Chiropractic for high blood pressure?

[TubbaBlubba]

TB,

I have no idea what a multi-quote is, I am just learning the ropes here.

As I understand it, this is a public blog, and because it is discussing my profession, and no other doctor is here to address the snide remarks (most of which I ignored), I am taking that role on.

I have helped maintain The Chiropractic Resource Organization website since 1996. We are an all-volunteer, non-commercial information website.

We donate more than half our yearly income back to chiropractic research, because we know how much more work needs to be done. And, I am a full-time practicing doctor...but over 15 years I have gathered a formidable collection of research articles for my profession to review.

So, when someone wonders about what research is out there, or why there is a dearth of research, someone needs to advise them that a significant portion of our research was (1) paid for from our own pockets, (2) and produced by field doctors with no specialized training in research methods.

It's only the last 10 years that the Federal government has finally accepted grant requests from DCs. And it's amazing the volume of studies and papers have been published since then.

I don't claim we have a ton of research to support what we do. YET.

It's only a matter of time until we have the infrastructure necessary to detail in depth what it is that's wrong with our patients (what we call a subluxation for lack of a better word) and how and why it is that they get better when we adjust them.

Hit the quotation mark button for every post that you want to quote, then hit the Quote button to quote them all at once.

Regarding your claim that there are no other doctors posting, I see at least one MD in this thread. Or did you mean "chiropractor" rather than MD?

 

[DrFrankmeister]

I take that to mean that you’re unable to produce any evidence in response to my request.

Blue Man

First off, thank you for your thoughtful response.

I thought I already made it clear. It doesn't matter (to me) if chiropractic is growing or experiencing a slow down. I'm not in the Practice Management industry.. My thinking is mainly influenced by these articles I read as I was graduating from chiropractic college:

David M. Eisenberg's 2 papers:

Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use
New England Journal of Medicine 1993 (Jan 28); 328 (4): 246–252


Trends in Alternative Medicine Use in the United States, from 1990 to 1997: Results of a Follow-up National Survey
JAMA 1998 (Nov 11); 280 (18): 1569–1575

If these 2 papers are taken seriously, then alt-med is not on the fringe, but is in fact the dominant for of care in America.

Which makes me ask: Considering that the complete NIH budget was $17 Billion, one could ask why the dominant form of care (based on Eisenberg's figures) in this country was funded with a small fraction of 1% of the research budget? (less than a rounding-error!) Why not go all out, and answer the question scientifically?

I’ll give you the benefit of the doubt then, but please supply robust data showing how many people have been cured of deafness through chiropractic treatment in the 100+ years that have passed since that famed adjustment administered to Harvey Lillard.

That's funny. DD Palmer thought he'd discovered the cause of deafness, and ran a big ad in the paper. When people came in, and he looked for that "bone out of place" in the upper thoracics, he didn't find it...but if he did find one "sticking out", he "adjusted" it. Strangely, some patients reported improvements in digestion, some with improved breathing. In fact, the Merrick System evolved from these observations...if someone had digestive issues, adjust them in the thoracic region associated with digestion. My school did not teach this form of antiquated analysis.

Please note what the results of that study actually say:
Not quite so convincing taken in context, is it?

Well, the table speaks for itself, whether it is 10 people or 10,000

Pain treatment -------------- Average Pain Relief
Chiropractic manipulation --------- 7.33 ±3.78
Nerve blocks --------------------- 6.75 ±4.76
Narcotics ------------------------ 6.37 ±2.74
Muscle relaxants ----------------- 5.78 ±2.88
Massage ------------------------ 5.48 ±2.73
Acupuncture -------------------- 5.29 ±3.22
Ibuprofen, aspirin ---------------- 5.22 ±2.83
Physical therapy ------------ ---- 4.45 ±2.66
Acetaminophen ------------ ----- 4.11 ±2.93

I'm certainly not trying to buffalo anyone. According to many of your own comments, chiropractic does not have "robust" research to support it. Every truthful study ALWAYS concludes with "more research is needed". Blah, blah.

And yet, when I read that plastic surgeons are maiming patients to "decompress" the suboccipital nerves as a form of treatment of headache, it makes me see blue.

Then I read a paper in the European Spine Journal, written by the Dutch Institute for Health Care Improvement. They explored “the effectiveness of pharmacological interventions [i.e., non-steroid anti-inflammatory drugs (NSAIDs), muscle relaxants, antidepressants, and opioids] for non-specific chronic low-back pain (LBP). That is medicine's arsenal for
"conservative treatment, yes?

Well the authors only uncovered 17 randomized controlled trials for pain treatments:
NSAIDs (n = 4),
antidepressants (n = 5), and
opioids (n = 8).
Amazingly, no studies were found for muscle relaxers!

In fact, one study demonstrated that muscle relaxers actually prolong recovery.

So, if robustness is high on your list, then how's them apples? Now I don't feel near so bad...but wait, what about the Meade studies, published in BMJ back in the 90s? I know medicine jumped all over those, finding any flaw they could pick at, but what I know is that patient satisfaction with chiropractic care vs. medical care is way higher in these studies. For me, that's enough.

I think it’s a little premature to get excited about a study involving just 10 patients.

Well, you're welcome to wait with baited breath, but I am excited. Why? Because it CONFIRMS what I have been seeing with hundreds of patients over 16 years. It confirms what I have seen in the x-rays of a few patients who have had multiple accidents over the years... each new x-ray looked better than the earlier one, even though the patient had just has a new trauma. Maybe that seems unimportant to you, but it was exciting for me and the patient too!

Not really. There are still many questions that need to be answered in relation to chiropractic maintenance care:

There are many answers needed for why MSG makes people sick too. I'll stay tuned. There are some interesting studies in the works.

Note: Maintenance care is not well researched and needs to be "investigated from several angels before the method is subjected to a multi-centre trial". So, very early days.

Hmmm. Have you read

Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II
J Manipulative Physiol Ther 2000 (Jan); 23 (1): 10–19

Rupert worked with 73 chiropractors from the 6 study sites. They reviewed files onall their chiropractic patients (age 65 years and over) who had received health-promotion and prevention services for at least 5 years, with a minimum of 4 visits per year, Their findings?

These doctor-patient contacts are primarily for chiropractic Maitenance Care care and result in a 50% reduction in medical provider visits. Therefore for these patients receiving MC, chiropractic management appeared to replace medical management rather than be complementary to medical treatment. This contrasts with previous work, which demonstrated that elderly chiropractic patients, including both those who do and those who do not receive MC, actually made more visits to medical providers in addition to their chiropractic visits. The need for hospitalization and the high costs associated with that service were markedly reduced for the patient receiving MC. The total annual cost of health care services for the patient receiving MC was conservatively estimated at only a third of the expenses made by US citizens of the same age. Patients also perceived MC services as highly beneficial to prevention and health promotion.

And, of course, more robust studies are in order. But...when will that be?

Here are a selection of links that would suggest otherwise:
The death certificate of 39-year-old John Hoffman whose stroke occurred around 3 hours after having a neck adjustment at his chiropractor’s office. He died 6 days later.

Not very reassuring is it?

Look, I am sure we can dig out plenty of cases where something happened to any person after any event. I am not dodging the possibility that some person somewhere may actually have been harmed by an adjustment. But all the research I have reviewed suggests that it is most likely that someone seeking care for their new neck pain or new, unique headache is already in the prodromal state of stroke onset. My Stroke and Chiropractic page starts with a long explanation of what IS known about the symptoms of someone who may be having a stroke, so we can get them to an Emergency Room. I have even sent a few patients with suspicious symptoms off to get neck scans, to protect them, but so far, not one of them has had any problem with their Vertebral Arteries. Not one. I remain cautious.

f that chiropractors can cause strokes by deliberately manipulating peoples’ necks.

I'm surprised that you don't seem to *get* this. People have strokes ALL THE TIME following innocuous activities of daily living. So how does that make chiropractic responsible for an event that is imminent, and will occur anyhow, because that person already has a diseased vessel?

The MOST you can say is that the PROXIMAL EVENT before they "had their stroke" was that they were washing their hair. It's not reasonable to blame their shower, OR their hair dresser, or their chiroprtactor.

A recent study exposed cadaveric specimens of blood vessels to 1000 repeated strain cycles of the magnitude of a diversified adjustment and found absolutely no histologically identifiable microdamage to that tissue. 1000 cycles!

Microstructural Damage in Arterial Tissue Exposed to Repeated Tensile Strains
J Manipulative Physiol Ther 2010 (Jan); 33 (1):14–19

This is a study designed and paid for by chiropractic researchers who really want to know IF what we do could cause harm. The simple truth is if you kiss your Grandma and she drops dead right in front of you...you did NOT kill your Grandma. Proximal event is NOT causation.

My “Chiropractic Risks” page isn’t nearly so generous

Like you, I am waiting. The more reasonable I find you, the more likely I am to actually review your EBM page. So far, the posts I have seen by you online all suggest someone who's more interested in taking pot shots at us, perhaps to draw attention. When I feel you are actually motivated bu good intentions, the more likely I am to share you with my profession.

Our website {B]www.chiro.org[/B] currently gets between 125-150,000 unique visits per month, and so I am cautious who's information I sponsor.

Because you have an ethical duty to err on the side of caution and disclose potential risks to your patients.

I don't believe you have ever bothered to actually asked me IF I do your version of Informed Consent. In fact, I discuss the vertebral artery with every patient, as I advise them to be careful with ANY motion of the head that involves extension AND rotation. That position puts the most stress on the section of the vertebral artery between C2 and C1, which incidently is where the bulk of VA dissections occur.

It is also why I do not practice diversified technique. I don't know how much you understand chiropractic technique, but I adjust the cervicals with the patient prone, with their head in slight flexion, P-A with an adjusting instrument. I still do not believe that diversified has *caused* a dissection that wasn't about to happen anyhow, but as you suggested, from day one, I chose to err on the side of caution.

In the 90s, many of us had the sinking suspicion that manipulation could be causing them...that's what motivated our researchers to REALLY look closely at the facts, and to construct some novel studies. Today, I don't believe it. It's just the luck of the draw. Some folks will have a stroke after any trivial event, be at my office, at the park, or at their MDs office. However, our hands are clean IF we actually considered whether the patient's complaints suggested a prodromal stroke.

I've had friends who chose NOT to adjust a patient, asked them to go to the hospital, and found out later that the patient went home and stroked out. Who's fault was that? Should we sue the patient for failing to follow the chiropractor's advice? Wasn't the patient *responsible* for causing the stroke? Hogwash. As the bumper sticker reminds us, stuff happens!

Has it never occurred to you that surgeons and physiotherapists, being part of mainstream medicine, are likely to be more upfront about reporting adverse events?

Not for a minute. My Iatriogenic Injury Page is filled with medical studies suggesting that only a tiny fraction of these injuries are ever reported....by hospitals, MDs, PTs or anyone else. I actually read this stuff before I paste it into our website. I have no illusions about the superior ethics of MDs or PTs. None.

BTW, German medical doctors can undertake around four weeks of training and study in manipulation as part of their CPD in order to practice what they term “chirotherapy”. And South Korean MDs appear to have an even stricter set up:
Personally, I think that South Korea has the right idea.

I think the World Health Organization has the right idea.

The World Health Organization (WHO) recently crafted and published the WHO Guidelines on Basic Training and Safety in Chiropractic (FULL TEXT Adobe Acrobat 512KB.) [ 1 ] in consultation with the World Federation of Chiropractic, the Association of Chiropractic Colleges and various chiropractic, medical, osteopathic, and other groups.

The Guidelines make it clear that chiropractic is a separate profession rather than a set of techniques that can be learned in short courses by other health professionals.

They also make it clear that medical doctors and other health professionals, in countries where the practice of chiropractic is not regulated by law, should undergo extensive training to re-qualify as chiropractors before claiming to offer chiropractic services. In some countries there have been recent efforts by medical groups to provide short courses of approximately 200 hours in chiropractic technique. The WHO feels this is a bad decision.

The World Health Organization guidelines indicate that a medical graduate should a require an additional minimum of 1800 class hours, including 1000 hours of supervised clinical training, before claiming to offer chiropractic services. [ 1 ]

1. World Health Organization Guidelines on Basic Training and Safety in Chiropractic
http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf

2. An Announcement About the Guideline's Publication​

I’ll leave that for readers to decide for themselves.

That is as it should be.

That may be true for the US, but it’s not really an issue here in the UK where most people rely on the NHS.

Are you familiar with AECC? Last year we gave our research grant to Dr. Al Breen, for his work on videofluoroscopy as an analysis tool. I look forward to touring the school one day. Princess Diana (bless her heart) was a patron of the school.

If you’re referring to the Wilk v AMA case, it’s interesting what the judge had to say about chiropractic:
Looks to me like chiropractors had a lucky escape.

Hey, it's a long document, and it (like the New Zeland Study before it) shed a lot of light on both our professions. We didn't get lucky. Medicine got slapped down for their aggressive bad behavior, and they also shelled out an unnamed sum to our chiropractic schools to pay for their harm.

But how do you know what my website’s like when you claimed the following at the end of post #45:
Did you decide to read it?

Time will tell, but them again...I am a reader, and it's only a matter of time until your site falls under the microscope.

 

[Blue Wode]

I take that to mean that you’re unable to produce any evidence in response to my request.

Blue Man

First off, thank you for your thoughtful response.

I thought I already made it clear. It doesn't matter (to me) if chiropractic is growing or experiencing a slow down. I'm not in the Practice Management industry.. My thinking is mainly influenced by these articles I read as I was graduating from chiropractic college:

David M. Eisenberg's 2 papers:

Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use
New England Journal of Medicine 1993 (Jan 28); 328 (4): 246–252


Trends in Alternative Medicine Use in the United States, from 1990 to 1997: Results of a Follow-up National Survey
JAMA 1998 (Nov 11); 280 (18): 1569–1575

If these 2 papers are taken seriously, then alt-med is not on the fringe, but is in fact the dominant for of care in America.

Which makes me ask: Considering that the complete NIH budget was $17 Billion, one could ask why the dominant form of care (based on Eisenberg's figures) in this country was funded with a small fraction of 1% of the research budget? (less than a rounding-error!) Why not go all out, and answer the question scientifically?

Here you are:

“We've been waiting for 16 years for the NIH to announce some major breakthrough in health care that has emerged from NCCAM. Unfortunately, most of the "alternative" research is driven by faith, hope, and ideology rather than science. As Dr. Wallace Sampson noted: the NCCAM "is the only entity in the NIH [among some 27 institutes and centers] devoted to an ideological approach to health”….. $2.5 billion spent, no alternative cures found…”

http://www.skepdic.com/NCCAM.html

I think that says it all.

I’ll give you the benefit of the doubt then, but please supply robust data showing how many people have been cured of deafness through chiropractic treatment in the 100+ years that have passed since that famed adjustment administered to Harvey Lillard.

That's funny. DD Palmer thought he'd discovered the cause of deafness, and ran a big ad in the paper.

So you’re conceding that he was wrong? BTW, in 1894, a local Iowa newspaper, The Davenport Leader, wrote the following about DD Palmer:

“A crank on magnetism has a crazy notion hat he can cure the sick and crippled with his magnetic hands. His victims are the weak-minded, ignorant and superstitious, those foolish people who have been sick for years and have become tired of the regular physician and want health by the short-cut method he has certainly profited by the ignorance of his victim. His increase in business shows what can be done in Davenport, even by a quack.”

(Ref. Rose Shapiro's book, Suckers, pp.135-136)

Please note what the results of that study actually say:
Not quite so convincing taken in context, is it?

Well, the table speaks for itself, whether it is 10 people or 10,000

Pain treatment -------------- Average Pain Relief
Chiropractic manipulation --------- 7.33 ±3.78
Nerve blocks --------------------- 6.75 ±4.76
Narcotics ------------------------ 6.37 ±2.74
Muscle relaxants ----------------- 5.78 ±2.88
Massage ------------------------ 5.48 ±2.73
Acupuncture -------------------- 5.29 ±3.22
Ibuprofen, aspirin ---------------- 5.22 ±2.83
Physical therapy ------------ ---- 4.45 ±2.66
Acetaminophen ------------ ----- 4.11 ±2.93

I'm certainly not trying to buffalo anyone. According to many of your own comments, chiropractic does not have "robust" research to support it. Every truthful study ALWAYS concludes with "more research is needed". Blah, blah.

And yet, when I read that plastic surgeons are maiming patients to "decompress" the suboccipital nerves as a form of treatment of headache, it makes me see blue.

Invasive procedures invariably carry risks, and, unlike many chiropractic encounters, informed consent will have been obtained beforehand. This is also worth remembering:

"Spinal manipulation can be associated with significant complications, often requiring surgical intervention."

Nonvascular complications following spinal manipulation
The Spine Journal (Nov-Dec 2005)
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=16291108&dopt=Abstract

So it's a two-way street.

Then I read a paper in the European Spine Journal, written by the Dutch Institute for Health Care Improvement. They explored “the effectiveness of pharmacological interventions [i.e., non-steroid anti-inflammatory drugs (NSAIDs), muscle relaxants, antidepressants, and opioids] for non-specific chronic low-back pain (LBP). That is medicine's arsenal for "conservative treatment, yes?

Well the authors only uncovered 17 randomized controlled trials for pain treatments:
NSAIDs (n = 4),
antidepressants (n = 5), and
opioids (n = 8).
Amazingly, no studies were found for muscle relaxers!

In fact, one study demonstrated that muscle relaxers actually prolong recovery.

Here’s the current science with regard to chiropractic for low back pain:

Combined chiropractic interventions for low-back pain

“Combined chiropractic interventions slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions. Future research is very likely to change the estimate of effect and our confidence in the results.”
(Walker BF, French SD, Grant W, Green S., Cochrane Database Systematic Review 2010; 4: CD 005427)

Comment on the above review from Professor Edzard Ernst:
“The hallmark treatment of chiropractors is spinal manipulation. If critical evaluations of spinal manipulation fail to show what chiropractors had hoped for, defendants may argue that chiropractic typically combines a wide range of modalities in practice, including manipulation, mobilisation, massage, exercise and heat. Thus, it might not be fair to judge the value of chiropractic solely by the effectiveness of spinal manipulation. This Cochrane review is an attempt to overcome this pitfall. Its results show that, for the most prevalent indication for chiropractic treatment (i.e. LBP), very few studies are available. Those that do exist are often seriously flawed. For acute and subacute LBP, chiropractic seems to be as good or marginally better than conventional treatments. However, I recommend taking this result with a pinch of salt; what is still required is independent replication through high-quality studies, which also account for the risks and costs associated with chiropractic. For chronic LBP, chiropractic does not seem to be any better than conventional treatments. All in all, this review serves as a poignant reminder that chiropractic may not be as soundly based on evidence as it is often made out to be.”

[Subscription to Focus on Alternative and Complementary Therapies required.]
http://www.ebm-first.com/chiropract...opractic-interventions-for-low-back-pain.html

I don't see how you can argue with that.

So, if robustness is high on your list, then how's them apples? Now I don't feel near so bad...but wait, what about the Meade studies, published in BMJ back in the 90s? I know medicine jumped all over those, finding any flaw they could pick at, but what I know is that patient satisfaction with chiropractic care vs. medical care is way higher in these studies. For me, that's enough.

I would venture that you’re talking about carpet thickness and “tea and sympathy” once again. It sounds to me like the placebo effect in action. However, with that, the nocebo effect also has to be considered:
http://www.chirobase.org/01General/placebo.html

I think it’s a little premature to get excited about a study involving just 10 patients.

Well, you're welcome to wait with baited breath, but I am excited. Why? Because it CONFIRMS what I have been seeing with hundreds of patients over 16 years. It confirms what I have seen in the x-rays of a few patients who have had multiple accidents over the years... each new x-ray looked better than the earlier one, even though the patient had just has a new trauma. Maybe that seems unimportant to you, but it was exciting for me and the patient too!

Chiropractic patients are being x-rayed to check on the progress of an intervention that’s supported by only very slim evidence? Presumably you haven’t been aware of the following…

"The validity of chiropractors' X-ray diagnoses is not well established. Small vertebral displacements or malalignments have no proven clinical relevance, dynamic studies have no proven value, and plain radiographs yield little relevant biomechanical information… In conclusion, the current, albeit incomplete, data suggest an overuse of spinal radiography by the chiropractic profession."

E. Ernst, MD, PhD, The British Journal of Radiology
http://bjr.birjournals.org/cgi/reprint/71/843/249.pdf

"Given that chiropractic is founded on pseudoscientific notions of health and that the concept of spinal subluxations has never been empirically validated, just what are chiropractors looking for in X-rays? And since chiropractic treatment cannot demonstrate efficacy to a reasonable standard, how will X-raying a patient lead to a therapeutic benefit? In addition, since the positive effects seen for some sort of back pain are only comparable to conventional treatment where no X-ray is required, surely there is always an alternative treatment plan that does not involve exposing the patient to the risk of ionising radiation?"

Is Chiropractic X-Raying Illegal?
http://www.quackometer.net/blog/2009/01/is-chiropractic-x-raying-illegal.html

X rays are a significant intervention. Anytime ionizing radiation is applied to a human being, there better be a good reason for it. If there is no evidence that the X ray will help in a meaningful way with diagnosis or treatment, then no X ray should be done. There is no clear reason any chiropractor should ever order an X ray.

Why do chiropractors order so many x-rays?
http://scientopia.org/blogs/whiteco...10/why-do-chiropractors-order-so-many-x-rays/

File under harms.

Not really. There are still many questions that need to be answered in relation to chiropractic maintenance care:

There are many answers needed for why MSG makes people sick too. I'll stay tuned. There are some interesting studies in the works.

Irrelevant. MSG has nothing to do with chiropractic healthcare claims.

Note: Maintenance care is not well researched and needs to be "investigated from several angels before the method is subjected to a multi-centre trial". So, very early days.

Hmmm. Have you read

Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II
J Manipulative Physiol Ther 2000 (Jan); 23 (1): 10–19

Rupert worked with 73 chiropractors from the 6 study sites. They reviewed files onall their chiropractic patients (age 65 years and over) who had received health-promotion and prevention services for at least 5 years, with a minimum of 4 visits per year, Their findings?

These doctor-patient contacts are primarily for chiropractic Maitenance Care care and result in a 50% reduction in medical provider visits. Therefore for these patients receiving MC, chiropractic management appeared to replace medical management rather than be complementary to medical treatment. This contrasts with previous work, which demonstrated that elderly chiropractic patients, including both those who do and those who do not receive MC, actually made more visits to medical providers in addition to their chiropractic visits. The need for hospitalization and the high costs associated with that service were markedly reduced for the patient receiving MC. The total annual cost of health care services for the patient receiving MC was conservatively estimated at only a third of the expenses made by US citizens of the same age. Patients also perceived MC services as highly beneficial to prevention and health promotion.

And, of course, more robust studies are in order. But...when will that be?

When chiropractors decide to dig into their mighty war chest to fund them? I would also draw your attention once again to your comments on the Meade studies and my reply that suggested that chiropractic’s main contribution to healthcare was clinic carpet thickness and “tea and sympathy”.
(Meade Report criticism > http://www.ebm-first.com/chiropractic/the-meade-report-criticism.html )

Here are a selection of links that would suggest otherwise:
The death certificate of 39-year-old John Hoffman whose stroke occurred around 3 hours after having a neck adjustment at his chiropractor’s office. He died 6 days later.

Not very reassuring is it?

Look, I am sure we can dig out plenty of cases where something happened to any person after any event. I am not dodging the possibility that some person somewhere may actually have been harmed by an adjustment. But all the research I have reviewed suggests that it is most likely that someone seeking care for their new neck pain or new, unique headache is already in the prodromal state of stroke onset.

So, bearing in mind that there are no reliable screening processes available to chiropractors, why would chiropractors manipulate the necks of such patients?

…chiropractors can cause strokes by deliberately manipulating peoples’ necks.

I'm surprised that you don't seem to *get* this. People have strokes ALL THE TIME following innocuous activities of daily living. So how does that make chiropractic responsible for an event that is imminent, and will occur anyhow, because that person already has a diseased vessel?

Because the event may not have been imminent, and if you can’t predict the event (we know that there’s no way to reliably screen for it), or identify patients with diseased vessels, then why would you exacerbate things by administering neck manipulation?

My “Chiropractic Risks” page isn’t nearly so generous

Like you, I am waiting. The more reasonable I find you, the more likely I am to actually review your EBM page.

That reveals a lot about you.

BTW, German medical doctors can undertake around four weeks of training and study in manipulation as part of their CPD in order to practice what they term “chirotherapy”. And South Korean MDs appear to have an even stricter set up:
Personally, I think that South Korea has the right idea.

I think the World Health Organization has the right idea.

The World Health Organization (WHO) recently crafted and published the WHO Guidelines on Basic Training and Safety in Chiropractic (FULL TEXT Adobe Acrobat 512KB.) [ 1 ] in consultation with the World Federation of Chiropractic, the Association of Chiropractic Colleges and various chiropractic, medical, osteopathic, and other groups.

The Guidelines make it clear that chiropractic is a separate profession rather than a set of techniques that can be learned in short courses by other health professionals.

And a 2003 WHO bulletin on Lower Back Pain also makes the following clear:

“People with low back pain often turn to medical consultations and drug therapies, but they also use a variety of alternative approaches. Regardless of the treatment, most cases of acute back pain improve. At the time, people in such cases may credit the improvement to the interventions some of which clearly are more popular and even seemingly more effective than others (e.g. chiropractic and other manipulative treatments in which the laying on of hands and the person-to-person interaction during the treatment may account for some of the salutary results).”

And …..

“The spread of chiropractic and other manipulative treatments worldwide has won many adherents to this treatment , who perceive that it works better than others. This hypothesis was recently put to the test (25) and, although the respondents still favoured such approaches (chiropractic adjustment, osteopathic manipulation, and physical therapy) perhaps because of the time spent and the laying on of hands meta-analysis cannot confirm the superiority of manipulative treatments (or, for that matter, of acupuncture and massage (26)) over other forms of therapy, or even time as a healer (25), which substantiates the contentions of WHO’s document (1). In most instances, manipulative treatments are more expensive than others (apart from surgery) and not more helpful to outcome (26)."

More here: http://skepticbarista.wordpress.com/2010/10/24/subluxations-who-said-what/

That may be true for the US, but it’s not really an issue here in the UK where most people rely on the NHS.

Are you familiar with AECC? Last year we gave our research grant to Dr. Al Breen, for his work on videofluoroscopy as an analysis tool. I look forward to touring the school one day. Princess Diana (bless her heart) was a patron of the school.

Yes. Here in the UK Alan Breen’s work has been critically analysed and been found to be severely wanting:
http://www.ebm-first.com/component/search/?searchword=Alan+Breen&ordering=&searchphrase=all

If you’re referring to the Wilk v AMA case, it’s interesting what the judge had to say about chiropractic:
Looks to me like chiropractors had a lucky escape.

Hey, it's a long document, and it (like the New Zeland Study before it) shed a lot of light on both our professions. We didn't get lucky. Medicine got slapped down for their aggressive bad behaviour…

And chiropractors are innocent when it comes to aggressive bad behaviour?
http://www.internationalskeptics.com/forums/showthread.php?t=121214

 

[DrFrankmeister]

Here you are:

Quote:
“We've been waiting for 16 years for the NIH to announce some major breakthrough in health care that has emerged from NCCAM. Unfortunately, most of the "alternative" research is driven by faith, hope, and ideology rather than science. As Dr. Wallace Sampson noted: the NCCAM "is the only entity in the NIH [among some 27 institutes and centers] devoted to an ideological approach to health”….. $2.5 billion spent, no alternative cures found…”

I think that says it all.

Does it really?

Your source *seems* to have confused the NCCAM budget with entire NIH budget for all 27 departments.

NCCAMs 1992 budget was a modest $2 million, and their highest income year was less than $70 million (2011). I don't have the time to do the math for you, but NCCAM's budget during 19 years is certainly not the rediculous sum your source claims it is. Look for yourself:

http://nccam.nih.gov/about/budget/congressional/#Amo

Why do you persist in quoting what are clearly biased mis-information websites?

Who IS SKEPDIC? Are they researchers, with scientific credentials? I hope not, because they are (1) wrong, and (2) probably know that, but prefer to mis-represent FACT to create bias and mis-understanding.

AND finally: NCCAMs role is NOT to "find cures" per se...it's role is to conduct BASIC SCIENCE research, and they are doing a good job at it.

So, you’re conceding that he was wrong? BTW, in 1894, a local Iowa newspaper, The Davenport Leader, wrote the following about DD Palmer:

Puh-lease!

Now your quoting antique newspapers as fact? Can you say "yellow journalism"? DD was also accused by this newspaper for running his son BJ over with a car. Not true, but in those days sensationalism sold newspapers.

As I mentioned previously, you seem fond of quoting opinionated and evidently biased websites as though they were primary (or peer-reviewed) materials. Not very convincing. What a waste of our time.

What I told you was that DD initially thought was that mis-alignment of the upper thoracic could be the *cause* of deafness. It was 1895, and science in general was pretty lacking in ALL healing professions. Remember the Flexnor Report?

What DD continued to discover over time was the relationship between spinal and nervous integrity and what are today referred to as "somatic dysfunction" (or "subluxation"). Please refer to Nansel's article if you'd like to learn more about how spinal adjusting appears to cure visceral disease. It's a challenging read, but then again, you're a science major...right?

http://www.chiro.org/research/ABSTRACTS/Visceral_Disease_Simulation.shtml
[/QUOTE]

Invasive procedures invariably carry risks...

Quote:
"Spinal manipulation can be associated with significant complications, often requiring surgical intervention."

Nonvascular complications following spinal manipulation
The Spine Journal (Nov-Dec 2005)
http://www.ncbi.nlm.nih.gov/sites/en...&dopt=Abstract

This study reviews 18 patients who received spinal manipulation from UN-NAMED PROVIDERS in the cervical, thoracic, or lumbar spine. And they report 3 deaths from unrecognized malignancies.

What am I to draw from these facts? That spinal manipulation *could* cause injury?

Well, thanks, but my 5-year doctoral program pretty much covered what I need to know, and in 16 years of practice I have not harmed a single person.

If you recall the article we discussed recently:

Vertebral Artery Dissections After Chiropractic Neck Manipulation in Germany Over Three Years

there is all kinds of inaccurate reporting in the biomedical literature, accusing "real live" chiropractors of doing harm, when a cursory (or more in-depth) review reveals that the bulk of those injuries were ACTUALLY caused by other (less trained) providers.

I WILL agree that messing with someone's spine, when you don't have significant training, can be injurious. DUH !

That is why the WHO stated that even Medical Doctors (who already have some form of basic training) would STILL require an additional 1800 hours, including 1000 hours of supervised training before they should monkey with people's spines.

http://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf

Here’s the current science with regard to chiropractic for low back pain:

(Walker BF, French SD, Grant W, Green S., Cochrane Database Systematic Review 2010; 4: CD 005427)

Comment on the above review from Professor Edzard Ernst:

Dr. Ernst is a self-appointed reviewer of CAM literature, with a background (I believe) as a naprapath or a homeopath. He has no training as a chiropractor or in spinal manipulation, nor any training (as far as I know) as a researcher, so excuse me if I don't take his pronouncements as the "last word".

I don't know enough about the Cochrane Collaboration to have an opinion, but I do agree that the combined research for spinal manipulation by ANY provider is sparse. Even so, there are numerous studies that suggest chiropractic management provides benefit to patients, and is cost effective, when compared with medical management:

Cost of Care for Common Back Pain Conditions Initiated With Chiropractic Doctor vs Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer
J Manipulative Physiol Ther 2010 (Nov); 33 (9): 640–643

An important 2010 study evaluated low back pain care for Blue Cross Blue Shield of Tennessee’s intermediate and large group fully insured population over a two-year period. The 85,000 BCBS subscribers in the insured study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no differences in co-pays. Thus, the data from this study reflect what happens when chiropractic and medical services compete on a level playing field.

The researchers, led by an actuary, compared the costs of low back pain care initiated with a doctor of chiropractic with care initiated through a medical doctor or osteopathic physician. They found that costs for the chiropractic group were 40 percent lower. Even after factoring in the severity of the conditions with which patients presented, costs when initiating care with a DC rather than an MD/DO were 20 percent lower. The researchers concluded that insurance companies that restrict access to chiropractic care for low back pain treatment may inadvertently pay more for care than they would if they removed such restrictions. According to this analysis, had all of the low back cases initiated care with a DC, this would have led to an annual cost savings of $2.3 million for BCBS of Tennessee.
​

A Nonsurgical Approach to the Management of Patients With Lumbar Radiculopathy Secondary to Herniated Disk: A Prospective Observational Cohort Study With Follow-Up
J Manipulative Physiol Ther 2009 (Nov); 32 (9): 723–733

A randomized trial by researchers at an outpatient rehabilitation department in Italy involving 210 patients with chronic, nonspecific low back pain compared the effects of spinal manipulation, physiotherapy and back school. The participants were 210 patients (140 women and 70 men) with chronic, non-specific low back pain, average age 59. Back school and individual physiotherapy were scheduled as 15 1-hour-sessions for 3 weeks. Back school included group exercise and education/ergonomics. Individual physiotherapy included exercise, passive mobilization and soft-tissue treatment. Spinal manipulation included 4-6 20-minute sessions once-a-week. Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.​

A Comparison Between Chiropractic Management and Pain Clinic Management for Chronic Low-back Pain in a National Health Service Outpatient Clinic
J Alternative and Complementary Medicine 2008 (Jun); 14 (5): 465–473

At 8 weeks, the mean improvement in RMDQ was 5.5 points greater for the chiropractic group than for the pain-clinic group. Reduction in mean pain intensity at week 8 was 1.8 points greater for the chiropractic group than for the pain-clinic group. This study suggests that chiropractic management administered in an NHS setting may be effective for reducing levels of disability and perceived pain during the period of treatment for a sub-population of patients with chronic low-back pain (CLBP).​

My Low Back Pain and Chiropractic Page contains many other similar, recent studies.

I would venture that you’re talking about carpet thickness and “tea and sympathy” once again. It sounds to me like the placebo effect in action. However, with that, the nocebo effect also has to be considered:

How prosaic, but your overall meaning eludes me.

I have gathered some information on placebo and nocebo on my The Problem with Placebos/Shams Page.

Did Organized medicine savage the Meade reports? That was nothing compared to what they did when the 1994 Agency for Health Care Policy and Research (AHCPR) released 3 reviews of treatment for low back, and confirmed the untested, questionable or harmful nature of many current medical therapies for LBP , and also stated that, of all forms of management they reviewed, only chiropractic care could both reduce pain AND improve function. Their national associations and their lobbiests actually drove our Federal government to close the AHCRP department. That's member dues in action.

Chiropractic patients are being x-rayed to check on the progress of an intervention that’s supported by only very slim evidence? Presumably you haven’t been aware of the following…

Please save your pointless lectures for those who routinely x-ray people without a rhyme or reason.

Irrelevant. MSG has nothing to do with chiropractic healthcare claims.

Wow, are you choosing to be obtuse, just for argument sake? The point of basic science work is to help explain what we see daily in clinical practice. However, I am not obligated to discontinue doing what I am trained AND licensed to do because there is insufficient research to explain how I get results.

If you stood face-to-face with my patients and told them they got better solely through placebo effects, they'd laugh, and then say "Cool!"

My newest patient is a 14 year old girl with a history of daily headaches for years. I have seen her 3 times in 7 days, but she has had zero headaches since day one. After a month of no headaches, I will declare her fixed.

When chiropractors decide to dig into their mighty war chest to fund them?

Hold on there buddy, you overstep your bounds.

1. Until this last decade, my profession paid for ALL our research. Name one medical profession that routinely funds their research? They are all on the dole, or get funding from drug manufacturers to speed up the release of the new wonder drug. Yawn.

2. How my profession chooses to spend their money is NONE of your concern!

3. Our National Association (ACA) probably has between 4-6000 paid members, at $600 a year, and from that money they receive a subscription to JMPT at a cost of around a hundred. That leaves their total income between 200-300K. Do you have ANY idea what the costs are to fund j ust ONE research project?

So, bearing in mind that there are no reliable screening processes available to chiropractors, why would chiropractors manipulate the necks of such patients?

Because the event may not have been imminent, and if you can’t predict the event (we know that there’s no way to reliably screen for it), or identify patients with diseased vessels, then why would you exacerbate things by administering neck manipulation?

Once again:

1. There is ZERO evidence of causality that SMT has EVER caused even one stroke. Trotting out endless stories about proximal events (be it star gazing, or seeing their medical doctor) is a classic waste of time, and a cheezy straw man argument. Show me PROOF, and then we can revisit the conversation.

2. My Stroke page clearly lists what IS known, so that doctors can distinguish potential prodromal stroke patients, to send them to the ER. In my case, 16 years of perfection, with no injury.

3. I am a doctor, doing what I am trained and licensed to do. Who are you, telling me how to do my job? Once again (pointlessly) I ask...what is YOUR training and qualifications? Even better, why not tell us all who funds your website, and pays your salary, while you tweet away?

Here in the UK Alan Breen’s work has been critically analysed and been found to be severely wanting:
http://www.ebm-first.com/component/search/?searchword=Alan+Breen&ordering=&searchphrase=all

Well...although your source seems to be yourself, and you have yet to mention your own training or knowledge base,, I will review your page and get back to you.

And chiropractors are innocent when it comes to aggressive bad behaviour?

I wish I had endless time, as you appear to have, to review every assertion found on the web.

The topic was the Wilk Case, and I don't recall any Supreme Court cases aimed at my profession, or any seriously-illegal activities comparable to what organized medicine wreaked on my profession, under the false guise of protecting the public.

Perhaps it's time you read the whole Wilk case, and not just the bits horded by these pseudo-evidence sites you are so fond of promoting.

 

[TubbaBlubba]

I'm surprised that you don't seem to *get* this. People have strokes ALL THE TIME following innocuous activities of daily living. So how does that make chiropractic responsible for an event that is imminent, and will occur anyhow, because that person already has a diseased vessel?

The MOST you can say is that the PROXIMAL EVENT before they "had their stroke" was that they were washing their hair. It's not reasonable to blame their shower, OR their hair dresser, or their chiroprtactor.

Presumably, this same logic applies to improvement after say... Chriopractic adjustment?

 

[DrFrankmeister]

Presumably, this same logic applies to improvement after say... Chiropractic adjustment?

Mr Blubba

I hope you don't mind my correcting your spelling.

Chiropractic is all about intention. I find a loss of fluid motion and restriction in a joint, and I apply a precise vectored force, along the plane lines of that joint, to break up the restriction and to improve joint function. What I do is an art, grounded in science.

A ticking time bomb has no intellect, and no choice in the matter. It's going to explode, because that is it's nature.

If you feel better blaming someone, perhaps you should look into who set the bomb ticking. Perhaps you can read about how homocysteine contributes to vascular disease:

http://www.chiro.org/nutrition/FULL/Kilmer_McCully_MD.shtml

 

[Blue Wode]

Here you are:

“We've been waiting for 16 years for the NIH to announce some major breakthrough in health care that has emerged from NCCAM. Unfortunately, most of the "alternative" research is driven by faith, hope, and ideology rather than science. As Dr. Wallace Sampson noted: the NCCAM "is the only entity in the NIH [among some 27 institutes and centers] devoted to an ideological approach to health”….. $2.5 billion spent, no alternative cures found…”

I think that says it all.

Does it really?

Your source *seems* to have confused the NCCAM budget with entire NIH budget for all 27 departments.

NCCAMs 1992 budget was a modest $2 million, and their highest income year was less than $70 million (2011). I don't have the time to do the math for you, but NCCAM's budget during 19 years is certainly not the rediculous sum your source claims it is. Look for yourself:

http://nccam.nih.gov/about/budget/congressional/#Amo

Why do you persist in quoting what are clearly biased mis-information websites?

Who IS SKEPDIC? Are they researchers, with scientific credentials? I hope not, because they are (1) wrong, and (2) probably know that, but prefer to mis-represent FACT to create bias and mis-understanding.

AND finally: NCCAMs role is NOT to "find cures" per se...it's role is to conduct BASIC SCIENCE research, and they are doing a good job at it.

I’m sure that Robert T. Carroll at the Skeptic’s Dictionary would welcome your feedback:
http://skepdic.com/feedback.html

Please refer to Nansel's article if you'd like to learn more about how spinal adjusting appears to cure visceral disease. It's a challenging read, but then again, you're a science major...right?

http://www.chiro.org/research/ABSTRA...mulation.shtml

No, it doesn’t cure visceral disease. The current science tells us that the only real - and apparently diminishing - evidence for chiropractic lies in the treatment of a sub-group of low back pain sufferers, and even then it's no better than cheaper, more convenient and safer options.

Invasive procedures invariably carry risks...

"Spinal manipulation can be associated with significant complications, often requiring surgical intervention."

Nonvascular complications following spinal manipulation
The Spine Journal (Nov-Dec 2005)
http://www.ncbi.nlm.nih.gov/sites/en...&dopt=Abstract

This study reviews 18 patients who received spinal manipulation from UN-NAMED PROVIDERS in the cervical, thoracic, or lumbar spine. And they report 3 deaths from unrecognized malignancies.

What am I to draw from these facts? That spinal manipulation *could* cause injury?

Yes.

Here’s the current science with regard to chiropractic for low back pain:

(Walker BF, French SD, Grant W, Green S., Cochrane Database Systematic Review 2010; 4: CD 005427)

Comment on the above review from Professor Edzard Ernst:

Dr. Ernst is a self-appointed reviewer of CAM literature, with a background (I believe) as a naprapath or a homeopath. He has no training as a chiropractor or in spinal manipulation, nor any training (as far as I know) as a researcher, so excuse me if I don't take his pronouncements as the "last word".

Professor Ernst, MD, is from four generations of conventional medical doctors. He qualified as a physician in Germany in 1978 where he also completed his M.D. and Ph.D. theses. He has received some training in acupuncture, autogenic training, herbalism, homoeopathy, massage therapy and spinal manipulation. His first post was in a homeopathic hospital in Munich, and he eventually became the Head of the Department of Physical and Rehabilitation Medicine in the University of Vienna’s Medical Faculty. It was there that he not only became very familiar with physical therapies, but that he was also trained in spinal manipulation and applied it clinically. See the end of his ‘Systematic Review of Case Reports of Serious Adverse Events Following Manipulation of the Cervical Spine (1995–2001)’ here:
http://www.mja.com.au/public/issues/176_08_150402/ern10520_fm.html

In essence, not only is Professor Ernst an experienced physician, but he is also a scientist who clearly likes to apply the cautionary principle (as in thorough risk/benefit assessments) in the interests of patient safety.

I don't know enough about the Cochrane Collaboration to have an opinion.

The Cochrane Collaboration is a worldwide network of independent scientists dedicated to systematically summarising the totality of the evidence related to specific medical subjects in a rigorous and transparently impartial fashion.

I would venture that you’re talking about carpet thickness and “tea and sympathy” once again. It sounds to me like the placebo effect in action. However, with that, the nocebo effect also has to be considered:

How prosaic, but your overall meaning eludes me.

I have gathered some information on placebo and nocebo on my The Problem with Placebos/Shams Page.

Did Organized medicine savage the Meade reports? That was nothing compared to what they did when the 1994 Agency for Health Care Policy and Research (AHCPR) released 3 reviews of treatment for low back, and confirmed the untested, questionable or harmful nature of many current medical therapies for LBP , and also stated that, of all forms of management they reviewed, only chiropractic care could both reduce pain AND improve function. Their national associations and their lobbiests actually drove our Federal government to close the AHCRP department. That's member dues in action.

I think things have moved on since then. However, I understand that the RAND reports findings still stand:

When the RAND (Research and Development) organization published its review of the literature on cervical spine manipulation and mobilization in 1996, it concluded that only about 11.1% of reported indications for cervical spine manipulation were appropriate...Since about 90% of manipulation in the United States is done by chiropractors who use spinal manipulation as a primary treatment for a variety of health problems, neck manipulation is more problematic among chiropractors than among physical therapists and other practitioners who use manipulation only occasionally in the treatment of selected musculoskeletal problems...All things considered, manual rotation of the cervical spine beyond its normal range of movement is rarely justified. The neck should never be manipulated to correct an asymptomatic "chiropractic subluxation" or an undetectable "vertebral subluxation complex" for the alleged purpose of restoring or maintaining health or to relieve symptoms not located or originating in the neck. There is no evidence that such subluxations exist."

http://www.sciencebasedmedicine.org/index.php/neck-manipulation-risk-vs-benefit/

BTW, the above quote was written by a chiropractor.

Chiropractic patients are being x-rayed to check on the progress of an intervention that’s supported by only very slim evidence? Presumably you haven’t been aware of the following…

Please save your pointless lectures for those who routinely x-ray people without a rhyme or reason.

You reveal yourself once again, and not in a positive light.

Irrelevant. MSG has nothing to do with chiropractic healthcare claims.

Wow, are you choosing to be obtuse, just for argument sake? The point of basic science work is to help explain what we see daily in clinical practice. However, I am not obligated to discontinue doing what I am trained AND licensed to do because there is insufficient research to explain how I get results.

Wasn’t that how blood-letters started out?

When chiropractors decide to dig into their mighty war chest to fund them?

Hold on there buddy, you overstep your bounds.

1. Until this last decade, my profession paid for ALL our research. Name one medical profession that routinely funds their research? They are all on the dole, or get funding from drug manufacturers to speed up the release of the new wonder drug. Yawn.

2. How my profession chooses to spend their money is NONE of your concern!

I can make observations. The most recent being that when the Foundation for Chiropractic Education and Research went bankrupt in 2009 the marketing group, the Foundation for Chiropractic progress secured several hundred thousand dollars purely for promotional purposes.

So, bearing in mind that there are no reliable screening processes available to chiropractors, why would chiropractors manipulate the necks of such patients?

Because the event may not have been imminent, and if you can’t predict the event (we know that there’s no way to reliably screen for it), or identify patients with diseased vessels, then why would you exacerbate things by administering neck manipulation?

Once again:

1. There is ZERO evidence of causality that SMT has EVER caused even one stroke. Trotting out endless stories about proximal events (be it star gazing, or seeing their medical doctor) is a classic waste of time, and a cheezy straw man argument. Show me PROOF, and then we can revisit the conversation.

2. My Stroke page clearly lists what IS known, so that doctors can distinguish potential prodromal stroke patients, to send them to the ER. In my case, 16 years of perfection, with no injury.

3. I am a doctor, doing what I am trained and licensed to do. Who are you, telling me how to do my job? Once again (pointlessly) I ask...what is YOUR training and qualifications? Even better, why not tell us all who funds your website, and pays your salary, while you tweet away?

I have shown you proof, and given you a good explanation about the importance of adopting a cautious attitude. Your defensive rudeness and denials about the matter do you - and your profession - no favours.

 

[DrFrankmeister]

Yes. Here in the UK Alan Breen’s work has been critically analysed and been found to be severely wanting:
http://www.ebm-first.com/component/s...archphrase=all
Yes. Here in the UK Alan Breen’s work has been critically analysed and been found to be severely wanting:
http://www.ebm-first.com/component/search/?searchword=Alan+Breen&ordering=&searchphrase=all

Blue Man

You call these 2 minor paragraphs a CRITICAL ALALYSIS of Dr. Breen's WORK? Other than mentioning his status a a doctor, you fail to discuss anything about his work. I suspect you actually have NO IDEA what Dr. Breen's field of study actually is.

In reality these 2 "blurbs" amount to nothing more than a weak form of character assassination. Very weak.

I'm truly shocked at the trash you call evidence. Shame on you!

You have the credibility of Penn & Teller, with none of their humor, style or grace. Thumbs-down, Blue Man.

 

[TubbaBlubba]

Mr Blubba

I hope you don't mind my correcting your spelling.

Chiropractic is all about intention. I find a loss of fluid motion and restriction in a joint, and I apply a precise vectored force, along the plane lines of that joint, to break up the restriction and to improve joint function. What I do is an art, grounded in science.

A ticking time bomb has no intellect, and no choice in the matter. It's going to explode, because that is it's nature.

If you feel better blaming someone, perhaps you should look into who set the bomb ticking. Perhaps you can read about how homocysteine contributes to vascular disease:

http://www.chiro.org/nutrition/FULL/Kilmer_McCully_MD.shtml

I'm not sure I understand that this affects the fact that the most you can say is that they had a proximal event (involving joint pressure) prior to a purported (presumably subjective) improvement. There is, according to your logic, no way to statistically determine that something may have CAUSED the improvement.

As such for instance, if you have a controlled, heterogenous group who take aspirin, and one identical group who doesn't, and finds out that the one taking aspirin has less heart attacks resulting from blood clotting, all you can determine is that people who have heart attacks don't take aspirin? I'm just trying to understand how your logic applies to other matters. Presumably if one does epidemiological studies between people having strokes, and determine that chiropractic adjustment may have a causative effect, this is determined through measuring otherwise equal groups, one who had adjustment and one who didn't? Or am I missing something here?

 

[DrFrankmeister]

I'm not sure I understand that this affects the fact that the most you can say is that they had a proximal event (involving joint pressure) prior to a purported (presumably subjective) improvement. There is, according to your logic, no way to statistically determine that something may have CAUSED the improvement.

Very clever! Chiropractic as the proximal event before someone has a (spontaneous?) subjective improvement! I like that! hehehe

Do you doubt that people can develop spinal pain from loss of joint function?

Do you doubt that manipulation can correct that?

If I recall, the topic started around whether or how manipulation could lower blood pressure. The 2007 "pilot study" suggested that yes, it can.

I mentioned a series of other studies showing the benefits of chiropractic care in my last post to Blue Man, but BM choose to ignore them, while he cherry picks things to argue about.

If anyone is interested in looking at those other trials, I'll be around.

 

[DrFrankmeister]

I have shown you proof, and given you a good explanation about the importance of adopting a cautious attitude. Your defensive rudeness and denials about the matter do you - and your profession - no favours.

No...you didn't. You lectured smugly, talking down to an already very cautious doctor, while posing as a supposed knowledge specialist. Your credibility as evidence-man is sorely lacking, because your "critical analyses" of Dr. Breen's "work" are an embarrassment to any true fan of evidence.

If you feel I have been rude to you, perhaps it's time to look in the mirror, Blue Man to see what you have done to encourage the professional disregard I hold you in.

 

[TubbaBlubba]

Do you doubt that people can develop spinal pain from loss of joint function?

Do you doubt that manipulation can correct that?

Weasel words all over the place. Loss of joint function from what? Inflammation? I seriously doubt you would be able to do much to a Bechterew's pastient. Again, manipulation? Can that help? Perhaps, but the questions are, how OFTEN does it help, how good are patients at knowing when it will help, how scrupulous are chiropractors in admitting when it won't help, how well can we study the objective benefits of chiropractic, how safe is it in relation to how much benefit it grants, if there are any actual detectable physiological changes as a result from adjustment, et cetera. The question is NOT whether there is any situation at all where it can help, because that is an utterly trivial matter.