Chiropractic Woo?

[Rodney]

No, it would be his choice, but I would warn him that chiropractic/spinal manipulative treatment is known to be associated with serious risks. He might want to minimize his time under the knife, but I’m sure that he wouldn’t want to spend the rest of his life in a wheelchair, or worse...

Do you have evidence that chiropractic/spinal manipulative treatment is more dangerous than conventional medical treatment for back pain?

 

[JJM]

So, I take it that you disagree with this statement by William Lauerman, chief of spine surgery and a professor of orthopedic surgery at Georgetown University Hospital, about chiropractic treatment for short-term back pain:

"Three or four days, can't get out of bed, that sort of thing" -- Lauerman says, "is one of the few things that has been demonstrated to significantly alter the natural history of acute back pain. . . . People get better quicker if they go to a chiropractor for a few visits."

Has the study been refuted?

Has it been accepted by health professionals? Many conditions, even chronic ones, go into remission for no obvious reason.

But he sure knows that the conventional treatment he tried before turning to a chiropractor was a complete failure. And, I would venture to say, that treatment was also far more expensive than what the chiropractor is charging.

And I would venture to say that masseurs would do the same for less.

Would you ever consider faulty conventional treatment to be quackery?

Yes, if it were as irrational and unsupported as AltMed, such as chiropracty. Why do you ask?

Would that include the author's chiropractor?

Is that not clear?

 

[Rodney]

Has it been accepted by health professionals? Many conditions, even chronic ones, go into remission for no obvious reason.

So why did the author's condition go into remission only after the chiropractic, and not the conventional, treatment?

And I would venture to say that masseurs would do the same for less.

Again, Dr. Laureman states: "People get better quicker if they go to a chiropractor for a few visits."

Yes, if it were as irrational and unsupported as AltMed, such as chiropracty. Why do you ask?

Because you're giving conventional medicine a free ride. I think it's safe to day that most people turn to chiropractors only after medical doctors have been unable to help them.

Is that not clear?

I was asking if you consider the author's chiropractor a quack. Are you saying that all chiropractors are quacks?

 

[JJM]

So why did the author's condition go into remission only after the chiropractic, and not the conventional, treatment?

I guess it happened that way.

Again, Dr. Laureman states: "People get better quicker if they go to a chiropractor for a few visits."

He (?) must be unaware that testimonial means little; and that literature shows masseurs are as effective.

Because you're giving conventional medicine a free ride. I think it's safe to day that most people turn to chiropractors only after medical doctors have been unable to help them.

Conventional med is a separate issue. Chiropracty is a cult of quackery that has been steadily undermined by facts since 1895. The faults of evidence-based-medicine are irrelevant. Get it?!

I was asking if you consider the author's chiropractor a quack. Are you saying that all chiropractors are quacks?

Their own surveys show that the vast majority are. It does not matter if the author found one who realizes that s/he is really only a masseur/masseuse; that does not vindicate the vast majority who have delusions of grandeur.

 

[Furcifer]

I always thought that Chiropractics fostered a dependancy by not addressing causation. The risk of permanent damage by physically manipulating the spine back into "alignment" meant it should be sought only as a temporary solution, for a very short period of time. The thing is a bottle of pills comes with this warning, but Chiropractors don't. There should be a recommended dosage for Chiropractors. In response to the OP, I think it becomes woo if it presented as a solution to a problem, instead of a temporary relief to the problem.

 

[Blue Wode]

Do you have evidence that chiropractic/spinal manipulative treatment is more dangerous than conventional medical treatment for back pain?

Here's what the Adverse effects of spinal manipulation: A systematic review study (which was published in this month’s Journal of the Royal Society of Medicine) has to say about that:

The effectiveness of spinal manipulation for most indications is less than convincing.5 A risk-benefit evaluation is therefore unlikely to generate positive results: with uncertain effectiveness and finite risks, the balance cannot be positive.

-snip-

It is, of course, important to present any risk-benefit assessment fairly and in the context of similar evaluations of alternative therapeutic options. One such option is drug therapy. The drugs in question—non-steroidal anti-inflammatory drugs (NSAIDs)—cause considerable problems, for example gastrointestinal and cardiovascular complications.72,73 Thus spinal manipulation could be preferable to drug therapy. But there are problems with this line of argument: the efficacy of NSAIDs is undoubted but that of spinal manipulation is not, and moreover, the adverse effects of NSAIDs are subject to post-marketing surveillance while those of spinal manipulation are not. Thus we are certain about the risks and benefits of the former and uncertain about those of the latter. Finally, it should be mentioned that other therapeutic options (e.g. exercise therapy or massage) have not been associated with significant risks at all.

Ernst, E. Adverse effects of spinal manipulation: A systematic review. J R Soc Med 2007; 100:06-0100.1-9

http://www.jrsm.org/cgi/content/full/100/7/330

[My bold and underscoring]

 

[Rodney]

Here's what the Adverse effects of spinal manipulation: A systematic review study (which was published in this month’s Journal of the Royal Society of Medicine) has to say about that:

Quote:
The effectiveness of spinal manipulation for most indications is less than convincing.5 A risk-benefit evaluation is therefore unlikely to generate positive results: with uncertain effectiveness and finite risks, the balance cannot be positive.

-snip-

It is, of course, important to present any risk-benefit assessment fairly and in the context of similar evaluations of alternative therapeutic options. One such option is drug therapy. The drugs in question—non-steroidal anti-inflammatory drugs (NSAIDs)—cause considerable problems, for example gastrointestinal and cardiovascular complications.72,73 Thus spinal manipulation could be preferable to drug therapy. But there are problems with this line of argument: the efficacy of NSAIDs is undoubted but that of spinal manipulation is not, and moreover, the adverse effects of NSAIDs are subject to post-marketing surveillance while those of spinal manipulation are not. Thus we are certain about the risks and benefits of the former and uncertain about those of the latter. Finally, it should be mentioned that other therapeutic options (e.g. exercise therapy or massage) have not been associated with significant risks at all.

Ernst, E. Adverse effects of spinal manipulation: A systematic review. J R Soc Med 2007; 100:06-0100.1-9

http://www.jrsm.org/cgi/content/full/100/7/330


[My bold and underscoring]

I don't see anything in the above that address this contention by the author of the Washington Post article:

"A study conducted over seven years by a physician and a chiropractor and reported in June's Journal of Manipulative and Physiological Therapeutics showed that patients who turned first to chiropractors and other alternative-medicine professionals for care were hospitalized and had surgery 60 percent less often and spent 85 percent less on pharmaceuticals than those with medical doctors as primary care providers."

Also, bear in mind that most people with spinal problems will begin by trying low risk options, such as exercise and massage. However, if they don't work, a higher risk option must be tried. So, the real question is whether the best option is NSAIDs, surgery, or chiropractic care.

 

[Blue Wode]

I don't see anything in the above that address this contention by the author of the Washington Post article:

"A study conducted over seven years by a physician and a chiropractor and reported in June's Journal of Manipulative and Physiological Therapeutics showed that patients who turned first to chiropractors and other alternative-medicine professionals for care were hospitalized and had surgery 60 percent less often and spent 85 percent less on pharmaceuticals than those with medical doctors as primary care providers."

As JJM has already pointed out, the Journal of Manipulative and Physiological Therapeutics is a non-medical publication of dubious authority.

Also, bear in mind that most people with spinal problems will begin by trying low risk options, such as exercise and massage. However, if they don't work, a higher risk option must be tried. So, the real question is whether the best option is NSAIDs, surgery, or chiropractic care.

...and whether patients are given enough information to make informed choices about these treatment options.

 

[fls]

If you had your way, would you ban the author from seeking chiropractic treatment after conventional treatment had failed?

I don't think it is reasonable to expect conventional medicine to abandon people based upon some unspecified set of criteria.

I don't see anything in the above that address this contention by the author of the Washington Post article:

"A study conducted over seven years by a physician and a chiropractor and reported in June's Journal of Manipulative and Physiological Therapeutics showed that patients who turned first to chiropractors and other alternative-medicine professionals for care were hospitalized and had surgery 60 percent less often and spent 85 percent less on pharmaceuticals than those with medical doctors as primary care providers."

One cannot directly compare two highly self-selected groups. They are likely to have quite different outcomes, regardless of the care they receive.

Also, bear in mind that most people with spinal problems will begin by trying low risk options, such as exercise and massage. However, if they don't work, a higher risk option must be tried. So, the real question is whether the best option is NSAIDs, surgery, or chiropractic care.

That is not the right question, as (for example) NSAID's would be suggested for different conditions than surgery. I think the real question is whether or not one can justify the field of Chiropractic given that the one service that they provide that is evidence-based, manipulation for a few specific conditions, is just as effectively provided by physiotherapists anyway. The rest of the time, Chiropractic is designed to be a make-work project.

Linda

 

[Rodney]

I don't think it is reasonable to expect conventional medicine to abandon people based upon some unspecified set of criteria.

I'm not asking whether conventional medicine should abandon people with spinal problems, only whether it should actively attempt to prevent people from seeking out chiropractors, even when conventional medicine has failed to help those people.

One cannot directly compare two highly self-selected groups. They are likely to have quite different outcomes, regardless of the care they receive.

So what is the best way to evaluate conventional and chiropractic care for spinal problems?

That is not the right question, as (for example) NSAID's would be suggested for different conditions than surgery. I think the real question is whether or not one can justify the field of Chiropractic

And, if it can't be justified by say, a team of medical doctors appointed by the AMA to look into its efficacy, should it be prohibited?

given that the one service that they provide that is evidence-based, manipulation for a few specific conditions, is just as effectively provided by physiotherapists anyway. The rest of the time, Chiropractic is designed to be a make-work project.
Linda

Is there a study that shows physiotherapists are as effective as chiropractors in treating every type of spinal condition?

 

[fls]

I'm not asking whether conventional medicine should abandon people with spinal problems, only whether it should actively attempt to prevent people from seeking out chiropractors, even when conventional medicine has failed to help those people.

You weren't talking about preventing people from seeing chiropractors. Rather you brought up the idea of physicians making referrals to chiropractors, the justification for which was that some unspecified line had been crossed (conventional medicine has failed - whatever that's supposed to mean) beyond which anything goes. That rather than offering thoughtful and considered suggestions based on research, experience and knowledge, we should abandon them to the vagaries of a profession that has no compunction about pulling ideas from their a**.

So what is the best way to evaluate conventional and chiropractic care for spinal problems?

Randomized, double-blind, placebo-controlled trials.

And, if it can't be justified by say, a team of medical doctors appointed by the AMA to look into its efficacy, should it be prohibited?

Before we consider referral, the same standards we apply to consideration of any type of treatment should be applied to those offered by chiropractic.

Is there a study that shows physiotherapists are as effective as chiropractors in treating every type of spinal condition?

Where spinal manipulation has shown to be effective in treating a specific condition, it makes no difference whether that manipulation is provided by a chiropractor or a physiotherapist.

Examples:
http://www.bmj.com/cgi/content/full/329/7479/1377
http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed&cmd=Retrieve&list_uids=14973958

Linda

 

[Rodney]

You weren't talking about preventing people from seeing chiropractors.

No, but I'm still unclear whether you believe that consumers should be at least discouraged by the government from seeing chiropractors.

Rather you brought up the idea of physicians making referrals to chiropractors, the justification for which was that some unspecified line had been crossed (conventional medicine has failed - whatever that's supposed to mean)

What I mean is that conventional medicine has been unable to resolve someone's health issue. In the case of the author of the Washington Post article, he says that he had three unsuccessful back operations.

beyond which anything goes. That rather than offering thoughtful and considered suggestions based on research, experience and knowledge, we should abandon them to the vagaries of a profession that has no compunction about pulling ideas from their a**.

So why do you suppose Georgetown surgeon Lauerman states: "I'm an orthopedic spine surgeon, so I treat all sorts of back problems, and I'm a big believer in chiropractic."

Randomized, double-blind, placebo-controlled trials.

Do those unambiguously show that conventional medicine is more effective than chiropractic medicine in treating spinal problems?

Before we consider referral, the same standards we apply to consideration of any type of treatment should be applied to those offered by chiropractic.

Okay, but let's suppose that you specialized in treating back pain and that, despite your best efforts, your patient's back pain had not been alleviated. What would your course of action be?

Where spinal manipulation has shown to be effective in treating a specific condition, it makes no difference whether that manipulation is provided by a chiropractor or a physiotherapist.

Examples:
http://www.bmj.com/cgi/content/full/329/7479/1377
http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed&cmd=Retrieve&list_uids=14973958

Linda

Do you discount any studies published in the Journal of Manipulative and Physiological Therapeutics?

 

[JJM]

TF Bergman, D.C. (former editor of "Chiropractic Technique"):

Quote:A challenge for the future is to classify and place all chiropractic techniques into a framework that allows determination as to whether any of them has a basis in fact. ... Studies designed to compare effectiveness ... have not been done.
Advances in Chiropractic vol. 2, DJ Lawrence, ed. (Mosby, 1996) [my bold]

The Chiropractic Centennial Foundation noted (From Simple Beginnings, a videotape, Davenport IA, 1996) that different chiros practice more than 100 techniques. (Some work only on the neck, others on the perianal region, some only on the spine, whereas others recommend dietary supplements ...)

So, a senior chiro tells us (in a chiro publication) there is no known basis in fact for chiro practices, and a chiro group counts 100 of these practices. That is not a good situation. WT Jarvis, PhD, (whose doctoral research subject was chiropracty) has noted that chiros are a diverse group, united only in their opposition to criticism.

Your first problem in choosing a chiro is to find one of the minority (less than 5%) who reject "subluxations" and try to work like physical therapists. The next problem is to find a chiro who is competent to work at that level.

 

[RogueWave]

I have benefitted greatly from chiropractors for years. Once I had numbness and tingling in my arm from my shoulder to my fingers that lasted a month. Neurologists found nothing wrong with me. One good crack to my neck from a chiropractor was all it took. I got up from the table and I was cured.

 

[JJM]

Do you discount any [sic] studies published in the Journal of Manipulative and Physiological Therapeutics?

I think you meant "all," and I do because they print studies as grossly flawed as the one you cited.

Think about it: if one does a high-quality study, one wants to see it in a high-quality journal; not a quack magazine. Publication in JMPT means either that it was rejected by quality journals; or that the author has no faith in the work. If the author is not impressed, I am not impressed.

If you could not discern the blatant problems with the JMPT article you cited, why are you arguing here? There is a problem with the uninitiated thinking they can sort out technical stuff.

I like Articulett's sig-line "If you can't understand; maybe it's you: http://www.apa.org/journals/features/psp7761121.pdf " I hope I have not noted it here, recently. It cites an article concerning the confidence people have inre subjects (healthcare, in this case) about which they are ignorant.

 

[JJM]

I have benefitted greatly from chiropractors for years. Once I had numbness and tingling in my arm from my shoulder to my fingers that lasted a month. Neurologists found nothing wrong with me. One good crack to my neck from a chiropractor was all it took. I got up from the table and I was cured.

Do you understand the notion that anecdote/testimonial proves nothing?

 

[Miss Anthrope]

I have benefitted greatly from chiropractors for years. Once I had numbness and tingling in my arm from my shoulder to my fingers that lasted a month. Neurologists found nothing wrong with me. One good crack to my neck from a chiropractor was all it took. I got up from the table and I was cured.

Many people report similar types of experience from taking sugar pills. From visiting faith healers. From mediation and prayer. From visualizing pink healing light to the correct chakra. For me, I can occasionally get rid of headache by imagining little tiny janitors sweeping up the pain into a tiny pile that finally disappears. What these all have in common is the power of suggestion and belief.

 

[Rodney]

I have benefitted greatly from chiropractors for years. Once I had numbness and tingling in my arm from my shoulder to my fingers that lasted a month. Neurologists found nothing wrong with me. One good crack to my neck from a chiropractor was all it took. I got up from the table and I was cured.

Very interesting. Can you supply any more details, such as what the neurologists advised you to do and how you came to see a chiropractor?

 

[JoeEllison]

I have benefitted greatly from chiropractors for years. Once I had numbness and tingling in my arm from my shoulder to my fingers that lasted a month. Neurologists found nothing wrong with me. One good crack to my neck from a chiropractor was all it took. I got up from the table and I was cured.

"Years"? For the same problem?

 

[RogueWave]

Do you understand the notion that anecdote/testimonial proves nothing?

I know that a testimonial doesn't necessarily prove anything. But it does help to support a hypothesis - namely, that chiropractic care can provide benefit to some for certain conditions. Seeing and experiencing is believing - at least for me. My arm was practically numb. I lay on the table, face down. My neck was adjusted. I got up and all the feeling was immediately restored to my arm. I have never had the numbness since, but the neck is getting a bit stiff again. I could use another adjustment.