Chiropractic - False Advertising

[JJM]

I have wondered about this. From what I have read it seems that while a few strokes have been identified as caused by chiropractic, the actual risk is so low that it can't even be calculated properly. I can't help feeling that arguments along these lines are simply used for their emotional value and not because they are actual based on good evidence. While I am obviously against chiropractic, we have to criticise it for what it is, and not fall into the trap of using arguments simply because we want them to be true. Does anyone have any good data on the actual risks?

The chiros would have you think the number is too small too calculate.

The real significance is that the manipulation that causes the stroke has no therapeutic value that cannot be achieved with safer methods. That means the risk/benefit ratio is HUGE (division by zero). There is no reason to give a person a vigorous neck-snap. This is a deadly serious appeal to reason, not emotion.

As for good data- The realtionship between chiro and stroke was only recognized relatively recently. One problem is the stroke can occur days after treatment. Another problem is figuring out the number of people who receive the neck-snap. This is an active area of investigation. However, the risk/benefit makes the neck-snap procedure unacceptable, no matter how infrequent the strokes.

 

[fls]

I have wondered about this. From what I have read it seems that while a few strokes have been identified as caused by chiropractic, the actual risk is so low that it can't even be calculated properly. I can't help feeling that arguments along these lines are simply used for their emotional value and not because they are actual based on good evidence. While I am obviously against chiropractic, we have to criticise it for what it is, and not fall into the trap of using arguments simply because we want them to be true. Does anyone have any good data on the actual risks?

The problem is that one has to suss out the incidents. It is clear that there is gross under-reporting of the incidence. If you go looking through malpractice records and formal reports, you only find a handful. But if you look on a proactive basis, you find many more. Probably the best way to answer this kind of question (rare outcome) is with case-control studies.

http://stroke.ahajournals.org/cgi/content/full/32/5/1054
http://www.cmaj.ca/cgi/content/full/166/6/794
http://www.quackwatch.org/01QuackeryRelatedTopics/chirostroke.html

Conventional medicine is held accountable for rare complications, so chiropracty should not be excluded from the same consideration. I agree that it is often used as an appeal to emotion. And its use in that manner leaves conventional medicine open to a similar argument - and conventional medicine has caused more direct harm than chiropractic ever has. Focussing on harm misses the point. The benefit from conventional medicine vastly outweighs the harm - and we know this because we carefully research and monitor this issue. However, the benefit from chiropracty is unlikely to outweigh the harm, since the only demonstrated benefit is symptom relief in a few specific conditions.

But in reality, I think the greatest harm from Chiropracty is the waste of time, money and effort, and foresaking the benefit of effective conventional treatments.

Linda

 

[blutoski]

I would like to see your evidence that there is not good money in chiro

Actually, this is a true problem: there are too many chiros, so they're unprofitable on average, and very competitive. I read that about a third of DCs are not making money in their field. This skews the data, because the 'average' income of chiropractors in a specified region does not include the $0 incomes of those who have left the profession and are making a living in another occupation.

For example, when I worked on an assembly-line in the '90s, two of my coworkers were DCs who found they couldn't make a living in private practice, so worked fulltime in the shop during the week, and took clients in a home-office on weekends to enhance their primary incomes.

My provincial Occupational Profile statistics show that the mean average income is $46k/yr. In the call-center where I work, 18-year-olds with a highschool degree working the phones make an average of $55k/yr.

This recent article comes to mind: Young people struggle to deal with kiss of debt

 

[blutoski]

I have wondered about this. From what I have read it seems that while a few strokes have been identified as caused by chiropractic, the actual risk is so low that it can't even be calculated properly. I can't help feeling that arguments along these lines are simply used for their emotional value and not because they are actual based on good evidence. While I am obviously against chiropractic, we have to criticise it for what it is, and not fall into the trap of using arguments simply because we want them to be true. Does anyone have any good data on the actual risks?

It almost doesn't matter, because the College is usually getting their six.

If a profession is self-regulating, and the members are following correct practise, then even if somebody dies, there has been no act of malpractise.

What you need to demonstrate is that the DC was departing from an accepted standard of care for his profession. In the case of neck manipulations, this doesn't seem to be taken seriously by the College, therefore, it does not need to be taken seriously by the chriopractor.

From a legal point of view.

 

[JJM]

“Why becoming a chiropractor may be risky”
http://www.chirobase.org/01General/career.html

Many new graduates are dumped into the cold, hard world where survival values often displace ethics. Many discover that they are not in a true profession, but a guild of survivors who must sink or swim. A large percentage ­ half, according to chiropractic sources ­ fail in practice. This is one reason that chiropractors have the unhappy distinction of having the highest default rate of all who obtain Health Education Assistance Loans from the federal government. (Figures released in January 1998 showed that 817 chiropractors owed a total of $59 million. ...)

“Analysis of the Chiropractic Section of the Occupational Outlook Handbook”
http://www.chirobase.org/03Edu/ooh.html

 

[Skeptic Ginger]

Chirobase is a branch of Quackwatch. A chiropractor who practices to their recommended (non-subluxation) standard is little more than a masseur/masseuse. That is why chiropractic colleges can’t abandon that fiction. And too few chiropractors follow the “modern” model.

There is a medical subluxation (a dislocated joint), and chiros originally claimed that is what they were diagnosing and correcting in the spine. In the 1960s and early 70s, They were forced to admit they were wrong about that. Instead of changing their practices; in good, cult fashion they redefined their subluxation.
Association of Chiropractic Colleges: http://www.chirocolleges.org/paradigm_scopet.html
In plain English: “Whatever I can pretend to fix and bill you for.”

Moreover, the chiro sublux wasn’t merely a spinal problem- they claimed it influenced the health of visceral organs. This is what leads to the inflated claims of efficacy that inspired this thread. They claim (for example) they can subtly influence kidney function with a spinal “adjustment.” The fact that transplanted kidneys (and hearts, and livers …) work fine with no connection to the spine hasn’t influenced their “thinking.”

It's coming back to me. I think I also exchanged a bit of this conversation with Dr Barrett via an e-mail or 2. Quite a while back I e-mailed him with concerns as to why he wasn't harder on chiropractors and he seemed to defend them. A couple years later he sounded more opposed and it seemed the Quackwatch site was more negative. I don't know if I misinterpreted Quackwatch earlier or if it had been edited.

More digging and it turned up Barrett had written a thesis or something involved in researching chiropractic care. I'll link to it if I have time to find it later.

 

[Skeptic Ginger]

The problem is that one has to suss out the incidents. It is clear that there is gross under-reporting of the incidence. If you go looking through malpractice records and formal reports, you only find a handful. But if you look on a proactive basis, you find many more. Probably the best way to answer this kind of question (rare outcome) is with case-control studies.

http://stroke.ahajournals.org/cgi/content/full/32/5/1054
http://www.cmaj.ca/cgi/content/full/166/6/794
http://www.quackwatch.org/01QuackeryRelatedTopics/chirostroke.html

Conventional medicine is held accountable for rare complications, so chiropracty should not be excluded from the same consideration. I agree that it is often used as an appeal to emotion. And its use in that manner leaves conventional medicine open to a similar argument - and conventional medicine has caused more direct harm than chiropractic ever has. Focussing on harm misses the point. The benefit from conventional medicine vastly outweighs the harm - and we know this because we carefully research and monitor this issue. However, the benefit from chiropracty is unlikely to outweigh the harm, since the only demonstrated benefit is symptom relief in a few specific conditions.

But in reality, I think the greatest harm from Chiropracty is the waste of time, money and effort, and foresaking the benefit of effective conventional treatments.

Linda

Here is another synopsis of the problem from "Chiropractic class notes".

The artery in question continues extracranially into the spinal column. Stroke is not the only possible risk, paralysis is another. If a person has an existing aneurysm, (vessel wall weakness looks like a ballooning out of the artery), they may be prone to the accident with minor trauma including neck manipulation.

 

[JJM]

It's coming back to me. I think I also exchanged a bit of this conversation with Dr Barrett via an e-mail or 2. Quite a while back I e-mailed him with concerns as to why he wasn't harder on chiropractors and he seemed to defend them. A couple years later he sounded more opposed and it seemed the Quackwatch site was more negative. I don't know if I misinterpreted Quackwatch earlier or if it had been edited.

More digging and it turned up Barrett had written a thesis or something involved in researching chiropractic care. I'll link to it if I have time to find it later.

Barrett is a funny fellow. He edited Chotkowski's book "Chiropractic, the Greatest Hoax of the Century" and Homola's books presenting a limited scope of practice in a favorable light. I asked him about that, and his answer was not satisfying.

On another occasion, I was dissapointed with the way Homola answered questions at Chirobase. Q: When should a chiro take xrays? A: blah blah blah For a couple paragraphs. Then- "Never, very few are competent; go to a radiologist." I wrote to Barrett (not realizing it was Homola's domain at the time) and suggested the final sentence should be the first sentence. Barrett replied that "some chiros are competent."

I think he is friends with some chiros that function well in a limited scope of practice. Thus, he has to choose his fights.