MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Daniels and Vogel recently published an article entitled “Consent in osteopathy: A cross sectional survey of patients’ information and process preferences” (INTERNATIONAL JOURNAL OF OSTEOPATHIC MEDICINE 2012, 15:3, p.92-102). It addresses an important yet woefully under-researched area.

I find most laudable that two osteopaths conduct research into medical ethics; but the questions still are, does the article tell us anything worth knowing and is it sufficiently rigorous and critical? As the journal does not seem to be available on Medline, I cannot provide a link. I therefore take the liberty of quoting the most important bits from directly the abstract here.

Objective: To explore and describe patients’ preferences of consent procedures in a sample of UK osteopathic patients.

Methods: A cross sectional survey using a new questionnaire was performed incorporating paper and web-based versions of the instruments. 500 copies were made available, (n = 200) to patients attending the British School of Osteopathy (BSO) clinic, and (n = 300) for patients attending 30 randomly sampled osteopaths in practice. Quantitative data were analysed descriptively to assess patient preferences; non-parametric analyses were performed to test for preference difference between patients using demographic characteristics.

Results: 124 completed questionnaires were returned from the BSO sample representing a 41% response rate. None were received from patients attending practices outside of the BSO clinic. The majority (98%) of patient respondents thought that having information about rare yet potentially severe risks of treatment was important. Patients’ preferred to have this information presented during the initial consultation (72%); communication method favoured was verbal (90%). 99% would like the opportunity to ask questions about risks, and all respondents (100%) consider being informed about their current diagnosis as important.

Conclusion: Patients endorse the importance of information exchange as part of the consent process. Verbal communication is very important and is the favoured method for both receiving information and giving consent. Further research is required to test the validity of these results in practice samples

The 0% response-rate in patients from non-BSO practices is, of course, remarkable and not without irony. In my view, it highlights better than anything else the fact that informed consent rarely appears on the osteopathic radar screen. In a way, this increases the praise we should give the two authors for tackling the issue.

The central question of the survey is whether patients want to know about the risks of osteopathy. This is more than a little bizarre: informed consent is not an option, it is a legal, moral and ethical obligation. It seems therefore odd to ask the question “do you want to learn about the risks which you are about to be exposed to?”

Even odder is, I think, the second question “when do you want to receive this information?” It goes without saying that informed consent has to happen before the intervention! This is what, common sense tells us, the law dictates and ethical codes prescribe.

There is general agreement amongst health care professionals and ethicist that verbal consent does suffice in most therapeutic situations, that patients must have the opportunity to ask questions, and that informed consent also extends to diagnostic issues. So, the questions referring to these issues are also a bit strange or naive, in my view.

The article might be revealing mostly by what it does not address rather than by what it tells us. It would be really valuable to know the percentage of osteopaths who abide by the legal, moral and ethical imperative of informed consent in their daily practice. To the best of my knowledge, this information is not available [if anyone has such information, please let me know and provide the reference]. Assuming that it is similar to the percentage of UK chiropractors who obtain informed consent, it might be seriously wanting: only 45% of them routinely obtain informed consent from their patients.

Another issue that, in my view, would be relevant to clarify is the nature of the information provided by osteopaths to patients, other than that of serious risks associated with spinal manipulation/mobilisation. Do they tell their patients about the evidence suggesting that osteopathy does (not) work for the condition at hand? Do they elaborate on non-osteopathic treatments for that disease? I fear that the answers to these questions might well be negative.

Imagine a patient being told that there is no good evidence for effectiveness of osteopathy, that the possibility of some harm exists, and that other interventions might actually do more good than harm than what the osteopath has to offer. How likely is it that this patient would agree to receiving osteopathic treatment?

For most alternative practitioners, including osteopaths, informed consent and most other important ethical issues have so far remained highly uncomfortable areas. This may have a good and simple reason: they have the potential to become real and serious threats to their current practice and business. I suspect this is why there is so very little awareness of and research into the ethics of alternative medicine: “best not to wake sleeping lions”, seems to be the general attitude.

The survey by Daniels and Vogel, even though it touches upon an important topic, avoids the truly pertinent questions. It therefore looks to me a bit like a fig leaf shamefully hiding an area of potential embarrassment.

And where do we go from here? I predict that the current strategy of alternative practitioners to ignore and violate medical ethics as much as possible will not be tolerated for much longer. Double standards in health care cannot and should not survive. The sooner we begin addressing some of these uncomfortable questions with rigorous research, the better – perhaps not for the practitioner but certainly for the patient.

115 Responses to Informed consent is a serious threat to osteopaths and other alternative practitioners

  • Edzard Ernst wrote: “Another issue that, in my view, would be relevant to clarify is the nature of the information provided by osteopaths to patients, other than that of serious risks associated with spinal manipulation/mobilisation. Do they tell their patients about the evidence suggesting that osteopathy does (not) work for the condition at hand? Do they elaborate on non-osteopathic treatments for that disease? I fear that the answers to these questions might well be negative.”

    It seems that Professor Ernst’s fears regarding osteopaths are somewhat underscored by the UK General Chiropractic Council’s chiropractor-friendly definition of ‘evidence based care’ which apparently does nothing to prevent chiropractic prejudices from flourishing. See http://tinyurl.com/b9fm29f

    Indeed, such ‘misinformed consent’ seems to be a fairly common sales tactic among alternative practitioners…

    Quote
    We just came across a fancy patient information form that was given to a patient after an assessment by a clinician. The form just blew our minds (but not in a good way) because it seemed to be the perfect clinical tool for generating ongoing pain and disability, and all by the simple process of ramping up the fear. So, just for fun, we thought we’d take you through it…Page 2 “Your nervous system controls everything”… The terrifying consequences of subluxations…The “Spinal Decay Report” Oh my goodness my spine is crumbling!…What is wrong with giving patients detailed information? Absolutely nothing but ultimately information should be accurate and empower the patient to make good decisions. The problems here are legion.”
    http://bodyinmind.com.au/misinformation-patient-back-pain/

    In addition to the above, it’s also worth remembering that *practitioner forgery* on consent forms is on record http://tinyurl.com/bdt2yrx

    Finally, with regard to risks of treatment, it would seem that alternative practitioners are prone to evading non-compliance by abusing the concept of ‘therapeutic privilege’:
    http://rheumatology.oxfordjournals.org/content/43/5/666.2.full

    To me, it’s all about not losing customers in order to perpetuate lucrative livelihoods. I’m not sure how the situation can be resolved.

  • the situation can only be resolved by first of all increasing awareness of the problems that clearly exist. at present, hardly anyone seems to know that alternative practitioners are disregarding essential concepts of medical ethics on a daily basis. my first publication on the ethics of alt med dates back to 1996 http://www.ncbi.nlm.nih.gov/pubmed/8863142 !! some ethicists have now noted the problem and are beginning to write about it. NHS decision-makers have to follow suit and regulators must address the MISINFORMED CONSENT that seems to be the rule in alt med and violates patients’ rights.

  • “the situation can only be resolved by first of all increasing awareness of the problems that clearly exist. at present, hardly anyone seems to know that alternative practitioners are disregarding essential concepts of medical ethics on a daily basis.”

    In 1993 I conducted my first audit of completion of documentation in Medical Records. One criteria I looked for was that “informed consent should be recorded as sought and given for treatment”

    Ok some times the information was sparse as in ” patient information leaflet given” or the slightly better “Patient OK with plan” but the indication that informed consent for treatment had been recieved was present in 87% of all medical notes and information on treatment given was in 95% of nursing discharge checklists.

    The sparsity was noted, and procedures put in place to address the issue and increase the quality of the content. (“e even designed a steroid warning card specifically for asthmatic paediatric patients on the dangers of childhood illnesses such as measles and chicken pox when using steriods) This information was seen as a human right for our patients. It was our duty to tell them. As arrogant as some medical staff could be, not one was so arrogant as to believe he/she had the right to treat patients with the lack of humanity to do otherwise.

    Until the issue of informed consent is addressed in alternative treatments, Practitioners have no comeback against terms such as Fraud, Charlatan Snake oil salesmen and far far worse.

  • Consent is not just an issue in CAM, no one told me that I might loose all sensation in my hands and feet from chemotherapy all they mentioned was tingling and reaction to cold. I now know it happens to 30% of patients and some never get the feeling back, my doctors did not want to add to the stress of being treated for stage 3 rectal cancer and scare me further. I have taken the view they are doing their best to help me and will not pursue it even if I never get all the feeling back. In the US parents get far more information on the risks from vaccination in the VIS sheets than the do from the red book in the UK, where they only mention irritation on the site of the injection and crying.

    Regarding the risks from manipulation, Dont you think that this could be determined by the level of skill of a practitioner and one should be guarded making generalisations from case studies or anecdotes as Blue Wode has. If a surgeon has a shaky hand and injures a patients does this mean all the skilled surgeons with steady hands are dangerous and surgery should be avoided.

    I have been in Kingston upon Thames almost 20 years, I am fairly well known here. I can say with confidence I, me Richard Lanigan has never hurt anyone, my children, family, friends, or clients. No one has ever complained of being hurt, so what should I tell patients based on your “evidence”; there was this guy in Canada or a guy in the US who over extended and rotated a womens neck who presented at his clinic, then this lady experienced a stroke soon after the manipulation. Bearing in mind that every five minutes someone in the UK will have a stroke and although ten risk factors have been identified, not one of them is manipulation. If I had client who was “high risk” of stroke who presented with neck pain, I would make every effort to ensure a stroke was not in progress before manipulating their spinal joint, because I can imagine the reaction if I failed to pick it up and subsequently manipulated her spine. The fact is there is no causal evidence of a relationship with spinal manipulation and stroke. I am sorry, I am not convinced that I am causing people to have strokes as you believe and that I need to warn them of this risk. If I thought for a moment that there was a significant risk of me hurting people never mind killing them, I would not do it. Its laughable that you guys believe that I am prepared to risk the life of my children and clients for money, when I could make much more money renovating houses full time.

    • I have been in practice for 25 years and can say the same. I trained at the European College of Chiropractic in Bournemouth which opened its doors in 1965. In 48 years there has not been one serious incident. And that is where students provide chiropractic care. A quick calculation: approx 4.2 miilion patient visits without incidence. Now that is an impressive safety record in anybody’s book. (except Prof Ernst of course)

    • There is European Medicines Agency where you can find any authorised drug, including chemoterapy agents, and read about side effects and more.
      Yes, doctors are not perfect, but it does not mean chiropractors and osteopaths never hurt their clients.

  • SECTION 1. NEW LAW A new section of law to be codified in the Oklahoma Statutes as Section 161.21 of Title 59, unless there is created a duplication in numbering, reads as follows:

    Chiropractic physicians in this state shall obtain informed, written consent from a patient prior to performing any procedure that involves treatment of the patient’s cervical spine and such informed consent shall include the risks and possible side effects of such treatment including the risk of chiropractic stroke.

    SECTION 2. This act shall become effective November 1, 2013

    i got this information from Jann J Bellamy [thanks Jann]

  • Oklahoma, is that the place they can carry guns into the clinic? So let me try again with a question.

    “Regarding the risks from manipulation, Dont you think that this could be determined by the level of skill of a practitioner and one should be guarded making generalisations from case studies or anecdotes as Blue Wode has. If a surgeon has a shaky hand and injures a patients does this mean all the skilled surgeons with steady hands are dangerous and surgery should be avoided?

    • Richard Lanigan wrote: “If a surgeon has a shaky hand and injures a patients does this mean all the skilled surgeons with steady hands are dangerous and surgery should be avoided?”

      You are forgetting that surgery is normally of profound benefit to patients. Neck manipulation, on the other hand, is of negligible benefit and there are catastrophic risks associated with it.

      • Surgery is normally beneficial to patients but it also has catastrophic risks associated with it. Focusing on risk, as insurance companies do, let’s take a look at professional indemnity insurance. For doctors and surgeons an annual premium would be somewhere between five and twenty THOUSAND pounds. As an osteopath, my annual premium is still under three HUNDRED pounds for ten million pounds of indemnity. Now what does that tell you? I rest my case.

        • have you heard about the concept of risk and benefit?
          yes surgery is associated with risks, but what are the benefits? almost every simple appendectomy is a life-saving operation. how many osteopaths have saved a life? surgeons have to take risks to save lives and have to pay high insurance premiums as a consequence. osteopaths have no or very few effective treatments which carry relatively few risks. so they pay far less for insurance.
          the case that you want to rest is no case – it merely displays your embarrassing naivety.

        • I got endometrial cancer at the age of 34 and had to undergo hysterectomy. Surgeon damaged bladder, vesicovaginal fistula developed, actually, by the time of reconstruction a big part of bladder had simply rotted away, but everything went well. And, since cancer was stage I, I did not need any other treatment.
          So, big bad oncogynecologist (because urologist after all saved me)? Or just anatomy ? – bladder placed close top the uterus+ I was much younger than her usual patients (with decent muscle tone)…..

        • Of course, there were osteopaths and other quacks (well, I would not have gone to them, but many do) threatments of which may have turned out to be harmless (though not necessarily), byt they would also be completely useless against cancer.

  • Absolutely not true. The usual misleading statements made by the so-called ‘sceptics’ The risk of surgery is huge eg 1 million deaths per annum worldwide whereas chiropractic care is effective and extremely safe. 2 strokes in 10 million. Unbelievable the lack of integrity displayed by sceptics!

    • the risk of surgery??? you are such an alround expert, aren’t you? there is anything from appendectomy to full facial re-construction, from coronary bypass to pulling an ingrown toenail. 200 years ago, an appendicitis was a near death sentence. i am afraid you are talking out of your proverbial!

    • Hundreds of people die worldwide every year in collisions involving ambulances. I think we should have teams of stretcher-bearers to ensure that patients are transported in a low-risk environment.

      Yes, people die during surgery. Some surgeries have very high death rates. As part of the informed consent process, patients are told this. The choice is usually between certain death in the next few months, or surgery with a potential to provide significant life extension but with a risk of death during surgery.

      The benefits of chiropractic manipulation are about the same as for any form of manual therapy, the risk of stroke is essentially unique to chiro. Under those circumstances it would be insane to choose chiropractic neck manipulation over a less extreme manipulative therapy.

      As an aside, the term “manipulative therapists” seems strangely apt…

      • Well Guy you seem to have demonstrated your total lack of understanding of chiropractic with your post above. The ‘ risk’ of chiropractic you are referring to is 2 in 10 million….in other words hardly any risk at all. To put that into a context the risk from spinal surgery (not life saving surgery) is 200 000 in 10 million…….now that is what I call a RISK. When one considers the rate of failed back surgery is extremely high….more than 50% ….we can see that the risk vs benefit is called into question.
        You seem to make the common mistake thinking that chiropractic=manipulation. This is not true. There are plenty of chiropractic techniques that do not use manipulation to correct the function of spinal joints. The risk with these techniques is even less….. negligible

        Your statement “the risk of stroke is essentially unique to chiro.”……..please provide the evidence.

        • ER: 2:10 000 000? this is as much of a guess as the figure of 1: 30000 that i could quote. the reason: there is no adverse-effect monitoring system in this area, as you should know. so stop misleading the readers of this blog.

          • ‘there is no adverse-effect monitoring system in this area’…….so then how do you know it is so dangerous….something you just made up to mislead readers? Anecdotal evidence I guess….totally acceptable in EBM when it comes to alt med no doubt and chiropractic especially.

          • case-reports [anecdotal evidence] are important in any type of health care when it comes to assessing risk.

          • Eugen: So how do you know it’s safe?

            But there is a chiro incident reporting system, isn’t there? I’ve asked you this before, but you didn’t answer. Perhaps you could answer now?:

            How many incidents have been reported to CPiRLS?

        • @ Eugen Roth

          Re your request for evidence that the risk of stroke is essentially unique to chiro, see fig.2 here:
          http://ptjournal.apta.org/content/79/1/50.full

          • BW: Thank you for the link. ‘One hundred seventy-seven published cases of injury reported in 116 articles were reviewed. The cases were published between 1925 and 1997. The most frequently reported injuries involved arterial dissection or spasm, and lesions of the brain stem. Death occurred in 32 (18%) of the cases’. So we are talking about 32 deaths in 72 years. Taking into account that there are about 80 000 chiropractors in the USA alone we can see that the incidence of injury due to cervical spinal manipulation is extremely low. Lets say if we average it out over 72 years and we take 20 000 chiropractors each doing 30 cervical manipulations per day, 220 working days per year for 72 years. What do we get: 930 million cervical manipulations and 32 deaths in 72 years………do you call this a significant risk.

          • BW: I asked the Prof a question which he has refused to answer. I wonder what your opinion is:

            Is it beneficial for a patient to have spinal joints free from aberrant biomechanics?

          • Alan: Richard answered. Could not see why you needed the question answered twice. I cannot answer how many incidences have been reported but if you had read my previous posts you would have seen for example that the Anglo European College of Chiropractic where I studied was founded in 1965 and to this day not one serious event has occurred. A rough calculation show after more than 4 million manipulation done by students who have not attained the level of a skilled chiropractor yet, no injuries. As usual no amount of evidence will suffice. Sceptics refuse to accept any evidence that shows chiropractic to be safe and effective but will accept any evidence to ‘alt med bash’.

          • Eugene

            My question was: “How many incidents have been reported to CPiRLS?”

            This seems to be the only reporting system in place (unless you can tell us of another?), so if you don’t know how many incidents have been reported (nor, presumably, any other details about any incidents), how do you know chiropractic is safe? Do you want me to take your word for it? Maybe you are very safe and maybe there have been no serious events at the AECC, but how do you extrapolate that to all other chiros? Or is that just what someone there told you?

            But why do you just say ‘not one serious event has occurred’? Are you aware of minor ones, perhaps? Is there a system for recording minor adverse events?

    • Here is a file about major causes of death just in EU, so it seems 1 million is not so much. In addition what exactly do you mean? Mistakes, negiligence? Or just deaths? Because there are really wery risky opperations, especially if patient is fat, diabetic, smoking (all ar any of these). And then there is ignoring reccomendations. I am not a surgeon, but, being a patient I have seen plenty of those who eat before surgery, stuff themselves after, especially with products they are not allowed to eat, do not walk despite they are told to, smoke despite they are told not to….
      Surgeons are not perfect but they do wonders, and everything they do has real results, not just couple of soreness followed by the same life with disease as before.

  • In fact the latest research from Canada proves that chiropractic procedures to the cervical spine do not place any undue mechanical stress to the Internal Coratid artery….no more than the normal range of motion. But you try to misrepresent the facts by scaremongering in order to create fear amongst the public. This clearly is not in the public interest especially when one considers the risk of medical treatments…..197 000 deaths per annum due to iatrogenic causes in the USA only. NSAD kills about 20 000 people per annum. Come on BW where are the ethics?

    • another reminder: it’s the risk/benefit ratio that counts. please try to improve your understanding of the fundamental concepts of health care.

  • Blue Wode stated “You are forgetting that surgery is normally of profound benefit to patients. Neck manipulation, on the other hand, is of negligible benefit and there are catastrophic risks associated with it”.

    You are missing the point I was making as illustrated by the Pediatric surgeons in Bristol ten years ago. Some procedures that were safe in a skilled hand became down right dangerous in an unskilled hand. Neither of you are being very “scientific” making these generalizations about the risk from a procedure based on a number of anecdotes when there are so many factors which could have led to the risks you refer to. In Bristol the problem was not surgery, it was an unskilled surgeons. I have no problem stating some chiropractors are not skilled, the irony being most end up doing research about the very activity they were not good at.

    I have over 5,000 patient files in my practice and would have performed a neck manipulation on every single one of them and never had a complaint. You seemed to be suggest in your comments about the Bolton, Thiel, study that patients did not complain because they may have died as there was no follow up in that study to see if patients were still alive after neck manipulation. From your research how many of my clients do you estimate had a stroke after manipulation. Most of my 5000 client files are from Kingston upon Thames and presumably would have been rushed to Kingston Hospital. So if you give me your estimate, then I could send Kingston Hospital a list of my patients and ask them to see how valid your guestimate is.

    • there could, of course, be another reason for the lack of complaints: dead patients usually do not return to your clinic. i am not trying to be funny – the absence of any equivalent of a post-marketing surveillance has to be considered in virtually all alt med.

  • OK, so how many clients do you believe have died at my hands, or had a stroke post manipulation 100, 50,10,1. Presumably you would like to be sure of what you are taking about and whether the anecdotes you refer to are a result of spinal manipulation. I am more than happy to cooperate in any study and I am 100% confident it would demonstrate that not one of my clients have ended up in Kingston hospital after having their neck manipulated?

  • Heart Rate Variability is a very important indicator of health. Chiropractic has a positive effect on HRV and therefore health (not disease treatment). I think it is important to clear a common misconception. The critics of chiropractic say that chiropractors claim to treat disease. I think this is the result of confusing the medical term ‘disease’ (meaning pathology) and the chiropractic term ‘dis-ease’ (meaning lack ease and/or co-ordination in the nervous system). In a state of ‘ease’ messages are sent to and from the brain effectively and normal physiology manifests. However in a state of ‘dis-ease’, maybe caused by stresses of various kinds (Selye), the quality of the messages to and from the brain are negatively effected and this has a negative effect on physiology. As we know the quality of this nerve transmission is essential for health to manifest…….The QUALITY of healing is directly proportional to the functional capability of the Nervous System to send and receive nerve messages. Janson Edwards MD Phd.

    • again wrong: heart rate variability is an interesting surrogate outcome measure; its relevance to heath is still uncertain.
      what you say about “the quality of the message to and from the brain” is speculation or, to be blunt, nonsense.
      the notions and definitions about disease does not absolve you from showing that what you do to patients generates more good than harm.

      • The Prof said: ‘ “the quality of the message to and from the brain” is speculation or, to be blunt, nonsense’. However it seems you are wrong…some quotes for you:

        Gray’s Anatomy states: “Every organ, system and function of the human body is under direct control of the central nervous system”

        “An intact nervous system will lead to optimum functioning of the human body”
        Dorland’s Medical Text

        “Hyper functional or Hypo functional neurons along a neural chain prevent normal nerve transmission causing disturbances in the homeostasis of the cells, tissues and organs.”
        Dr. T. N. Lee
        Academy of Pain Research

        The QUALITY of healing is directly proportional to the functional capability of the Nervous System to send and receive nerve messages. Janson Edwards MD Phd.

        So Prof it is clear that chiropractic improves brain function, improves nerve transmission, improves autonomic nervous system homeostasis (confirmed by improved HRV) and therefore improves health and quality of life.

        • you relly should learn how to read my responses properly; what i did say was: “WHAT YOU SAY ABOUT THE QUALITY OF THE MESSAGE….”
          do you really think i don’t know that organs are under the control of th CNS? it is what you and other chiros make out of this, that is nonsense.

  • Well just a short search about the significance of HRV as a health indicator reveals the following: Results of our occupational studies on the
    association of basic types of autonomic cardiovascular control (assessed by HRV) with non-specific
    morbidity revealed significant correlations between abnormal autonomic cardiovascular control and diseases
    which include in their etiology autonomic dysfunction (e.g., diabetes, hypertension, neuroses, ulcer duodeni,
    and autonomic disturbances) [Nikolova et al, 2003].
    http://ftp.rta.nato.int/public//PubFullText/RTO/MP/RTO-MP-HFM-108///MP-HFM-108-18.pdf
    Regarding your rant – ‘“the quality of the message to and from the brain” is speculation or, to be blunt, nonsense’……I do not accept at all. Your lack of knowledge regarding chiropractic is becoming more and more evident. If HRV improves the patient benefits……like it or not.

  • I see you deleted my post with a reference showing that HRV is a good indicator of health….interesting and also very disappointing!!
    Regarding the nervous system’s role in the disease process here is some more info which I am sure you will delete as well:
    Med Hypotheses. 1994 Nov;43(5):285-302.
    Thalamic neuron theory: theoretical basis for the role played by the central nervous system (CNS) in the causes and cures of all diseases.
    Lee TN.
    Source
    Academy of Pain Research, San Francisco, CA 94132.
    Abstract
    The Thalamic Neuron Theory (TNT) postulates that the central nervous system (CNS) is involved in all disease processes, as the CNS not only processes incoming physical and chemical information from the periphery, it also sends out physiological commands to the periphery in order to maintain homeostasis for the entire body. Inherent in its capacity to learn and adapt (i.e. to habituate) is the CNS’ ability to learn to be sick (pathological habituation) by looking in certain deranged central neural circuitries, leading to chronic disease states. These pathologically habituated states can be reversed by dehabituation through manipulation or modulation of the abnormal neural circuits by physical means (physical neuromodulation) like acupuncture, or chemical means (chemoneuromodulation) such as Chinese medicine, homeopathy or other modern medical techniques in a repetitious manner to mimic the habituation process. Chemoneuromodulation can also be achieved by delivery of minute amounts of pharmacological agents to specific sites in the periphery such as the acupuncture loci. It is hypothesized that humoral and neurotrophic factors and cytokines could be highly effective neuromodulating agents. TNT assumes the blue print for embryological development is embodied in the phylogenetically ancient part of the brain. This primordial master plan, organized in the form of a homunculus, possibly encased in a small nucleus, retains control over the subsequently evolved parts of the brain so that the entire CNS functions like a composite homunculus which controls the physiological functions of the entire body. TNT further postulates that the master homunculus takes the shape of a curled up embryo with its large head buried close to its pelvic region, with its large feet and hands crossed over to the contralateral sides. Neuronal clusters along a neuronal chain in the homunculus represent acupuncture points in the periphery. The neuronal chain itself represents a meridian and Chi is nothing more than the phenomenon of neurotransmissions. Certain new theoretical concepts such as the principles of Adynamic Stat and Bilaterality are also presented. Many difficult to explain clinical observations in modern medicine, Chinese herbal medicine, acupuncture and homeopathy can now be adequately explained using TNT. Based on this model, new therapeutic techniques can be launched to combat a whole host of intractable diseases.
    http://www.ncbi.nlm.nih.gov/pubmed/7877522

  • do you know what a theory is?

  • The point about the post mentioning Thalamic NeuronTheory was just to illustrate that chiropractic is not based on some weird ideas dreamt up by a son of a grocer who practised magnetic healing in 1895 (so did many medical doctors…Mesmer). You seem to want to create an idea that the practice of chiropractic is not based on any scientific principle but on some kind of ‘weird stuff’. Anyway a little quote for you: “To understand HEALTH is to understand the central role of the brain and the nervous system in maintaining the resistance of the body. HEALTH MAINTAINENCE is the PRIMARY function of the brain not educated thoughts, language, poetry and other functions usually associated with the brain.” – Robert Ornstein Phd and David Sobel MD

  • it’s called a THEORY for good reason: it is not accepted knowledge and it is not for clinical routine.

  • So Prof what you advise somebody with depression to do? Go see their GP and get Prozac or go to the health food store to buy tryptophan, essential fatty acids and get some exercise, eat a healthy diet, meditate……taking your favourite risk vs benefit into consideration.

    http://www.youtube.com/watch?NR=1&v=z_XFfdkJXnM

    • the very first post on this blog set out the ground rules – please read them; here are some important points:

      Before we start discussing some of the the issues around alternative medicine, let me establish a few ground rules for the debates on this blog. I do like clearly expressed views and intend to be as outspoken as politeness allows. I hope that commentators will do the same, no matter whether they agree or disagree with me. Yet a few, simple, principles should be observed by everyone commenting on my blog.

      Libellous statements are not allowed.

      Comments must be on topic.

      Nothing published here should be taken as medical advice.

      All my statements are comments in a legal sense.

      Conflicts of interest should always be disclosed.

      I will take the liberty of stopping the discussion on any particular topic, if I feel that enough has been said and things are getting boring or repetitive

      so, this means i will not give medical advice and you should stay with the subject of the post.

  • Well Prof one cannot disagree with you that civil behaviour is required on your blog. However, I find that some what hypocritical as you refer to chiropractors as being quacks, frauds, unethical, unscientific, money grabbers, etc. You basically use every word imaginable to discredit chiropractic, you do not acknowledge anything positive about this profession, misrepresent the ‘dangers’ of chiropractic to scare the public by using emotive phrases like ‘chiropractic causes arteries in your neck to disintegrate (resaerch shows this to be a fallacy) but you expect chiropractors to sit back without any defence of their profession. What makes the situation even more difficult to accept that you seem to have taught Spìnal Manipulative Therapy to medical doctors in Germany who practise ‘chirotherapie’ which you call quackery! How is this possible? The truth is that the vast majority of chiropractors are very well educated, practise in an ethical way, have their patients’ wellbeing at heart, continue with ongoing education in order to serve their patients in an even more effective way, strive through scientific investigation to understand the mechanism by which chiropractic works eg the effects of chiropractic care on the brain, nerve transmission, the autonomic nervous system and even the immune system, etc. But you relentlessly attack chiropractic by misrepresenting the facts in order to discredit chiropractic in the eyes of the public. If you carried out these actions against an individual you would most probably be sued for slander but you call an ethical dialogue!

    • i am glad you agree with the “ground rules”. however, they also include to stay on topic! this is clearly off topic.
      i will respond nevertheless and ask you where exactly i posted anything libellous on this blog. i am not aware of such statements. yet, if you search the internet, you find plenty of libellous statements by chiros about me – and you managed to post several as well, i think. so, in future, let’s keep it clean!

  • OK…so agree not to label chiropractors as quacks. unethical, fraudsters offering bogus treatments. So lets have a constructive dialogue. To do so you would have to acknowledge something beneficial about chiropractic. Can you think of anything?

  • i probably could, but i do not like to be pressurised into statements by you or anyone else.

    • Lol……excellent……ok….what about a big ‘please’.

      So in your opinion what do chiropractors need to do to ‘clean up their act’.

  • thus far and you haven’ t read the post? Its about informed consent. Implement it. Practice it. Before you touch a patient. Sound rules for all! (or answer on topic why you think Chiropractors should be exempt.)

    • ER never stays on topic; i have asked him several times. he prefers to persue his very own agenda of white-washing chiropractic.
      SO EUGEN, HOW ABOUT IT? WHY DO CHIROS DO OFTEN NOT OBTAIN INFORMED CONSENT?
      DOUBLE STANDARS? UNETHICAL BEHAVIOUR?

      • You see Prof there you go again…..UNETHICAL BEHAVIOUR?…….why do you hate alt med so much and chiropractors and homeopaths in particular especially as you were involved in both of those disciplines for a large part of you life?

  • I think Richard answered that for you. Anyway as far as I know they do…….. (Strawman?)

  • Not a strawman, its the topic of the post. Who are “they”? not my question. I ask “you” directly. “What do you do”? “do you think or believe that Alt practitioners should be exempt from seeking informed consent.? Please stay on topic. I am politely asking you YOUR opinion. I will form my opinion on whether your behavior is unethical from your response.

  • Your opinion of me is irrelevant. Anyway have a nice day.

  • Hey Prof,

    The patient appears to be suffering from an inability to focus on house rules and a surplus of passive aggressive responses. I have heard this condition has been described in certain journals as “Trollish.”

    A compassionate response to this affliction, (certainly holistic, definitely could be individually targeted, and integrated with other areas) could be the creation of a quarantine ward on your blog where these behaviors can be managed more appropriately.

    I know there are one or two commentators here who may relish the challenge of managing the conflicted outpourings these poor sad individuals can be afflicted with

    This will leave a cleaner, happier community to discuss the important issues.

    Happy to apply for the role of Matron;-)

  • Prof, my grateful thanks for this blog, No I am not a medic, (queue Troll attack) but I have the right to good, informed evidence, so that I can make good, informed choices. Yours is a voice that’s vital to the discussion – like wise, the voices of the dissenters are also important, for comparison purposes :-))

    This space is important for patients, important for all who value evidence over marketing. My choices are also made by my assessment of the intellectual integrity of both sides of an argument, thus my opinion of the debaters “is actually” relevant. (since to the Prof, I’m a patient – to ER I’m a customer – ex )

    Under no circumstances would I entertain the idea of visiting a chiropractor again. Nor allow a family member to. My friends who do use chiropractors are starting to challenge themselves as to why, and I will continue to support informed choice as a basic right with all of them. If I needed further convincing then the responses from ER have settled the matter. I feel sorry for Richard as I think he is quite genuine, but Pilates helps me as much as a chiropractor ever did and I get a months course for the price of a 15 min treatment. Yup I know before anyone says it, anecdote is not evidence.

    One more chance ER. Do you think that I, as a patient/customer have a right to know the risks of a treatment you propose. I know the Prof thinks I have the right to know about risks for a treatment he would propose. Careful, There may be more customers lurking here thinking their opinion “is” relevant.

    • Sue your condescending tone is quite nauseating to be honest. Do I inform patients about the ‘risk’. Yes. Well if you call the risk of stroke from chiropractic care being 2 in 10 million a risk. To put that into a context the risk of spinal surgery is 200 000 in 10 million. So to bang on about the risk of chiropractic is ridiculous and just scaremongering.
      In my case I do not use manipulation but an instrument called ‘Impulse’……so the risk is even less……in other words almost none. I explain the risk of driving to my practise is greater than the risk of my chiropractic care.
      Before you start attacking the science behind the ‘Impulse’ let me inform you it is FDA approved and has CE certification. Apart from that it is based on research some of which was published in one of the most prestigious medical journals namely SPINE.
      http://neuromechanical.com/index.php?option=com_wrapper&wrap=Research&Itemid=79

      http://news.neuromechanical.com/neuromechanical/news/post/Chiropractor-Presents-Cervical-Spine-Biomechanics-Research-at-International-Orthopedic-Conference.aspx

      I note your prejudiced attitude towards chiropractic. Are you aware that Prof Ernst who you hold in such high regard actually taught this ‘dangerous quackery’ (in your and the esteemed Prof Ernst’s opinion) to hundreds of medical doctors in Germany and Vienna. This ‘quackery’ that he taught is called ‘Chirotherapie’ which about 5400 German medical doctors practise and are re-imbursed by the German state. You should ask Prof all about it especially about his happy times in Vienna.

      Sue I love the ingratiating comments directed at my colleague, Richard, no doubt trying to make him look a good guy and me a nutter. You play every mind game in the book. I also love your veiled threats.

      Hey Prof you really have brought the Big Guns in!!….Lol

      • you do cite odd sites here pretending they constitute evidence!
        you are also proclaiming lies yet again: i never said or wrote that i taught “hundreds of med students” in hannover and vienne spinal manipulation – mainly because i didn’t.
        THIS IS THE LAST TIME I POST ONE OF YOUR COMMENTS THAT CONTAIN SUCH OVERT FALSEHOODS!

        • OK…you were the head of the department then….splitting hairs.

          • telling lies is not splitting hair!!!
            i was head of dept ok; but we did not run courses for med students on spinal manipulation.
            gosh, it is tiresome to correct your falsrhoods!!!!
            would it not be easier to stop them?

    • sue wrote: “This space is important for patients, important for all who value evidence over marketing…My friends who do use chiropractors are starting to challenge themselves as to why, and I will continue to support informed choice as a basic right with all of them.”

      Your friends are quite right to question the quality of care that they are receiving from their chiropractors, not least because it is apparent that the regulator for chiropractors in the UK, the General Chiropractic Council (GCC), is not fulfilling the main part of its remit – i.e. its duty to protect patients. For example, its guidance on the Vertebral Subluxation Complex (2010) stated the following:

      Quote
      “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. Chiropractors are reminded that:

      …when practising, the care they “select and provide must be informed by the best available evidence, the preferences of the patient and the expertise of practitioners…” (GCC Code of Practice and Standard of Proficiency: effective 30 June 2010; section S3.2)

      …when advertising, claims for chiropractic care “…must be based on best research of the highest standard” only. (GCC Guidance on Advertising, March 2010)

      However, it should be noted that the above has no bearing on chiropractors’ scope of practice.
      Ref: http://tinyurl.com/av3yyaj

      Indeed, the GCC has allowed quack practices such as craniosacral therapy and applied kinesiology to fall within its definition of evidence-based care:
      http://jdc325.wordpress.com/2009/06/09/incompetence-and-the-general-chiropractic-council/

      Does anyone else think that this leaves the GCC open to accusations that it is protecting the livelihoods of chiropractors rather than the welfare of patients?

  • I am trembling in anticipation………nicely wrapped up ad hom Sue!!

  • I did not use any ad hom in my response to you however I did use sarcasm about your response in my note to the Prof. I apologise for this it should be beneath me.

    I asked you for your answer to a straight direct question relevant to the topic. Your response was a classic. No you did not respond to the question, you patronised and ignored me. This is the action of a troll. I did not patronise you in response, I explained why in your market place your assessment of my opinion is incorrect.

    You did not know that I am not now nor ever been a medic or nurse. I have however seen, in a conventional hospital setting where I worked for 6 years, just how dangerous, to the patient, the clinicians, and the reputation of the hospital the lack of informed consent and the difficulty of monitoring the outcomes can be. I hold conventional medicine to a VERY high standard. People may have expected me to be on the side of Alt medicine given my background.

    But I cant hold alt practitioners to the same standard because in terms of process, I believe that Alt Med is Just. Not. There. I do, however expect practitioners to begin the dialogue, and actually welcome the initiative Edzard describes in his original post. Even if its flawed in structure, Alt Practitioners can take it, shape it, improve it till it becomes meaningful. The dialogue begins? Why are you so strongly opposed?

    Yup I am but a small fish in a very big pond Eugene, This is my preference. If you like, I can resurrect contacts from my time on the council of the Patients Association and ask them if they too feel that Patients voices are indeed, in this discussion, irrelevant. This is not a veiled threat. It would be just a considered response. Its the reality of the sound of the Patients Voice. I ask you very politely to listen. I really believe that forums like this are perfect platforms for learning. I also ask that you share with the forum the excellent results that I believe you obtain from the Listening To Patients I know you must do. There is much to learn for Conventional Medicine in this. (See “the immorality of medicine by D J Weatherall)

    Not a big Gun,I am a very small fish. I really dont care what your opinion is of me. However, one last thing. I did NOT infer, call or in ANY way imply that you are a “nutter” I NEVER would. this is entirely your interpretation and you are entirely wrong.

  • Prof Ernst said: “telling lies is not splitting hair!!!
    i was head of dept ok; but we did not run courses for med students on spinal manipulation.
    gosh, it is tiresome to correct your falsrhoods!!!!
    would it not be easier to stop them?”

    Fair enough and I apologise. However in my defence I asked you on numerous occasions to clear up the question whether you taught SMT. You chose to be evasive.

    • so when you don’t know something, you take the liberty of assuming. i do not accept any more apologies from you for misleading the readers of this blog. you have done this too often!

    • Well done, Eugen Roth. I came here reasonably open minded, and have now formed an opinion that Chiropractics should not be trusted untill they accept, build and maintain full and honest accountablility. Well done you.
      I find that anyone who uses the phrase ‘Big Pharma’ without irony is posessed by a particular mindset, and is unable to make balanced and informed medical decisions.

      Please don’t bother replying; I won’t be engaging in conversation.

  • Eugen Roth wrote: “…we can see that the incidence of injury due to cervical spinal manipulation is extremely low”

    No we can’t. It is only the tip of the iceberg as chiropractors have either no – or very unreliable – adverse event reporting systems.

  • Euten Roth wrote: “Is it beneficial for a patient to have spinal joints free from aberrant biomechanics?”

    Depends what you mean by ‘aberrant biomechanics’. Degenerative disc disease is common in most people over 40, and very often without any symptoms. Pain from sprains and strains normally resolves in time, and for the remaining MSK disorders, physiotherapists are available to help with them without the quackery baggage and unnecessary treatments that are associated with most chiropractors. For an unfortunate few patients, there will be no relief and they will have to resort to coping tactics. IOW, chiropractors are surplus to requirements.

    • Ok so what you are saying is that only physiotherapists can deal with aberrant biomechanics of spinal joints. Strange because research has shown physio to be no better than placebo and in some cases even prolong healing time.

      • Which research, because exercises under guide of qualified physiotherapist strengthen muscles that holds spine, thus improving posture, also make coordinatination better…. It is real effect.

  • BW: This is quite funny….you dont accept your own reference that you provided, namely, http://ptjournal.apta.org/content/79/1/50.full

    Which shows 32 deaths in 72 years. Statistics show us that 142 000 children died in the last 20 years due to childhood vaccinations but you are concerned about the ‘devastating’ effects of chiropractic care, namely, 32 deaths in 72 years, Come on BW!!

  • @ Eugen Roth

    It’s actually far more than 32 deaths in 72 years. See the 10 pages of case reports (mainly attributed to chiropractors) in the following link. Again, they are likely to represent only the tip of the iceberg:
    http://web.archive.org/web/20061210090746/http://neck911.com/death.html

    As for vaccinations, the measles vaccine prevented 7.5 million deaths worldwide in the six years between 1999 and 2005
    http://www.ebm-first.com/vaccination-concerns/205-measles-deaths-tumble-by-60-worldwide.html

    How many deaths has chiropractic prevented?

    • Chiropractic saves plenty of lives….How?…..Well BW as you well NSAD kill about 20 000 per annum in the USA alone. Another commonly used drug, Vioxx, killed 60 000. Chiropractic is a drugless profession so the patients who use chiropractic care dont take these drugs that lead to countless deaths. And that BW is how chiropractors save lives.

      Or an example…….the risk of death from spinal surgery is 200 000 in 10 million. Many patients who were scheduled for spinal surgery no longer had to be exposed to this risk after chiropractic care. Another example how chiropractic saves lives. But equally important is that chiropractic care enhances quality of life.

      Hey Prof….your favourite mantra: Benefit must outweigh risk. The risk of death from spinal surgery is 200 000 in 10 million and 50% of spinal surgery fails. Is this an acceptable risk/benefit? Please comment.

      • Eugen Roth wrote: “Chiropractic saves plenty of lives….How?…..Well BW as you well NSAD kill about 20 000 per annum in the USA alone.”

        Re NSAIDs, for a true comparison with chiropractic spinal manipulation one would have to take into account the following:

        Quote:
        “1. No prospective randomized trial conclusively demonstrates that chiropractic management reduces the incidence of serious NSAID complications, such as fatal gastrointestinal bleeding.

        2. NSAIDs taken at recommended doses for a short time are generally very low-risk for appropriately selected patients — particularly the relatively young not on corticosteriods, anticoagulants, alcohol or tobacco and without a history of ulcers or severe comorbid illness.

        3. Many patients continue to take NSAIDs while undergoing spinal manipulation. Moreover, spinal manipulation can frequently cause an exacerbation of pain, which might cause some patients to increase or initiate NSAID therapy. [Ref. Ernst E. Prospective investigations into the safety of spinal manipulation. Journal of Pain and Symptom Management, 21(3): 238-242, March 2001]

        4. Herbal recommendations seem to be common among DCs; some remedies have actions similar to NSAIDs, while others directly affect bleeding per se. A set of reports by the North American Spine Society includes an 18-page reference chart listing approximately 70 herbs with their uses, potential side effects, and (known) potential interactions.

        5. While side effects of low-back manipulation appear to be very uncommon, some chiropractic back-pain patients also receive neck manipulation, which entails additional risks.

        6. Manipulation is much more expensive than NSAID treatment. So if both are equally effective, manipulation would be much less cost-effective.”

        Ref: http://www.chirobase.org/18CND/03/03-03.html

        It’s also worth remembering that packets of NSAIDs contain Patient Information Leaflets detailing risks. However, it is evident that not all chiropractors warn patients about the risks associated with their manipulative treatments (which, if you remember, is what this blog post is highlighting).

        I would also venture that because the number of people taking NSAIDs is bound to be much higher than those receiving spinal adjustments, then NSAIDs are likely to be far safer. In addition to that, NSAIDs have been proven to work and their adverse effects are recorded and acknowledged:

        Quote:
        “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. 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.”

        I would recommend reading the whole paper from which the above quote was lifted:
        http://jrsm.rsmjournals.com/cgi/content/full/100/7/330

        Essentially, you seem to be saying that the failings in ‘alternative’ medicine should be exposed and corrected only after conventional medicine has put its house in order. That is not ethical.

        Eugen Roth wrote: “Another commonly used drug, Vioxx, killed 60 000.”

        Once again, I would remind you that:

        Quote:
        “Doctor-bashers use their numbers to argue that alternative medicine is safer. Maybe it is. I suppose not treating at all would be safer still. It depends on how you define “safe.” To my mind, a treatment is not very “safe” if it causes no side effects but lets you die. Most of us don’t just want “safe:” we want “effective.” What we really want to know is the risk/benefit ratio of any treatment.

        The ironic thing is that all the statistics these doctor-bashers have accumulated come from the medical literature that those bashed doctors have written themselves. Scientific medicine constantly criticizes itself and publishes the critiques for all to see. There is NOTHING comparable in the world of alternative medicine.

        When errors are identified, doctors take actions to prevent them. We are constantly trying to reduce the number of medication errors, the number of unnecessary surgeries, the overuse of antibiotics, etc. It’s one thing to say that more efforts are needed. It’s something else to condemn all of modern medicine because we imperfect humans have not managed to entirely eliminate all errors.”

        Ref: http://www.sciencebasedmedicine.org/index.php/death-by-medicine/

        Eugen Roth wrote: “Chiropractic is a drugless profession so the patients who use chiropractic care dont take these drugs that lead to countless deaths. And that BW is how chiropractors save lives.”

        Aren’t chiropractors in the US and the UK actively seeking prescribing rights at the moment? Also, please remember the following which is lifted from point 3 in one of the quotes above:

        Quote:
        “Many patients continue to take NSAIDs while undergoing spinal manipulation. Moreover, spinal manipulation can frequently cause an exacerbation of pain, which might cause some patients to increase or initiate NSAID therapy.”

        [Ref. Ernst E. Prospective investigations into the safety of spinal manipulation. Journal of Pain and Symptom Management, 21(3): 238-242, March 2001]

  • @ Eugen Roth

    Here’s a better link to those case reports (make sure you read the preamble):

    Significance of published case studies and case reports: Highest Neck Manipulation – Occiput to cervical one (atlas) and cervical one to cervical two (axis)
    http://web.archive.org/web/20060924185308/http://www.chirovictims.org.uk/images/Detailed%20database%20high%20neck%20manipulation%20reports.doc

    • BW….there is no such thing as risk-free. The ‘risk’ of chiropractic care is minimal compared to the risk of medical interventions. There has to be a level playing field. If we really want to know about risk all one has to do is look at the insurance industry. Risk is their business. If you compare the malpractice insurance of chiropractors in the USA where litigation is rampant you will find that chiropractors pay a fraction of what medical practitioners do. This to me is irrefutable evidence about the low risk of chiropractic care. It simple….if what you do carries a high risk then you pay a high malpractice insurance. If what you do carries a low risk then you pay a low malpractice insurance. I am certain that you will not accept this point either which demonstrates one thing to me – blind prejudice!

      BW you relentlessly bang on about the risk of chiropractic care and no amount of evidence will ever satisfy you.

      • Eugen Roth wrote: “…there is no such thing as risk-free. The ‘risk’ of chiropractic care is minimal compared to the risk of medical interventions.”

        What is it you don’t get about risk/BENEFIT assessments? See:
        http://www.ebm-first.com/chiropractic/the-meade-report-criticism/551-spinal-manipulation-for-the-early-management-of-persistent-non-specific-low-back-pain-mdash-a-critique-of-the-recent-nice-guidelines.html

        Eugen Roth wrote: “If you compare the malpractice insurance of chiropractors in the USA where litigation is rampant you will find that chiropractors pay a fraction of what medical practitioners do.”

        That’s because, unlike MDs, chiropractors are mainly dealing with non life-threatening conditions.

        • BW wrote: That’s because, unlike MDs, chiropractors are mainly dealing with non life-threatening conditions.”

          According to you chiropractic is life threatening. My point was that the ‘risk’ of chiropractic is reflected in the malpractice insurance that chiropractors pay which is low….low risk = low malpractice insurance premiums. Its not rocket science.

          • Eugen Roth: “According to you chiropractic is life threatening.”

            Yes, it is life-threatening when chiropractors are being unethical – i.e. there is no need to manipulate the cervical spine when there are safer, cheaper and more convenient options available. Nor does the cervical spine need ‘adjusting’ to correct mythical ‘subluxations’.

            Eugen Roth: “My point was that the ‘risk’ of chiropractic is reflected in the malpractice insurance that chiropractors pay which is low….low risk = low malpractice insurance premiums. Its not rocket science.”

            And my point was that chiropractors aren’t dealing with very sick patients and they don’t use invasive techniques which carry substantial risks. Further, since chiropractic adverse event reporting systems are either non-existent or poorly utilised by chiropractors, insurance companies will possess very little data illustrating the risks.

          • Do you really think it wise to base your healthcare decisions on what insurance companies think?

          • If insurance company employees and regulationg authorities believe in chiropractics, this does not make it safe.
            And what is so complicated about risk/benefit ratio.
            Take e.g. those crying babies. Big, bad doctors will examine baby and tell mum that there is nothing to worry about, tell her not to use coffee and some other things if she is breastfeeding, maybe reccomend feneel or cummin tee…. thats it. And mom will calm down and realise her baby is absolutely normal.
            But chiropractor…..

  • BW wrote: ‘physiotherapists are available to help with them without the quackery baggage and unnecessary treatments that are associated with most chiropractors.’ …….Strange that you should say this as research shows physio to be no better than placebo and in same cases actually prolongs healing time.

    BW wrote: ‘chiropractors are surplus to requirements’………well millions of people around the world who visit chiropractors daily disagree with you. Most patients visit chiropractors as a last resort trying anti inflammatory drugs, muscle relaxants, painkillers and physio first. What this means is that chiropractors actually get the tough cases, the patients that medicine and physio failed and guess what? The vast majority of these patients are helped by their chiropractor. This explains why 80% of chiropractic patients are extremely satisfied with the care that they received from the ‘quackery’ that you call chiropractic. From your posts you seem to feel threatened by chiropractic so I guess that you are a physio.

    • Eugen Roth wrote: “…millions of people around the world who visit chiropractors daily disagree with you.”

      Millions of people around the world also swear by quackery such as homeopathy. It’s called the Argumentum Ad Populum logical fallacy: http://en.wikipedia.org/wiki/Argumentum_ad_populum

      Eugen Roth wrote: “Most patients visit chiropractors as a last resort trying anti inflammatory drugs, muscle relaxants, painkillers and physio first. What this means is that chiropractors actually get the tough cases, the patients that medicine and physio failed and guess what? The vast majority of these patients are helped by their chiropractor.”

      You seem to be ignoring many other factors, including self-serving biases. IOW, what about demand characteristics (e.g. the customer is unwilling to admit to having experienced poor outcomes if a great deal of time and money has been invested); the possibility that the condition may have run its natural course (i.e. self-limiting or cyclical ailments regressing to the mean); spontaneous remission; the placebo effect (enhanced by touch); the possibility that some allegedly cured or relieved symptoms were probably psychosomatic to begin with; and misdiagnosis.

      Eugen Roth wrote: “…80% of chiropractic patients are extremely satisfied with the care that they received from the ‘quackery’ that you call chiropractic.”

      FYI, chiropractic academics David Byfield, Susan King, and Peter McCarthy of the Welsh Institute of Chiropractic at the University of Glamorgan claim that it’s been shown that

      Quote
      “…patients are very pleased and satisfied with chiropractic care whether they get better or not”

      http://web.archive.org/web/20041215180456/www.familychiropractic.co.uk/news/Articles/article3.htm

    • BW wrote: ‘physiotherapists are available to help with them’. So in your opinion physios have the skills to deal with mechanical problems of the spinal column, this that correct?

      • It is correct. Exercise can prevent or at least postpone operation, and after operation it is absolutely essential to continue exercising. That is the difference: serious work to develop muscles and brief fiddling, leaving patient with the same body as before.

  • ‘ the customer is unwilling to admit to having experienced poor outcomes if a great deal of time and money has been invested); the possibility that the condition may have run its natural course (i.e. self-limiting or cyclical ailments regressing to the mean); spontaneous remission; the placebo effect (enhanced by touch); the possibility that some allegedly cured or relieved symptoms were probably psychosomatic to begin with; and misdiagnosis.’………..and none of this applies to medical practice?? Of course it does.

  • I am taking care of a medical doctor who is visiting me for various musculoskeletal complaints. I wonder which one of the above categories she fits into? Maybe ‘ relieved symptoms were probably psychosomatic to begin with’

  • All systems of thought are equally true and equally false,depending how you use them. You can use them in service to the ego or you can use them in service to truth.

    Which are you more interested in Alan? Your ego or the truth? Especially taking your ad hominem into account….
    ‘Good grief. You really understand so very little, don’t you?’

    I do not see much service to the truth by the sceptics on this blog. To me it seems alt med bashing is its purpose and not examining evidence.

    • Eugen you will probably be aware that Gordon W Allport studied the nature of prejudice and where it leads and produced his ‘Ladder of Prejudice’ in his book The Nature of Prejudice in 1954 (which is still available):

      1. Antilocution: Antilocution means a majority group freely make jokes about a minority group. Speech is in terms of negative stereotypes and negative images. This is also called hate speech. It is commonly seen as harmless by the majority. Antilocution itself may not be harmful, but it sets the stage for more severe outlets for prejudice. (e.g. Ethnic jokes)
      2. Avoidance: Members of the majority group actively avoid people in a minority group. No direct harm may be intended, but harm is done through isolation. (e.g. Social exclusion)
      3. Discrimination: Minority group is discriminated against by denying them opportunities and services and so putting prejudice into action. Behaviors have the specific goal of harming the minority group by preventing them from achieving goals, getting education or jobs, etc. The majority group is actively trying to harm the minority. (e.g. Jim Crow laws, Apartheid, Koreans in Japan)
      4. Physical Attack: The majority group vandalize, burn or destroy minority group property and carry out violent attacks on individuals or groups. Physical harm is done to members of the minority group. Examples are lynchings of blacks, pogroms against Jews in Europe and British Loyalists in the 1700s.
      5. Extermination: The majority group seeks extermination or removal of the minority group. They attempt to eliminate either the entire or a large fraction of a group of people

      It is so sad – and very worrying – that we still see all steps on this ladder in the world today. It starts with the first step and that is exactly where we must all work to prevent prejudice taking even one further step.

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