It is WRONG to claim that chiropractic cures things that are not clinically indicated, but it is also wrong to claim that chiropractic has no evidence.

Fact 1 – vertebral artery dissection leading to stroke is an unfortunate side effect to extension of the neck in already unwell patients, and has been proven to be just as likely to occur when going to the hairdresser or any movement invloving extension of the neck. Because of this chiropractor’s neck adjustments DO NOT involve extension of the neck. Incidence of stroke after chiropractic are about 0.01% and are due to individual chiropractors having poor technique.

Fact 2 – Chiropractic degrees are 4 or 5 years long and go through accreditation with universities. They also include plenty of clinic training. If they use Xray, it is because they have learnt imaging as part of the course. Seriously people, if they didn’t have rules and regulations, the profession would have been destroyed a long time ago.

Fact 3 – Chiropractic is within the NICE guidelines and is clinically indicated for GP’s to refer in a whole host of musculoskeletal conditions. These conditions have plenty of decent evidence. Other conditions for which chiropractic might be clinically indicated for in the future are very difficult to prove given the nature of treatment, and may well be proven in time. Remember that the nature of evidence is such that it includes ALL evidence availible to the practitioner ranging from RCT’s to clinical experience. Medical doctors use drugs which aren’t first line in the guidelines due to previous good experiences with said drugs.

I won’t go into any more as many of you are far too ignorant to understand. If I can just get through to one person, maybe it will stop people being so short sighted.

How much have you actually studied the subject from a non-biased standpoint? Looked at the research rather then just some dude’s book? He HATES chiropractors. This makes him biased.

Rant over,
Ed

http://www.webmd.com/hypertension-high-blood-pressure/news/20070316/chiropractic-cuts-blood-pressure?page=2

This refers back to post # 50 on this page.

He would say that Chiropractics could help fix a lot of things and might be able to cure a few things but was certainly not a cure all.

Were he alive I think he would be rather upset at the BCA’s behavior.

Perhaps they could adjust themselves, as chiropractics may cure hysteria, insanity and stupidity.

I can only share my experience.
Several years ago I experienced a loss of sensation and motor control in my left arm over a period of several months. I went to my primary care physician, who examined me, prescribed some anti-inflammatories, and said if the situation didn’t resolve itself he’d consider exploratory surgery on my shoulder. My response was “No way are you doing EXPLORATORY surgery anywhere NEAR my neck!”

On the recommendation of a friend, I went to her chiropractor the next day and explained the situation. He examined me, probing my neck, spine, shoulder and arm with hands and other tools. He then took a couple of x-rays and another type of scan (something to measure muscle tension, IIRC), then told me “Let me look at these. Come back tomorrow morning and we’ll talk.” He made no promises of a remedy.
I whimpered in pain, and he said to take whatever pain-killer and anti-inflammatory I needed, but he wouldn’t do anything until he’d reviewed the scans.
I was back the following morning, and my left arm was almost useless. I could barely move it, and couldn’t feel light sensations.
The chiropractor showed me the x-rays and pointed out 3 items, the primary one being the C5 vertebrae. It was clearly not in line with the rest of my neck, and appeared to be pinching the nerve controlling my left arm. The muscle scans appeared to back this up, with the muscles around the area showing significantly more tension than elsewhere.
The chiropractor then explained what he planned to do, and the results he expected. I concurred, and gave him permission to manipulate the vertebrae back into alignment. He then proceeded to gently pull and twist my neck, at the same time pushing on the vertebrae with his thumbs. After about 30 seconds, there was a very brief, sharp, pain in my neck, a “pop” sound, and I felt my left arm come alive and tingle as though plugged into an electrical socket. The chiropractor continued to massage and manipulate my neck and back, and much of the stress I was experiencing seemed to fade.
I had a massage and a manipulation performed twice a day for a week, then twice a week for 2 weeks, then once a week for a month, then he said “It looks like your muscles aren’t pulling your vertebrae out of alignment any more. Come back when/if you feel out of sorts.” I didn’t go back for over a year, and I’m pretty sure C5 wouldn’t have been realigned “on its own”.

Chiropractic isn’t for everybody. But it worked for me. YMMV. Be an informed consumer. Extraordinary claims require extraordinary proof. My chiropractor doesn’t make any claims that I consider unwarranted, and specifically tells me what it CAN’T do.

It raises an important issue.

The whole notion of evidence-based medicine is relatively new. Track back references to the term and you will find that it rarely appeared more than 20 years ago.

This really reflects that fact that that much medicine practiced before then really did not come with the full scientific evidence that we now demand.

In other words, medicine is a latecomer to real science, with its demands for peer review and do on.

What we see now is a bunch of medics finally realising that they purveyed bogus remedies for years. (Leeches anyone?) They are now rounding on the quacks who now use the same approach that was once central to conventional medicine.

Maybe the BCA is just a few years behind the medics in demanding evidence for treatments. Unfortunately, the late conversion of “reputable” medicine to scientific evidence makes it hard to take them as seriously as their case deserves. There is still a lot of stuff coming out of the likes of the BMA that makes not much scientific sense.

Think of all those doctors who refuse to wash their hands enough to stem the onslaught of MRSA. Evidence based medicine is irrefutable. But the sawbones are still too lazy of arrogant to pay attention.

What I think is interesting is that many published peer reviewed studies have demonstrated that well over 50% of medical practices are not supported by scientific evidence.

OK, first off, this is unconvincing without some citations.

However, you do raise an important point: how much of current mainstream medical practice is supported by actual data? 30 years ago, I might have believed your figure of 50%. Now, not so much.

I do not know if you are old enough to have heard of thalidomide (but I’m sure Wikipedia can help you out there), but all new medical procedures and treatments introduced to the market since about 1960 have required trials to demonstrate three things:
(1) Safety;
(2) Efficacy;
(3) That they are at least as good as the current treatment (e.g. just as effective but with fewer side effects, or the same side effects but more effective, or whatever – it depends on the treatment).

So, in 2009, I would guess that most of the treatments carried out as part of mainstream medical practice do have a basis in actual evidence.

And, yet it appears that many in the public are demanding that the chiropractic profession supply 100% scientific proof.

Not 100%. Just proof that it does what they claim. Some hard evidence would be better than what they have now.

I have family members that have been saved from surgery thanks to “unscientific, bogus” chiropractic care.

Too little detail. What were the actual conditions involved here?

And remember, there actually is some evidence that chiropractic can treat back and joint problems.

Is it “scientific” for the drug Vioxx to have killed over 25,000 people?

What a bizarre question.

The big pharma company that made Vioxx has been demonstrated to have behaved unethically in their promotion of that drug. (This affair is discussed in Ben Goldacre’s Bad Science.) It does not exemplify correct modern medical practice.

Why hasn’t Singh thrown stones at the medical profession who annually performs 2.4 million unnecessary surgeries at the cost of 11,900 lives?

Erm … well, maybe he does. Have you tried looking up his articles?

And, again, without a citation your figures could have been plucked from the air.

It’s much easier to pick on a small profession perhaps.

This does not make him wrong about the BCA.

The BCA promotes chiropractic as a treatment for various conditions for which there is no evidence whether it works or not. The BCA, as the professional, organised figurehead of chiropractic in the UK, has a duty of care to know whether what they promote actually does what they claim. IN short, Singh was right about them.

You are cherry picking some of my statements and ignoring others.

Not true. I addressed the larger proportion of your post.

You are making presumptions based upon your opinions and biases.

Also not true. This is, in fact, what you have been doing.

The key point here, my dear Dr Rosenberg, is that (for the most part) chiropractic is not supported by evidence. Now, as several people will readily acknowledge, there is some evidence that chiropractic may be of benefit in treating back and jointy issues. However, the BCA, which is the official body of chiropractic in the UK, has supported all sorts of wild claims about chiropractic, without the slightest bit of evidence to support it.

I never used the word “subluxation” in my post and I don’t use that word with my patients.

I never said you did – but many other chiropractors do use that word, and the BCA supports its use. Many chiropractors use it as a term to “explain” how what they do is supposed to fix problems. But it is merely a cover for ignorance.

Surprised?

Not really.

You have to understand that there are very different types of chiropractors today.

I understand that there is no standard chiropractic, but I am not familiar with its sub-types. However, the BCA is the professional organisation for all chiropractors in the UK. If any chiropractor has a problem with how their profession is viewed by the public, the BCA is largely responsible.

There is the group I suspect you are ranting against. They are against research and anything medical. There is a smaller but growing group who are very interested in research and validating how what we do works.

Well, in that case you guys really need to get your house in order.

In the meantime, I suggest you write to the BCA and tell them exactly what you think of the unsupported claims thay make for chiropractic.

We can’t make up for the lack of research.

Agreed.

We can only move forward and in the last 10-15 years we have made great strides in this area. There have already been major studies done that validate chiropractic care but you seem to ignore them for some reason. If you think they’re “useless” please point to a specific study and explain what exactly is “useless” about it. Until then you’re just stating a groundless opinion with nothing to back it up.

Please cite where these studies have been published in peer-reviewed journals.

This is truly “unscientific”.

Well, it would be if I were wrong.

However, I have never seen any defender of chiropractic able to cite a controlled double-blind trial that shows a benefit from chiropractic exepct in cases of back or joint problems.

Are you going to be the first?

I stated that I have good working relationships with respected MDs in the community. For five years I specialized in pain management with a team of physicians. I don’t expect to see patients forever and don’t want them to be “addicted” to me. I don’t sell long term care plans. I stated that chiropractic research is lacking and why, but that it has been gaining ground in the last 10-15 years because we recognize the need for it. I compared chiropractic with medical training and how similar they are today.

Again, you seem to be demonstrating that you are the exception among chiropractors.

Most importantly I asked you guys to explain to me your understanding of some basic anatomy, neurology, and physiology but you conveniently ignore that.

Seriously, there is not time or space here for me to discuss my understanding of such things. And they are entirely OT anyhow.

However, if you are trying to say that chiropractors shouldn’t be expected to understand how what they do works, you are wrong. Even if I cannot explain connections between chiropractic manipulations and supposed changes in symptoms, I don’t need to because I’m not trying to sell a treatment. As a person selling medical intervention, you should either have evidence that it works, or at the very least a sound theoretical basis for how and why it should work. You seem to have neither.

Furthermore, if you wish to complain about us ignoring your questions, perhaps yuou can set an example by not ignoring questions asked of you . . . ?

Failing that, did you want to be the pot, or the kettle?

Until you can answer these questions I have nothing more to discuss with you. Here goes again:

See if you can come up with a relationship between the brain, spine, joints, muscles, and the rest of the body. Tell me how joint mechanoreceptor function plays a role in one’s health. Explain to me how having fixated joints would cause a global decrease in function. Tell me about the relationship between structure and function.

This is all irrelavnt. I don’t offer any kind of medical intervention for a fee.

The real issue is twofold:
(1) That the BCA touts chiropractic as a cure for many ills where there is no evidence of it having any benefit whatever;
(2) That many chiropractors do not inform their customers of the risk of stroke associated with certain kinds of cervical manipulation.

Be honest. Keep it positive. Be informed.

Perhaps you should be honest with yourself, too. There are many things claimed by chiropractors with no evidentiary support at all. No-one here is criticising you specifically; rather the criticism is levelled at chiropractors in general and the BCA in particular.

However, you defence of chiropractic in general has been unconvincing. You have not cited evidence that chiropractic is a successful treatment for (for instance) colic. You have not expounded a sound theoretical basis for chiropractic. While you point out that you do not use the term “subluxation”, neither have you denounced its use among chiropractors in general.

Additionally, you have claimed that your anecdotes are the equivalent of real evidence, which indicates a lack of understanding of the standards of evidence required in modern medicine. Without an experimental control, your anecdotes are no more than post hoc ergo propter hoc.

ummm,the brain, spine, joints, muscles, and the rest of the body are clonally derived from pluripotent embryonic stem cells, that’s one relationship. How about the CNS (brain and spinal cord) directs the PNS (nerves outside CNS) to contract muscles which cause bones to pivot on joints and move the body. I’ve a degree in biochemistry and a decade as an academic neuroscientist so I can list some more if you wish. I also know enough to call BS when someone claims that chiropractic manipulations can remove subluxations to increase nerve connections thereby freeing up the immune system to attack invaders, to paraphrase another poster here.

As my old enzymology professor Dr. Chan used to say, “Structure is function”. For your other questions, please specify which mechanoreceptor(s) and a ‘global decrease in function’ of what?

I agree with your assertion that mainstream chiropractors are against research and anything medical. A minority have at least some understanding of the need for proper research and you appear to be in the group. The ‘useless’ data comment was based on your claim that you knew it worked based on your personal observations rather than controlled scientific analysis. Yes, I am assuming that most chiropractors do not have a system in place for long term follow-up or controlled studies. You did suggest that you’ve heard about a “small but remarkable study” that supports your contentions, but no reference was provided.

When you complain about a lack of funding for research you start to sound like all the other apologists for the multibillion dollar ‘alternative’ health industry. Get every chiropractor to chip in $100 and you would have enough for a first class trial. Try some fund raising.

“There have already been major studies done that validate chiropractic care but you seem to ignore them for some reason.”

Yes, some temporary pain relief can result from some chiropractic manipulations. That does not validate most of the outrageous claims that are common in the field. Or are you saying that studies have validated the notion that chiropractic care can prevent cancer? I know where to look and I haven’t read that!

Also, when a patient feels better after a manipulation that does not mean the your particular explanation of the underlying mechanism is correct. You understand that don’t you? Physical contact with a member of your species is very therapeutic in a number of settings. Google ‘Robert Sapolsky’ if you want to learn more.

Let’s look at this evidence: not ONE chiropractor has EVER applied to win the million dollars that the James Randi Educational Foundation has had on offer for more than ten years now.

Could be that chiropractors don’t claim “paranormal, supernatural, or occult power”s as you state on your webpage, http://www.randi.org/site/index.php/1m-challenge.html

You are cherry picking some of my statements and ignoring others. You are making presumptions based upon your opinions and biases.

I never used the word “subluxation” in my post and I don’t use that word with my patients. Surprised? You have to understand that there are very different types of chiropractors today. There is the group I suspect you are ranting against. They are against research and anything medical. There is a smaller but growing group who are very interested in research and validating how what we do works. We can’t make up for the lack of research. We can only move forward and in the last 10-15 years we have made great strides in this area. There have already been major studies done that validate chiropractic care but you seem to ignore them for some reason. If you think they’re “useless” please point to a specific study and explain what exactly is “useless” about it. Until then you’re just stating a groundless opinion with nothing to back it up. This is truly “unscientific”.

I stated that I have good working relationships with respected MDs in the community. For five years I specialized in pain management with a team of physicians. I don’t expect to see patients forever and don’t want them to be “addicted” to me. I don’t sell long term care plans. I stated that chiropractic research is lacking and why, but that it has been gaining ground in the last 10-15 years because we recognize the need for it. I compared chiropractic with medical training and how similar they are today.

Most importantly I asked you guys to explain to me your understanding of some basic anatomy, neurology, and physiology but you conveniently ignore that. Until you can answer these questions I have nothing more to discuss with you. Here goes again:

See if you can come up with a relationship between the brain, spine, joints, muscles, and the rest of the body. Tell me how joint mechanoreceptor function plays a role in one’s health. Explain to me how having fixated joints would cause a global decrease in function. Tell me about the relationship between structure and function.

Be honest. Keep it positive. Be informed.

Dr. Rosenberg

The problem is that you chiropractors don’t understand why we scientists consider your evidence to be useless. What about the patient in pain who comes to a DC, receives no benefit (perhaps some harm) and just never returns? You don’t see them everyday but they still exist, you just ignore them. How many of your patients belong to that group who claim great benefit but have to return for treatment on a regular basis? Interesting psychology there but hardly evidence for any “cures” from the treatment.