MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Musculoskeletal and rheumatic conditions, often just called “arthritis” by lay people, bring more patients to alternative practitioners than any other type of disease. It is therefore particularly important to know whether alternative medicines (AMs) demonstrably generate more good than harm for such patients. Most alternative practitioners, of course, firmly believe in what they are doing. But what does the reliable evidence show?

To find out, ‘Arthritis Research UK’ has sponsored a massive project  lasting several years to review the literature and critically evaluate the trial data. They convened a panel of experts (I was one of them) to evaluate all the clinical trials that are available in 4 specific clinical areas. The results for those forms of AM that are to be taken by mouth or applied topically have been published some time ago, now the report, especially written for lay people, on those treatments that are practitioner-based has been published. It covers the following 25 modalities: 

Acupuncture

Alexander technique

Aromatherapy

Autogenic training

Biofeedback

Chiropractic (spinal manipulation)

Copper bracelets

Craniosacral therapy

Crystal healing

Feldenkrais

Kinesiology (applied kinesiology)

Healing therapies

Hypnotherapy

Imagery

Magnet therapy (static magnets)

Massage

Meditation

Music therapy

Osteopathy (spinal manipulation)

Qigong (internal qigong)

Reflexology

Relaxation therapy

Shiatsu

Tai chi

Yoga 

Our findings are somewhat disappointing: only very few treatments were shown to be effective.

In the case of rheumatoid arthritis, 24 trials were included with a total of 1,500 patients. The totality of this evidence failed to provide convincing evidence that any form of AM is effective for this particular condition.

For osteoarthritis, 53 trials with a total of ~6,000 patients were available. They showed reasonably sound evidence only for two treatments: Tai chi and acupuncture.

Fifty trials were included with a total of ~3,000 patients suffering from fibromyalgia. The results provided weak evidence for Tai chi and relaxation-therapies, as well as more conclusive evidence for acupuncture and massage therapy.

Low back pain had attracted more research than any of the other diseases: 75 trials with ~11,600 patients. The evidence for Alexander Technique, osteopathy and relaxation therapies was promising by not ultimately convincing, and reasonably good evidence in support of yoga and acupuncture was also found.

The majority of the experts felt that the therapies in question did not frequently cause harm, but there were two important exceptions: osteopathy and chiropractic. For both, the report noted the existence of frequent yet mild, as well as serious but rare adverse effects.

As virtually all osteopaths and chiropractors earn their living by treating patients with musculoskeletal problems, the report comes as an embarrassment for these two professions. In particular, our conclusions about chiropractic were quite clear:

There are serious doubts as to whether chiropractic works for the conditions considered here: the trial evidence suggests that it’s not effective in the treatment of fibromyalgia and there’s only little evidence that it’s effective in osteoarthritis or chronic low back pain. There’s currently no evidence for rheumatoid arthritis.

Our point that chiropractic is not demonstrably effective for chronic back pain deserves some further comment, I think. It seems to be in contradiction to the guideline by NICE, as chiropractors will surely be quick to point out. How can this be?

One explanation is that, since the NICE-guidelines were drawn up, new evidence has emerged which was not positive. The recent Cochrane review, for instance, concludes that spinal manipulation “is no more effective for acute low-back pain than inert interventions, sham SMT or as adjunct therapy”

Another explanation could be that the experts on the panel writing the NICE-guideline were less than impartial towards chiropractic and thus arrived at false-positive or over-optimistic conclusions.

Chiropractors might say that my presence on the ‘Arthritis Research’-panel suggests that we were biased against chiropractic. If anything, the opposite is true: firstly, I am not even aware of having a bias against chiropractic, and no chiropractor has ever demonstrated otherwise; all I ever aim at( in my scientific publications) is to produce fair, unbiased but critical assessments of the existing evidence. Secondly, I was only one of a total of 9 panel members. As the following list shows, the panel included three experts in AM, and most sceptics would probably categorise two of them (Lewith and MacPherson) as being clearly pro-AM:

Professor Michael Doherty – professor of rheumatology, University of Nottingham

Professor Edzard Ernst – emeritus professor of complementary medicine, Peninsula Medical School

Margaret Fisken – patient representative, Aberdeenshire

Dr Gareth Jones (project lead) – senior lecturer in epidemiology, University of Aberdeen

Professor George Lewith – professor of health research, University of Southampton

Dr Hugh MacPherson – senior research fellow in health sciences, University of York

Professor Gary Macfarlane (chair of committee) professor of epidemiology, University of Aberdeen

Professor Julius Sim – professor of health care research, Keele University

Jane Tadman – representative from Arthritis Research UK, Chesterfield

What can we conclude from all that? I think it is safe to say that the evidence for practitioner-based AMs as a treatment of the 4 named conditions is disappointing. In particular, chiropractic is not a demonstrably effective therapy for any of them. This, of course begs the question, for what condition is chiropractic proven to work! I am not aware of any, are you?

120 Responses to Usefulness of alt med for “arthritis” is very limited

  • I read this article, and the accompanying one on supplements, and found them very illuminating. I have lupus related arthritis and my rheumatologist advised me many years ago to try Omega 3 fish oils, and I was interested to see there was some positive benefits from that, as there was also for ginger and boswellia. I am generally skeptical about alternative therapies, but do feel there is a danger of throwing the baby out with the bathwater here. As someone who is unfortunately in the position of taking NSAIDS long term, anything that will allow me to safely reduce the dosage seems to me to be a good thing.

    So, as the skeptical saying goes, is the evidence for Omega 3 now sufficient for it to be considered to have made the move from alternative medicine to medicine?

    • omega-3, taken in sufficiently high doses inhibit inlfammatory processes via the prostaglandin pathway. therefore they are promissing for arthritis, however, i am not sure about the clinical evidence in relation to lupus.

      • Thanks for the reply. A quick google leads me to suspect that it works in the same way as NSAIDS and taken at high enough levels may well have the same gastric side effects.

  • You point out the dangers of complimentary therapies like chiropractic. Would you like to comment on the dangers of anti-inflammatory drugs like Vioxx that killed more than 60 000 people and caused many more people to suffer from heart related problems as a result of taking the drug? Also, statistics state that these type of drugs kill about 20 000 people per annum in the USA alone.

    I find it amazing that you are so concerned about the so called dangers of herbalism, homeopathy, chiropractic, etc but you turn a blind eye to the 100 0000 to 200 000 people (depending on what research you read) that the medical profession and their master the Pharmaceutical industry kill per year in their relentless drive to increase their mega profits by even more.

    I guess the reason why you choose not to see these facts is that one ‘cannot bite the hand that feeds you’.

    I know that medicine pretends to be ‘evidence based’ so I have included an article for your info despite that you will obviously dismiss it as rubbish. http://www,greenmedinfo,com/blog/evidence-based-medicine-coins-flip-worth-certainty [Link disabled by admin because of possible malicious software as flagged up by Google.]

    • So Prof I see you choose not to comment on the dangers of Vioxx and other non steroidal anti inflammatory drugs.Why? Double standards??However you are comcerned about Reiki and Alexander Technique!!!!

      • perhaps because alt med is my area of expertise?

        • Maybe you could spread your wings a bit??

        • or perhaps it’s off the market – which shows, i think, that post-marketing surveillance is effective [no such mechanism in chiropractic!]

          • Chiropractors dont kill 60 000 people with one single intervention. How many drugs have been withdrawn from the market in the last 15 years because they have been proven to be dangerous or useless. Please take into consideration that these drugs supposedly had gone through stringent ‘scientific’ procedures and FDA approval before being unleashed on the poor gullible man in the street. Why have Big Pharma had to pay BILLIONS OF DOLLARS in various lawsuits in the recent past? Why are vaccinations immune (forgive the pun) from prosecution? And you want us to believe this is science???? you got to be kidding.
            It turns out that not only is alternative medicine extremely safe and effective but it also saves lives. How? By keeping people away from dangerous drugs and surgery which kills millions!!

            But the public needs to saved from the dangers of Qi Gong and Hypnotherapy according to Prof Ernst. MMmmmm

  • I know as a scientist you like to weigh up all the evidence on both sides of the argument so I have included a link for you.

    http://www.youtube.com/watch?v=zSobxKv4Umk&feature=em-share_video_user

    The question arises: Which is more dangerous? Medicine or Complimentary Therapies? I wonder what the ethical answer is.

  • ER: the answer is quite simple: alt med is my field of inquiry!!! you sound like someone telling a neurologist off because he is not an oncologist. let me state it very clearly: EVERY TREATMENT THAT DOES NOT GENERATE MORE GOOD THAN HARM IS NOT FIT FOR PURPOSE. but if you think one can justify bogus treatments with the deficits in other areas of health care, you are mistaken. the fact that many people die in road accidents does not mean our trains do not need to be safe!

    • Strawman….I am not justifying any bogus treatments. This is totally misleading obviously trying to suggest that alternative therapies …..you practised one of those for 30 years…are all bogus. As usual the medical profession is trying to asume the position of authority as a smoke screen to divert the public attention away from who actually poses the greatest threat to their safety.

    • EVERY TREATMENT THAT DOES NOT GENERATE MORE GOOD THAN HARM IS NOT FIT FOR PURPOSE. Do you mean like Statin drugs, most psychiatric drugs and particularly chemotherapy in most instance?

  • EE: You can make up various rules to advance your one sided argument (in my opinion a witch hunt). However all treatments whether allopathic or alternative have some risk attached. So when you say chiropractic is dangerous causing the vertebral artery to disintegrate (research shows this to be a fallacy) leading to stroke (2 in 10 million) as a patient one has to compare the other treatment options available like spinal surgery (200 000 Deaths in 10 million) or take anti inflammatory drugs (Vioxx killed 60 000) and other non-steroidal drugs kill 20 000 per annum in the USA. As a patient one has to make a choice. If one applied your theories regarding the risk of alternative treatments to medical treatments then no medical treatments would be available. In other words you do not apply the same stringent rules to medicine. eg aspirin for cardiovascular disease prevention has been shown to be useless and dangerous, same with statin drugs. Selective Seratonin Inhibitor drugs like Prozac are also shown to be useless and dangerous. In fact they have been implicated in most of the mass killings in the USA and you are concerned about the safety of homeopathy and Bach Flower remedies – get real.

    Hope you enjoyed the movie.

    • Eugene, it’s you who needs to get real here, risk/benefit analysis is not a made up rule. The very drug you cite – Vioxx – was withdrawn because its benefits didn’t outweigh the risks. And the benefits were real and mesurable, not just wishful thinking.

      • Well Vicky you are wrong. In fact Vioxx is till on the market. Why? Let me inform you…the risk to patients’ lives are not relevant. What is relevant is $$$$$$$….billions of $$$$. So more people can die for Big Pharma to increase their mega profits. The only risk Big Pharma is interested in is how big the next lawsuit will cost them.

        A U.S. Food and Drug Administration advisory panel narrowly agreed Friday that Merck’s recalled drug Vioxx was safe enough to return to the market, and gave the regulatory green light to Pfizer’s Celebrex and Bextra.

        The panel voted 17-15 to allow Vioxx to come back to pharmacy shelves, but only if it bears a stern “black box” warning advising users that it can cause heart trouble in patients at risk of developing cardiac problems.

        17-15…you gotta be kidding!!!!

        • Vioxx is withdrawn. I don’t know about a FDA advisory panel (I’m not in the US), and even if they allow it to be sold again in the near future it’s still because of careful consideration of both risks and benefits. You claimed that was a made-up rule – it’s not.

          • Strawman arguement….I never claimed risk was unimportant. One person died from tzking Kava Kava and it was banned. 60 000 died from Vioxx which still is prescribed. …..And alternative medicine is the one that poses a huge risk to the public…ye right!!!!

          • You’re the one building the straw man: I said it wasn’t a made-up rule (which you claimed it was). And no, Vioxx is WITHDRAWN, you cannot get it anywhere (legally), you won’t get it prescribed and it’s not produced anymore.

  • the principle of risk/benefit analysis is not my “rule” but the basis for all good health care. what are the benefits of upper spinal manipulation [risk = stroke] and what are the benefits of aspirin, for instance [alleviation of pain, prevention of heart attackes vs GI-bleeding]. it is you who needs to get real, i.e. understand the very basics of medicine.

  • You persist with this nonsense about cervical manipulation causing stroke. No amount of evidence will satisfy you. Why??
    As a matter of interest – why does nearly every orthopaedic surgeon in Germany perform ‘Chirotherapie’ if it is so dangerous?

    http://www.ncbi.nlm.nih.gov/pubmed/23140796
    Internal Carotid Artery Strains During High-Speed, Low-Amplitude Spinal Manipulations of the Neck.
    Herzog W, Tang C, Leonard T.
    Source
    Killam Memorial Chair, Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Canada Research Chair (Tier 1) in Molecular and Cellular Biomechanics, Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Professor in Kinesiology, Medicine, Engineering and Veterinary Medicine, Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada. Electronic address: walter@kin.ucalgary.ca.
    Abstract
    OBJECTIVE:
    The primary objective of this study was to quantify the strains applied to the internal carotid artery (ICA) during neck spinal manipulative treatments and range of motion (ROM)/diagnostic testing of the head and neck.

    METHODS:
    Strains of the ICA (n = 12) were measured in 6 fresh, unembalmed cadaveric specimens using sonomicrometry. Peak and average strains of the ICA obtained during cervical spinal manipulations given by experienced doctors of chiropractic were compared with the corresponding strains obtained during ROM and diagnostic testing of the head and neck.

    RESULTS:
    Peak and average strains of the ICA for cervical spinal manipulative treatments were significantly smaller (P < .001) than the corresponding strains obtained for the ROM and diagnostic testing. All strains during ROM and treatment testing were dramatically smaller than the initial failure strains of the ICA.

    CONCLUSIONS:
    This study showed that maximal ICA strains imparted by cervical spinal manipulative treatments were well within the normal ROM. Chiropractic manipulation of the neck did not cause strains to the ICA in excess of those experienced during normal everyday movements. Therefore, cervical spinal manipulative therapy as performed by the trained clinicians in this study, did not appear to place undue strain on the ICA and thus does not seem to be a factor in ICA injuries.

    Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  • EE: You claim that acupuncture is nonsense as well as any other alternative therapy. However it seems that the most prestigious medical school in the world disagrees with you and even offers course in acupuncture as part of the education offered at Harvard.

    http://cme.med.harvard.edu/index.asp?SECTION=CLASSES&ID=00332317

    Please comment Prof.

  • Censorship is misrepresentation…….pathetic……a total lack of integrity. And ‘Prof’ that is exactly what you do…mispresent the facts and mislead the mindless.

  • i got interested in the question who is EUGEN ROTH and found him here http://www.quirovidasana.com/eugenroth.html
    he is a chiro who also offers reiki and hot stone massage in his practice. that might explain some of the above comments.

  • Hey Prof I am flattered that you took the time to visit my website. I hope you enjoyed it. You should check my FaceBook page too. You could become a fan you know.All you have to do is click on the ‘Like’ button. Maybe you will learn that chiropractic is not the ‘crazy stuff’ you get your followers to believe. By the way your post is misleading…I do not practice Reiki or Hot Stone Massage. You should try it as it is very relaxing…..better than taking a dangerous drug like Xanax.

    • i did not claim you practice reiki ot hot stone massage. try to read more carefully!

      • “he is a chiro who also offers reiki and hot stone massage in his practice. that might explain some of the above comments”

        Come on Edzard you implied it?? Eugen’s practice offers this service not him. Kingston hospital offers aromotherapy to cancer patients my surgeon would be furious if you were to say he offered Aromatherapy in the Cancer unit.

      • Eugen: Why is hot stone therapy provided at your clinic?

        • I do not know whether you are familiar with the work of Hans Selye (General Adaptive Syndrome) on stress and particularly on the ‘Fight or Flight Syndrome’ which results in Sympathetic Nervous System stimulation. Chronic stress can have a negative effect on physiology. So the reason to offer Hot Stone Therapy. Massage and Aromatherapy is to encourage relaxation and a quietening of the Sympathetic Nervous System. This does not sound like quackery to me as it is based on a sound scientific principle. It is not offered a treatment for any illness or condition – just as a relaxation technique.
          I have included a link for you: http://brainconnection.positscience.com/topics/?main=fa/selye

          • relaxation is a sound principle; finally you get something right!
            but does that mean any relaxing intervention is an effective therapy?

  • So in the perfect world according to Prof Ernst all alternative medicine should be banned. Did I get that right or am I being paranoid?

  • So the medical treatment for most arthritic conditions is a dangerous cocktail of drugs – NSAD, addictive painkillers, etc. lets now start talking surgery should we. Not evidence based at all and often no better than placebo (eg key hole surgery on the knee) and ofcourse extremely dangerous!
    Complications of surgical care have become a major cause of death
    and disability worldwide.
    Data from 56 countries showed that in 2004 the annual volume of major
    surgery was an estimated 187 million–281 million operations (3), or
    approximately one operation annually for every 25 human beings alive. This is a
    large and previously unappreciated volume with significant implications for
    public health. It is almost double the annual volume of childbirths—in 2006,
    there were approximately 136 million births (4)—and is at least an order of
    magnitude more dangerous. While the rates of death and complications after
    surgery are difficult to compare since the case mix is so diverse, in industrialized
    countries the rate of major complications has been documented to occur in 3–16%
    of inpatient surgical procedures, and the death rate 0.4–0.8% (5,6). Nearly half
    the adverse events in these studies were determined to be preventable. Studies in
    developing countries suggest a death rate of 5–10% associated with major
    surgery (7–9), and the rate of mortality during general anaesthesia is reported to
    be as high as 1 in 150 in parts of sub-Saharan Africa (10). Infections and other
    postoperative complications are also a serious concern around the world.
    Avoidable surgical complications thus account for a large proportion of
    preventable medical injuries and deaths globally. Adverse events have been
    estimated to affect 3–16% of all hospitalized patients (11–14), and more than half
    of such events are known to be preventable. Despite dramatic improvements in
    surgical safety knowledge, at least half of the events occur during surgical care
    (5,6). Assuming a 3% perioperative adverse event rate and a 0.5% mortality rate
    globally, almost 7 million surgical patients would suffer significant complications
    each year, 1 million of whom would die during or immediately after surgery.
    Surgical safety has therefore emerged as a significant global public health
    concern.
    http://www.gawande.com/documents/WHOGuidelinesforSafeSurgery.pdf

    • where did you learn all this? at chiro college? you should ask your money back! it seems to me that they mis-taught you.

      • I do not think so!! Unbelievable!! Paranoid…what a joke. At least I am not deluded. Of course alt med needs more research. But despite the billions of dollars given for medical research medicine and pharmaceuticals are extremely dangerous. In fact the research questions whether medicine does more home than good. Where as people who use chiropractic care long term use 50% less medication and surgery and enjoy good health.

        According to the Journal of the American Medical Association – On balance the data remains imprecise and the BENEFITS that the US health care currently deliver MAY NOT outweigh the aggregate health HARM it imparts.

        .In a recent review of retracted studies in the drug- and biomedical literature, drug studies were found to have the highest number of incidents of scientific misconduct. Nearly 75 percent of retracted drug studies were attributed to scientific misconduct such as data falsification, fabrication, questionable veracity, unethical conduct and/or plagiarism
        Scientific fraud is on the rise. According to the most recent data, the number of scientific retractions have climbed more than 15-fold since 2001
        According to a former drug company researcher, 47 of 53 landmark cancer studies published in the world’s top journals could not be replicated—a validation process that is essential to establish scientific merit
        Despite retractions, fabricated research may still inadvertently live on, as it may have been cited by numerous other studies and once a finding is accepted in the medical community, it’s difficult to flush out. Worse yet, according to a recent study nearly 32 percent of retracted papers were not noted as having been retracted by the journal in question, leaving readers completely in the dark………and you call this science??

        Yes I can see why you want to ban my comments. The truth makes you feel uncomfortable.

        • uncomfortable? not in the least! i am beginning to find you amusing – please carry on.

          • My God if this does not make you feel uncomfortable what does? I am glad you find me as entertaining as I find you and your friends…I see Blue Wode has also entered the fray. But I thought Blue Wode was actually Prof Ernst. Was I just being paranoid again? I obviously need my atlas adjusted to improve my brain function. Why?…because…. Dr Sperry MD, Nobel Prize Recipient for Brain Research states: ‘90% of the stimulation and nutrition of the brain is generated by the movement of the spine’. And guess what chiropractors do…..they correct spinal biomechanics…… Why?…..because…..
            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 now Prof you may be learning what chiropractic is really about and that it is indeed based on some real science. That is why Chiropractic is both effective and safe. By the way you have not mentioned which alternative therapies meet your requirements. I thought we were making spoe progress for a minute. So disappointing,

      • So Prof I noticed you side stepped the issue of the dangers of surgery. Maybe you should check out the mortality rate of spinal surgery and neck surgery in particular. Once you check it out I am sure you will be down to your local chiro to have your spine checked out…..remember you are as young (biologically) as your spine is flexible. As a matter of interest: Research shows that long term chiropractic patients have higher thiol levels in their blood that non chiropractic patients. As you well know thiol levels indicate the level of DNA repair. So the higher your thiol levels are the younger your biological age is.

        • i cannot comment on the dangers of surgery – in contrast to you, i perfer to write about things i understand.

          • You claim to write about things you understand. Well clearly you dont understand about chiropractic as you thought it is a treatment for arthritis which it is’nt. Your reason for not commenting on the dangers of surgery is extremely weak. However you your lack of understanding about chiropractic does not stop you from commenting….double standards!

  • @ Eugen Roth

    Are you saying that the failings in ‘alternative’ medicine should be exposed and corrected only after conventional medicine has put its house in order, despite the fact that around 80% of conventional medicine is supported by evidence and only 7% of CAM is?

    Compared with conventional medicine, can you reveal how often ‘alternative’ medicine abandons interventions when they are known to be ineffective and/or dangerous?

  • BW: Your question is ridiculous and misleading…of course not! You claim 80% of conventional medicine is based on science. You got to be kidding! This is absolute nonsense….80& …in your dreams….more like 15%. Another misleading statement by the ‘sceptics’ who pretend to be science based and who pretend to be saving the public from the so-called dangers of alternative medicine.

    Pharmaceuticals company Bayer, for example, recently revealed that it fails to replicate about two-thirds of published studies identifying possible drug targets (Nature Reviews Drug Discovery, vol 10, p 712).

    Bayer’s rival Amgen reported an even higher rate of failure – over the past decade its oncology and haematology researchers could not replicate 47 of 53 highly promising results they examined (Nature, vol 483, p 531).

    And you call this science!!

    • there is plenty of data showing that around 80% of the conventional treatments used in dialy routine are evidence-based. the 15% figure refers to a sample of ~4000 existing therapies [including alt med] regardless of the question whether they are frequently used or not.
      there is nothing like a little half-knowledge to confuse those who want to listen to poorly versed chiros, is there?

    • Why do you not comment?

    • Eugen Roth wrote: “You claim 80% of conventional medicine is based on science. You got to be kidding! This is absolute nonsense….80& …in your dreams….more like 15%.”

      That’s not true, but even if it was, 15% would still be double the evidence for CAM.

      Also…

      Quote
      “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…If the doctor-bashers want to play statistics, how about comparing death rates with modern scientific medicine to death rates with alternative medicine and death rates with no medicine at all. That might really be interesting!”

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

    • Eugen: Why do you believe it is 15%?

  • Eugen Roth wrote: “The QUALITY of healing is directly proportional to the functional capability of the Nervous System to send and receive nerve messages.”

    In that case, don’t you find it surprising that it doesn’t seem to help with chiropractors’ longevity? Apparently it’s less than the general population…
    http://www.ebm-first.com/chiropractic/various-concerns/618-does-chiropractic-add-years-to-life.html

    Do chiropractors themselves not receive chiropractic care?

    • Would you like to comment on the longevity of dentists and medics. As far as chiropractors are concerned. Not sure what you are talking about as two chiropractic greats Sid Williams and Reggie Gold died recently who were in their 80s. If it is true then it is because of the dedicated service they selflessly gave to their patients that eventually took its toll on these passionate practitioners who gave their all to benefit mankind.

      • Eugen Roth wrote: “Would you like to comment on the longevity of dentists and medics.

        I don’t know the stats for dentists, but if you read the link that I provided you will see that MDs enjoy the greatest longevity.

        Eugen Roth wrote: “As far as chiropractors are concerned. Not sure what you are talking about as two chiropractic greats Sid Williams and Reggie Gold died recently who were in their 80s.”

        They weren’t “greats”. They were a pair of greedy ‘Mercedes 80s’ chiroquack leaders who undoubtedly enjoyed a very high standard of living. Unfortunately, they have left a trail of mayhem in their wake that could take at least a generation to rectify.

        Eugen Roth wrote [re chiropractors having the lowest longevity]: “If it is true then it is because of the dedicated service they selflessly gave to their patients that eventually took its toll on these passionate practitioners who gave their all to benefit mankind.”

        On the other hand, it’s more likely that their premature deaths were a result of using CAM (including chiropractic) rather than conventional medicine for their health issues (possibly coupled with the long-term stress and insecurity of being self-employed and on low incomes).

        • you just contradicted yourself…first chiropractors are…..greedy ‘Mercedes 80s’ chiroquacktors…….then you mention….’.the long-term stress and insecurity of being self-employed and on low incomes’.

          BW: You claim to be science based but you make unsubstantiated claims like…..’it’s more likely that their premature deaths were a result of using CAM (including chiropractic)’….ridiculous

          • Eugen Roth wrote: “you just contradicted yourself…first chiropractors are…..greedy ‘Mercedes 80s’ chiroquacktors…….then you mention….’.the long-term stress and insecurity of being self-employed and on low incomes’”

            No I didn’t contradict myself. I wrote “They were a pair of greedy ‘Mercedes 80s’ chiroquack leaders”. It was the quack leaders (and their unethical chiropractor colleagues) that I was talking about. It was far from a lucrative decade for all chiropractors.

            Eugen Roth wrote: “BW: You claim to be science based but you make unsubstantiated claims like…..’it’s more likely that their premature deaths were a result of using CAM (including chiropractic)’….ridiculous”

            Why is it ridiculous? For example, we know that many chiropractors were, and still are, against public health measures such as vaccination, and many scoff at ‘allopathic’ medicine (including yourself, apparently).

  • BW: I can only answer for chiropractic. As the vast majority of chiropractic interventions have been proven to be safe and effective from day one in 1895 it has not been necessary to abandon many interventions. In today’s reality chiropractic is subject to stringent regulation unlike the medical profession who are a law unto themselves. This evidenced by example that the medical treatment of cancer is regulated by an act of parliament in the UK passed in 1937!!!!! Pathetic!! Clear evidence that there is no regulation by government. In fact it is medicine and Big Pharma who gets government to dance to their tune – for example the swine flu debacle where governments were forced by Big Pharma to spend hundreds of millions on Tamiflu which has been shown to be useless as have most flu vaccines……in fact according to Dr J Anthony Morris (former Chief Vaccine Control Officer at the FDA)…’There is no evidence that any influenza vaccine thus far developed is effective in preventing or mitigating any attack of influenza. The producers of these vaccines know that they are worthless but they go on selling them anyway’.

    • Eugen Roth wrote: “I can only answer for chiropractic. As the vast majority of chiropractic interventions have been proven to be safe and effective”

      Chiropractic’s hallmark intervention, spinal manipulation, is not safe and currently carries an unfavourable risk/benefit profile. See: http://tinyurl.com/6b6nkzg

      Eugen Roth wrote: “In today’s reality chiropractic is subject to stringent regulation…”

      So why does a large quack element continue to flourish?

      Eugen Roth wrote: “In fact it is medicine and Big Pharma who gets government to dance to their tune…”

      Chiropractors are also guilty of duping legislators. In the UK, they lobbied them into granting them statutory regulation prematurely – not least in an attempt to legitimise the industry to help chiropractors earn more money.

      • your link is ridiculous. The article was written by Prof Ernst who obviously has an agenda to destroy chiropractic and who is willing to go to any length to achieve this.

        ‘Chiropractors are also guilty of duping legislators’……..ridiculous!! If anybody dupes the legislators it is Big Pharma and the medical profession so that THEY can earn more billions of $$$$ than they already do.

        • huuuu, the paranoia is showing again. what proof do you have that i want to destroy anything? my entire work is aimed at improving health care, not destroying it.

  • Edzard, you end your article by asking “For what condition is chiropractic proven to work! I am not aware of any” can I say I agree with you. Chiropractic is not a treatment for any medical condition and its unfortunate we use those terms to explain to laypeople. Unfortunately we live in a society where the public likes these labels put on conditions and these labels are not an exact science, for example, above you use the generic label of “arthritis” which covers a broad range of conditions that could be, degenerative, inflammatory, metabolic or even autoimmune. In the case of Osteoarthritis there may be up to 30% degeneration of the joint before it can be seen on Xray and once the Hyaline layer of cartilage is gone its not coming back. So its fair to say that by the time the “condition” Osteo Arthritis is diagnosed by a doctor its pretty advanced and the pain is probably chronic and the prognosis is not good. No one is going to cure the degeneration or any of the “conditions” you have named above, unless you believe in devine intervention. So if you are looking for “evidence” of a cure for arthritis, I am sorry to have to tell you that you have been wasting your time looking in these Journals as there isn’t a cure.

    So what is the person supposed to do? They learn to manage their pain, most people do it with drugs. Others do it in the knowledge that pain is an emotional experienced influenced by many neurologicla inputs to the brain. These inputs can be interfered with at the spinal level by what Melzak and Wall called the “pain gate”, I apologise if I am going above your level of expertise. When receptors in a spinal joint are activated by a chiropractic adjustment or SMT it WILL have an inhibitory effect on pain transmission as will sticking needles in someone, or hitting them with a shovel, however knowing which joint to adjust will make a difference and if you want that explained you should go study chiropractic. So here we are taking about reducing pain transmission for a period of time, not a cure, please tell me if you disagree with Melzak and Wall? Or dont believe spinal joints have mechano receptors?

    So the key to the medical treatment of arthritis would be to manage “arthritis” before it shows up on a x-ray or is producing pain. You may not agree so there is no point in explaining what is involved. So my question to you is what do you understand by Osteo Arthritis and how should it be managed. Using the car analogy is there something in your opinion that could be done before the car breaks down on the motorway, or should the health service simply wait until these problems are visible on x-ray.

    • Richard – from my interaction with Prof Ernst he does not seem to understand that chiropractic does not function in the allopathic model (ie the diagnosis and treatment of symptoms and disease). As an Emeritus Professor of complimentaty medicine he should be aware that chiropractic is a HEALTH CARE SYSTEM and not a disease treatment system.

      • another absolution from the obligation to demonstrate evidence?

        • No. There is evidence that long term chiropractic care results in enhanced health and a 50% decline in utilisation of medical procedures. Maybe that is why Big Pharma and their side kicks (the medical profession) are so vehemently anti chiropractic. Its bad for business!!

    • and this strange “philosophy” absolves you from demonsrating that you actually do any good at all? are you trying to turn health care into a religion?

    • the claim here is, i think, that chiro is an effective preventative measure. any evidence for that?

  • It seems to me the medical profession and Big Pharma are running scared. Why?…because the ‘antibiotic miracle’ is quickly coming to an end. The population in the USA consume the most amount of medication per capita in the world but are the sickest and most unhealthy as evidenced by their obesity rate of about 70% of the population. That is the horrendous effect Big Pharma has had in the USA. Stem cell therapy has been nothoing less than a damp squid. So Big Pharma are pinning their hopes on gene therapy. But guess what: Chiropractic is ahead of the game you be glad to hear. Epigenetics tell us that health enhancing or disease enhancing genes can be switched on by our perception of the environment. And guess what we perceive our environment through our Nervous System and what does chiropractic do? It enhances Nervous System function. How? Well read my post above about Dr Sperry.

    • “… the ‘antibiotic miracle’ is quickly coming to an end”??? Evidence?
      Oh no, the contrary might be true. From epidemiological research in southern central Europe it is “known” (but IGNORED!) that about a quarter of the adults are chronically infected with B.burgdorferi, that is tick-transmitted borreliosis. (A vacchination is not in sight, same with H.pylori: antibiotics / AB are the causal approach, regularly curing the infection.)

      What scares “big pharma” is the high effectiveness of cheap (generic) doxycycline. So – together with rheumatologists, neurologist, psychiatrists… – they declare borreliosis as practically irrelevant, so they can keep on “treating” the victims with non-causal bogus, just like the quacks, psychologists etc. You’re on the same side, exploiting the victims (and insurances) without healing them.

      Doxy (or minocycline) have been shown to be remarkably effective in early RA (O’Dell et al. years ago) – but nobody cares.
      Of course the nonsense-concept of “auto”immune disease has to be abandoned for RA – it is caused by a chronic infection (A. Ebringer et al. since about 1985).
      For MS it is plain to see that it cannot be “auto-immune”, because the plaques are asymmetric, which cannot be explained without the “root cause” within the plaques: spirochetes / borreliae (Gabriel Steiner “Die multiple Sklerose” 1962, discovered by him more than 3 decades earlier, at that time neuropathology professor at the university of Heidelberg), transmitted by ticks (G.Steiner review on MS 1922). Unfortunately he died at about the time doxy became available, so he had no chance to test it. But such studies have begun, with very encouraging results so far.
      Space (limit of the blog comment software) prevents me to list more examples: ABs have a brilliant future!

  • Anyway Prof I must really thank you (seriously)…Why…. Well this debate (?) has really made me feel I am on the right side of the fence. I chose to become a chiropractor not because I could not get into medical school but because I believed in the central role that the nervous system plays in maintaining health. 25 years later I have more certainty than ever that I made the right choice. This debate (?) with you has just re-enforced that I made the right decision. Anyway I really have to go now as it is my anniversary and my beautiful wife calls for my undivided attention which I obviously cannot resist.

    • we are so pleased for you; i am sure.

    • ahhhh!!! and that is news to conventional medicine??? so glad we can learn from chiros about the importance of the nervous system,, and neurologists will be even more delighted than i.

      • Yes that is correct. You are beginning to see the light. Conventional medicine could learn lots from alternative medicine. That is why more and more medical schools offer courses in homeopathy and acupuncture. They then call it ‘Functional Medicine’.

  • A Chinese proverb:

    “The superior doctor prevents sickness,
    the mediocre doctor attends to impending
    sickness, and the inferior doctor treats actual
    sickness.”

    As chiropractors our objective is to improve function and quality of life in individuals. So chiropractors fit the description of ‘superior doctor’. On the other hand allopathic doctors treat disease.

    • “… allopathic doctors treat disease. ”
      Many of them vaccinate —> PREVENT diseases. (Smallpox have been eradicated, polio is almost eradicated…)

      After the (re)discovery of Helicobacter (Nobel Prize 2005) millions over millions of patients have received eradication therapy, which typically heals in a one week course – anything to compare in quackery?
      Many migraine patients after eradication therapy were free of headaches (IGNORED / not followed up, as far as I know), which suggests that a chronic infection could cause migraine.

      To give a hint: in Southern Germany in a large epidemiological study (D. Hassler et al., DMW 1992) ca. 17% were found to be chronically infected with B. burgdorferi. Almost half of them had chronic headaches – which of course respond to proper antibiotic therapy!
      Unfortunately headache “experts” ignore this fact: obviously it is much more profitable to “treat” headaches over decades instead of curing them within a week or two. That’s what modern medicine is like: don’t ask for the “root cause”, which may be cured – and profit endlessly from millions of chronically ill persons. And in this it’s equivalent to quackery.

      What needs to be restored (cf. Robert Koch etc. more than a century ago): a focus on the “root causes”. Unfortunately that doesn’t seem to be (in) the interest of Prof. Ernst…

  • @eugen: am i the only one who shivers with the sentence: what do chiropractors do: we correct the spine… What is there to correct? Don’t start the subluxation story, no rx or mri will show you any subluxation of a vertebra… There is nothing to correct… Muscles tense up because joint are inflamed… So you don’t have to correct anything… Make your patient move out of the pain…
    Same result, no potential harm or killing your patient…

  • “another absolution from the obligation to demonstrate evidence”

    Not at all, but if there is no cure for arthritis, why ask Eugen to produce evidence of a cure. You are saying CAM does not work, he is saying drugs dont work. We are all agreed so lets talk about an approach that may work. Lets talk about joint function and the effect a chiropractic adjustment has on a dysfunctional spinal joint. You may not agree that maintaining joint function is important to general wellbeing however the “evidence” is overwhelmingly to the contrary. As demonstrated by changes in the medical management of ligament injuries in recent years.

    I will ask my question again Edzard. What do you understand by Osteo Arthritis and how do you think it should it be managed? Using the car analogy is there something in your opinion that could be done before the car breaks down on the motorway, or should the health service simply wait until these problems are visible on x-ray? When most of the evidence you refer to above is accumulated

  • this was all very fascinating, i’m sure. i hope it displayed the mind-set of some chiros well. as we have gone round circles several times, i will now abstain from further comments and call it a day.

  • Love your twitter feed. Thanks
    What about curcumin for joint pain?
    I am as skeptical as you about alt med, but trying to have an open mind if there is evidence for efficacy.

  • I personally believe Chiropractic is good for you… I helped me before with some back problems.
    I dont know, maybe I believed in it so much my mind did the hole work. Nevertheless, Im better now…

  • Very interesting discussion. – Richard L. stated that neither CAM nor drugs work in osteo arthritis (OA). Therefore PREVENTION must be attempted. I doubt that chiropractic can prevent degeneration of cartilage.

    What all parties ignore: the CENTRAL question is, what CAUSES cartilage degeneration, what might cause chronic (low grade) inflammation? Years ago I did a course on arthritis (RA, gout) for medical students and at that time did a lot of literature research on possible causes. A few results:
    — According to Alan Ebringer et al. RA is caused by a chronic (upper) UTI by P.mirabilis. According to O’Dell et al. mino- or doxycycline often can stop early RA. (—> PubMed.)
    — Doxy seems to be effective in (knee) OA (from my memory). How might that be explained?
    — Lyme arthritis most often affects the knee, and the antibiotic (AB) of choice is doxy (not for young children)! The knee may be affected by Reiter arthritis, a reactive arthritis caused by a number of infections of the urogenital tract – again doxy is one of the ABs available for therapy.
    It is obvious that the AB has to be used before major cartilage destruction!

    — In iron storage (genetic hemochromatosis, up to 1% in some populations) joint affections are an early sign: I wonder if research is done along this line?
    — Francesco Facchini in a study demonstrated that depletion of stored iron by serial phlebotomies was effective in chronic gouty arthritis: http://www.ncbi.nlm.nih.gov/pubmed/12832712
    Dr. Ernst: you always ask for evidence – your comment?

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