therapists, Osteopathic Physicians, and Medical Doctors” sponsored by the Department of Rehabilitation Sciences, College of Allied Health, OUHSC.

Bill Kinsinger, MD, is past President of the Oklahoma Society of Anesthiologists, and since 1994 has been in private practice of obstetric anaesthesiology. Since 1990 he has conducted investigations and research of the chiropractic industry.

Dr Kinsinger is also associated with the Neck911 network, a volunteer organisation devoted to raising awareness of injuries associated with the practice of chiropractic:
http://www.neck911usa.com/

Blue Wode

19th April 2008, 05:03 AM

As ‘Chiropractic Awareness Week’ gets under way, here’s what scientist and broadcaster, Simon Singh, has to say about it in the Comment is Free section of today’s Guardian:

‘Beware the spinal trap’

This is Chiropractic Awareness Week. So let's be aware…

http://www.guardian.co.uk/commentisfree/2008/apr/19/health

JJM

29th April 2008, 05:06 PM

There is an interesting article on chiro and stroke here http://www.sciencebasedmedicine.org/?p=94

Morrigan

30th April 2008, 08:58 AM

More or less off-topic, but... a friend of mine recently got tinnitus after an unfortunate strike to the head during kendo training. For a few weeks his ears were ringing really loudly and no doctors or physical therapists seemed to help him.
Then someone said, "oh, I had a friend with tinnitus, but he went to a chiro and it disappeared instantly!". I was immediately suspicious and I got very worried when another said he'd contact our friend and recommend a chiro. Even if we assume that the anecdote is true, tinnitus has hundreds of different causes and there's no way to know it'd be remotely beneficial to our friend.... and the last thing he needed was a risky spine or neck manipulation!

Fortunately, he didn't go to a chiro after all... but less fortunately, he went to see an acupuncturist instead. :newlol And, of course, he claims his ringing has decreased dramatically since then. I didn't have the heart to tell him it was just a placebo, he seemed so relieved that he could sleep again... and besides, I figure that if he's going to get a woo placebo treatment, acupuncture is equally worthless, but far less risky than a chiro, no? I just hope that if his tinnitus does subside, that he doesn't continue to spend his money into useless appointments.

JJM

30th April 2008, 10:57 AM

Morrigan, post #143,

I suspect that the safety of acupuncture is not well-understood, and problems are under-reported. We know that people have been infected from inadequately cleaned (sterilized) equipment. In addition, lungs have been punctured, and hearts have been fatally punctured. Medicine has a record of trying to identify errors in order to prevent them, chiro and acu are actively sweeping problems under the rug. Chiro is bigger than acu, so we know less about the dangers of acu.

Morrigan

30th April 2008, 04:08 PM

True, but I suspect that the odds of having dirty needles at the acupuncturist are rather low, compared to the dangers of neck manipulation?

arthwollipot

30th April 2008, 09:03 PM

I had my neck manipulated for years with no apparent ill-effects.

Blue Wode

1st May 2008, 12:03 AM

I had my neck manipulated for years with no apparent ill-effects.

So did Pierrette Parisien.

Quebec Coroner: Patient Death Caused by Chiropractic Adjustment

A Quebec coroner has concluded that a chiropractic adjustment contributed to the death of a Montreal woman. Coroner Paul G. Dionne said the death of Pierrette Parisien, a 36-year-old mother of two, was accidental*, but that the chiropractic neck adjustment she received "created damages to the blood vessels in her neck, leading to her death."

Parisien had been a regular chiropractic patient for nine years prior to her Feb. 20, 2006 appointment…

http://findarticles.com/p/articles/mi_qa3987/is_20070604/ai_n19287954

*This was also the ruling of the Coroner in the Lana Dale Lewis case where the use of the word "accidental" meant "not due to natural causes”. The Coroner’s Jury were clearly instructed by the Coroner and other counsel that if they were convinced that the cause of Lana Lewis' stroke was as a result of the neck manipulation, this would be a traumatic origin of the stroke, and their verdict would be 'accident’:
http://www.chirobase.org/15News/lewis.html

Blue Wode

1st May 2008, 12:14 AM

I suspect that the odds of having dirty needles at the acupuncturist are rather low, compared to the dangers of neck manipulation?

If it's any help, this is what Professor Edzard Ernst and scientist Simon Singh had to say about the safety of acupuncture a couple of weeks ago:
Studies have shown that acupuncture treatments can result in slight pain, bleeding or bruising.

These adverse reactions are only minor and transient, but they occur in roughly 10 per cent of patients so are relatively common.

Slightly more serious side-effects include fainting, dizziness and vomiting, but these are less common and usually associated with anxious patients who may have a fear of needles.

Although most patients may accept such risks as an unsurprising consequence of being pierced with needles, there are two serious adverse effects to consider.

The first is infection. There have been several documented cases of patients contracting diseases such as hepatitis.

The journal Hepatology documented how 35 out of 366 patients contracted hepatitis B from an acupuncture clinic in America.

The infection was caused by re-using needles that have not been properly sterilised, and part of the problem may be due to the Chinese tradition of storing needles in alcohol solutions, which is not sufficient to protect against hepatitis viruses.

The second is that needles might puncture a major nerve or organ.
For example, needling at the base of the skull can lead to brain damage, and there are more than 60 reported cases of punctured lungs.

Most worrying of all, there is a report of an acupuncturist inserting a needle in the chest of an Austrian patient which pierced her heart and killed her.
Normally, needling at this point is entirely safe because the sternum protects the heart, but one in 20 people have a hole in that bone which cannot be felt or seen.

Although acupuncture carries some common and serious risks, it is important to stress that the common risks are not at all serious and the serious risks are not at all common - they need to be seen in the context of the millions of treatments given each year.

Moreover, the serious risks can be minimised by visiting a medically trained acupuncturist who has a full knowledge of anatomy and uses disposable needles.

On the other hand, the evidence for the efficacy of acupuncture ranges from zero for a range of conditions to borderline for some types of pain relief and nausea.

Hence, it's only worth considering for pain relief and nausea - and only then if you feel the supposed benefits outweigh the small risks.

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=559711&in_page_id=1774

And here’s what they had to say about chiropractic:
DOES IT WORK? There is no evidence to suggest that spinal manipulation is effective for anything but back pain and even then conventional approaches (such as regular exercise and ibuprofen) are just as likely to be effective and are cheaper.

Neck manipulation has been linked to neurological complications such as strokes - in 1998, a 20-year-old Canadian woman died after neck manipulation caused a blood clot which led to stroke. We would strongly recommend physiotherapy exercises and osteopathy ahead of chiropractic therapy because they are at least effective and much safer.

If you do decide to visit a chiropractor despite our concerns and warnings, we very strongly recommend you confirm your chiropractor won't manipulate your neck. The dangers of chiropractic therapy to children are particularly worrying because a chiropractor would be manipulating an immature spine.

http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=557946&in_page_id=1774

And, to sum up, this is what they propose (in their book Trick or Treatment? Alternative Medicine on Trial) that all acupuncturists be compelled by law to disclose to their patients about acupuncture…
WARNING: This treatment has shown only very limited evidence that it can treat some types of pain and nausea. If it is effective for these conditions, then its benefits appear to be short-lived and minor. It is more expensive than conventional treatments, and very likely to be less effective. It is likely that its major impact is as a placebo in treating pain and nausea. In the treatment of all other conditions, acupuncture either has no effect other than a placebo effect. It is a largely safe treatment when practised by a trained acupuncturist.

…and this is what they propose that all chiropractors be compelled by law to disclose to their patients about chiropractic therapy:
“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.”

Armed with that information, it all boils down to personal choice.

robinson

1st May 2008, 09:03 AM

robinson

1st May 2008, 09:06 AM

More or less off-topic, but... a friend of mine recently got tinnitus after an unfortunate strike to the head during kendo training. For a few weeks his ears were ringing really loudly and no doctors or physical therapists seemed to help him.

Off topic reply: I just read about a new (to me at least) treatment for tinnitus, using a laser to stimulate the cells, causing them to heal up. Don't know much yet, but it is being done by a clinic up the road, real Doctors as far as I can tell. Supposed to work for a certain percentage of people who have the treatments done.

Blue Wode

1st May 2008, 10:19 AM

We really should do something about this problem. Every year thousands of people die, millions are crippled. I don't understand how they even stay in business, with the patient roles decreasing like crazy.

And the lawsuits. How do they afford the malpractice insurance? And why hasn't at least one Media outlet done a series on the grieving families of the hundreds of thousands of people killed over the years?

And the cripples, you see them everywhere, dragging there distorted spines around, in terrible pain. Why don't they warn people of the dangers? Why do they keep telling their friends to go? Can't they see the extreme pain and bad posture right in front of them?

Tens of Millions of disabled people on Government checks, draining the economy, all because of quackery. Can't anything be done?

So what’s your point? Are you saying that it’s acceptable for people to die or be severely crippled as a result of chiropractic treatment? Or that it’s OK as long as only a few people are affected? If so, presumably you’d be comfortable repeating your quote above to Diane Rodrigue:

http://www.rte.ie/news/2005/0505/primetime.html

(About 25 min 45 sec in)