MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

A few weeks ago, The College of Chiropractors, a Company Limited by guarantee, was given a royal charter. A royal charter is a formal document issued by a monarch, granting a right or power to an individual or an corporate body. They are used to establish significant organisations such as cities or universities.

This is how the event was protrayed by chiropractors [link disabled by admin due to possible malware]:

Rarely granted, a Royal Charter signals permanence and stability and, in the College of Chiropractors’ case, a clear indication to others of the leadership value and innovative approach the College brings to the development of the chiropractic profession. The Royal Charter essentially formalises the College’s position as a unique, apolitical, consultative body, recognising its role in promoting high practice standards and certifying quality and thus securing public confidence.

For those of us who are not familiar with the College, here is how they describe themselves and their history:

On the advice of a senior medical figure, an organisational model similar to that of a Medical Royal College was devised. Thus, the College of Chiropractors was conceived during 1997 and incorporated in 1998 as an independent body to develop, encourage and maintain the highest possible standards of chiropractic practice for the benefit of patients.

Over the next couple of years the embryonic ‘College’ grew with a regional faculty infrastructure, the mainstay of the organisation, becoming firmly established in order to foster education locally. As an independent body, separate from any of the political groups, members were able to share information and expertise from all areas of the profession. Following its incorporation in October 1998, the College of Chiropractors was formally launched on 28th April 1999 at the King’s Fund.

The College is now an academic membership organisation with almost 3000 members worldwide, and the following objectives:

  • to promote the art, science and practice of chiropractic;
  • to improve and maintain standards in the practice of chiropractic for the benefit of the public;
  • to promote awareness and understanding of chiropractic amongst medical practitioners and other healthcare professionals and the public;
  • to educate and train practitioners in the art, science and practice of chiropractic;
  • to advance the study of and research in chiropractic.

From my perspective, this begs numerous questions; here are just some of them:

1) Have UK chiropractors truly been promoting “high practice standards and certifying quality and thus securing public confidence”?

I would argue that they have been doing the opposite. They made bogus therapeutic claims by the hundreds on their websites, and when Simon Singh had the courage to make this public, they sued him for libel. Call me old-fashioned, but I fail to see how this maintains “the highest possible standards of chiropractic practice for the benefit of patients” nor how this might “promote the art, science and practice of chiropractic.”

2) Is it truly for the benefit of the people that so many chiropractors deny the considerable risks of spinal manipulation?

I would have thought that this is a serious disservice to the people and the health of the nation and believe it reflects an irresponsible disregard of the precautionary principle in health care.

3) How can we accord the high aims of the College with the fact that UK chiropractors demonstrably violate fundamental rules of medical ethics, e.g. informed consent, and that their professional bodies must be aware of this fact, yet have so far failed to do anything about it?

I think there is a discrepancy here that needs explaining.

4) Does the College truly “advance the study of and research in chiropractic?”

We have shown that UK research into chiropractic has not increased but decreased since statutory regulation. This leads me to suspect that regulation is being abused as a means of gaining recognition and not as a mechanism to protect the public.

Considering all this, I find that the status of the other Royal Colleges has been de-valued by the ascent of this organisation. And I ask myself WHAT NEXT? A COLLEGE OF WINDOW SALES-MEN, perhaps? Or would this giving a bad name to the poor window-salesmen?

47 Responses to What is next? A Royal College of window-salesmen?

  • I’m not so sure the ‘royal’ title means much these days. And anyway after this it means even less.

  • In my view, the prefix `Royal’ only serves to devalue the body to which it is attached. There is nothing to be admired in an association with a family which can’t claim authority on merit, and whose members are known to interfere with the political process. Hence, the accolade seems particularly appropriate for a college of quacks.

  • it might mean something to the chiros!

  • dr michael dixon, the prolonged harm of prince charles into health care, mentioned in 2004 that this might be on the cards
    http://www.clinchiropractic.com/article/S1479-2354(04)00035-5/abstract

  • Rob Finch, the Chief Executive of The Royal College of Chiropractors, is on record with “no suggestion that chiropractic is unsafe” http://webcache.googleusercontent.com/search?q=cache:z0i06_LmE10J:www.slideshare.net/ecupresident/contact-magazine-september+&cd=9&hl=en&ct=clnk&gl=uk
    AND HE MUST BE CORRECT, HE HAS ROYAL BACKING!

  • Oh dear Professor Ernst, you seem to have shown your true colours you claim to be unbiased, objective and professional yet your comments appears to be mostly sour grapes!

  • It would appear that rather than “securing public confidence” the College of Chiropractors’ Royal Charter is helping to conceal a major public health concern – i.e. Health Secretary, Jeremy Hunt, decided to approve the Royal Charter,
    http://www.zenosblog.com/2012/11/a-right-royal-chiro-cock-up/#comment-164986

    …despite the College’s failure to meet the requirements set out by the Privy Council:
    http://www.zenosblog.com/2012/11/a-right-royal-chiro-cock-up/

    Prof. Ernst wrote: “Rob Finch, the Chief Executive of The Royal College of Chiropractors, is on record with “no suggestion that chiropractic is unsafe” http://webcache.googleusercontent.com/search?q=cache:z0i06_LmE10J:www.slideshare.net/ecupresident/contact-magazine-september+&cd=9&hl=en&ct=clnk&gl=uk
    AND HE MUST BE CORRECT, HE HAS ROYAL BACKING!”

    Perhaps his source for that claim is the College’s Chiropractic Patient Incident Report and Learning System (CPIRLS) which has been greatly under-utilised by chiropractors for reasons which include “fear of retribution, being too busy, and insufficient clarity on what to report”:
    http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1888-british-chiropractic-association-members-attitudes-towards-the-chiropractic-reporting-and-learning-system-a-qualitative-study.html

    Meanwhile, in addition to the adverse event data which are accumulating in the medical literature, just a couple of weeks ago in the US it was revealed that between September 1, 1990 and January 29, 2012, a total of 5,796 chiropractic medical malpractice reports were filed, many from chiropractic patients who suffered strokes and other injuries…
    http://www.hg.org/article.asp?id=29867

    We know that knighthoods can be revoked, but hopefully Royal Charters can be too.

    For readers interested in learning more, the following blog post is worth a read:
    http://www.quackometer.net/blog/2012/11/the-royal-college-of-vestigial-victorian-fairground-mystic-bone-setters.html

  • The very fact that your website title is underlined by the letters you have after yor name screams to me and anyone with half a brain that you are trying to make a point. That you are in your opinion someone of such high standing and importance that anything you say must be true and gospel. That MAY work on many people, but unfortunately those who read your article will find it full of very UNprofessional and childish name-calling, along with misuse of quotes, unsubstantiated claims about chiropractic and a style of writing which is far from scientific.
    Perhaps if you chose to write in a less biased and obviously one-sided manner, your arguments would be more convincing.

    • What a nasty and ignorant comment.

      • Alan so do you also think that saying “..WHAT NEXT? A COLLEGE OF WINDOW SALES-MEN, perhaps? Or would this giving a bad name to the poor window-salesmen?” is also a nasty and ignorant comment? or are you happy with double standards?

        • at least it these were questions. yours were exclamations!

        • andy said:

          Alan so do you also think that saying “..WHAT NEXT? A COLLEGE OF WINDOW SALES-MEN, perhaps? Or would this giving a bad name to the poor window-salesmen?” is also a nasty and ignorant comment? or are you happy with double standards?

          There could well be a college for window sales men (or women), but I would refer you to Teacakes comment.

        • andy wrote:

          “or are you happy with double standards?”

          Perhaps you meant to write:

          “Or are you happy with double glazing”?

    • Dr Quack wrote:

      The very fact that your website title is underlined by the letters you have after yor name screams to me and anyone with half a brain that you are trying to make a point. That you are in your opinion someone of such high standing and importance that anything you say must be true and gospel.

      No, that’s just your mean-spirited interpretation, which is a reflection of you, not on EE. The first question raised by quacks about skeptic bloggers is about their qualifications. Now you’ve got a blogger here who has spelled his qualifications out on the front page for everyone to examine, he gets accused by some nasty quack of being some kind of megalomaniac. How reassuringly predictable.

      In fairness, however, I had only skimmed through this latest blog and it was Dr Quack’s accusations that made me re-read it carefully in search of this alleged ‘name-calling’, etc. Didn’t find any of it so perhaps Dr Quack could clarify? Point to all the examples of name-calling, explain how quoting at length with links to sources is ‘misuse of quotes’, what are the ‘unsubstantiated claims about chiropractic’? As for the writing style, you do realise this is a blog not a scientific paper?

      Hope you find the other half of your brain some day.

  • sorry to hear that you only have half a brain; get better soon!

  • I think there’s a fundamental and important difference between the Royal College of Chiropractors and any putative Royal College of Window Salesmen.

    People actually need windows, and there is an evidence base for their efficacy.

  • So now we have the Rancid College of Manipulative Quacks. A Royal Warrant used to mean something, and was a source of pride. Here it will be a source of hubris and will undermine the legitimate institutions which carry this imprimatur.

  • Probably about as credible as the ‘Chartered Society’ of Physiotherapists of which some 6000 are members of the Acupuncture Association of the said ‘Chartered Soccety’ of Physiotherapy who prescribe a treatment tool frequently maligned by Ernst and others as quackery and yet dish it out in the NHS and private sector without even a peep from him or his disciples!

    • and where have you got this from?
      i very rarely criticise the setting but the lack of evidence! what i write about this applies to any setting. acupuncture for smoking cessation is not evidence-based wherever it happens, for instance. do not try to accuse me of conducting a turf war, because this is not what i do.

      • So in article about spinal manipulation on this blog, you criticize two professions for using spinal manipulation of the neck and do not mention other professions that do use spinal manipulation of the neck, even though in one of your links is to an Am J Med. 2002 May;112(7):566-71, where the abstract states “Reports in any language containing data relating to risks associated with spinal manipulation were included, irrespective of the profession of the therapist”. So one of the articles you link to is a search on all professions (settings)

        Therefore is it the case that you should not name the profession or setting if doesn’t matter (which you argued against) or you should name all the professions (or settings) that are involved in using techniques or treatments which lack evidence!

        • we have been over this ad nauseam.
          i think you do not have a point here.
          even if you did: chiros do mostly manipulation, osteos mobilisation, physios exercise.

          • i know so many physios that use manipulation, and so do osteos. So your clam that physios only do exercise only really applies for the NHS!

          • PaDDy said:

            i know so many physios that use manipulation, and so do osteos. So your clam that physios only do exercise only really applies for the NHS!

            You need to re-read what Prof Ernst actually wrote.

  • Not accusing, observing.

  • Actually no, I think I’m pretty damned accurate!

    • Professor Ernst surely it is time for these types of debates to mature and grow up (this is true for both sides of the arguement). Posting rude and inflammatory blogs such as yours is not professional and leads people like Bill Kusiar to draw reasonable (evidence based) conclusions. My earlier point that it indicates that you maybe acting in a biased, unprofessional and less than objective way is, I think, fair. If my use of an exclamation mark offended then I apologize.

      The comments of your “supporters” following my earlier comments in this blog support the view that the debate needs to grow up. Additionally, in your twitter feed you stated “yes, i as a bit angry when i wrote it” hardly a rational response of an objective, unbiased scientist.

      I suspect that the subject matter of Royals and chiropractors together was too personally too significant to you and the result was obvious. In such circumstsnces surely you should declare your conflict of interest rather than allow (or even encourage) all this stone throwing.

      I feel that these are important debates but the parties all loose credibility when it descends to this level.

      I am also sorry if you feel offended by my comments, they are not meant in that way but merely constructive criticism.

      Regards

      • To Andy, Dr Quack, Bill Kusiar and others who take the same view.

        The above blog is a comment on a recent event: the awarding of a Royal Charter to chiros. EE has quoted the chiros at length and taken issue with some of the things they are saying. He’s expressed his arguments and provided links where appropriate. He ends with a comment that may seem “rude and inflammatory” to those he’s criticising in this blog but to those of us unaffected by this issue, it seems a perfectly reasonable conclusion, given the arguments he’s presented – arguments which neither Andy nor Dr Quack nor Bill have attempted to engage with.

        Andy’s saying EE is “acting in a biased and less than objective way” but hasn’t shown us how. Bizarrely, he claims Bill Kusiar has drawn “reasonable (evidence based) conclusions”. But all we’ve had from Bill is the usual ‘whataboutery’ we get from quacks who don’t like what has been written about them but, because they can’t refute the arguments against them, they resort instead to accusing the writer of bias because he’s written about them and not about someone else.

        Guys, when you accuse someone of bias/lack of objectivity, ‘name-calling’, ‘misuse of quotes’, ‘unsubstantiated claims about chiropractic’ and anything else your fevered imagination can dream up, you’ve really got to be specific (that means using quotes) and you’ve got to make a coherent argument. Otherwise you just look like embittered quacks who can’t defend themselves.

  • yes, i agree that growing up would be a good thing. however, i do not see why i cannot be a bit angry some time. this does not mean that i am biased. it was i who produced the evidence in my post that UK chiros have behaved less than professional in the last years. refute that evidence or show that it is biased and you might have a point.
    i am angry because i am a member of two royal colleges and see their standing de-valued – as i pointed out in my post.

    • and there are very deserving institutions which did not get the ‘ROYAL’ prefix, e.g. the coll public health, the coll emergency medicine. does anyone think that the chiros are more deserving than those?
      what i and others are angry about is that merit, professionalism etc. is being ignored here.

  • Readers might be interested to know that the President-Elect of the Royal College of Chiropractors is former General Chiropractic Council Chairman, Peter Dixon:
    http://www.colchiro.org.uk/default.aspx?m=44&mi=299 (scroll down the link)

    Peter Dixon is a chiropractor who was a member of the controversial NICE Low Back Pain Guidance Group that endorsed the use of chiropractic. He encountered further controversy when it was shown that he seemed unable to critically evaluate the Meade Report (much touted by chiropractors):

    In response to the following claim (lifted from the Meade Report) on Peter Dixon’s website,

    Quote
    “ . . . patients who received chiropractic treatment improved by 70% more than those given hospital out-patient.”

    Professor David Colquhoun undertook an in-depth analysis of the Meade Report’s data:

    Quote
    “…hang on. If we look at the paper, Meade et al., 1990 …several things jump out …on average, the effect is 7 percent (on the 100 point scale), NOT 70 percent as claimed on the web site of Peter Dixon Associates…What this paper really tells you is that neither treatment is very effective and that there is little to choose between them. It is really most unfortunate that the chairman of the GCC should show himself to be so careless about evidence at a time when the evidence for the claims of chiropractors is under inspection as never before. It does not add to their case for criticising Simon Singh and it does not add to one’s confidence in the judgement of the NICE guidance group.”
    http://www.dcscience.net/?p=1718

    A little more from Professor David Colquhoun…

    “I am curious to know why it is that when I telephoned two of the practices belonging to Peter Dixon Associates, I was told that they could probably treat infantile colic and asthma. Such claims have just been condemned by the Advertising Standards Authority.”
    http://www.dcscience.net/?p=1593

    The Royal College of Chiropractors’ motto is “promoting professional excellence”, does anyone really believe that?

  • It’s worth adding that in his forthcoming role as President of The Royal College of Chiropractors, Peter Dixon will be presiding over its faculties – including these three:

    The Faculty of Paediatrics http://www.colchiro.org.uk/default.aspx?m=21&mi=139&ms=53&title=Paediatrics%20-

    Evidence against chiropractic ‘paediatrics’
    http://www.ebm-first.com/chiropractic/treating-children.html

    The Faculty of Craniopathy http://www.colchiro.org.uk/default.aspx?m=21&mi=139&ms=52&title=Craniopathy

    Evidence against craniopathy:
    http://www.ebm-first.com/craniosacral-therapy.html )

    The Animal Faculty http://www.colchiro.org.uk/default.aspx?m=21&mi=139&ms=55&title=Animal

    Evidence against chiropractic for animals:
    http://www.ebm-first.com/component/search/?searchword=veterinary%20chiro&searchphrase=all&Itemid=141

    Behind all the window dressing, there seems to be an almost empty shop. Chiropractic for dummies, anyone?

  • Oh dear………The evidence suggests that for non specific low back pain manipulation provides as good an effect as any available treatment. LBP, which incidentally is the single biggest cause of global disability, is probably reoccurring and can often develop into chronic disabling conditions. Chiropractic is no cure, along with any other approach, as all the evidence points to appropriate and skilful management over time, by qualified clinicians, who have the time and expertise to pursue an evidence informed approach, where evidence is available, to manage their patients responsibly, compassionately and with continuity throughout short, medium or long term problems. Physiotherapist do this, Osteopaths do this and so do the vast majority of chiropractors by a judicious and skilful application of manipulative and mobilisation skills, reassurance, clinical support, exercise and advice. The vast majority are compassionate, patient centred, responsible, professional and hard working individuals to whom tens of thousands of patients have recieved care and return for care having felt benefit.

    And incidentally the risk of stroke is far greater after visiting a GP than a chiropractor. ( J. David Cassidy, Eleanor Boyle, Pierre Côté, Yaohua He, Sheilah Hogg-Johnson, Frank L. Silve and Susan J. Bondy. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. Eur Spine J. 2008 April; 17(Suppl 1): 176–183.) Why, because people with early stroke often have symptoms such as neck pain and headaches and go an visit a physician. Does that then mean that because that physician is the last person the patient saw before their stroke that they are then to blame for the subsequent stroke………I think not….in fact that is only representative of a wholesale misunderstanding of cause and effect……..and Prof Ernst…your supposed systematic review on stroke and chiropractic is utter polemic and unsystematic to the point of being mere opinion…goodness me……what a shower

    Really….are manipulators really that bad…….. and how come manipulating physiotherapists and osteopaths don’t appear to attract the same vitriol…..bias indeed Professor Ernst……what on earth did a chiropractor do to you in the past to stick in your craw so badly………because that’s what most of this playground eye poking appears to be. Personal, misrepresentative attack. Shame on you….when you so pointedly hang your hat on that scientist hook

    • Complex wrote: “The evidence suggests that for non specific low back pain manipulation provides as good an effect as any available treatment…Chiropractic is no cure, along with any other approach, as all the evidence points to appropriate and skilful management over time, by qualified clinicians, who have the time and expertise to pursue an evidence informed approach, where evidence is available, to manage their patients responsibly…”

      Sadly, you are overlooking the subluxation-based pseudoscientific beliefs of most chiropractors:

      Quote
      “Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them (11). And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment.”

      Ref: Spinal manipulation for the early management of persistent non-specific low back pain — a critique of the recent NICE guidelines, Edzard Ernst, Int J Clin Pract (18th August 2009).
      Reference (11) is Ernst E. Chiropractic: a critical evaluation. J Pain Sympt Man 2008; 35: 544–62. Page 6 of the paper mentions a report that indicates that only 11% of all cervical manipulations are “appropriate” and gives the reference Coulter I, Hurwitz E, Adams A, et al. The appropriateness of manipulation and mobilization of the cervical spine. Santa Monica, CA: RAND, 1996:18e43.

      Complex wrote: “And incidentally the risk of stroke is far greater after visiting a GP than a chiropractor. ( J. David Cassidy, Eleanor Boyle, Pierre Côté, Yaohua He, Sheilah Hogg-Johnson, Frank L. Silve and Susan J. Bondy. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. Eur Spine J. 2008 April; 17(Suppl 1): 176–183.)”

      That paper had serious flaws. Here are some of them:
      http://www.ebm-first.com/chiropractic/risks/491-chiropractic-and-stroke-evaluation-of-the-paper-risk-of-vertebrobasilar-stroke-and-chiropractic-care-results-of-a-population-based-case-control-and-case-crossover-study-spine-2008-feb-15334-suppls176-83-cassidy-jd-boyle-e-c.html

      Complex wrote: “Really….are manipulators really that bad”

      Most chiropractors are, apparently.

      Complex wrote: “…and how come manipulating physiotherapists and osteopaths don’t appear to attract the same vitriol…..bias indeed Professor Ernst……what on earth did a chiropractor do to you in the past to stick in your craw so badly………because that’s what most of this playground eye poking appears to be. Personal, misrepresentative attack. Shame on you….when you so pointedly hang your hat on that scientist hook.”

      FYI, accusations like that are a credibility loser. See here:
      http://edzardernst.com/2012/12/ad-hominem-attacks-are-signs-of-victories-of-reason-over-unreason/

      • Dear Wode

        I entirely concur with the notion that amongst most of not all professions there are those that pursue less then orthodox views. Indeed I am as frustrated and saddened by this as I suspect you are. However, if you add one drop of Indian ink to a pint of water it has the tendency to tun the entire solution black. In much the same way, if you focus on the extremes and report little of the vast majority it will appear that the entire profession is whacky, as these are precisely the only views and comments reported. Might I suggest that a fair degree of sampling bias may be present in the comments on this blog. As I said, and strongly stand by, the vast majority of these clinicians are responsible, well trained, skilful diagnostician that posses specialised knowledge and tools to address musculoskeltal pain. The evidence says that the approach is effective and cost effective and at least as good, and perhaps significantly better in certain subgroups, as anything else on offer for non specific back pain and neck pain. Its a very large group of people that have these problems, it costs a huge amount to society economically and personally to those with more chronic problems. GPs dont have the skills or the time often to address these non life threatening, yet impactful conditions and so one might propose that a large number of well trained musculoskeletal specialists including manipulative physios, osteos or chiros might deliver a social and clinical service in addressing these problems for patients that number in millions every year.

        Call me deluded, but couldn’t this be a plausible description of what chiropractic as the vast majority of the profession do?

        Ps. I have all the credibility I need thank you from my friends, my family and my colleagues, many of whom are clinicians or respected academics as I suspect do you. I really don’t mind if in your eyes a little is shaved off….

        pps…may I also suggest that Wode is somewhat out of date as a battle pigment

        • Complex wrote: “…if you focus on the extremes and report little of the vast majority it will appear that the entire profession is whacky”

          If you did your homework properly you’d know tht the vast majority of your profession indulge in blatant quackery. Here are the data:

          A large survey of (and by) chiropractors which was carried out in 2003 (McDonald W, Durkin K, Iseman S, et al, ‘How Chiropractors Think and Practice’, Seminars in Integrative Medicine, 2004 V.2 No.3 92-98, Institute for Social Research, Ohio University) revealed that 89.8% of chiropractors in the USA (where well over 50% of chiropractors practice) felt that spinal manipulation should not be limited to musculoskeletal conditions – a figure which appears to be supported by this 2004 survey of chiropractors in Portland, Oregon…
          http://www.chirobase.org/02Research/laidler.html
          …which found a 100% incidence of beliefs and practices that were unsubstantiated or clashed with established scientific knowledge. Interestingly, the McDonald et al survey also revealed that 9 in 10 chiropractors believed in (fictitious) subluxations, 4 in 5 thought they were involved in visceral illness, and 2 in 10 thought they explain all of illness (so-called straight chiros).

          A further indication that the majority of chiropractors are using spinal manipulation as a panacea can be found in research which the World Federation of Chiropractic (WFC – an association of chiropractic organisations in 85 countries) gathered during its 2004-2005 consultation on ‘The Identity of the Chiropractic Profession’. It gives valuable insight into the chiropractic profession’s perceptions of itself on an international scale. For example, not only did the consultation result in the participating chiropractors’ unanimous agreement that the most appropriate public identity for the profession within health care was “The spinal health care experts in the health care system” – a definition which clearly allows pseudoscientific chiropractic practices to continue to flourish – it also produced a document entitled “Abstracts of Previous Relevant Research” which cited 2003 McDonald et al study, and specifically mentioned the following in section E, #6:

          Quote:
          “Approximately 9 in 10 [USA chiropractors] confirmed that the profession should retain the term “vertebral subluxation complex” (88.1%) and that the adjustment should not be limited to musculoskeletal conditions (89.8%). Subluxation is rated as a significant contributing factor in 62.1% of visceral ailments.”

          In addition to that, the results of the WFC consultation produced a chart called “Perceptions of How the General Public Perceives the Chiropractic Profession”. It illustrates the percentage of chiropractors who said that the following phrases described the profession “perfectly” (7 on a scale of 1 to 7) or almost perfectly (6):

          Quote:
          “Management of vertebral subluxation an its impact on general health”
          – 65% of chiropractors said that the general public should perceive chiropractic that way
          “Management of vertebral subluxation”
          – 57% of chiropractors said that the public should perceive chiropractic that way

          Those figures are supported by a 2007 survey of UK chiropractors which revealed that traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of respondents, with 63% considering the subluxation to be central to chiropractic intervention:
          http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1188-the-scope-of-chiropractic-practice-a-survey-of-chiropractors-in-the-uk.html

          Indeed, in 2010, the vitalistic Alliance of UK Chiropractors (which claims to be the largest of the four UK chiropractic associations), pressured the UK regulator, the General Chiropractic Council (GCC), into changing its former stance about there being no evidence to link imaginary chiropractic subluxations to “health concerns”. Shockingly, when the GCC caved in it apparently provided no evidence to support its U-turn. See:
          http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1827-alliance-of-uk-chiropractors-october-2010-newsletter.html

          Over to you now, Complex. Do you have more up to date than those I have supplied above?

          • I can’t and wont engage with what the American professions views are as I think it is probably chiropractors in the UK that we need to focus on, unless of course you or people you know are going across the pond for regular treatment.

            However, when focusing on the UK, where I suspect we both live, I notice that you have taken your quotes from a site, also less than balanced in my view and only quoting a limited paragraph from the original study.

            Going to the original study itself the sample actually returned was of only around 11.7% of the profession in the UK at the time. So figures you correctly quote are in fact percentages of just over 1 in 10 of all chiropractors

            For example…….”with 63% considering the subluxation to be central to chiropractic intervention” is in fact only 157 chiropractors out of a total population at the time of 2134 clinicians, hardly I would say the vast majority.

            Indeed the authors themselves admit, and I quote “The results of this study are limited owing to the low number of participants, which prevents the findings being generalizable to the whole profession”, which is ironically, exactly what you are trying to do Mr Blue and exactly my point regarding the idea that those representing much more mainstream views (i.e., those compatible with a musculoskeletal focused specialism using a variety of skills acquired through 5 years at Masters level education to manage patient responsibly and ethically) probably constitute the majority of the profession.

            And yes, the profession has come from a history of magnetic healers, who at the turn of the last century were looking to contemporary ideas to explain the paucity of clinical knowledge as indeed was medicine which was quite happily prescribing leeches and laudanum, along with re usable antimony pills and huge doses of X rays to see people entire skeltons……..yes…everyone back then had whacky ideas based on lack of knowledge.

            BUT, along with medicine, the chiropractic profession has matured. It has embraced funding research, has collaborated with academics and research groups in other UK HE institutions, and along with considerable further change has, in short, modernized and with the ongoing output from university based mainstream health care education, is continuing to do so. And yes, it may politically and culturally still have some way to go, but then so does the NHS in its treatment of old people laid up in SOME hospital wards. BUT that doesn’t mean that the vast majority of clinicians in hospitals aren’t super committed, compassionate, highly trained professionals trying to do their best, and trying to do better. Unless you want to take up the simplistic tabloid based bashing of the medical profession with simplistic ideas and sensationalist headlines……..oh…hang on…that sounds familiar

            Things change, systems evolve, knowledge is gained and developed and through the logic inherent in the scientific method and approach, we improve because we know more. If your so concerned about the manipulative professions (Osteopaths and Physiotherapist included) maybe you could offer ways of improving where you see us lacking, and guiding where you see us failing. Clearly having set yourself up as a gold standard, it appears morally and intellectually incumbent on you to disseminate your wisdom in the name of improvement and not subjugation.

            However, I suspect a constructive approach is not half as much fun being the dismissive arrogant cherry picker that you appear to be, a pursuit endlessly able to find fault with whatever counter arguments are put.

            So I’m going to get on with my science and I’ll leave you to the ranting

            Adieu Monsieur Bleu

  • Complex wrote: “I notice that you have taken your quotes from a site, also less than balanced in my view and only quoting a limited paragraph from the original study.”

    It adds to what the scientific community continues to observe about chiropractic.

    Complex wrote: “Going to the original study itself the sample actually returned was of only around 11.7% of the profession in the UK at the time. So figures you correctly quote are in fact percentages of just over 1 in 10 of all chiropractors.”

    That’s correct, and I would venture that it’s the more ethical element of chiropractors who respond such surveys. In other words, with chiropractic having such a poor image, don’t you think that if the majority of chiropractors practised ethically that they would all be clamouring to be included in practice surveys? Indeed, wouldn’t they be conducting as many surveys as possible in order to prove the current data wrong?

    On that point, I ask again, do you have any better data?

    Complex wrote: “BUT, along with medicine, the chiropractic profession has matured.”

    In your dreams.

    Complex wrote: “It has embraced funding research, has collaborated with academics and research groups in other UK HE institutions, and along with considerable further change has, in short, modernized and with the ongoing output from university based mainstream health care education, is continuing to do so.”

    I would urge readers to take a couple of minutes to read the following about chiropractic university education in the UK:

    1. The Anglo European College of Chiropractic and its dubious track record with regard to research:
    http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1820-in-praise-of-chiropractic-.html

    2. The Welsh Institute of Chiropractic, to which enquiries have been made in the past regarding the science base for its teachings:
    http://sciencedigestive.blogspot.co.uk/2010/06/email-to-university-of-glamorgan.html
    (I understand from the neuroscientist who made the enquiries that they were met with evasive responses.)

    Complex wrote: “If your so concerned about the manipulative professions (Osteopaths and Physiotherapist included) maybe you could offer ways of improving where you see us lacking, and guiding where you see us failing. Clearly having set yourself up as a gold standard, it appears morally and intellectually incumbent on you to disseminate your wisdom in the name of improvement and not subjugation.”

    I have pointed out ways in which chiropractors could improve themselves for years and still see no attempt from them to establish the basics – i.e. standardisation and the implementation of *reliable* adverse event reporting systems.

    Complex wrote: “However, I suspect a constructive approach is not half as much fun being the dismissive arrogant cherry picker that you appear to be, a pursuit endlessly able to find fault with whatever counter arguments are put. So I’m going to get on with my science and I’ll leave you to the ranting. Adieu Monsieur Bleu.”

    Once again:
    http://edzardernst.com/2012/12/ad-hominem-attacks-are-signs-of-victories-of-reason-over-unreason/

  • OK…………Yes yes, I said no more, but clearly this is fun and as an academic who spent years trying to expose false thinking and champion the truth…I just cant (YET) let your comments go….

    The adverse event reporting is called Chiropractic Patient Incident and learning reporting system (CPiRLS), run by the Royal College of Chiropractors, who you feel deserve such maligning (http://rcc-uk.org/index.php/cpirls/). Its limitation is that is self reporting and of course you will say that that just doesn’t cut the mustard, but an entirely similar system is there for GPs (The Yellow Card Scheme). Interestingly there has been a 39% drop in GPs reporting adverse events leading to a paper this February published in the BMJ titled ‘GPs are urged to report adverse drug reactions after a 37% slump over nine years’ (http://www.bmj.com/content/346/bmj.f690). In the real world it is pretty difficult to get clinicians to keep up with this stuff, so I am neither knocking the GPs or the Chiropractors. However, at the very least the chiropractors have a system. Perhaps you can tell me oh wise one which system in the world achieves this perfectly.

    Another recent report on adverse events is here……interestingly those receiving sham had significant numbers of adverse events, but in any case all events (manipulated or sham) were entirely non serious……….http://www.ncbi.nlm.nih.gov/pubmed/23778372.

    I guess this cant be said for NSAID pain killers (aspirin and the like) where a comprehensive study suggested that, and I quote ‘ “NSAIDs cause approximately 3500 hospitalisations for and 400 deaths from ulcer bleeding per annum in the UK in those aged 60 years and above”. This translates to a attributable risk of around 270 per 10,000. (http://gut.bmj.com/content/52/4/600.full) That’s without the evidence that the ibuprofen family of drugs are increasingly linked to higher risk of CHD. NOW, I’m not knocking these medications. They are very useful and serve millions of people well, but one must look at relative risk and benefit. In aspirins case that risk/benefit is considered worth it and GPs will happily (as will the public themselves) prescribe huge quantities of them every year.

    Now given that Low Back Pain is the number 1 global disability burden, and that no treatment or management for it is any better than manipulation ( i.e. manipulation is as good as anything out there) AND that the estimated incidence is of serious side effect is at the very worst 1 per 10,000, it looks like there could be a risk benefit case to make.

    Really, we can all play with numbers. Here’s a headline, ‘Taking aspirin shown to be 270 times more dangerous than going to see a chiropractor!: New research study shows!!’…………..Is that the balance the research deserves?

    You seem to re direct me to an awful lot of publications by Edzard??…..is that you Edzard?….is it…is it! :>)

    • Complex wrote: “The adverse event reporting is called Chiropractic Patient Incident and learning reporting system (CPiRLS), run by the Royal College of Chiropractors, who you feel deserve such maligning (http://rcc-uk.org/index.php/cpirls/). Its limitation is that is self reporting and of course you will say that that just doesn’t cut the mustard, but an entirely similar system is there for GPs (The Yellow Card Scheme).”

      Chiropractic was invented nearly 120 years ago, and first arrived in the UK in 1924. However, the CPiRLS has only been on the go for around six years http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154058/ whereas the Yellow Card System was introduced 50 years ago. I think readers will be able to draw the obvious conclusion from that.

      Complex wrote: “Interestingly there has been a 39% drop in GPs reporting adverse events leading to a paper this February published in the BMJ titled ‘GPs are urged to report adverse drug reactions after a 37% slump over nine years’ (http://www.bmj.com/content/346/bmj.f690).”

      Fair comment, but let’s not forget the very significant fact that the public has always been able to report to the Yellow Card System http://yellowcard.mhra.gov.uk/ I understand that chiropractic patients cannot report to the CPiRLS. Is that correct?

      Complex wrote: “In the real world it is pretty difficult to get clinicians to keep up with this stuff…”

      It is vastly more difficult for those practicing real medicine to stay current than it is for chiropractors (who, by comparison, have a very narrow scope of practice).

      Complex wrote: “…at the very least the chiropractors have a system.”

      In the UK only (U.S. chiropractors have a loophole), and even then it is greatly underutilised for reasons that include “fear of retribution, being too busy and insufficient clarity on what to report”. See here:
      http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1888-british-chiropractic-association-members-attitudes-towards-the-chiropractic-reporting-and-learning-system-a-qualitative-study.html

      Complex wrote: “Another recent report on adverse events is here……interestingly those receiving sham had significant numbers of adverse events, but in any case all events (manipulated or sham) were entirely non serious……….http://www.ncbi.nlm.nih.gov/pubmed/23778372. “

      Here’s a critical evaluation of that study:

      QUOTE
      “The authors state that no serious adverse effects were observed. With less that 200 patients participating, it would have been most amazing to see a case of arterial dissection or stroke. From all we currently know, such events are quite rare and occur perhaps in one of 10,000 patients or even less often. This means that one would require a trial of several hundred thousand patients to note just a few of such events, and an RCT with several million patients to see a difference between real and sham treatment. It seems likely that such an undertaking will never be affordable.”
      http://edzardernst.com/2013/06/strong-evidence-for-a-causal-link-between-chiropractic-treatment-and-adverse-effects/

      Complex wrote: “I guess this cant be said for NSAID pain killers (aspirin and the like) where a comprehensive study suggested that, and I quote ‘ “NSAIDs cause approximately 3500 hospitalisations for and 400 deaths from ulcer bleeding per annum in the UK in those aged 60 years and above”. This translates to a attributable risk of around 270 per 10,000. (http://gut.bmj.com/content/52/4/600.full) That’s without the evidence that the ibuprofen family of drugs are increasingly linked to higher risk of CHD.”

      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, many 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 [– and used judiciously -] manipulation would be much less cost-effective.”

      Source: 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, we know that many chiropractors fail to warn patients about the risks associated with their manipulative treatments. Additionally, NSAIDs have been proven to work and their adverse effects are recorded and acknowledged *globally* by the medical community. But perhaps most importantly, other equally valid therapeutic options (e.g. exercise therapy or massage), which have not been associated with significant risks, are available to patients.

      Complex wrote: “Now given that Low Back Pain is the number 1 global disability burden, and that no treatment or management for it is any better than manipulation ( i.e. manipulation is as good as anything out there) AND that the estimated incidence is of serious side effect is at the very worst 1 per 10,000, it looks like there could be a risk benefit case to make.”

      I disagree. With cheaper, safer, and more convenient options such as exercise and massage, why should anyone risk chiropractic spinal manipulation when there is no standardisation (i.e. quackery continues to flourish unchecked), and its true risks continue to be unknown?

      Complex wrote: “Really, we can all play with numbers. Here’s a headline, ‘Taking aspirin shown to be 270 times more dangerous than going to see a chiropractor!: New research study shows!!’…………..Is that the balance the research deserves? You seem to re direct me to an awful lot of publications by Edzard??…..is that you Edzard?….is it…is it!”

      Here’s where chiropractic and other alternative medicines fail greatly:

      Quote:
      “Scientific medicine constantly criticizes itself and publishes the critiques for all to see. There is NOTHING comparable in the world of alternative medicine.”

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

  • Look….chiropractors treating patients are safe………lots of people get musculoskeletal pain……they don’t have a lot of choices and GPs don’t want to deal with them…when they do it is more expensive because most patients that go to chiropractors do so free to the NHS as they pay themselves…..most people get better and surveys show that chiropractic patients rate their satisfaction with treatment as being nearly 100%………it’s safe! it’s cheap to the NHS and it’s as effective as anything else…..

    So. I think it’s probably OK…the evidence can be interpreted by you as non existent and me as good enough to suggest it as an alternative if you so choose as a patient in pain…..we will always disagree…..the nature of science as you know is one where definitive truths will never be available, at least in medicine…that’s just the nature of it…

    Anyway…it’s been a blast. Edzard……I hope you are well and remain so…….in the end we are all small and rather insignificant…..we do our best when we try to tell the truth. Mine and yours just take a different take on what the world has so far shown us……

    • Complex wrote: “I think it’s probably OK…the evidence can be interpreted by you as non existent and me as good enough to suggest it as an alternative”

      Of course you think the evidence is good enough. You need to earn a living.

  • A fellow of the royal college of chiropractic- what nonsense. This is misleading to the public just as their use of the title doctor.
    I am dually qualified in osteopathy and medicine. I would be deeply embarrassed if osteopathy were to follow suit. After qualifying as a doctor, I became a member of the royal college of surgeons and then a fellow of the royal college of radiologists. To earn the privelidge to use these titles after my name I had to sit a total of thirteen postgraduate exams. What professional exams do the chiropractors have to take in order to call themselves a fellow of the college?? This is totally misleading and I have to say a disgrace. They are masquerading as proper doctors and fooling the public. Thank goodness the osteopathic profession has the sense not to follow.

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