Was I Wrong About Chiropractic?

This post is in response to some comments left by an anonymous chiropractor.

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Hi, Anon.

Thanks for the time that you put into your response. I truly do appreciate your comments. I have a few quibbles, of course, as you might expect.

I'm puzzled that you say "it's a deliberate misrepresentation" to associate the (purported) dangers of CSMT with chiropractic. What I said was "there is evidence to suggest that [the chiropractor] actually put me at greater risk of suffering a stroke". Even if I were not put at greater risk, or if you were inclined to argue that CSMT is not common chiropractic practice, I find your assertion that I'm being intentionally deceptive surprising and offensive.

Case studies are just well reported anecdotes and the plural of anecdote is not data. Although they have their place in the research evidence hierarchy, case studies are not capable of determining causation of benefit or harm.

I could not agree more. :)

The data gathered in the article seems to support that if you require cervical spine manipulative therapy, go to a chiropractor, as they appear to be associated with less adverse events than medical providers or physiotherapists.

Interesting. I will reassess my position with regard to the level of danger presented by CSMT.

But is CSMT necessary? From what I understand, it is classified as an alternative therapy. As a treatment, is it indicated for any particular medical condition? If so, would you cite research supporting its efficacy? If it is unnecessary, why take even a marginal risk?

No study to date has shown manipulative therapy to be less effective than standard/usual care, suggesting it is at least as good and valid an option for patients with spinal pain complaints as medical care. However, when clinical practice guidelines are applied, it appears that chiropractic care fairs much better than usual care (see Bishop et al. 2010 - http://www.ncbi.nlm.nih.gov/pubmed/20889389 )."

I believe that Drs. Ernst and Singh reached similar conclusions in their evaluations: that manipulation of the spine has some efficacy for when treating accute lower back pain. I have no reason to dispute those findings.

Finally, an argument I've read on various pages of your blog goes something like, 'The study was positive for chiropractic, but the study was done by a chiropractor'. This is argument by innuendo - leading the reader to assume the study if [sic] flawed because it was a chiropractor that performed it rather than a rational discussion of the actual flaws of such a study.

That's a fair point. I will attempt to be more cautious in the future. What I said was: "I found myself wondering (perhaps unfairly) whether [the study] had been carried out by a chiropractor. It had. Unfortunately, I am unable (and, frankly, unqualified) to assess the study's strengths and weaknesses." You will see that I was aware of my own shortcomings in this area when I wrote that paragraph.

I am not a medical professional, and I am not in the business of providing medical advice.

Further, this argument implies that others are more reliable (i.e. a 'real' doctor), which is a tacit appeal to authority rather than a critical appraisal of the research.

No, it doesn't. It implies that practitioners of complementary and alternative medicine have a vested interest in validating their own practices, especially when the efficacy of their techniques is hotly debated in the academic literature. I have similar reservations about studies performed by pharmaceutical companies who are engaged in testing their own drugs. Even without any flaws in the study itself, the file-drawer effect can be a major problem.

The use of the 'not a "real" doctor' moniker is an appeal to ridicule – another informal fallacy.

Sure. Which is why I didn't use it. I simply pointed out that chiropractors are not medical doctors, and are not required to attend medical school. (Neither is Simon Singh, but I don't go around saying that he isn't a "real" doctor.) I made this distinction not to discredit chiropractors, but to clarify a point made earlier by someone else who was claiming that chiropractors weren't "real doctors". It had nothing to do with an appeal to ridicule.

Indeed, you go on to say, "This is similar in other disciplines; those doing research tend to have additional training beyond that of a clinician or technician." Bravo! Although it is common to assume that a medical doctor would know how to do medical research, this is an unfounded assumption. There is an important distinction to be made between clinician and researcher, in any discipline.

In science it is the quality of the argument that is to be judged NOT the person making the argument as is rampant on so-called skeptic boards.

Agreed. I do not frequent skeptic boards, so I cannot speak to the frequency of ad hominem attacks.

This is why many genuine research scientists think of 'skeptics' as strict adherents of orthodoxy rather than bona fide critical thinkers.

That's absurd. If you're not engaging in "bona fide" critical thinking, then you're not being a skeptic. And I have no interest in what "many genuine research scientists" think of the skeptic movement.

1.a. Is there any level of evidence that would change my opinion?

Absolutely!

1.b. Is that level of evidence greater than for other claimants?

In some cases, yes. I believe that it is appropriate to require evidence that is proportional to the prior plausibility of the claim. A claim that disruptions in the flow of innate intelligence caused by vertebral subluxations have a negative impact on my health requires more evidence than the claim that some insects are herbivorous.

2. Do I question my own beliefs when I 'Question Everything'?

Although it is easy to fall prey to the cognitive biases that plague the best of us, I certainly try!

3. Do I entertain the notion that I may be wrong?

Certainly. If I did not entertain just such a notion, I would not have stopped visiting the chiropractor in the first place.

I do my best to honestly and openly admit the edges of my own expertise. I am excited about critical thinking and the promotion of science. I may sometimes come to the wrong conclusion, but I am always willing to reevaluate my position.

Since you claim to be both a chiropractor and a skeptic, Anon, I'm curious as to your thoughts on the distinction between straights, mixers, and reforms. What do you think of the idea of innate intelligence?

As a skeptic, you must recognise that you work in a profession with other professed chiropractors who are tireless promoters of nonsense. Do you speak out on this topic? Do you caution your patients and friends that when chiropractors claim to be able to cure allergies, ear infections, and the like, their claims are not only implausible but unsupported by evidence?

As always, I appreciate any comments on the subject that you may have.

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Edit: I recommend reading the comments on this post, as they may further provide further elucidation.