Chiropractic medicine.

[fls]

"Alternative medicine" is simply a shorthand way of saying "medicine that hasn't been proved to work".

I don't think that's the case. There are many treatments that haven't been proved to work that aren't called alternative - any drug in development, novel surgeries, extensions of rehabilitation techniques, etc., etc. Physicians and medical researchers are always trying new things, such as extending established treatments to novel uses or trying to come up with novel therapies, but we don't call what they do 'alternative'. It's simply normal/conventional medicine.

I think 'alternative medicine' is something else. It is therapies that are used despite the fact that have already been demonstrated to be ineffective or are highly likely to be ineffective. What is different about them is the attitude towards evidence, not the absolute amount of evidence. In the case of using herbals, what is 'alternative' is not the idea that plants can contain useful medicinal properties. It is the idea that a long tradition of subjective evaluation and observation is a useful way of gathering reliable knowledge. Our scientific evaluation of plant extracts has led us to discover that the traditional use of these extracts was wholly inadequate when it came to discovering which uses were ineffective and which uses were effective in situations any more complicated than symptom relief (or generation in the case of things like laxatives and purgatives). The same goes for harm.

Those herbalists who treat the body of knowledge derived from traditional uses of plants and/or scientific information that is preliminary at best, as though it has enough accuracy and reliability to guide the use of these plants in the prevention and treatment of disease, are practicing 'alternative medicine' because we have already demonstrated that this assumption is false. The ratio of useful information to useless information is very low. The inability to discover when you are wrong is a demonstrably ineffective way to make progress.

Hence my signature.

Linda

ETA: I admit that I got my threads a little mixed-up, but my point applies to any 'alternative medicine', including Chiropractic.

 

[Mashuna]

One more thing: I had a lively discussion with this American Chiropractor about the American cars. He claims that European and Japanese cars are better than American cars. I'm convinced that this is not true. Can anyone tell me why Americans tend to overestimate the quality of foreign goods?

Personally, I think he's right. European and Japanese cars generally are better than American cars. Although it all depends on your definition of 'better', and you can certainly pick a good American car and compare it to a bad European car.

Although I see you're based in Italy - I've never driven Italian cars, but have had good experiences with German and Japanese cars, bad experiences with American.

Here endeth the derail.

 

[Phytotherapist]

JJm - The one I metioned allowed me to see the whole working day his "treatments" and to ask questions. Of course I don't know what Chiropractic is otherwise I would be a Chiropractor. I just try to understand how much it is effective compared to conventional treatments (only for pain treatment). I don't think Chiropractic could be beneficial for Dysmenorrhoea, Allergies, Stress, Insomnia etc.

I have a few leaflets in Italian advertising Chiropractic (written by the American Chiropractors working here). I'll try to translate it in English: * Chiropractic is third among health professions after Medicine and Dentistry and is rapidly growing. * More than 50,000 Chiropractors in USA treat more than 2,000,000 people each day (it means about 40 a day). * More than 90% of insurance companies (in USA) cover expenses for chiropractic treatment. * More than 17 Universities in USA offer chiropractic courses. These Universities are authorized and recognized by the Federal Government and by all 50 States. * Universities teaching chiropractic are similar to Medical Schools. 11 chiropractic and 22 Medical school were compared which show that chiropractic students must attend 4,485 hours compared to 4,248 hours for students in Medicine. Here are the hours by subject for chiropractors (in brackets for MDs). Anatomy 520 (508), Physiology 420 (326), Pathology 205 (401), Chemistry 300 (326), Bacteriology 130 (114), Diagnosis 420 (324), Neurology 320 (112), Radiology 217 (148), Psychiatry 65 (144), Obstetrics 65 (148), Orthopaedics 225 (156). Total: 2,887 (2,706). I have the copy of their Course Syllabus which is very similar to ours (MDs). I'd like to know whether the above is correct or not.

There is an excellent Clinic in my region (near Venice) with an Orthopaedic specialist, a Physiotherapist and a Chiropractor (American of course), working together on the same patients: the Orthopaedic specialist makes the correct diagnosis and prescribes the treatment carried out by the Physiotherapist and the Chiropractor (manipulations). Why would they need the help of the chiropractor if chiropractic is always less effective in pain treatment than conventional treatment? There are many more questions on this issue and this is why I don't have a definitive opinion on Chiropractic. The line that separates conventional Medicine from quack "medicine" (if it is quack than it's not medicine) is not so obvious. Please forgive my English!

 

[fls]

They why is chiropractic separate from medicine or physiotherapy?

Linda

 

[Eos of the Eons]

Just look at the crazy education chiros get compared to people who actually learn how the body really works.

http://www.rebuildyourback.com/chiropractic/school.php

 

[Blue Wode]

The British Chiropractic Association has now issued a statement rebutting the findings of the study published in this week’s Lancet. See latest media release here:
http://www.chiropractic-uk.co.uk/default.aspx?m=5&mi=21&title=Media+Area

Its ‘Notes to Editors’ section, in which it continues to tout the Meade Trial in support of chiropractic, is a particular disgrace:

Parallels can be drawn from this study with the results of the Meade Trial (1990) BMJ 2nd June 1990, Vol.300 – pages 1431-1437, Low back pain of mechanical origin: randomised comparison of chiropractic ad hospital outpatient treatment which compared chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin and found that “chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management” (physiotherapy). These findings were endorsed by the follow-up Meade trial published in BMJ Vol.311 on 5 August 1995 which further indicated that “those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals” (physiotherapy).

Here’s what the British Chiropractic Association fails to mention:

From 1991

Effectiveness of chiropractic and physiotherapy in the treatment of low back pain: a critical discussion of the British Randomized Clinical Trial

The results are difficult to extrapolate, because only a small portion of the eligible patients participated, and chiropractic seems to be clearly superior only in the subgroup originally presenting to a chiropractic clinic. We conclude that it is premature to draw conclusions about the long-term effectiveness of chiropractic based on the results of this study alone.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1833493

From 1995

Results were clinically trivial

EDITOR,--T W Meade and colleagues have provided further data from their study comparing chiropractic with hospital physiotherapy.1 Unfortunately, their report is far from convincing. The "headline" advantage of chiropractic over hospital management at three years (29%) sounds impressive but refers to an improvement of three points on the 100 point Oswestry scale, or one and a half responses on the questionnaire. This difference may be statistically significant but is clinically trivial.

In their original article the authors noted that chiropractic was 50% more expensive,2 and in the latest report they note that the chiropractic group had more treatments in the long term. The measured improvement does not seem to support such an expenditure.

The design of the study was criticised after the first paper was published.3 The patients initially presenting to a chiropractor were self selected on the basis that they believed that chiropractic would be effective (as they were expecting to pay for treatment). It is interesting that only the patients referred by chiropractors showed a significant advantage for chiropractic. Those initially recruited in hospital practice showed no significant difference. The study compares private practice with NHS treatment, with all the implications for environmental and personal factors that this brings. The follow up rate (70% and 77%) is inadequate and would preclude publication in some journals.4 Analysis by intention to treat does not obviate this deficiency. Important variables such as psychological disturbance are not addressed, although these are noted to have a greater impact on results than does treatment.5

It is disappointing that in the five years between the reports these and the other criticisms that were raised were not more fully addressed. Despite the acclamation of the first report in the popular media, I do not think that this study has advanced our understanding of the treatment of back pain in any useful way.

http://bmj.bmjjournals.com/cgi/content/full/311/7015/1302

From 1998

“Chiropractors often cite the trial of the UK Medical Research Council in defence. They say it favoured chiropractic over physiotherapy. This trial, however, is much misinterpreted as both its treatment groups received spinal manipulation." Professor Edzard Ernst, The London Independent

http://findarticles.com/p/articles/mi_qn4158/is_19981208/ai_n14204324/pg_1

Where is the integrity of this profession?

 

[JJM]

{snip} Of course I don't know what Chiropractic is {snip}

Then, you should not be promoting it. Perhaps the person you watched did not really practice it. The second post in this series directed you to a place where you can learn the facts.

{snip} Chiropractic is third among health professions after Medicine and Dentistry and is rapidly growing.

A fallacious appeal to popularity.

{snip} More than 90% of insurance companies (in USA) cover expenses for chiropractic treatment.

That is because they are required to do so by law. Legislators are not informed on health care, and readily pass legislation that does not spend tax dollars.

More than 17 Universities in USA offer chiropractic courses.

Not "universities." They are stand-alone colleges. Respectable universities have rejected chiro affiliation.

Universities teaching chiropractic are similar to Medical Schools. {snip}

This is chiro propaganda/wishful-thinking. It is not a question of how many hours chiros spend in school, what matters is what they are really taught. They spend a lot of time on the basics of their cult, regardless of the title or description of the course. Their clinical experience before being licensed to practice is laughable. I think Eos has addressed this.

{snip} I'd like to know whether the above is correct or not.

It is not- see the literature.

{snip} Why would they need the help of the chiropractor if chiropractic is always less effective in pain treatment than conventional treatment? {snip}

Chiro is not less effective in low-back pain and certain headaches- it is as effective as (less expensive) massage. Why would a doctor hire a chiro (?) some doctors don't understand the nonsense.

 

[JJM]

{snip} Where is the integrity of this profession?

It is not a profession, it is a cult. Thanks for the useful references.

 

[Phytotherapist]

Mashuana - On the other hand I had bad experiences with German cars (Mercedes S, Volkswagen Golf, Porsche Cayenne)and Japanese cars (Mazda5) and good experiences with American cars (Grand Cherokee 4.7 and Chrysler 300 C CRD Touring). Top Italian cars (Ferrari, Maserati and Lamborghini) are also good.
I had a Porsche Cayenne that was unpractical inside, very hard to drive and very uncomfortable. On the other hand, Grand Cherokee is spacious, very comfortable and I could drive it the whole day without getting tired. It is also incredibly capable off-road and costs 50% less than Cayenne.

More American cars (Ford, GM and Chrysler) are sold in Ialy than Japanese. This means that Italians think that American cars are better than Japanese cars (which are also very uncomfortable). I know that people after buying Japanese cars are often reluctant to admit the error but the fact is that only few of them buy again a Japanese car.

I'm not promoting American cars as I'm not promoting Chiropractic. I just say that the world is not only black and white, that there are many quacks (not you!) on this thread that know nothing about Medicine (and life) and their words have the effect of strenghtening "alternative" quacks.

 

[fls]

I'm not promoting American cars as I'm not promoting Chiropractic. I just say that the world is not only black and white, that there are many quacks (not you!) on this thread that know nothing about Medicine (and life) and their words have the effect of strenghtening "alternative" quacks.

I realize that you are referring to people like me with your characterization, but your statement that our words strengthen alternative quacks is interesting. Can you elaborate on what you mean by that? I'm interested in your insights on this issue.

Linda

 

[JJM]

{snip} The line that separates conventional Medicine from quack "medicine" (if it is quack than it's not medicine) is not so obvious. {snip}

{snip} I just say that the world is not only black and white, {snip}

These statements are too vague to use. They remind me of the quack plea to realize that we don't know everything; therefore, we should allow anything.

In the case of chiropractic, it is unarguably quackery. If the chiropractor you observed was practicing evidence-based medicine, he was not practicing chiropractic.

 

[Phytotherapist]

Fls - I wasn't referring at people like you although I don't share some of your ideas. I would elaborate but my English is not good enough. My feeling is (I may be wrong) that they (quacks) are growing faster and faster all the time. I have many theories on this subject but I'm afraid I'm unable to explain it correctly.

 

[athon]

They why is chiropractic separate from medicine or physiotherapy?

Linda

I think this question needs repeating. The arguments in favour of chiropracty always focus on its similarities with physiotherapy or liken it to a back specialist, ignoring its roots in pseudoscience. Which is fine...except if it's no different to a back specialist (trained in medicine), then why chiropracty? What benefit does it offer over physio?

Athon

 

[Jeff Corey]

... there are many quacks (not you!) on this thread that know nothing about Medicine (and life) and their words have the effect of strenghtening "alternative" quacks.

That sounds like you are describing yourself.

 

[Blue Wode]

Hot on the heels of the Hancock et al study on spinal manipulation in the Lancet comes this article from Edzard Ernst:

Spinal manipulation: are the benefits worth the risks?
E. Ernst, Expert Review of Neurotherapeutics, November 2007, Vol. 7, No. 11, Pages 1451-1452
http://www.future-drugs.com/doi/full/10.1586/14737175.7.11.1451?cookieSet=1

This is interesting:

…the early chiropractic literature provides ample evidence for the fact that chiropractic was not originally meant as a treatment for musculoskeletal problems, but as a cure for any human condition [1].

To understand this seemingly bizarre claim a little better, one should glance at the concepts that underlie chiropractic. Palmer was convinced that he had discovered a law of nature. In his view, all human illness and disease were caused by the blockage of the 'innate intelligence’ through vertebral malalignments or subluxations. Therefore, all conditions could and should be treated with adjustments of these abnormalities, in other words, spinal manipulation. This would restore the flow of the innate intelligence and, in turn, would cure whatever condition the patient was suffering from [1].

It seems obvious to any critical evaluator that these concepts are little more than fantasy: there is no evidence for any innate intelligence, and there is no reason to assume that adjusting malalignments of vertebra (if they at all exist) are the cause of disease or illness…

And yet the McTimoney College of Chiropractic course in the UK apparently instructs its students in the following:

By correctly training the hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements).

http://www.mctimoney-chiropractic.org/mca_objectives.htm

Incredibly, that course (which has produced 500 practising chiropractors) is validated by the University of Wales as a BSc (Hons) Chiropractic degree:
http://www.mctimoney-college.ac.uk/cofc.htm

Even more bewildering is that the UK General Chiropractic Council stipulates in its Code of Practice and Standard of Proficiency that chiropractors’ provision of care must be evidence based. See section A2.3 of the Standard of Proficiency here:
http://www.gcc-uk.org/files/link_file/COPSOP_8Dec05.pdf

 

[Acleron]

Hypocrisy, inability to think logically and credulous acceptance of invalidated treatment modes are all characteristics of purveyors of woo, so I don't find it incredible or bewildering that the Chiropractic Council issues such statements or that it is taught in universities.

I just find it so damned depressing.

 

[Blue Wode]

Following on from the Hancock study which was published this month in the Lancet…

Patients with acute low back pain receiving recommended first-line care do not recover more quickly with the addition of diclofenac or spinal manipulative therapy.

-snip-

The spinal manipulative therapy given in this trial included a range of low-velocity mobilisation and high-velocity manipulation techniques done by physiotherapists with postgraduate training in manipulative therapy. A systematic review of spinal manipulation concluded that there is no evidence that high-velocity spinal mobilisation is more effective than low-velocity spinal manipulation, or that the profession of the manipulator affects the effectiveness of treatment.

Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial Hancock MJ et al; Lancet:370:1638-43 (2007)

http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf

…here’s a newly-published study which seems to support the findings of that study:

‘Nonspecific Low Back Pain and Return to Work’
American Family Physician
15th November 2007
http://www.aafp.org/afp/20071115/1497.html

Interestingly, no mention is made of ‘chiropractic’. As for spinal manipulation, it was mentioned once in a brief list of “treatments for which evidence of effectiveness is unclear”.


ETA: Here’s the very latest from Ernst:

Spinal manipulation: are the benefits worth the risks?
http://www.ukskeptics.com/documents/spinal_manipulation_benefits_risks.pdf

 

[zenotter]

I think this question needs repeating. The arguments in favour of chiropracty always focus on its similarities with physiotherapy or liken it to a back specialist, ignoring its roots in pseudoscience. Which is fine...except if it's no different to a back specialist (trained in medicine), then why chiropracty? What benefit does it offer over physio?

Athon

At least where I live, chiro offices seem to be way more accessible for people to travel to (the Starbucks of alternative wellness services, with one on each corner) compared with actually making an appointment at a hospital. I had physical therapy at a hospital after a car accident, which helped about as much as adjustments with my chiropractor back then. Both emphasized proper posture, adequate stretching/exercise, and all the common sense self-care things, anyway.

I think I've had a fortunate experience with finding a chiropractor's office that's not woo at all. Still, the only reason I go there nowadays is for the specialized massage (A.R.T.) that happens to be offered. I get so much benefit from that, plus my cost is way less than it would be otherwise since my health insurance covers appts with chiropractors.

 

[Blue Wode]

I think I've had a fortunate experience with finding a chiropractor's office that's not woo at all.

It would seem that you have considering that around 90% of chiropractors in the USA buy into the Palmer’s original subluxation theory, and four chiropractic associations here in the UK appear to support it.

Regards the one aspect of chiropractic that has been supported by a small amount of evidence (spinal manipulative therapy for low back pain), here’s an update from this week’s Consumer Health Digest newsletter published by the National Council Against Health Fraud:

Doubt cast on value of spinal manipulation and NSAIDS for acute back pain.

Australian researchers found that neither spinal manipulation or the
drug diclofenac hastened recovery of acute low-back pain patients who
had been properly counseled by their primary physician and prescribed
paracetamol for pain relief. The study involved 240 patients who
received either (a) diclofenac plus spinal manipulation, (b)
diclofenac and sham spinal manipulation, (c) spinal manipulation and
a placebo pill, or (d) sham manipulation plus a placebo pill. About
half recovered within two weeks and nearly all recovered within three
months.
[Hancock MJ and others. Assessment of diclofenac or spinal
manipulative therapy, or both, in addition to recommended first-line
treatment for acute low back pain: a randomized controlled trial.
Lancet 370:1638-1643, 2007]
http://www.ncbi.nlm.nih.gov/sites/e...med.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus

Diclofenac is a nonsteroidal antiinflammatory drug (NSAID).
Paracetamol is a pain-reliever marketed in the United States as
acetominophen or Tylenol. An accompanying editorial noted:

**Systematic reviews had concluded that NSAIDS and spinal
manipulation were more effective than placebos. However, the patients
in the reviewed studies did not have optimum first-line care, and the
apparent benefit was not large.

**Advice to remain active and prescription of paracetamol will be
sufficient for most patients with acute low back pain.
[Koes BW.
Evidence-based management of acute low back pain. Lancet
370:1595-1596, 2007]


http://www.ncahf.net/digest07/07-47.html

Full Text of the Hancock et al study here:
http://www.acatoday.org/pdf/Lancet_Acute_Back_Pain_Nov.07.pdf

Interestingly, the chiropractic profession in the UK is currently up in arms about the study, including its regulatory body which is protesting that it doesn’t address the effectiveness of ‘chiropractic’.

http://www.gcc-uk.org/files/page_file/LANCET Australian study statement9Nov07.pdf

It has even written to the Press Complaints Commission in an attempt to elicit a public apology from three newspapers for saying that chiropractic is ‘a waste of money’,

http://www.gcc-uk.org/files/page_file/Letter PCC 20Nov07 (Website).pdf

and despite the emerging lack of evidence for spinal manipulation it is currently actively promoting chiropractic as a career:
http://www.gcc-uk.org/files/page_file/CAREERS LEAFLET FINAL FOR WEBSITE30Nov07.pdf

Could the chiropractic PR machine be taking lessons from the homeopathy community?

 

[simonmaal]

Not only is chiropractic nonsense, it can be dangerous for two reasons. First, ham-fisted manipulation can cause injury and secondly (and more significantly), consulting a chiropractor can cause a person to forego proper medical care.