Crticism of Chiropractic

[Blue Wode]

There's been an interesting collection of responses to my posting to JJM:

1. The most egregious comment was the claim by "blue wode" that NCCAM spent $2.5 billion (LOL!) in 17 years. That was the total budget of NIH for all 27 instuitutes. The first year (1993?) the total alt-med budget was #1 million. WOW! I'm not sure how much clinical research you've done, but most trials I've seen budgets for were in the range of 1/4 to 1/2 million each, so how far would a million go?

Apparently the real cost is much higher:
http://www.sciencebasedmedicine.org/?p=341

 

[Blue Wode]

This is quite a revealing account of an undercover trip to a chiropractic clinic in the UK:
http://www.skepticat.org/2010/03/inside-the-spine-wizards-den/

IMO, it further justifies the heavy criticism that's repeatedly levelled at the chiropractic industry.

 

[fls]

2. I truly appreciated Linda's response. Your first point that The only conclusion which can be drawn from this study is that people who choose to visit a chiropractor tend to be quite different from the general population. may or may not be true.

It may or may not be true, but epidemiology 101 would tell you that it would be very foolish to assume that it is not.

And it is a prospective study.

Yes, prospective studies are one type of observational study.

As for your comments about the "subluxation complex", I didn't realize you expected me to "prove" it's existence. I'd prefer to leave that to the NIH and the research centers at our colleges.

Isn't that the point? Without evidence that there even exists something called the "subluxation complex", how is it not quackery to offer treatment based on an idea which is increasingly contradicted by advances in medical knowledge?

Observational versus experimental: Until the mid 90's MDs were blocked by the AMA and various other named medical sociaties from teaching, or conducting research with my profession. We were blocked access to any federal grant money to do research, and in fact the first 5 or 6 million granted to my alma mater Palmer college (in the late 90's) was primarily devoted to improving the infrastructure for research, and for funding some students to complete PhD study in epidemiology and public health. This is NOT a complaint....it's just background. Any research published and conducted previous to that was 100% funded by our federally un-subsidized schools. This is unheard of in the medical world, paying out of your own pocket to fund research.

Chiropractic was thought up long before medicine established its own evidence base. And the availability of federal funds for research is a relatively recent addition. Chiropractic had similar opportunities to take the path that medicine took when it comes to introducing a science-based approach. I agree that they are now at a disadvantage because they chose not to do so. But if, as you say, funds are tight, wouldn't it make more sense to make good use of those funds through the performance of studies which provide useful results, instead of performing studies like the observational study you first referred to, where no useful conclusions can be drawn? And this still doesn't explain why reasonable research is performed only to be ignored (such as the research which fails to show that chiropractic is effective against most tested conditions).

Also, self-funding of medical research is common, as well as making uses of non-federal sources of funds (non-profits/foundations, institutional funds, commercial sources) which should also be readily available to chiropractic.

As your comment "This evidence report does not support your assertion that the use of chiropractic in children is evidence-based. For one thing, that report was directed at manual therapies, not solely chiropractic therapies," I never said it was solely about chiropractic. Do you have compelling proof that neck pain, low back pain, or headaches in children is uniquely different than that experienced by aldults? I believe that was the point I was trying to make.

It should be. Adults suffer from different conditions than children and the causes of back pain are different. Also there are substantial differences in anatomy and physiology between children and adults - for example, the extent of ossification of the bones differs.

And the point about manual therapies is that there is no justification for chiropractic as a 'profession' if it doesn't offer anything specific to chiropractic, but simply represent therapies that are available through already well-established professions. You don't need a whole new 'profession' to offer advice to quit smoking, for example. Without "subluxation complexes", chiropractic at best simply represents a hodge-podge of advice and therapy culled from other professions. At worst, it is redundant and depends upon the promotion of a non-scientific approach to health.

Linda

 

[JJM]

... 1. The most egregious comment was the claim by "blue wode" that NCCAM spent $2.5 billion (LOL!) in 17 years. ...

All the chiros had to do to get some of the money was write a grant proposal that could compete with faith-healing and homeopathy.

... We were blocked access to any federal grant money to do research, ...

Not any longer.

Even so, there has been some good work done, and there's plenty more to do.

Where is it published. After all, in your business job #1 should be finding the elusive subluxation. So far, we only know it fictional. http://www.sciencebasedmedicine.org/?p=3022

You did have a research fund http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54144 "Over the foundation's history, volunteers contributed more than 33,000 articles and helped fund over 152 randomized, controlled trials concerning chiropractic manipulation, as well as supported over 100 research fellowships leading to MS and/or PhD degrees." Yet, no evidence for the subluxation.

 

[JJM]

There is a good article on chiros' bogus pediatric claims here:
http://www.sciencebasedmedicine.org/?p=4950

 

[BillyJoe]

...by a chiropractor!

 

[Tomblvd]

As for your comments about the "subluxation complex", I didn't realize you expected me to "prove" it's existence. I'd prefer to leave that to the NIH and the research centers at our colleges.

Subluxation has been the absolute foundation of chiropractic since day one, and that was over one hundred years ago. It's been taught as fact in every chiro school in existence, and most chiros still toss the word around as a given.

Shouldn't anyone who looks at this without blinders on find the fact that chiropractic subluxations have yet to be proven very, very disturbing, at the least?

 

[BillyJoe]

Subluxation has been the absolute foundation of chiropractic since day one, and that was over one hundred years ago...
...shouldn't anyone who looks at this without blinders on find the fact that chiropractic subluxations have yet to be proven

And there are now over a hundred definitions of "subluxation" in an attempt to obfuscate that fact.

 

[Dorian Gray]

The way to test it:
Take 1000 people. Put them all to sleep. Perform chiropractic techniques on half of them (called 'chiros'), randomly, double blind. Do nothing for the other half (called 'sleepers'). Wake them all up. Tell half the sleepers and half the chiros that they received nothing. Tell the other half of the sleepers and the other half of the chiros that they received chiropractic treatment. Ascertain the results.

If all the chiros report feeling better, improved, more functional, more mobile, totally boingy in the chakra, or whatever, while all the sleepers report feeling simply rested, then chiropractic is an objective technique, is verifiably beneficial, and therefore is medicine.

However, if the half that are TOLD they received chiropractic treatment feel better, while the half that slept feel simply rested, then chiropractic is mind-over-matter, psychosomatic, mental, etc., is a subjective technique, and therefore is not medicine.

 

[Dorian Gray]

Incidentally, is acupuncture a verified objective medicine? Or acupressure?

 

[Gord_in_Toronto]

The way to test it:
Take 1000 people. Put them all to sleep. Perform chiropractic techniques on half of them (called 'chiros'), randomly, double blind. Do nothing for the other half (called 'sleepers'). Wake them all up. Tell half the sleepers and half the chiros that they received nothing. Tell the other half of the sleepers and the other half of the chiros that they received chiropractic treatment. Ascertain the results.

If all the chiros report feeling better, improved, more functional, more mobile, totally boingy in the chakra, or whatever, while all the sleepers report feeling simply rested, then chiropractic is an objective technique, is verifiably beneficial, and therefore is medicine.

However, if the half that are TOLD they received chiropractic treatment feel better, while the half that slept feel simply rested, then chiropractic is mind-over-matter, psychosomatic, mental, etc., is a subjective technique, and therefore is not medicine.

But. But. Such a test would be very expensive. And the chiroquacks have only had a hundred years to set up such a test. These things take time you know.

 

[BillyJoe]

Incidentally, is acupuncture a verified objective medicine? Or acupressure?

No.

(But this thread is about chiropractic so I cannot elaborate without incurring the wrath of the anal retentives who keep our threads clean)

BJ

 

[Blue Wode]

The chiropractic subluxation: 1895–12 May 2010
RIP​

Obituary: The death of the subluxation
http://www.zenosblog.com/2010/05/obituary-the-death-of-the-subluxation/

UK General Chiropractic Council acknowledge that terms such as joint misalignment or dysfunction have the same meaning as subluxation. Simply using different terminology is not a get out clause:
http://skepticbarista.wordpress.com...s-we’ve-never-considered-the-research-part-2/

 

[Delscottio]

So where does this leave them? Sports massages? They havent got much left really.

 

[Blue Wode]

So where does this leave them? Sports massages? They havent got much left really.

It's interesting you should mention that. It was an issue that was highlighted back in 1976:

"If a chiropractor limited his practice to muscular conditions such as simple backaches, if he saw patients only on referral from medical doctors after medical diagnosis has been made, if he were not overly vigorous in his manipulations, if he consulted and referred to medical doctors when he couldn't handle a problem, and if he avoided the use of x-rays, his patients might be relatively safe. But he might not be able to earn a living."

http://www.chirobase.org/12Hx/hr76.html

In the UK, I suspect that chiropractors will be desperate to secure a large patient bank via NHS referrals now that they have NICE's dubious endorsement of their skills.
(See here for criticism of NICE's decision http://www.dcscience.net/?p=1516)

However, according to a flyer for a forthcoming chiropractic seminar in the UK, all is not well...

The aim of the meeting is to widen knowledge on issues around commissioning. A number of practitioners will have approached their local PCT only to be turned away. Our aim is to investigate ways of changing the PCT'S views, therefore improving the accountability and access to care for all patients, with musculoskeletal conditions especially back pain and, hopefully, create an environment where patients are seen in the appropriate place, by an appropriate person, for a particular condition and without a prolonged wait.

The NICE Guidelines are concerned with increasing the options GP's can give to patients, and improving the speed of access by increasing the amount and variety of treatment in the community. Little has happened since then. Investigating the inclusion of Chiropractors and Osteopaths into a possible Forum might bring a change to the current system.

http://www.colchiro.org.uk/gfx/uplo...Innovation - Are they synonymous, Taunton.pdf

I can't help thinking that they will have to reform under another name (so as to lose the quackery connotations of chiropractic) if they want to be accepted into mainstream healthcare.

 

[Blue Wode]

I wonder what the chiropractic industry will make of this:

GUIDANCE ON CLAIMS MADE FOR THE
CHIROPRACTIC VERTEBRAL SUBLUXATION COMPLEX

The chiropractic vertebral subluxation complex is an historical
concept but it remains a theoretical model. It is not supported by any
clinical research evidence that would allow claims to be made that it
is the cause of disease or health concerns.

Chiropractors are reminded that

 they must make sure their own beliefs and values do not
prejudice the patients’ care (GCC Code of Practice section A3)

 they must provide evidence based care, which is clinical
practice that incorporates the best available evidence from
research, the preferences of the patient and the expertise of
practitioners, including the individual chiropractor her/himself
(GCC Standard of Proficiency section A2.3 and the glossary)

 any advertised claims for chiropractic care must be based only
on best research of the highest standard (GCC Guidance on
Advertising issued March 2010)


May 2010
General Chiropractic Council
44 Wicklow Street
LONDON WC1X 9HL
T: 020 7713 5155
[email protected]
www.gcc-uk.org

http://www.gcc-uk.org/files/page_file/guidance_on_claims_for_VSC_May_2010.pdf

 

[Mojo]

"The preferences of the patient" constitutes evidence, does it?

 

[BenBurch]

"The preferences of the patient" constitutes evidence, does it?

My back problems are cured by threesomes with cute 20-Somethings. I suppose this means I can get a prescription for that?

 

[zeno2712]

My take on it: In Memoriam

 

[Lothian]

My back problems are cured by threesomes with cute 20-Somethings. I suppose this means I can get a prescription for that?

Even if you did what is the chance of you finding a Pharmacist who has 2 cute 20-Something rent boys in stock?


Incidentally the BCA’s last accounts were filed just over a year ago. I will keep an eye out for those ending Dec 09. Might make for some interesting reading.