No, but I'm still unclear whether you believe that consumers should be at least discouraged by the government from seeing chiropractors.
The role of the government is to ensure that chiropractic follows licensing requirements, such as truth in advertising (which it doesn't if compared to medicine (which would be the responsible comparison)). And my question was whether or not it can justify professional status in the first place, considering that it fails on several critical characteristics (skill based on theoretical knowledge, public service and altruism (no demonstrable contribution to public health), self-regulation, testing of competence, etc.) and is otherwise redundant (services are duplicated by other professions/trades).
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.
I think you have a false impression about the process. Realistically, you can only make this determination (if it can be made at all) in retrospect.
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."
There is nothing particularly remarkable about that statement for several reasons. The extent to which physicians follow evidence-based medicine is variable (it represents a paradigm shift to some degree and we are still in a period of transition), so it is easy to fish around and find individuals who do not closely follow more objective evaluations. Back surgery is not very effective for back pain, and in a way chiropractic represents a placebo control for back surgery. It looks more like he has discounted the extent to which people improve on their own - attributing effects both to surgery and chiropractic without taking the placebo component into account (we have evidence that back surgeons as a group have done this (overestimated the benefit of their surgery)). And he deals with conditions which chiropractic may help, although not to a greater extent than other conventional treatments and not in a way that provides any theoretical basis to the underlying idea of subluxations.
Do those unambiguously show that conventional medicine is more effective than chiropractic medicine in treating spinal problems?
Yes. They can unambiguously show which treatments are effective and which are not. Evidence-based medicine means that effective treatments become conventional treatments and ineffective ones do not.
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?
To continue to evaluate the clinical situation and make suggestions based on evidence, or novel suggestions from a theoretical basis. And to enlist the opinions of people with specialized knowledge and experience.
Alternatively, I'd draw upon the powers on randomness and use two dice to select a letter of the alphabet, find a medical medium whose name starts with that letter and try the remedy du jour. In this case, I came up with B for Browne, so my patient is now on lecithin. Of course, any improvement (i.e. normal variation in the course of the problem, ongoing improvement from prior conventional treatments, subjective variation in the assessment of symptoms, worsening of any of the above but to a lesser extent than arbitrary expectations, etc.) will now be attributed to the lecithin with a wide latitude given to the temporal association. This result will then be generalized and constitute proof for my assertion that the entire snake oil industry is not a waste of time and money.
Do you discount any studies published in the Journal of Manipulative and Physiological Therapeutics?
Peer-review serves to help me determine whether or not I can trust the authors' conclusions. This is important in areas where I am relatively ignorant and would not be able to make this determination on my own. But in the case of the JMPT, I can do my own peer-review. The problem with journals such as the one that you reference, is that because the "peer-review" is not done by people who are familiar with the ways in which scientific experimentation has shown us we can be fooled, they often allow stuff that has fooled the researchers into making invalid conclusions to pass. This means that people who are otherwise ignorant about the field should not trust the conclusions of the researchers.
For example, the research that you referenced earlier about chronic neck pain did not include a placebo-control group. We already know that the only consistent effect from placebo is a change in subjective perception and pain perception while the condition runs its natural course. And the outcome in that particular study was a change in pain perception without any change in the underlying condition. The placebo effect is always present, but the researchers did not provide any way of determining what, if anything, could also be attributed to the effect of chiropractic treatment. That makes their reported conclusion invalid. You cannot support your assertions by citing conclusions (without further evaluation) from research in a journal that regularly allows false conclusions to be published. That is the distinction that is being made when we refer to peer-reviewed journals.
I am willing to look at individual studies in the JMPT, but I will determine what conclusions can be drawn from the results rather than paying attention to what conclusions the authors drew.
Linda