British Chiropractic Association v Simon Singh

Not true. The majority of chiropractors still do subscribe to the superstition.
The point is not if the majority believe in something, but that what they do about neck and lower back pain actually helps. It was claimed that without subluxations chiros have nothing, but here you disagree with Simon Singh who describes how chiros are divided into two or more groups, and some of them do not use the concept of subluxations.

My point is that we should stick to the facts and concentrate on Simon Singh's message that some treatments work, but are no better than known safe treatments. Simon Singh carefully avoided branding all chiro treatments as worthless; his famous "not a jot of evidence" was specifically for ear infections and the like, where there is not a jot of evidence.
 
As described in "Trick or Treatment", there are actually a lot of chiropractors who do not subscribe to the subluxation superstition. Are they no longer practising chiropracty?

These are ones that often still claim they can treat infant colic and ear pains, so they are still interested parties in Simon Singh's libel case.
To add to what Blue Wode said- they (chiros) simply endorse different terms. They also endorse different (meaninless) descriptions for the "lesions" (subluxations or otherwise) they "identify and treat."

In the USA, very few chiros abandon the fundamentals of chiro "education" and try to work within the bounds of evidence-based therapy (i.e., like physical therapists). The problem is, they do not have the education of a physical therapist- so their customers are left to wonder whether they can truly serve in that capacity.
 
What they do that does help is not Chiropractic - for which there is no evidence of benefit.

For example, one local Chiro treats lower back pain first by chiropractic manipulation and THEN by using a rather powerful TENS machine. Guess which one provides the benefit?
 
What they do that does help is not Chiropractic - for which there is no evidence of benefit.
Simon Singh and Edzard Ernst seem to differ. Have you read "Trick or Treatment"?

For example, one local Chiro treats lower back pain first by chiropractic manipulation and THEN by using a rather powerful TENS machine. Guess which one provides the benefit?
So you are saying it may actually be OK for them to advertise that they can treat lower back pain?
 
Simon Singh and Edzard Ernst seem to differ. Have you read "Trick or Treatment"?
You should re-read their book, they are tepid in their support of chiro. Also, look up Ernst's many papers on chiro, he doubts its value. Outside the USA, osteopaths are quacks; yet Singh and Ernst rate them a little above chiros (damning the osteos with faint praise).
So you are saying it may actually be OK for them to advertise that they can treat lower back pain?
The evidence is that chiropractors may be as effective as any other treatment (including massage). However, spinal manipulation is not exclusive to chiro, and it is certainly not correcting imaginary subluxations; so it is not really a "chiropractic" treatment.
 
Simon Singh and Edzard Ernst seem to differ. Have you read "Trick or Treatment"?

Some chiropractors also give advice about diet and exercise. Does that help? Yes. Is it chiropractic? No.

I may need to re-read the book, but that essentially is what Simon Singh and Edzard Ernst say about chiropractic. The part of what they do that helps is not actually chiropractic, it is massage. The part of what they do that IS chiropractic - the spinal manipulations - do not help. It is also the potentially dangerous bit. Their point of view is that, because there is no evidence of benefit from spinal manipulation and there is evidence of harm, it should not be used.
 
The point is not if the majority believe in something, but that what they do about neck and lower back pain actually helps.

So it doesn't matter how much of the practice is treating things that there is no evidence at all, in stead of it being a more dangerous method of treating neck and back issues?
 
According to the index, the "authors' advice and conclusions" on chiropractic therapy are set out on pp 168-70 and 179-80.

P. 168: "In short, the scientific evidence suggests that it is only worth seeing a chiropractor if you have a back problem".

There then follow 6 pieces of advice for anyone who is considering seeing a chiropractor: to see "mixers" rather than "straights", to avoid excessive numbers of sessions, to not allow a chiropractor to be your primary care provider, to avoid chiropractors who use unorthodox diagnostic techniques such as kinesiology, to check the chiropractor's reputation and, (p. 170) "last, but not least, try conventional treatments before turning to a chiropractor for back pain. They are generally cheaper than spinal manipulation and just as likely to be effective. There are other reasons for following the conventional route, which we will come to later in the chapter."

Safety isn't brought up until after this, on p. 171. On page 179 they mention the advice given earlier and say that they "would like to add to this advice in the light of the serious risks that we have now outlined." They then in light of this "strongly recommend" physiotherapeutic exercise as an alternative, and also recommend osteopathy ahead of chiropractic. And finally (p.180) they add that if you must see a chiropractor, don't let them manipulate your neck.

So even before considering the risks, and even for back pain, they are recommending "conventional treatment" before chiropractic or other forms of spinal manipulation. The risks merely tilt the balance a little further, and towards osteopathy rather than chiropractic if manipulation is being considered.
 
The point is not if the majority believe in something, but that what they do about neck and lower back pain actually helps. ...
I missed this. Look at what Singh and Ernst have to say, again. Their (chiro) neck manipulation is too dangerous and their back manipulation is too ordinary (others do it, thus it is not truly chiropractic).
 
According to the index, the "authors' advice and conclusions" on chiropractic therapy are set out on pp 168-70 and 179-80.
Thanks for looking it up. I had just got out the book when I read your post.

I may have exaggerated Singh's claims of the effectiveness of chiropractic treatments and in the book Singh may have understated his concerns about the safety of the treatments.

The point I made that chiropractic treatment actually seem to work, even if they are not preferable to other treatments, stands, though now conventional treatments are also preferable because of effectiveness.

I think we are doing skepticism a disfavour by exaggerating our statement to claim that "mixers" are not chiropractors. A chiropractor in Denmark told me years ago that there are no "straight" chiropractors in Denmark. That is probably an overstatement, but it would be foolish criticise these chiropractors for not being real chiropractors. I think we can leave that squabble to the chiropractors themselves. We should also not claim that chiropracty does not work when we cannot back it up. We should limit the "not a jot of evidence"-bit to that for which there is not a jot of evidence.

In the "Spinal Trap" article, Simon Singh wrote:
Beware the Spinal Trap said:
But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.
He goes on using half the article on the dangers of chiropractic treatments, which is what led me to believe was his main criticism of the treatment. After all, he clearly states that manipulating the spine can cure some problems.
 
Steenkh, bearing in mind that spinal manipulation is not real chiropractic, but rather a technique that chiropractors have adopted, apparently to give themselves an air of legitimacy (see http://jmmtonline.com/documents/HomolaV14N2E.pdf ), you cannot escape the fact that a responsible risk/benefit assessment for chiropractic spinal manipulation as an intervention for back pain is largely unfavourable - as explained in the following quote which is lifted from a critique of the recently released (UK) NICE guidelines for low back pain:
“…serious complications occur mostly (not exclusively) after upper spinal manipulation. So the guideline authors felt that they could be excluded. This assumes that a patient with lower back pain will not receive manipulations of the upper spine. This is clearly not always the case. Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them. And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment of spinal manipulation for back pain.”

http://tinyurl.com/y8dmwcs

Ref: Ernst, E. Spinal manipulation for the early management of persistent non-specific low back pain - a critique of the recent NICE guidelines, Int J Clin Pract, 18th August 2009. Reprints available from author.


In view of the above, perhaps it's not surprising that the most recent Systematic Review of Systematic Reviews of Spinal Manipulation (2006) concludes that there is no convincing evidence to suggest that spinal manipulation is a recommendable treatment option for any medical condition:
http://www.jrsm.org/cgi/content/full/99/4/192
 
... I think we are doing skepticism a disfavour by exaggerating our statement to claim that "mixers" are not chiropractors. ...
Why don't you go to the more extensive literature and learn about it. www.quackwatch.org and its subsidiary www.chirobase.org and books like "The Health Robbers" "Inside Chiropractic" and "Examining Holistic Medicine."

Let me try again to explain the terms. A chiropractor is anyone with such a license. They are free to do just about anything they can think of, therefore- what they do is not necessarily chiropractic. When they give advice on diet and exercise, or try to imitate physical therapy, you have no way of knowing if what they say or do is correct. Some claim they learn this in chiro school; but any school that concentrates on imaginary subluxations cannot be reliable on anything else. After all, if they really learned anatomy and physiology they could not believe in subluxations.

That said, many chiros are distancing them selves from the term "subluxation" and simply substitute another term (I think Blue Wode has a list of 300 alternatives). They also have re-defined it in vague ways. Thus, when a chiro says they don't work on subluxations, most of them really do but simply use alternative names and descriptions.
 
Well, I believe I have made my point, but found no support for it here.

I am perhaps most surprised that people here insist in fighting the same battles that chiropractors apparently fight themselves, regarding who are real chiropractors, and who are not.

I acknowledge that chiros are mainly woo, though not necessarily in Denmark, and I will continue criticizing the practice in Denmark for what is documented as being less efficient, and more dangerous.
 
...many chiros are distancing them selves from the term "subluxation" and simply substitute another term (I think Blue Wode has a list of 300 alternatives). They also have re-defined it in vague ways. Thus, when a chiro says they don't work on subluxations, most of them really do but simply use alternative names and descriptions.


That is one of the main problems with chiropractic. How would patients know that the treatment they were receiving was legitmate and not based on a ritual that reflected the chiropractor's own quack beliefs?

Here's the link to that huge list of alternative names for chiropractic 'subluxations' that JJM mentioned:
http://www.internationalskeptics.com/forums/showpost.php?p=5404275&postcount=14
 
Just a reminder that the term "subluxation" has varied meanings and is a widely recognised medical term for a partially dislocated joint, organ or tendon.
http://en.wikipedia.org/wiki/Subluxation

Not everyone may be aware of this.
And crook is the the act of crooking or bending.

So presumably when Chiropractors bend the spine correcting subluxations we can legitimatly call them crooks.
 
Just a reminder that the term "subluxation" has varied meanings and is a widely recognised medical term for a partially dislocated joint, organ or tendon.
http://en.wikipedia.org/wiki/Subluxation

Not everyone may be aware of this.


And not everyone may be aware of what Professor Edzard Ernst wrote in New Scientist last year:
FOR many people, chiropractic appears almost mainstream. Some chiropractors even call themselves "doctor". In the UK, chiropractors are regulated by statute, and in the US they like to be seen as primary care physicians. It is therefore understandable if people hardly ever question the evidential basis on which this profession rests.

The origins of chiropractic are surprising and rather spectacular. On 18 September 1895 Daniel Palmer, a "magnetic healer" practising in the American Midwest, manipulated the spine of Harvey Lillard, a janitor who had been partially deaf since feeling "something give in his back". The manipulation apparently cured Lillard of his deafness. Palmer's second patient suffered from heart disease, and again spinal manipulation is said to have effected a cure. Within a year or so, Palmer had opened a school, the first of many, and the term he coined, "chiropractic", was well on its way to becoming a household name.

The only true cure
Palmer convinced himself he had discovered something fundamental about human illness and its treatment. According to Palmer, a vital force - he called it the "Innate" - enables our body to heal itself. If our vertebrae are not perfectly aligned, the flow of the Innate is blocked and we fall ill. Chiropractors speak of these misalignments as "subluxations" (in conventional medicine, a subluxation means merely a partial dislocation). The only true cure is to realign the vertebrae by manipulating the spine, and in the logic of chiropractic it follows that all human illness must be treated with spinal manipulations. Many chiropractors also assert that we need regular "maintenance care" even when we are not ill so that subluxations can be realigned before they cause a disease. In the words of Palmer "95 per cent of all diseases are caused by displaced vertebrae, the remainder by luxations of other joints".

All diseases are caused by 'subluxations' blocking the flow of the 'Innate'
This bit of history is important because it explains why many chiropractors treat all sorts of conditions, not just back pain. In fact, in the early days, back pain was not an issue for chiropractors at all. Today they are divided into roughly three camps. One adheres religiously to Palmer's gospel - indeed, at one stage Palmer considered establishing chiropractic as a religion. Another has moved on and now employs a range of non-drug treatments in addition to manipulations, mainly for treating back pain. The third group is situated somewhere in between these two extremes and, at least occasionally, treats many conditions other than back pain.


More...
http://www.newscientist.com/article/mg20227101.100-what-you-should-know-about-chiropractic.html


Now here's something that nobody seems to be able to answer:

How would a patient know what camp his or her chiropractor fell into, and, perhaps more importantly, how many patients would know enough about chiropractic to ask in the first place?


ETA: Lifted from Zeno's blog post http://www.zenosblog.com/2010/01/discover-chiropractic/ here's what the Scottish Chiropractic Association claims:
Sometimes vertebrae can become misaligned or fixated causing interference with the mental impulses that travel between the brain and the rest of the body. Chiropractors refer to this as a vertebral subluxation. A subluxation can cause pain, imbalance, fatigue, lowered resistance to disease and a general decline in health.

Doctors of Chiropractic specialise in locating and then correcting vertebral subluxations with a chiropractic spinal adjustment permitting normal nerve transmission, innate recuperative capability, and effective health and adaptation of the person.
 
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The point I made that chiropractic treatment actually seem to work, even if they are not preferable to other treatments...


But since, in the case of the condition for which it is apparently about as effective as other treatments (back pain, particularly lower back) the other treatments aren't particularly effective either, it doesn't seem work too well for anything.

A classic CAM research approach, BTW: compare your therapy to an ineffective "conventional" treatment.
 
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