Chiropractic medicine.

[Acleron]

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

Not embraced but more insidiously, accepted.

 

[tsig]

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.

I don't believe a single word you wrote. If you believe it why aren't you a chiropractic.?

 

[tsig]

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.

Teh teck is to get the money to release from the wallet.

 

[JoeTheJuggler]

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]

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]

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

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]

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]

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]

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]

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]

{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]

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]

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

 

[Acleron]

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]

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 Indirect and non pecuniary interests July 07.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]

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]

It is easy to put down chiropractic medicine.

Yes, fraudulent pseudoscience IS easy to put down!

 

[JJM]

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]

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]

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 Australian study statement9Nov07.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