Main Site

This is Gem Newman's blog. Return to the main site.

Quotation

03 December 2010

Was I Wrong About Chiropractic?

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


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.



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

14 comments:

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

    Which research scientists are these? I am a 'genuine research scientist' and I do not know of any scientists in my own field or any other that are not themselves critical thinkers and skeptics. Stating what 'many scientists think' is akin to vague assertions such as 'Scientists say,' and 'it is well known that,' and are usually synonymous with 'I couldn't bother doing any research to support my opinion.'

    With respect to the legitimacy of chiropractic, a so-called medical profession that rejects the well-founded Germ Theory of Medicine, regardless of whether individual practitioners hold this belief, places it in the category of pseudo-science until it can provide evidence that spinal mis-alignment, and not viral and bacterial infection, is responsible for disease.

    As I understand it, chiropractic was invented in 1895 by D.D. Palmer, a grocer, who did something to the back of a deaf man who claimed he could hear afterwards. Palmer concluded that all disease was caused by misaligned bones. Legitimate fields of science are not invented whole cloth by one person, but develop gradually, through the contributions of many scientists whose work is subject to peer review.

    As such, I feel that chiropractic belongs in the same camp as naturopathy and homeopathy - unscientific shams.

    ReplyDelete
  2. I would tend to concur, Sean.

    At the same time, I'm aware that there is a small (from what I understand) group of science-based chiropractors who shun the subluxation hypothesis and the idea of innate intelligence, and who are actively working to bring the chiropractic community in line with science-based medicine.

    For that reason, I don't want to tar all chiropractors with the same brush; I'm concerned that there might be a bit of a genetic fallacy involved with stating that because D.D. Palmer was a wackaloon, therefore chiropractic is bunk. (I'm not saying that this is your position, Sean; but some might infer it, so I figured that I'd bring it up.) At the same time, chiropractic was founded by a wackaloon, and the whole belief structure upon which chiropractic was originally based is bunk.

    From the Wiki: "In May 2010 the General Chiropractic Council, the statutory regulatory body for chiropractors in the United Kingdom, issued guidance for chiropractors stating that the chiropractic vertebral subluxation complex 'is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.' [Source.] A similar stance is taken by the National Health Service: 'There is also no scientific evidence to support the idea that most illness is caused by misalignment of the spine.' [Source.]"

    ReplyDelete
  3. Thanks for the reply, Spurll, and for posting the GCC's statement, which I was unaware of. The timing of it, however, looks suspiciously like back-pedaling in the wake of the failed law suit against Simon Singh who, as I'm sure you know, criticized British chiropractors for claiming to be able to treat colic and asthma with spinal manipulation. So this capitulation is certainly a recent one.

    Despite the terseness of my previous post, I do realize that not all chiropractors reject Germ Theory. However, although spinal adjustments performed by chiropractors have been shown to reduce lower back pain, the same treatments can be given by physiotherapists who, unlike chiropractors, have been trained at accredited post-secondary institutions and in whom I place a great deal more trust. Since it can be difficult to separate the wackaloons from the legitimate practitioners within the chiropractic profession, you'll never catch me visiting one.

    I've pretty much given up trying to convince my friends of the folly of chiropractic, though. Since I can't even convince my own sister to stop seeing a naturopath, I doubt I'll ever succeed in convincing anyone that chiropractors are not legitimate doctors.

    I'm really enjoying your blog, by the way. Keep up the great work!

    ReplyDelete
  4. Part 1 of 6
    Thank you for responding to my comments so quickly. I’ll be honest; I didn’t expect a response on an old thread… Much of what has been said is fair. There are some areas with which I disagree, and I will try to address them. Please forgive me if this is a bit disjointed, as I’m doing this on-the-fly and trying to address each concern as it was brought up.

    When I talked about ‘deliberate deception’ I was not referring to you specifically or your previous comments, but rather the common practice of labeling a profession (chiropractic) as dangerous rather than a procedure (cervical spinal manipulation). I’m sorry if I’ve offended you, as this was sincerely not my intention. The use of insult to support an argument is a sign of paucity of thought and I would not intentionally engage in this.

    I was referring rather to the repetitive use of the term “chiropractic manipulation” rather than the descriptive and accurate term “cervical manipulation” as a common narrative-building tool. For example, this is done in reports such as those by Reuter, et al., (2006) titled “Vertebral artery dissections after chiropractic neck manipulation in Germany over three years”, which identifies a profession as the implied and sole cause when their data clearly show otherwise. Or articles such as those by Edzard Ernst titled “Death by Chiropractic” which reference cases in which the provider was not a chiropractor, as was clearly stated in the body text of the original paper. Theses ‘claims’ are then referenced and repeated building a narrative of risk out of proportion to the actual risk. Although it is possible these are simply innocent oversights, it seems unlikely.

    Cervical spinal manipulation is a very common procedure (Haldeman et al., 1999 Spine 24: 785-94.) and the risk appears to be no greater than when visiting your medical doctor for neck pain (Cassidy et al., 2008 http://www.ncbi.nlm.nih.gov/pubmed/18204390). In fact, using the methodology of Rothwell et al (http://www.ncbi.nlm.nih.gov/pubmed/11340209), Cassidy et al looked at the likelihood of a patient having a VAD following a visit to a chiropractor and compared that with the likelihood of this happening following a visit to a medical doctor. Rothwell’s study found one is 5x more likely to be diagnosed with a VAD if one had previously seen a chiropractor. This study was touted as proof positive that chiropractors caused stroke. In repeating Rothwell’s study, Cassidy (with a researcher from Rothwell’s group, Susan Bondy) compared the risk to that of visiting a medical doctor under similar circumstances. As it turns out, one is slightly more likely to have seen a GP prior to VAD diagnosis than a chiropractor. Does this mean that family doctors ‘cause’ dissecting strokes? Of course not. When we consider the major symptoms of VAD is neck pain headache, it appears that people with neck pain and headache go to the provider that they think will help. As is the current understanding, the problem is not causal but rather one of diagnostic inaccuracy. It also appears from this study that GP’s are no better at diagnosing VAD symptoms than are chiropractors.

    Continued…

    ReplyDelete
  5. Part 2 of 6
    Let me be clear, the evidence shows the risk of VAD following cervical spinal manipulation is the same for all providers (DC, PT, MD), as there does not appear to be a causal link rather a temporal one. At the risk of sounding pedantic, and for the benefit of lay readers, the difference is this:

    Causal association = B follows from A
    Temporal association = AB occur at the same time but are not otherwise related

    Temporal links do not imply causation. For example, people on airplanes {people with neck pain} eat peanuts {cervical manipulation}. Some airplanes crash {VAD}. This does not mean peanut consumption causes plane crashes. Although this is simple to state, this is very difficult to demonstrate in health research. However, the above research as well as research using animal models ( i.e. http://www.ncbi.nlm.nih.gov/pubmed/15614240 , http://www.ncbi.nlm.nih.gov/pubmed/18667811), pathogenesis and biomechanics of VAD (i.e. http://www.ncbi.nlm.nih.gov/pubmed/12183695 , http://www.ncbi.nlm.nih.gov/pubmed/20534313), and epidemiological research that shows these events to be extremely rare and by all accounts appears to point in the direction of very little to no risk. Risks do not exist in a void. They must be compared to the risks associated with other therapies such as NSAIDs, Muscle relaxants, analgesics, physical therapies (ultrasound, estim, etc.), as well as the risk of doing nothing.

    There is no therapy class officially considered ‘alternative therapy’ but rather it is a lay label applied to therapies not offered by orthodox medicine. How we define ‘alternative’ should be considered – for example, spinal manipulative therapy done by chiropractors for low back pain has been shown to have better outcomes than standard medical care (Bishop et al., 2010); so does this mean that medical care should be considered ‘alternative therapy’ based on efficacy? So you can see there is a problem with this label, both in definition and application.

    Which brings us to the next argument, “Even if the risk is extremely low, if there is no benefit the risk is not worth it” or the zero denominator argument. Cervical SMT may be indicated for people with cervical pain syndromes such as neck pain, cervicogenic-type headaches, and radiculopathies (http://www.ncbi.nlm.nih.gov/pubmed/20510644). The concept of ‘necessity’ is always debate in pain treatment. Is oxycontin necessary? Are various surgeries necessary and what is the risk and efficacy of these therapies (i.e. http://www.ncbi.nlm.nih.gov/pubmed/20736894)? After all, pain is not life threatening. All I can say is that in those suffering cervical pain syndromes, there is good evidence of clinical efficacy and safety for therapies employed by chiropractors to alleviate their pain, if that pain is interfering with their ability to conduct and enjoy their life.

    Continued…

    ReplyDelete
  6. Part 3 of 6
    Gert Bronfort et al recently wrote a paper that summarizes the evidence for and against the effectiveness of manual therapies for various conditions. Although not the most robust methodology, it is a good overview of conditions for which there does seem to be biological and clinical plausibility (http://www.ncbi.nlm.nih.gov/pubmed/20184717). It was commissioned by the BCA and was instrumental in them giving up tilting at windmills. (As an aside – there was a substantial outcry from chiropractors in Britain against the BCA’s actions, which I think played a major role in them giving up the fight).

    “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” – the same could be said of all healthcare providers and researchers, this is not unique to chiropractic (i.e. http://www.ncbi.nlm.nih.gov/pubmed/16443796). The influence of pharmaceutical companies and funding sources on published results is notorious for this. The scientific ‘debate’ regarding the efficacy and safety of chiropractic, however, has waned tremendously as the more robust studies have shown SMT to be a valid and relatively safe therapy for spinal pain syndromes. Here is one of the dark realities of health research; someone has to pay for it. It is always the case. This funding is a source of bias. That is why one must declare conflicts of interest. That is why there is a peer-review process for publication. That is why randomized control trials must be registered beforehand or not get published. Although not perfect, there are checks and balances designed to prevent this. Because it is not perfect, those of us that read the health literature must be critical.

    The ‘real’ doctor comments are fair and I realize you (Spurll) didn’t use it. Again, this was not directed specifically at you – if I gave that impression I am sorry – when debating in type, it may seem as though I’m more aggressive than I’m trying to be, emotion doesn’t translate well in Times New Roman. In fact, the ‘real’ doctor thing is a running joke in most limited scope healthcare providers and non-professionals (DC, DDS, OD, PhD) – we hear it all the time. It is only a problem when used in the support of an argument or as an insult.

    With regard to my comment on ‘skeptics’ as adherents of orthodoxy – upon rereading my comment, I can see that this doesn’t make the point I was trying to make. I was trying to make a distinction between lay skeptics (as in the person that just read a Richard Dawkins book and now considers themselves a skeptic), and being skeptical (i.e. a critical thinker that appraises the science appropriately with directed effort and skill) – I think you know what I’m talking about. The ‘research scientists’ of which I spoke, and so clearly over generalized (sorry), are specifically healthcare researchers – particularly those within my sphere of contact (and before you say it, no, not just chiropractors). To vaguely generalize as I did was inappropriate. However, there is a difference between being a lay skeptic and skeptically appraising the science (i.e. a critical thinker). That was the point I was trying to make. I ask you (and Sean), how would you react to someone (or a some group), who knows comparatively little about your discipline (I’m not trying to be pejorative although it sounds a bit that way) incorrectly appraising the literature and casting dispersions upon what you do under the guise of being skeptical? I suspect in a similar dismissive fashion.

    Continued…

    ReplyDelete
  7. Part 4 of 6
    When I asked if the level of evidence must be greater than that for other claimants what I meant was – All things being equal, is evidence of improved outcomes from SMT weighed the same as evidence for improved outcomes from, say, oxycontin?

    So, now to the Chiropractic questions.
    As I’ve said previously, I do not speak for all chiropractors, but I do speak for a large (and growing) percentage of them. We don’t generally use the straight/mixer/reform monikers any more as they are not particularly descriptive, have a lot of historical baggage, and can be confusing to those not familiar with this jargon. Typically the two camps are subluxation-based (or philosophically-based) and evidence-based chiropractors. Innate intelligence is a shoddy metaphysical means of explaining homeostasis left-over from a hundred years ago. Subluxation is an unfortunate term in that it is confusing (it means a partial dislocation and has a very different meaning in orthopaedics), does not explain particularly well the phenomenon we see (the manipulable lesion), has pseudoscientific baggage (held over from a hundred years ago), and has no good evidence for its existence. That being said, some use it as the equivalent of ‘joint dysfunction’ or zygopophyseal joint-type pain syndromes. I don’t use the term as it is not helpful clinically, has very little support, and has too much baggage.
    “As a skeptic, you must recognize [sic] that you work in a profession with other professed chiropractors who are tireless promoters of nonsense.” Yes. I’m very aware. I’m also not alone. Here is a good analogy of the dilemma and challenge (http://www.ncbi.nlm.nih.gov/pubmed/18759966). There are a lot in my profession that are working hard to change this.

    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? The plausibility of claims should be assessed by outcomes research, not knee jerk reactions pro or con (http://www.ncbi.nlm.nih.gov/pubmed/18507834 , http://www.ncbi.nlm.nih.gov/pubmed/20825650). As such I’m cautious about using the term ‘implausible’ in health research – there was a time when Heliobacter was an implausible mechanism of gastric ulcers. However, to answer your question – upon reading your question, I laughed and thought, “yes, vigorously”. But I also caution my patients on the unsupported claims of other healthcare professionals that I hear everyday in my practice (i.e. MRI’s (and other imaging) improve back pain outcomes – nope!; muscle relaxants are effective for all low back pain - nope (just talk to a pharmacist); the best way to get better from spine pain is rest and removal from activity – again, nope…). How do you decide if the information your GP is giving you is correct? Do you know if the prescription has been studied for the condition for which it was prescribed or how safe it is (i.e.http://www.ncbi.nlm.nih.gov/pubmed/21131639 , http://www.ncbi.nlm.nih.gov/pubmed/20601654) ? If you find out that a prescription was ‘off-label’, not studied for efficacy, and not studied for adverse events, would your contention be applicable?


    “As such, I feel that chiropractic belongs in the same camp as naturopathy and homeopathy - unscientific shams.” If you believe this statement then you clearly have not critically appraised the biomedical literature on the subject.

    Continued…

    ReplyDelete
  8. Part 5 of 6
    “As I understand it, chiropractic was invented in 1895 by D.D. Palmer, a grocer, who did something to the back of a deaf man who claimed he could hear afterwards. Palmer concluded that all disease was caused by misaligned bones.” Yes, this is how it was supposed to have happened, of course, without the historical context. Most of us believe it to be a myth.

    “…chiropractic was founded by a wackaloon, and the whole belief structure upon which chiropractic was originally based is bunk.” Yep. And you may want to add that his son, BJ Palmer, was a megalomaniac with a penchant for evangelical-style big tent gatherings – a real nutjob. They’ve been dead for some time. The key words you’ve used are ‘belief structure’ and ‘originally based’. I understand early paleontology was more closely related to treasure hunting than science – I presume, however, this is currently not the case. There was a time when foul humours were considered the basis of disease.

    Legitimate fields of science are not invented whole cloth by one person, but develop gradually, through the contributions of many scientists whose work is subject to peer review. …as is the case in the last 20 years in chiropractic, since research funding (like the NIH) has been available , albeit in homeopathic quantities ;-p. Research dollars dictate what research gets done…as a research scientist I’ll assume you work on grants and your research, at least to some degree, is dictated by the grant that pays you. I’ve worked on research grants and had to justify the time I spent working on each grant, thus the funding sources dictated the research I did.

    “…the same treatments can be given by physiotherapists who, unlike chiropractors, have been trained at accredited post-secondary institutions and in whom I place a great deal more trust.” The manipulation provided by most physiotherapists is not taught in university (the U of Manitoba does not teach manipulation) but rather weekend courses.

    The “they-are-not-taught-in-universities” argument is an interesting one. The full argument seems to go something like “Chiropractors shouldn’t be in universities because they can’t be trusted / Chiropractors can’t be trusted because they are not taught in universities”. And there is some truth to both of these, although together they make a rather circular argument. Outside the US, most chiropractic training is performed in Universities. In Canada, there are two chiropractic schools, one in Toronto (Canadian Memorial Chiropractic College – CMCC) and one at Université du Québec à Trois-Rivières (UQTR). So, CMCC is the only non-university based college in Canada, but not for lack of trying. CMCC had been in talks with universities like York…here is an interesting discussion of why this merger was not completed (www.atkinson.yorku.ca/~pgrayson/pdfs/chiropractic.PDF). It seems this has less to do with science and more to do with turf warfare.

    Continued…

    ReplyDelete
  9. Part 6 of 6
    “Since it can be difficult to separate the wackaloons from the legitimate practitioners within the chiropractic profession…” It is really not that difficult. Just ask questions. Are they problem-focused/goal-oriented (“tell me about your back pain”) or are they focused on your insurance coverage? Do they give you a diagnosis (other than subluxation) with a treatment plan and a tentative release date? Do you get relief from your pain with a short course of treatment? Do they offer to correspond with your family doctor? Do they seem uncomfortable if you ask them to do this? Do you have to go to health talks and bring your family in? You can figure this out in the first few minutes… I think everyone should do this with all healthcare services they use. I’ve been diagnosed by a GP with a “inflamed rotator cuff” without him even touching me – not a particularly sensitive or specific method of diagnosing shoulder disorders. How do you tell if the other healthcare providers in your life are legitimate?

    “Since I can't even convince my own sister to stop seeing a naturopath...” Have you considered her feelings and that she may be getting a benefit from this?

    “I'm really enjoying your blog, by the way. Keep up the great work!” Agreed.


    Sorry for the ridiculous length of this… I won’t do it again. Promise.

    ReplyDelete
  10. "Sorry for the ridiculous length of this… I won’t do it again. Promise."

    Heh. I'll hold you to that! I haven't had time to read through your remarks yet, but once I have there will be a more thorough reply.

    As a point of interest, I don't have comment moderation turned on (which just means that Dennis Markuze doesn't spend enough time here to make it necessary), but for some reason your comments keep getting blocked by Blogger's new spam filter. I'm not sure exactly why that is, but I have to keep fishing them out of the bin. In any event, if you make a comment and it doesn't appear immediately that's probably what happened.

    ReplyDelete
  11. Evidently I spoke too soon, as the spam filter has also caught some of DM's garbage. It seems like the sensitivity is good, it's just the specificity of the thing that's out of whack.

    Get to work on those type one errors, Blogger!

    ReplyDelete
  12. Okay, now that I've finally finished the Creation Museum post I have some time to address a few things.

    "Theses [sic] 'claims' are then referenced and repeated building a narrative of risk out of proportion to the actual risk."
    Sure. The media also tends to report relative risk increase rather than absolute risk increase, which can be misleading. A threefold increase in risk may still leave the absolute risk very small.

    "Cervical SMT may be indicated for people with cervical pain syndromes such as neck pain, cervicogenic-type headaches, and radiculopathies"
    Great. It was an honest question! At the same time, I think that mileage may vary. When I was receiving chiropractic treatment regularly (one or more times monthly), it was routine for the practitioner to "crack my neck" several times, not in response to a complaint but seemingly because it was part of the "preventative" treatment. Either the chiropractor or my experience with him may have been atypical (this is, of course, nothing more than an anecdote), but it would seem to me that in cases such as these (however common or uncommon they are) CSMT is unnecessary. (But I think that you address this later when when discussing separating the good practitioners from the bad.)

    "there was a substantial outcry from chiropractors in Britain against the BCA’s actions, which I think played a major role in them giving up the fight"
    Good for them! I wish that had been better covered in the blogosphere. I certainly don't recall hearing about it.

    "Here is one of the dark realities of health research; someone has to pay for it. It is always the case. This funding is a source of bias. That is why one must declare conflicts of interest. That is why there is a peer-review process for publication. That is why randomized control trials must be registered beforehand or not get published. Although not perfect, there are checks and balances designed to prevent this. Because it is not perfect, those of us that read the health literature must be critical."
    Agreed, unreservedly.

    "emotion doesn't translate well in Times New Roman"
    Not even the mighty Helvetica is equal to that task, my friend. :)

    "The key words you've used are 'belief structure' and 'originally based'."
    Yup. And as I had just finished stating that we can't get here from there. Just because it started off as quackery doesn't mean that all of it still is (that would be the genetic fallacy to which I had just referred).

    "It is really not that difficult. Just ask questions."
    That's always good advice!

    Thanks for your comments, Anon. They were thoughtful and informative. I will be more careful about speaking of your profession in such broad strokes in the future.

    ReplyDelete
  13. Thanks Spurll.
    I don't think my comments will persuade or disuade many but I appreciate your openness. I was at a seminar early in my chiropractic career where the lecturer said something to the effect, "It is good to have an open mind, but not so open your brains fall out".

    Keep up the good work and let none of us allow our brains to fall out.

    ReplyDelete
  14. Thanks for sharing such useful and great information, Many studies of treatments used by chiropractors have been conducted, with conflicting results. Though some Chiropractors claim a variety of benefits, existing research only supports the effectiveness of manual therapy for the treatment of low back pain, neck pain, some forms of headache and some extremity joint conditions.

    ReplyDelete