MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The dismal state of chiropractic research is no secret. But is anything being done about it? One important step would be to come up with a research strategy to fill the many embarrassing gaps in our knowledge about the validity of the concepts underlying chiropractic.

A brand-new article might be a step in the right direction. The aim of this survey was to identify chiropractors’ priorities for future research in order to best channel the available resources and facilitate advancement of the profession. The researchers recruited 60 academic and clinician chiropractors who had attended any of the annual European Chiropractors’ Union/European Academy of Chiropractic Researchers’ Day meetings since 2008. A Delphi process was used to identify a list of potential research priorities. Initially, 70 research priorities were identified, and 19 of them reached consensus as priorities for future research. The following three items were thought to be most important:

  1.  cost-effectiveness/economic evaluations,
  2.  identification of subgroups likely to respond to treatment,
  3.  initiation and promotion of collaborative research activities.

The authors state that this is the first formal and systematic attempt to develop a research agenda for the chiropractic profession in Europe. Future discussion and study is necessary to determine whether the themes identified in this survey should be broadly implemented.

Am I the only one who finds these findings extraordinary?

The chiropractic profession only recently lost the libel case against Simon Singh who had disclosed that chiropractors HAPPILY PROMOTE BOGUS TREATMENTS. One would have thought that this debacle might prompt the need for rigorous research testing the many unsubstantiated claims chiropractors still make. Alas, the collective chiropractic wisdom does not consider such research as a priority!

Similarly, I would have hoped that chiropractors perceive an urgency to investigate the safety of their treatments. Serious complications after spinal manipulation are well documented, and I would have thought that any responsible health care profession would consider it essential to generate reliable evidence on the incidence of such events.

The fact that these two areas are not considered to be priorities is revealing. In my view, it suggests that chiropractic is still very far from becoming a mature and responsible profession. It seems that chiropractors have not learned the most important lessons from recent events; on the contrary, they continue to bury their heads in the sand and carry on seeing research as a tool for marketing.

29 Responses to Chiropractors continue to bury their heads in the sand

  • Wait…I think I think I’m seeing a pattern here… You don’t like drug-free approaches to health, particularly chiropractic health care? Seems to me to be a bit of an unhealthy obsession to focus on. Sure, there is always more that needs to be done, but modern medicine kills more than 800,000 Americans and more than 150,000 Britainians EACH YEAR from medical errors that should have been prevented. That’s like 8 or 10 filled jumbo jets crashing EACH DAY! While it is commendable that you and your allopaths pals are doing your part to reduce the world’s population and thus the strain on the resources of the planet, wouldn’t it be more productive to focus your ire in that direction? This medical death toll has just been getting worse and worse with each passing year.

    Seems to me that I would be pulling my hair out over this while sipping high tea. Just sayin’.

    • SkepdicProf wrote: “Wait…I think I think I’m seeing a pattern here…”

      Well I certainly am. Let’s go back to this comment of yours on another post:
      http://edzardernst.com/2014/01/chiropractors-use-of-x-rays/#comment-54955

      Hopefully you won’t be issued with another warning for posting insults and abuse. And before you start going through all your tiresome ‘arguments’, here’s medicine’s answers to its critics:

      Part 1
      http://www.sciencebasedmedicine.org/answering-our-critics-part-1-of-2/

      Part 2
      http://www.sciencebasedmedicine.org/answering-our-critics-part-2-of-2-whats-the-harm/

      And here’s a snippet from Death by Medicine:

      QUOTE
      “Doctor-bashers use their numbers to argue that alternative medicine is safer. Maybe it is. I suppose not treating at all would be safer still. It depends on how you define “safe.” To my mind, a treatment is not very “safe” if it causes no side effects but lets you die. Most of us don’t just want “safe:” we want “effective.” What we really want to know is the risk/benefit ratio of any treatment.
      The ironic thing is that all the statistics these doctor-bashers have accumulated come from the medical literature that those bashed doctors have written themselves. Scientific medicine constantly criticizes itself and publishes the critiques for all to see. There is NOTHING comparable in the world of alternative medicine.”

      Link http://www.sciencebasedmedicine.org/death-by-medicine/

    • Approximately 2.4 million Americans die per year (http://www.cdc.gov/nchs/fastats/deaths.htm). So, by your logic, one third are “killed by modern medicine”. That leaves two thirds to be “killed” by no treatment or CAM (read ineffective) treatments. I’d say modern medicine is far and away the better choice.

    • modern medicine kills more than 800,000 Americans and more than 150,000 Britainians EACH YEAR from medical errors that should have been prevented. That’s like 8 or 10 filled jumbo jets crashing EACH DAY!

      I think SDP is one of those “bots” one reads about that automatically spreads nonsense and misinformation.

      It would be interesting to know how often this ridiculous lie has been repeated here by this automaton?

      • Indeed. The usual zombie arguments.

      • Oh, it’s Bjorn again. It would be interesting to know how many you believe are killed each year by allopaths and their so-called “scientific” medical errors if you think that 800,000 Americans (and 150,000 Brits) is not accurate.

        • @SkepdicProf

          You made the claim; you provide the evidence to substantiate it.

          • You got me there, Al. No one here seems to like the numbers from “Death by Medicine” by a panel of MDs and PhDs. Seems it gets everyone’s knickers in a knot around here:
            http://www.lef.org/magazine/mag2004/mar2004_awsi_death_01.htm

            I think the number is higher than your view that since it’s real medicine there likely aren’t any and besides they died for a good cause in the name of real scientific medicine and all is well. But a simple use of Google of: how many Americans are killed by medical errors produces over 77 million results in .45 seconds for you to review.

            https://www.google.com/webhp?sourceid=chrome-instant&rlz=1C1RNNN_enUS387&ion=1&espv=2&ie=UTF-8#q=how%20many%20americans%20are%20killed%20by%20medical%20errors

            A few good articles summarizing things for you that are easy-to-read but puts things in perspective are:

            http://www.scientificamerican.com/article/how-many-die-from-medical-mistakes-in-us-hospitals/

            This one, from Medical News Today, mentions something about 390 jumbo jets crashing:
            http://www.medicalnewstoday.com/releases/11856.php

            This is a good one that puts things in perspective for a layman:
            http://www.forbes.com/sites/leahbinder/2013/09/23/stunning-news-on-preventable-deaths-in-hospitals/

            According to a new study just out from the prestigious Journal of Patient Safety, four times as many people die from preventable medical errors than we thought, as many as 440,000 a year.

            http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx

            This should be plenty to keep you busy for a while, Al. BTW (By the way) most of these studies don’t count those who may have been killed in nursing homes and they surely don’t include those who went home after seeing the allopath and then croaked. That adds on quite a few more scores of victims of so-called ‘modern medical health scare.’

            Hope this helps!

          • “SkepdicProf” (SPD) has proven his prowess at the art of Googleing but also that he is unable to sort out and comprehend what he finds.
            None but the usual, disreputable health-falsification sites quote more than a maximum estimate[sic] of 440.000 preventable errors that may have contributed to death, not ‘killed by’ . This figure, which is intentionally maximized for added impact, represents a very crude estimate reflecting the shoddy performance of US health services, not the state of medical science today.
            Of course we should not have to remind the audience that none of these speculations about medical errors say anything to support the credibility or applicability of alternative health measures (=quackery), which have been demonstrated to have a very substantial morbidity and death toll of their own, the magnitude of which is completely unknown.

            The quackster Gary Null and his disinformation opus “Death by medicine” is certainly not a credible source of anything. Neither are a score of quackster sites like Mercola’s, Mike Adams’s etc. who use fear, uncertainty and doubt (FUD) tactics to scare people in need of help away from real healthcare.

            SPD’s constantly repeating the demonstrably falsified figure of “800.000 killed annually by modern medicine” seems to indicate that he does not even read his own googled sources. He simply parrots the quackster lies.

            I have sometimes wondered whether this fabrication is only another deliberate ploy of the quackster’s FUD-offensive fuelled as usual by financial gain or whether one should apply Hanlon’s Razor and believe that they are suffering from a mental condition called “mythomania” that reverses their perception of truth.

          • Hey! American medicine is the best in the world–and don’t forget it!! Medical News Today, Public Health, these are real medical people. OK, maybe 400,000 victims were NOT killed, just made less alive than when they made their appointment with the allopath. Have it your way, Bjorn. As long as it is less than half-a -million I guess I would agree with you — it doesn’t sound so bad.

            Like I said, Bjorn, “knickers in a knot”.

  • Professor Ernst wrote: “It seems that chiropractors have not learned the most important lessons from recent events; on the contrary, they continue to bury their heads in the sand and carry on seeing research as a tool for marketing.”

    I think that’s the only fair conclusion that can be reached when you also consider the following:

    In 2009, just as the Foundation for Chiropractic Education and Research decided on self-liquidation and filed for bankruptcy…
    http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54144
    the chiropractic marketing group, the Foundation for Chiropractic Progress (F4CP), received a record pledge of support:
    http://chiro.org/wordpress/2009/09/29/what-are-our-priorities/

    Indeed, just yesterday, it was reported that the F4CP recently announced that one of its earliest supporters, Standard Process Inc., had officially surpassed the million-dollar donation mark, with total contributions expected to exceed $1,057,000 in 2014. Apparently “this impressive donation has helped to steadily increase the number of media impressions generated by the F4CP, which amounted to more than 31 billion in 2013”:

    Link: http://www.chiroeco.com/chiropractic/news/14956/50/f4cp%20congratulates%20standard%20process%20for%20surpassing%20million-dollar%20donation%20mark/

    But perhaps all this heavy investment in marketing isn’t surprising when you look at chiropractic’s downward spiral as predicted in scenario 2 here: http://www.altfutures.org/chiropracticfutures

    In support of scenario 2, let us not forget that chiropractic utilisation in recent years has never managed to exceed 7% of the population in the US, and chiropractic college enrolment in the US has remained flat since 2002. Here’s a very revealing graph:
    http://chiropractic.prosepoint.net/76525

    But, IMO, the main reason why chiropractors are very reluctant to undertake any serious research is that the evidence for spinal manipulative therapy – chiropractors’ hallmark treatment – is looking increasingly shaky: http://www.bodyinmind.org/spinal-manipulative-therapy-a-slow-death-by-data/

  • The comments from SkepdicProf fail to address the issues raised in the above article. He would be well advised to examine what the chiro’s have achieved in Denmark and follow their example. This is already happening in Canada, Switzerland, Australia and some parts of the UK and the USA. The survey referenced was published in the journal “Chiropractic and Manual Therapies” http://www.chiromt.com/ which is the journal of COCA http://www.coca.com.au/ which is leading the profession in Australia in the right direction. The journal has been described by chirobase (Which is a chiropractic skeptics site) as one of the only chiropractic journals prepared to discusses what is wrong with chiropractic. High praise indeed, maybe that is why it has been picked up by the Royal College of Chiropractic and The European Academy of Chiropractic. Pity there are not more like it, as it would put Edzard and Blue Wode out of business, though unfortunately I don’t think this will be happening for a while yet! (No rude comments in regards to this please Blue, be nice!)
    As for the chiropractic futures senario’s http://www.altfutures.org/chiropracticfutures referenced by Blue, I have been working on Senario 3 for 20+ years and it has worked well. I think the civil war described in senario 2 is ongoing and any salvo’s on the BS merchants should also be balanced by support for the good guys. HINT!
    SkepdicProf should read through Blue Wode’s links and references, it would be educational! Blue knows his stuff and is a good communicator ;-)

  • In light of the recent case of a 4 month old infant suffering a fractured neck, my co-authors (Dr John Cunningham, Dr David Hawkes) & I have called on Australin chiropractors to establish an Adverse Events Reporting System. Given the paucity of evidence for paediatric chiro, there is simply no justification for chiropractic intervention in infants & children. See here:

    https://www.mja.com.au/journal/2014/200/4/need-chiropractic-adverse-events-reporting-system-australia

    https://www.mja.com.au/insight/2014/7/support-chiropractor-reporting

    • @ Joanne Benhamu

      Re https://www.mja.com.au/insight/2014/7/support-chiropractor-reporting

      John Cunningham, an Australian spinal orthopaedic surgeon specialising in cervical and lumbar spinal degeneration and trauma, contributed this interesting comment (see 3/3/2014 – 10:31) below that piece:

      QUOTE
      “A problem with serious adverse events is that they will most likely not present to their treating professional, but to a hospital. A simple and inexpensive reporting system would be a simple question when a patient is admitted to the Emergency Department, “have you been treated by a let health practitioner in the last four weeks?”. This would be a screening test. If the later diagnostic codes matched the profession (eg: chiro/stroke, chinese med/poinsoning), then a more detailed examination of the practioners notes could be made. Who knows, we might find a particular manouver that is more dangerous than others?
      Additionally, it is not the CAA [Chiropractors’ Association of Australia – a trade body similar to the British Chiropractic Association and the American Chiropractic Association] who should be doing this. It is simply not their responsibility. It should be the CBA – the supervisory organisation – and not an industry group like the CAA. Any adverse event register run by the CAA would be immediately tainted, much like if the AMA ran one for doctors.”

      IMO, his suggestions should be implemented internationally, with lessons having been learnt from the shambolic Chiropractic Patient Incident Report and Learning System (CPiRLS) that was set up in the UK a few years ago…
      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

    • Hi Joanne,
      Would you consider the possibility that you are wrong about this? The medical industry kills a million a year (3000 per day) from medical mishaps and never issues any apologies to the next of kin and loved ones. So why get your knickers in a knot about a false story? Haven’t seen any apologies from the chiropractic-deniers here or anywhere else. Sup’ with dat?

      http://www.theaustralian.com.au/news/nation/chiropractor-cleared-over-break/story-e6frg6nf-1226740575036

      I mean, the baby is not even dead. That would be considered a success in the allopathic trades.

      • @ SkepdicProf

        Re: http://www.theaustralian.com.au/news/nation/chiropractor-cleared-over-break/story-e6frg6nf-1226740575036

        Notwithstanding the question why the infant was receiving chiropractic ‘treatment’ in the first place, here’s some pertinent background to that case:

        Call for age limit after chiropractor breaks baby’s neck
        “A baby’s neck has been broken by a chiropractor in an incident doctors say shows the profession should stop treating children. The injury was reported to the Chiropractic Board of Australia, which closed the case without reporting it to the public and allowed the chiropractor to keep practising as long as they undertook education with an ”expert in the field of paediatric chiropractic”… Melbourne paediatrician Chris Pappas cared for a four-month-old baby last year after one of her vertebrae was fractured during a chiropractic treatment for torticollis – an abnormal neck position that is usually harmless. He said the infant was lucky to make a full recovery. ”Another few millimetres and there would have been a devastating spinal cord injury and the baby would have either died or had severe neurological impairment with quadriplegia,” he said. Dr Pappas complained to the Australian Health Practitioner Regulation Agency (AHPRA), which referred the case to the Chiropractic Board. Three weeks ago, he received a letter from AHPRA saying the case had been closed after the chiropractor committed to completing further education. Dr Pappas said he was concerned the decision was an endorsement of chiropractic treatment for infants when there was no scientific evidence to support it. ”I think they have put the chiropractor’s interests before the interests of the public,” Dr Pappas said. ”[Treating infants] is inappropriate and it carries a very small but real risk of causing damage, and in some cases, devastating damage”.”
        Julia Medew, Amy Corderoy, Sydney Morning Herald (29th September 2013)

        Doctor stands by claim on baby injury despite chiropractic body’s denial
        “The peak body representing chiropractors says a Melbourne doctor’s claim that an infant’s neck was broken during a chiropractic treatment last year is wrong. However, the paediatrician involved, Dr Chris Pappas, has stood by his diagnosis of the baby’s injury and said a thorough investigation excluded any other possible causes…national president of the Chiropractors’ Association of Australia Dr Laurie Tassell said an expert report on the case commissioned by the Australian Health Practitioner Regulation Agency (AHPRA) and cited in The Australian showed the baby’s neck had not been broken. In a written statement, Dr Tassell said the baby had a condition known as congenital spondylolysis, a malformation of the spine that ”can be confused with a ‘hangman’s fracture’.” Dr Tassell declined to be interviewed or to comment on whether he had a copy of the report, but said the chiropractor who treated the infant had not applied sufficient force to cause a fracture.”
        Julia Medew, The Age (17th October 2013)

        No doubt baby’s neck was fractured doctors say
        “The furore surrounding a chiropractor accused of fracturing a baby’s neck gathered momentum today with claims the investigation was flawed…Spinal surgeon Mr John Cunningham said he and his colleagues had no doubt the child suffered a fracture…”I strongly suspect that the injury was through the congenital defect, the weak point, which would have contained cartilaginous tissue. This would not be visible on the initial CT as cartilage is simply not seen. A second CT, performed some weeks later [see paragraph 34 of the report], clearly indicates new bone formation and healing of a concurrent fracture.” Mr Cunningham said the CAA (Chiropractors’ Association of Australia) must have appreciated the significance of the second CT scan. “What I find disingenuous is the manner in which they only released to the press the first CT report,” he added.”
        Medical Observer (18th October 2013)

        Links available here: http://www.ebm-first.com/chiropractic/safe-for-children.html

        SkepdicProf wrote: “I mean, the baby is not even dead.”

        How callous. For a health professional, you should be ashamed of yourself.

    • Joanne…best you get your facts straight about that case. I do however agree that the treatment of infants by the Chiros should be reviewed.

      Ed. Don`t moderate my posts and delete them just because you don`t agree with them.

  • In response th Blue Wode:
    The Vohra paper http://pediatrics.aappublications.org/content/119/1/e275.abstract noted the poor level of reporting of adverse events, citing another study of less than 10% for drug adverse events, and stated the need for greater cooperation between doctors and chiropractors in reporting and investigating adverse events. This has been repeated by Joanne Benhamu and the article by John Cunningham. https://www.mja.com.au/insight/2014/7/support-chiropractor-reporting I agree 100% with John (as I stated in the comments section).
    The Vohra study also included one physio, one doctor and 2 “not specified” and two which were attributable to chiro’s were includes twice (out of 13 studied included). One of the frustrations being a chiropractor is the way blame is shifted onto us, but having said that, we must take responsibility for the adverse events that are definitely chiropractic and not bury our heads in the sand as Edzard stated.
    “Chiropractic Patient Incident Report and Learning System (CPiRLS) that was set up in the UK a few years ago…”
    This was a step in the right direction but as John Cunningham said is is simply not their responsibility and should be run by the national registration board.
    In response to the accreditation of pediatrics courses for continuing professional development (CPD) points by the royal college of chiropractic, something similar happened here, CAA accredited them while COCA did not and the vitriol from a chiro in the USA was interesting.

    The paper you cited http://adc.bmj.com/cgi/content/full/archdischild%3b86/5/382 has this:
    CLINICAL BOTTOM LINE
    “The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic. However, there is good evidence that taking a colicky infant to a chiropractor will result in fewer reported hours of colic by the parents.”
    Followed by
    “In this clinical scenario where the family is under significant strain, where the infant may be at risk of harm and possible long term repercussions, where there are limited alternative effective interventions, and where the mother has confidence in a chiropractor from other experiences, the advice is to seek chiropractic treatment.”
    I have difficulty connecting the two! The other co-author is Stephen Hughes (Paediatric SpR, Northwick Park Hospital, Harrow) should know better.

    • Thinking_Chiro wrote: “The Vohra paper http://pediatrics.aappublications.org/content/119/1/e275.abstract noted the poor level of reporting of adverse events.”

      Don’t forget that the Vohra paper didn’t consider harmful aspects of chiropractic ‘care’ that are far more common than reported adverse events. These include (a) decreased use of immunisation due to misinformation given to parents, (b) psychologic harm related to unnecessary treatment, (c) psychologic harm caused by exposure to false chiropractic beliefs about “subluxations” and (d) financial harm due to unnecessary treatment.

      • Pappas and Blue Wode have a very funny way of apologizing for organizing their 24/7 lynching party when the baby is fine. Pappas and Cunningham have a very vivid imagination that reveals more about their agenda of protecting their turf than anything else.

        Blue Wode wrote:
        “Don’t forget that the Vohra paper didn’t consider harmful aspects of chiropractic ‘care’ that are far more common than reported adverse events. These include (a) decreased use of immunisation due to misinformation given to parents, (b) psychologic harm related to unnecessary treatment, (c) psychologic harm caused by exposure to false chiropractic beliefs about “subluxations” and (d) financial harm due to unnecessary treatment.”

        Knickers in a knot, BW. You don’t know if any of this took place, because no one knows what took place in this child’s mind or the parents or anyone else’s mind for that matter in this case, especially you. Have you spoken with them about the intimate minutiae? All we know for sure is what is going on in the minds of the folks who have a hankerin’ for a hanging.

        BTW, medical trades don’t lose their license after killing people from errors and mishaps otherwise there would be 3000 less allopaths each day. As you cited, this baby made a complete recovery. No harm done except by the provocateurs as described above.

        • SkepdicProf wrote: “You don’t know if any of this took place, because no one knows what took place in this child’s mind or the parents or anyone else’s mind for that matter in this case…”

          You have taken my words out of context. I was generalising about other harms that could be experienced by children and their parents as a result of the chiropractic clinical encounter.

          • Blue Wode wrote:

            “You have taken my words out of context. I was generalising about other harms that could be experienced by children and their parents as a result of the chiropractic clinical encounter.”

            Even worse. 3000 killed each day in the U.S. and the U.K. from the medical encounter. Seems the “harms” from the “clinical encounter” in the medical trades is a lot more hazardous to one’s health.

            A very odd apology.

  • @ SkepdicProf

    Your attempts to goad me aren’t going to get the reactions you want. As for your obsession with medical harms, from now on every time you raise the issue I will be looping you back to here:
    http://edzardernst.com/2014/03/chiropractors-continue-to-burry-their-heads-in-the-sand/#comment-55498

    • Goad you? I wasn’t trying to goad you. YOU seem to do a good enough job displaying your biased agenda, emotional reactions and public displays of affectation without my help. You keep waxing on about harms from non-drug approaches that don’t exist.

      The charging bull destroying the China shop is the medical industry (3000 killed each day/ US$3.3 trillion cost each year), but you see a flea on the bull’s back, for example, chiropractic health care (ZERO killed) and are trying to convince us that that is the real problem. You point out the flea– no problem. I point out the bull and you have a cow.

      Its you who continues to “burry” your head in the sand.

  • Oy, yet another dubious link from your link farm of your pet sites from your like-minded pals. It has gotten very Wikipedia-like wearisome, Woe.

    But I see your point about what the harm is. According to your “site”, if one adds up everyone killed from natural, non-drug approaches in the last 100 years (368,379) which is likely a bogus, made-up number, it is still a fraction of the death toll that the allopaths are responsible for in one year alone. (1 Million killed each year) Incredible! Thanks for pointing this out to us.

  • Apology accepted, Woe.

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