MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Many proponents of chiropractic claim that chiropractic spinal manipulation therapy (SMT) for chronic low back pain (LBP) might save health care cost. As LBP is a hugely expensive condition, this is a mighty important question. The evidence on this issue is, however, flimsy to say the least. Most experts seem to conclude that more reliable data are needed. On this background, it seems relevant to note that a new relevant study has just become available.

The purpose of this analysis was to report the incremental costs and benefits of different doses of SMT in patients with LBP.

The researchers randomized 400 patients with chronic LBP to receive doses of 0, 6, 12, or 18 sessions of SMT. Patients were scheduled for 18 visits for 6 weeks and received SMT or light massage control from a chiropractor. Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days.

The results show that costs for treatment and lost productivity ranged from $3398 for 12 SMT sessions to $3815 for 0 SMT sessions with no statistically significant differences between groups. Baseline patient characteristics related to increase in costs were greater age, greater disability, lower quality-adjusted life year scores, and higher costs in the period preceding enrolment. Pain-free and disability-free days were greater for all SMT doses compared with control, but only SMT 12 yielded a statistically significant benefit of 22.9 pain-free days and 19.8 disability-free days. No statistically significant group differences in quality-adjusted life years were noted.

The authors drew the following conclusions from these data: a dose of 12 SMT sessions yielded a modest benefit in pain-free and disability-free days. Care of chronic LBP with SMT did not increase the costs of treatment plus lost productivity.

So, is chiropractic SMT for LBP cost-effective? I leave it to my readers to answer this question.

51 Responses to Is chiropractic treatment for chronic low back pain cost-effective?

  • Fantastic news! Even those that suffer from chronic back pain get disability free days. Many people would prefer to see the results of a study done on acute back pain and lost productivity.

    It would be a more complex study to run, but when patients choose where to go to seek help with their disabling back pain, the acute setting is much more realistic and I think the results would be much more definitive.

    • much more definitive?
      perhaps – but not necessarily in a positive sense. acute back pain disappears with or without treatment!

      • That part of the study is straightforward to control for, simply don’t treat half the subjects.
        The employers loss of productivity and the employees loss of earnings are easy to measure, just getting hold of patients in their acute stage is the harder part. This should be the threshing floor of cost-effectiveness in my opinion. You might be surprised by the results Edzard!

        • …and if you’d treat the controls with a placebo-manipulation ,e.g. manipulation at a level where there is no ‘subluxation’, you might ne surprised by the result, alex.

          • Yes, that would be an interesting 3rd group.
            But should we make sure that as well as no significant manipulation, the control groups should receive no massage, ergonomic/postural advice, or stretches to do at home?
            There’s quite a lot more to Chiropractic care than removing ‘subluxation.’ Were not just trying to throw the bathwater out here, but bathe the baby.

  • Good article.
    Cost effectiveness is a major issue in health these days. There have been several relevant recent papers on this topic:

    Cost-effectiveness of different strategies to manage patients with sciatica.
    http://www.ncbi.nlm.nih.gov/pubmed/24726924
    Spinal manipulation epidemiology: systematic review of cost effectiveness studies.
    http://www.ncbi.nlm.nih.gov/pubmed/22429823
    Prevention of low back pain: effect, cost-effectiveness, and cost-utility of maintenance care – study protocol for a randomized clinical trial
    http://www.trialsjournal.com/content/15/1/102
    Cost minimization analysis of low back pain claims data for chiropractic vs medicine in a managed care organization.
    http://www.ncbi.nlm.nih.gov/pubmed/20004800

    These are the right questions to ask and the right research.
    The next important question is asked here:
    Dose or content? Effectiveness of pain rehabilitation programs for patients with chronic low back pain: A systematic review.
    http://www.ncbi.nlm.nih.gov/pubmed/24861585

    • @ Thinking_Chiro

      No, the next important question is: what guarantee is there that a patient will find his/herself in the clinic of an evidence-based chiropractor?

      QUOTE
      “Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine…..someone may go to see a chiropractor and think they will be seeing a medical professional who will treat their musculoskeletal symptoms, but in reality they will see the practitioner of a cult philosophy of energy healing…The bait — claims that chiropractors are medical practitioners with expertise in the musculoskeletal system. The switch — practitioners of discredited pseudosciences that have nothing to do with the musculoskeletal system…..A more subtle form of the bait and switch among chiropractors is the treatment of musculoskeletal symptoms with standard physical therapy or sports medicine practices under the name of chiropractic manipulation. Ironically, the more honest and scientific practitioners among chiropractors are most likely to commit this subtle deception. The problem comes not from the treatment itself but the claim that such treatments are ‘chiropractic’…. But by doing so and calling it ‘chiropractic’ it legitimizes the pseudoscientific practices that are very common within the profession — like treating non-existent ‘subluxations’ in order to free up the flow of innate intelligence.”

      Ref: http://www.sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/

  • In reply to Blue Wode:
    “No, the next important question is: what guarantee is there that a patient will find his/herself in the clinic of an evidence-based chiropractor?”
    The health care consumer is protected by the same boards and legislation as when selecting a general practitioner. Additionally, the consumer exercises the same due diligence, utilises referral networks, doctor recommendations etc etc etc.
    Caveat Emptor, be it any health care practitioner!

    “Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine…..someone may go to see a chiropractor and think they will be seeing a medical professional who will treat their musculoskeletal symptoms, but in reality they will see the practitioner of a cult philosophy of energy healing…The bait — claims that chiropractors are medical practitioners with expertise in the musculoskeletal system.”
    That cult philosophy is not taught at universities here except in its historical context and you need to stop carpet bombing the profession and make the distinction! As I have referenced previously here http://edzardernst.com/2014/05/spinal-manupulation-little-more-than-a-theatrical-placebo/ the research shows that subbies are in the minority.
    The physio’s are referencing chiropractic research and adopting chiropractic techniques so the traffic is two ways. I read journals like “Spine” and “Pain” and “European Spine Journal” but I will not be setting up as an orthopod or neurosurgeon any time soon, but if my patients have had any form of surgery then I had better know whether it is safe treat them or not, so reading those journals is important! Both physio’s and chiro’s heavily reference and use Janda and the Prague school of medicines research and exercise protocols, and collaborators like Liebenson (Chiro) and Gray (Physio) are co-authoring books and lecturing together, yet they are not wannabe pseudo doctors!
    You demand change and reform, yet dismiss the reformers as “irrelevant”.
    I have referenced the latest research, both physio and chiro and medical, and you ignore it!
    Patients looking for a chiro make the distinction between subbies and EBP chiro’s, as do my referring doctors, so should you!
    As I have said before:
    Step 1: Point out the BS and criticise it! (You have my support, the profession needs it, both internal and external)
    Step 2: Point out whats right and support it!

    • Thinking_Chiro wrote: “The health care consumer is protected by the same boards and legislation as when selecting a general practitioner. Additionally, the consumer exercises the same due diligence, utilises referral networks, doctor recommendations etc etc etc.”

      Are you being serious? The boards and legislation protect chiropractors first and foremost. As for “the consumer exercises the same due diligence” (regarding finding an evidence-based chiropractor), please supply solid evidence in support of your assertion.

      Thinking_Chiro wrote: “That cult philosophy is not taught at universities here…”

      As I’ve pointed out to you before, Australia is not the rest of the world. Also, you seem to have overlooked the University of Central Queensland:

      QUOTE
      “Inspired by a visit to Disneyland this paper explores the challenges associated with the need to teach something that may not exist…”

      Read on
      http://www.ebm-first.com/chiropractic-questionable/2037-towards-better-teaching-about-the-subluxation-complex.html

      Thinking_Chiro wrote: “As I have referenced previously here…the research shows that subbies are in the minority.”

      And as I have referenced previously here, repeatedly, the research shows that subluxationists are the majority:
      http://edzardernst.com/2012/11/the-risk-of-neck-manipulation/#comment-8844
      Even the recent paper by McGregor et al http:// bit ly/ 1hBtAax [Link disabled by admin due to suspected malware] – which claims that the unorthodox element of chiropractors represents 19% of the profession – is flawed. Its 1st, 3rd, 4th, 5th, and 6th subgroup descriptions don’t exclude the unethical chiropractic element. In other words, chiropractors in 5 of the 6 subgroups could easily indulge in chiroquackery – (1) “Wellness”, (3) “general probs”, (4) “organic-visceral”, and (5/6) “subluxations”.

      Thinking_Chiro wrote: “You demand change and reform, yet dismiss the reformers as “irrelevant”.”

      You will know that attempts at chiropractic reform have been around since the 1960s. As the reformists have failed to take control of the profession over some 50 years, why do you think the future is going to be any different?

      Thinking_Chiro wrote: “Patients looking for a chiro make the distinction between subbies and EBP chiros.”

      Citations please, otherwise your claim is pure wishful thinking.

    • But Chiropractic is about subluxations and realignment. So if that is not what you are doing its not Chiropractic. Why try and change Chiropractic to what is already happening in other professions. I know you have said in the past that you believe you need to take advantage of the public’s opinion that Chiros are experts on the spine, I presume that this opinion is due to historical Chiro practice i.e. manipulations, that has at best little evidence to support.

      So their treatment by an evidence based chiropractor has to be bait and switch! Your attitude and knowledge however commendable does not change these facts.

    • Why don’t you just rechristen yourself as a physiotherapist and remove all possibility of people associating you with “subbies”? Or start a whole new pseudomedical cult with a title such as “spinopractic”?

    • So, Thinking Chiro…Looks like you have an escort in Blue Wode whenever you decide to poke your head into this “blog”. How is it going nudging Wode to your side or even having him meet you somewhere in the middle? Does he get it yet? Just wondering.

  • In Reply to Blue Wode:
    Studies of Chiropractic practice patterns-

    Chiropractic Observation and Analysis Study (COAST): providing an understanding of current chiropractic practice.
    http://www.ncbi.nlm.nih.gov/pubmed/24237100
    Management of patients with low back pain: a survey of French chiropractors
    http://www.chiromt.com/content/22/1/13/abstract
    Treatment preferences amongst physical therapists and chiropractors for the management of neck pain: results of an international survey
    http://www.chiromt.com/content/22/1/11/abstract
    Evidence-based practice in chiropractic practice: A survey of chiropractors’ knowledge, skills, use of research literature and barriers to the use of research evidence
    http://www.complementarytherapiesinmedicine.com/article/S0965-2299%2814%2900031-4/abstract
    Are Swiss chiropractors different than other chiropractors? Results of the job analysis survey 2009.
    http://www.ncbi.nlm.nih.gov/pubmed/20937430
    Practice patterns of 692 Ontario chiropractors (2000–2001)
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1839931/?tool=pmcentrez&report=abstract
    Perspectives of older adults on co-management of low back pain by doctors of chiropractic and family medicine physicians: a focus group study
    http://www.biomedcentral.com/1472-6882/13/225
    Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey
    http://www.biomedcentral.com/1472-6882/14/51

    The McGregor paper also stated:
    “From the data in our investigation, like the growth in medicine, it appears that the paradigm for the chiropractic profession has since shifted as well. Evidence of marginalization by the chiropractic profession of its unorthodox sect is indicated by the relative number of publications in its mainstream journal compared to the number associated with its dissident counterpart. From 1978 through 2004 for example, there were 1,394 abstracts available in the peer-reviewed and indexed journal most strongly affiliated with the chiropractic profession. For the same years there were only 55 abstracts associated with the periodical expressing a predominantly non-evidence-based view [3].”

    They also grouped the them into orthodox/unorthodox here:
    “Almost 19% (18.8% – 95% CI: 15.5 – 22.7) of chiropractors surveyed associated themselves with the predefined unorthodox perspective of “Chiropractic Subluxation as an Obstruction to Human Health”, while 81% (81.2% – CI: 77.3 – 84.5) were associated with a strata of a more orthodox view, identifying themselves with biomechanical disorders or musculoskeletal joint dysfunction. Of the 371 chiropractors in the orthodox group, the majority (53.1% – 95% CI: 48.0 – 58.1) strictly identified themselves in the strata labeled “Biomechanical”, defined as caring for musculoskeletal or neuromusculoskeletal problems such as low back and neck-related pain.”
    Add this to the other papers cited above and the results are consistent!

    As for institutions here, Central Queensland Uni is a problem, however Murdock, Macquarie and RMIT are not so as i have said they are definitely the minotity institution.
    You may remember years ago when Life Chiropractic College lost their accreditation and were subsequently put on probation.
    http://www.ontcm.com/dotnetnuke/NewsEvents/tabid/639/articleType/ArticleView/articleId/134/Life-University-Loses-Chiropractic-Accreditation.aspx
    The accreditation boards are taking action. CQU here is currently going through the accreditation process, so it will be lnteresting to see the outcome!
    You also cited recently on Twitter chiropractic students forming subluxation groups due to their frustractin with a lack of Sx within their courses!

    “Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine”
    How would you describe this?
    Is it a Chiropractor, is it an Osteopath? No, it is a Physical Therapist calling themselves an Osteopractor!
    http://spinalmanipulation.org/
    They also try to make the distinction by claiming all chiropractors are taught subluxation.

    “Thinking_Chiro wrote: “Patients looking for a chiro make the distinction between subbies and EBP chiros.”
    Citations please, otherwise your claim is pure wishful thinking.”
    It is discussed here:
    Epidemiology: spinal manipulation utilization.
    http://www.ncbi.nlm.nih.gov/pubmed/22289432
    “Across all geographic regions studied, patients receiving spinal manipulation most commonly report musculoskeletal symptoms of the low-back or neck. For example, in the 1974–1982 RAND Health Insurance Experiment in the US, two-thirds of all visits to chiropractors were for head, neck or back pain (Shekelle and Brook, 1991), a finding mirroring more recent data indicating that an even greater percentage of chiropractic patients (68%) may be seeking care for low-back complaints (Hurwitz et al., 1998), with non-mus- culoskeletal symptoms comprising a very small minority (Coulter et al., 2002; Coulter and Shekelle, 2005). Low back, neck and head pain accounted for about three-quarters of all visits to chiroprac- tors in Massachusetts and Arizona, 85% of which included spinal manipulation (Mootz et al., 2005). Similar findings have been re- ported from surveys in California (Gordon and Lin, 2004) and in Arizona, Connecticut, Massachusetts, and Washington State (Cher- kin et al., 2002). Data from osteopathic practices in the US suggest that osteopathic manipulative treatment may be used relatively more frequently than chiropractic spinal manipulation for non- musculoskeletal conditions (Johnson and Kurtz, 2002)”

    The reform is there Blue, Support it!

    In reply to Neil:
    In discussing “Bait and Switch” you are assuming that the rehab that I do is straight out of the physio’s textbooks. Have you asked where does it come from? The text I used is Craig Liebenson’s : Rehabilitation of the spine. It is a core text at most chiropractic institutions and virtually all Physiotherapy institutions here in Australia as well. It is based largely on the work of Janda and the Prague School of Medicine. Craig has also spent a lot of time in Prague working with them. I have been to his seminars and they are pure gold (Don’t sit in the front row of a rehab seminar on the first day. I was in a lot of pain by Sunday afternoon. OUCH). So you have the physio’s using a chiro text for spinal rehabilitation based on work done by the author with medico’s in Prague! Interesting what! He is now presenting with Gray Cook (Physiotherapist) http://www.movementlectures.com/MEG03121-39.html Going to their seminar soon! Cannot wait!
    You also have physio’s here calling themselves Osteopractors! http://www.spinalmanipulation.org is it an osteopath, is it a chiropractor? They try to make the distinction but it seems to be a case of “Grow your practice” by getting the public to think you are an osteopath and chiropractor!
    And Physio’s using activators http://physioworks.com.au/treatments-1/physiotherapy-instrument-mobilisation-pim I love how they claim they are evidence based then cite chiropractic literature.
    Food for thought!

    In reply to Frank O:
    The doctors who refer to me make the distinction between Subbie and EBP chiro, as do my patients. It seems to be the skeptics who exclusively see the subbies!

    • @ Thinking_Chiro

      Your studies of chiropractic practice patterns are small and isolated and don’t come anywhere near trumping the 85 country-strong 2004/2005 World Federation of Chiropractic survey. See here:
      http://edzardernst.com/2013/03/what-is-next-a-royal-college-of-window-salesmen/#comment-54269

      BTW, re your claim that the Chiropractic Observation and Analysis Study (COAST) “provides an understanding of current chiropractic practice”, I note that you have previously called it “a small cohort in Melbourne”. I also note that Harriet Hall (MD) at Science Based Medicine, who authored the post in the following link, has pointed out that the study…

      QUOTE
      “…tells us that a substantial number of chiropractors use quack methods, and the ones who do obviously can’t be science-based. It tells us that children are being treated with chiropractic in the absence of any evidence that it is effective…The study leaves many questions unanswered and raises some new ones; and it doesn’t provide any evidence to support the claims that chiropractic is being “reformed”.” [My bold]
      Link: http://www.sciencebasedmedicine.org/chiropractic-reform-myth-or-reality/

      Thinking Chiro wrote: “The McGregor paper…stated: “From the data in our investigation, like the growth in medicine, it appears that the paradigm for the chiropractic profession has since shifted as well. Evidence of marginalization by the chiropractic profession of its unorthodox sect is indicated by the relative number of publications in its mainstream journal compared to the number associated with its dissident counterpart.””

      That’s meaningless. The subluxationists don’t usually bother with serious research, and the remainder of chiropractors who attempt it have a wholly unimpressive record:
      http://edzardernst.com/2013/02/research-in-chiropractic-seems-in-a-dismal-state/

      Thinking_Chiro wrote about the McGregor paper: “They also grouped the them into orthodox/unorthodox here: “Almost 19% (18.8% – 95% CI: 15.5 – 22.7) of chiropractors surveyed associated themselves with the predefined unorthodox perspective of “Chiropractic Subluxation as an Obstruction to Human Health”, while 81% (81.2% – CI: 77.3 – 84.5) were associated with a strata of a more orthodox view, identifying themselves with biomechanical disorders or musculoskeletal joint dysfunction. Of the 371 chiropractors in the orthodox group, the majority (53.1% – 95% CI: 48.0 – 58.1) strictly identified themselves in the strata labeled “Biomechanical”, defined as caring for musculoskeletal or neuromusculoskeletal problems such as low back and neck-related pain.””

      Here’s what Jann Bellamy, one of the authors at Science Based Medicine, had to say about that:

      QUOTE
      “The survey was of Canadian chiropractors, most of whom graduated from Canadian Memorial Chiropractic College, which appears to have a more orthodox orientation than, for example, Life or Palmer…the groups not included in the unorthodox category doesn’t mean the others are necessarily free of unorthodox views. While the survey is interesting, I thought it disingenuous for the authors to compare the stratification in chiropractic to that of medicine. That we are talking about vastly different phenomena is illustrated by the two examples they offer from medicine: the original rejection of Jenner’s paper on smallpox, which occurred in 1797, and Duesberg’s claim that HIV is not a cause of AIDS, which has been widely and publicly decried by scientists, and not just in their own journals. Finally, even 18.8% is too much. That’s almost one in five and 100% too many. I imagine few would take comfort in a statement like “only 18.8% of medical doctors reject the germ theory of disease.”
      Ref the comments here: http://www.sciencebasedmedicine.org/a-cure-for-chiropractic-2/

      Thinking_Chiro wrote: “As for institutions here, Central Queensland Uni is a problem, however Murdock, Macquarie and RMIT are not so as i have said they are definitely the minotity institution.”

      Isn’t Macquarie proposing to ditch its chiropractic degree by 2015?

      QUOTE
      “… our chiropractic area does not meet our requirements from a research-intensive perspective”
      See http://www.announcements.mq.edu.au/others/proposed_changes_to_chiropractic_at_macquarie

      As for the Royal Melbourne Insitute of Techonology (RMIT), it recently won a Bent Spoon Award from Australian sceptics for being “the perpetrator of the most preposterous piece of paranormal or pseudo-scientific piffle”, for the alleged content of its chiropractic degrees: http://scepticsbook.com/wp-content/uploads/2011/11/Bent-Spoon.pdf
      The attainment of the dishonour was helped by the fact that RMIT treated children and infants at its on-campus paediatric chiropractic clinics. The clinics were subject to a series of complaints in 2011 by leading figures in medicine amid concern there was no evidence that chiropractic treatments on children were safe or effective. Perhaps not surprisingly, the university refused to comment on its award.

      Readers may be interested to learn that the above occurred only a few months after Australian scientist, Loretta Marron, submitted a 20-page document to the Australian Federal Health Minister requesting closure of the RMIT’s Chiropractic Paediatric Clinic on the basis that the it was “teaching inappropriate and potentially dangerous techniques that target pregnant women, babies, infants and children”. The document included: expert opinion from high profile and well-regarded Professors of Medicine relating to supposed efficacy of chiropractic; identified the claims made by lecturers and graduates from RMIT *and other chiropractic teaching institutions*; identified the relevant codes of conduct that were breached by graduates; identified research relating to spinal manipulation on a wide range of health conditions; referred to the General Chiropractic Council (UK) on comments on ‘subluxations’ and evidence-based practices [guidance which is currently being ignored by many UK chiropractors]; referred to the HCCC anti-vaccination campaign, which is supported by over 120 chiropractors; referred to a US-based court case which limited chiropractic diagnoses to biomechanical conditions of the spine and musculoskeletal system; and recommended that the competency and education standards for chiropractors be reviewed. Link:
      http://www.skeptics.com.au/wordpress/wp-content/uploads/RMIT-clinic-review.pdf

      It’s also interesting that, in the same year, RMIT’s Chiropractic Head of Discipline, Dr Tom Molyneux (presumably a Doctor of Chiropractic only), wasn’t very helpful towards a member of the public:

      QUOTE
      “…I went along to RMIT’s Open Day on August 14, 2011, with my camera, voice recorder and some prepared questions. As any good skeptical researcher would do, I went searching for the evidence and for the experts that might help me find it. Surely, if there is any up-to-date science behind chiropractic the leaders of chiropractic teaching in Australia would know? Would I be the one to eat humble pie and change my mind if the science had come of age?…I found a quiet moment to approach Tom [Molyneux] and engage in polite conversation. I introduced myself as a blog writer from the Australian Skeptics and asked Tom if he’d be willing to be interviewed. Tom was polite but firm in his answer, which was ‘no’…”
      Link: http://vicskeptics.wordpress.com/2011/10/03/rmit-not-so-open-day/

      Thinking_Chiro, do you have any updates on the status of the chiropractic degree at Macquarie, and what’s happening about eliminating the pseudoscience from the RMIT chiropractic degree(s)?

      Thinking_Chiro wrote in response to my asking for evidence that patients looking for a chiropractor were able to make the distinction between subluxationists and EBP chiropractors: “It is discussed here: Epidemiology: spinal manipulation utilization. http://www.ncbi.nlm.nih.gov/pubmed/22289432

      Please provide a link to robust evidence. That citation does not prove that (to quote you) “Patients looking for a chiro make the distinction between subbies and EBP chiros.”

      • Well, Thinking Chiro, it looks like Blue Wode really doesn’t like chiropractic health care or chiropractic doctors either for that matter, eh? He really unloaded on you, and that represents only a tiny fraction of the collection on his hard drive.

        But before you get all nervous, you have to read between the lines. He has an obvious habit of liberally quoting a dubious website called “science based medicine” as religiously as a son of missionary parents would quote the family bible. But this “website” is nothing more than a collection of “why we hate everything that’s not drugs” opinions from longtime his friends and other characters who hate everything that’s not drug-based. Pretty low if you ask me.

        I am also skeptical about MD Harriet Hall, a retired allopath from the medical trades and Jann Bellamy from the law trades, whom he cites as experts. IMO, they have dubious backgrounds, credentials and personal agendas that, in my view, fail the smell test. From my research they hold no weight nor expertise in the public’s or governmental’s eyes. Psychiatrists use plenty of “quack” methods. Not a peep from them about this. Likely because it is heavily drug-based and we all know the medical trades never met a drug they didn’t like.

        Macquarie says they want to focus on biomedical research and pour money into their hospital. That’s fine. These suck up gazillions in money. Nothing to do with chiropractic. They don’t want to jeopardize their pharmaceutical industry handouts with non-drug approaches, so they are ditching natural, non-toxic, pharma-free healthcare. Pretty simple matter of boiling down to money, as usual. Just dollars and cents.

        If you want more details, I will be happy to send them to you, if you can stomach it.

        • “…in my view fail the smell test…”???
          really???
          “…pharmaceutical industry handouts…” please do show us the evidence!

  • In Reply To SkepdocProf:
    I thoroughly enjoy my encounters with Blue and he makes a good argument! If he ever comes to Sydney I would happily take him to dinner and invite a few like minded chiropractors for a great meal and great conversation!
    As for “does he get it”, he can be a tad blinkered at times but all good things take time! Until then I will keep my research references on hand at all times!

  • Well, happy to hear that. Just keep in mind that Blue Wode, and everyone here, is using “reform” as a euphemism for “elimination”.

  • In Reply to Blue Wode:
    “Here’s what Jann Bellamy, one of the authors at Science Based Medicine, had to say about that”
    Canadian Memorial is one of the institutions that is worthy of your support and they recently poached Simon French from us!
    Palmer is producing some good research now. CMCC are the primary educator of chiro’s in Canada, so a survey would reflect that. It would be interesting to see where the unorthodox chiro’s came from! Life, especially with Brian Kelly at the helm is a problem. When you add all the studies together it is fairly consistent. The Swiss survey in 2009 http://www.ncbi.nlm.nih.gov/pubmed/20937430 has a better spread across many colleges and a 70% response rate and no local institution bias and they also had a similar result!

    The paediatric clinic at RMIT is an issue. Until there is research to support it then its a no go. If they are doing research there then I would reconsider. I will make some inquiries!
    Interestingly, I heard that at that time a reporter with a baby presented to one of MQU’s intern clinics in an attempt to bait or entrap them but was referred on to a doctor!

    “That’s meaningless. The subluxationists don’t usually bother with serious research”
    I agree with you in regard to the subbies and one of the papers above discusses their research output in comparison to the orthodox chiropractors which you should not dismiss. Again, indicating where your support for reform should go!

    “That citation does not prove that (to quote you) “Patients looking for a chiro make the distinction between subbies and EBP chiros.”
    Good question Blue, I have looked through the research and it is virtually all in regards to the condition the chiropractor is treating, which is overwhelmingly musculoskeletal, not the reason the patient presented to the chiro. I would assume that the two are the same as what the chiro treats is what the patient presented with seeking help! Interesting!
    There are some papers on why patients seek a CAM practitioner in general, but not chiropractic specifically!

    The biggest change in the way I practice has been the incorporation of more and more rehabilitation over the last 15 years. No one has asked where the source of this rehab is from and most skeptics have assumed that we have poached it from the physio’s. This is not the case as I have stated above. In regards to the spine it is the physio’s who use a chiropractic text!

    I hate to admit this but SkepdocProf has made a good point. Are you seeking to eliminate the chiropractic profession or help push the reform process forward from without and within the profession? I am all for accountability and critical assessment leading to progress.

  • In reply to Blue Wode:
    Your studies of chiropractic practice patterns are small and isolated and don’t come anywhere near trumping the 85 country-strong 2004/2005 World Federation of Chiropractic survey. See here:
    http://edzardernst.com/2013/03/what-is-next-a-royal-college-of-window-salesmen/#comment-54269

    The WFC survey asked multiple questions and you are cherry picking again. Similar percentages for musculoskeletal and evidence based practice! Additionally, a study in Portland Oregon where school kids asked 48 chiro’s over the phone about subluxation! Hardly conclusive!

    “I would venture that it’s the more ethical element of chiropractors who respond such surveys”
    Are you certain? The subluxation based chiropractic minority are becoming more vocal the more threatened and marginalised they become!

    • Thinking_Chiro wrote: “The paediatric clinic at RMIT is an issue.”

      Is “an issue” the same as “a problem”? In the context of this discussion, I’d say that it is. (Remember, you claimed “Central Queensland Uni is a problem, however Murdock, Macquarie and RMIT are not”.)

      Thinking_Chiro wrote: “I have looked through the research and it is virtually all in regards to the condition the chiropractor is treating, which is overwhelmingly musculoskeletal, not the reason the patient presented to the chiro. I would assume that the two are the same as what the chiro treats is what the patient presented with seeking help! Interesting!” [My bold]

      Why would you assume that the two are the same? How do you eliminate this from the picture…

      QUOTE
      “Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine…..someone may go to see a chiropractor and think they will be seeing a medical professional who will treat their musculoskeletal symptoms, but in reality they will see the practitioner of a cult philosophy of energy healing…The bait — claims that chiropractors are medical practitioners with expertise in the musculoskeletal system. The switch — practitioners of discredited pseudosciences that have nothing to do with the musculoskeletal system.”
      Ref: http://www.sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/

      In other words, by what means would a patient be able to distinguish between a spinal manipulation (scientific) and a ‘specific adjustment’ (quackery)?

      Thinking_Chiro wrote: “Are you seeking to eliminate the chiropractic profession or help push the reform process forward from without and within the profession?”

      Neither. I’m pointing out inconsistencies in chiropractors’ arguments. The survival of chiropractic is entirely up to the chiropractic profession. Only it can decide if it wants to embrace universal reform or experience a gradual demise.

      Thinking_Chiro wrote: “The WFC survey asked multiple questions and you are cherry picking again.”

      I don’t see what’s cherry picked about this result from the survey:

      Chiropractors who said that the following phrases described the profession “perfectly” (7 on a scale of 1 to 7) or almost perfectly (6)

      “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

  • In reply to Blue Wode:
    “The survival of chiropractic is entirely up to the chiropractic profession. Only it can decide if it wants to embrace universal reform or experience a gradual demise.”
    I totally agree Blue. We must clean our own house, with all Constructive Support appreciated!!!!!!!!!!!!!! 🙂
    Universal reform of the deeply entrenched marginalised subbies will be nigh on impossible! There has to be a distinction made between orthodox and unorthodox chiropractors. Any attempts to clearly define our scope of practice has met with opposition from them. They must face the choice of change or perish!
    As for CQU, we will have to see the outcome of their accrditation which is still being processsed!
    Constructive criticism that is well referenced and thought out is important to the profession. Supporting the reformers within the profession is a vital part of this process!

  • Thinking_Chiro wrote: “There has to be a distinction made between orthodox and unorthodox chiropractors.”

    And who’s making that distinction obvious to the public? It’s scandalous that chiropractors’ regulators, globally, continue to enable double standards. As for “unorthodox chiropractors”, let’s call a spade a spade: they’re quacks. In fact, the “orthodox” ones could also be viewed as quacks since we know that true chiropractic is pure pseudoscience. I suggest that the “orthodox” ones seriously think about evolving into evidence-based neuro-musculoskeletal therapists – or, better still, retraining as physiotherapists.

    Meanwhile, there is no way that chiropractic treatment for chronic low back pain, were it to be universally accepted as a cost-effective option, could be recommended. Here’s why:

    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.

  • In Reply to Blue Wode:
    “And who’s making that distinction obvious to the public? It’s scandalous that chiropractors’ regulators, globally, continue to enable double standards.”
    Every profession has the good, the bad and the ugly. It is up to the consuimer to exercise due diligence be it a GP, surgeon, physio or chiro. Same boards and same legislation covering all! As for double standards, most education institutions have moved on while the legislators are playing catch-up.

    “I suggest that the “orthodox” ones seriously think about evolving into evidence-based neuro-musculoskeletal therapists”
    Already there Blue as are the majority of my collegues. Its how I practice and also market myself to my referring doctors and patients and they make the distinction. I have been doing this my entire career. Its one of the reasons I was invited to join doctors in a medical centre 5 years ago!

    “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”
    Your carpet bombing again Blue! We are not all subbies and as for adequate risk assessment, that is done with every patient no matter what the problem, spinal or peripheral, followed by informed consent. That has been mandatory here since 2000 following a patient who went in for surgery on one eye and became blind in both eyes. It resulted in a court case that led to mandatory informed consent across all professions. (I have had informed signed consent forms since 1995 and we are on our 6th edition). Any treatment of the spine requires a valid clinical reason, more so with the cervical spine. Blanket full spine xrays no matter what the presenting complaint is in violation of the guidelines here. Fishing expeditions like that lead to a cascade of unnecessary treatment. This recent medical paper on the topic is could just as easily apply to chiropractic. http://www.ncbi.nlm.nih.gov/pubmed/24831502

    Does chiropractic have its problems, absolutely!
    Is there a solution, yes, and it has been happening for years. Help push the reformers that are providing the solution!

    • Thinking_Chiro wrote in response to my comment And who’s making that distinction obvious to the public? It’s scandalous that chiropractors’ regulators, globally, continue to enable double standards: “Every profession has the good, the bad and the ugly. It is up to the consumer to exercise due diligence”

      What an appalling cop-out. Doesn’t it concern you that the chiropractic regulators fail to make it clear to the public that there are two different types of chiropractor and that the majority are quacks? What’s the point of regulation if consumers aren’t given the *basic* information that they require? IOW, why don’t the regulators – who claim to exist to protect the public – care that consumers, in droves, are having their time and money wasted, and their lives put at risk, from being ensnared *unwittingly* by quackery?

      Thinking_Chiro wrote: “…as for adequate risk assessment, that is done with every patient no matter what the problem, spinal or peripheral, followed by informed consent. That has been mandatory here since 2000.”

      You are completely wrong about that. Here’s why:

      Consent or submission? The practice of consent within UK chiropractic
      “In this recent investigation which focused on approaches to consent of a small sample of practicing UK chiropractors, only 23% reported that they always discussed serious risk with their patients.”
      J. M. Langworthy and C. le Fleming, Institute of Musculoskeletal Research and Clinical Implementation, AECC, UK (Journal of Manipulative and Physiological Therapeutics, January 2005)
      http://www.ncbi.nlm.nih.gov/pubmed/15726031?dopt=Abstract

      Consent: Its Practices and Implications in United Kingdom and United States Chiropractic Practice
      “Results from this survey suggest a patient’s autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk.”
      Langworthy JM, and Cambron J, Institute for Musculoskeletal Research and Clinical Implementation, [AECC], Bournemouth, UK (July-August 2007)
      http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17693332&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

      Chiropractors have an ethical duty to tell their patients about risks
      “The Bournemouth team sent questionnaires about risk-related issues to 200 randomly selected UK chiropractors and received 92 responses. Their results show, among other things, that “only 45% indicated they always discuss [the risks of cervical manipulation] with patients … ” In plain language, this means that the majority of UK chiropractors seem to violate the most basic ethical standards in healthcare. If we assume that the 92 responders were from the more ethical end of the chiropractic spectrum, it might even be the vast majority of UK chiropractors who are violating the axiom of informed consent.”
      Edzard Ernst, The Guardian Science Blog (12th July 2011)
      http://www.guardian.co.uk/science/blog/2011/jul/12/chiropractors-ethical-duty-patients-risks?CMP=twt_fd

      Thinking_Chiro, for an evidence-based chiropractor you don’t appear to be very clued up.

    • Thinking Chiro wrote:
      “I suggest that the “orthodox” ones seriously think about evolving into evidence-based neuro-musculoskeletal therapists”
      Already there Blue as are the majority of my collegues. Its how I practice and also market myself to my referring doctors and patients and they make the distinction. I have been doing this my entire career. Its one of the reasons I was invited to join doctors in a medical centre 5 years ago!

      So you studied extra years and extra hard to earn a doctorate degree to become a physiotherapist technician? What’s wrong with doing non-evidence-based methods to help people? It’s done all the time in psychiatry. It’s done all the time in medicine, too. The drug stores are filled with non-evidence-based pharma products. Much of what the family allopath down the street does is a non-evidence-based crap shoot with your’s and your family’s health. (“Here, try this. No help? Try that. Oh, your BP dropped and you fainted in a sweat? OK, stop that one and try this purple one!”)

      Did you know that pain clinics run by the allopaths inject steroids into people’s spines to control pain? Did you also know that the products they use are clearly marked by the pharma companies that these products are not to be used for injections into people’s spines as they have never been proven safe or effective for this purpose? It says so right on the label. A spine MD showed it to me. Doesn’t stop them.

      I know this doesn’t justify why we should do this, but that’s what health care is all about. Other wise you can have a computer figure everything out and no need to see a doctor at all.

      Example: Just the other day, the mother of a family I have been providing health care to for years calls me and says that she is bringing her college-age daughter to me. Seems she contracted shingles on her face and in her eye. A very bad case. Eye swollen shut, pain galore, forehead looks like it has been burned. Been to the ER, ophthalmologist, family allopath, got antibiotics, shingle Rx, pain killers. Not much change in almost two weeks. Mother brings daughter for help. I analyze, palpate, adjust, all the things no one here likes. Also do cranial techniques on her head (wearing gloves I keep for just such rare occasions).

      As usual after a very needed adjustment, she sleeps that night the best she has been able to sleep since she got this. Also, her eye has opened for the first time in almost two weeks. The pain has decreased by 50%. Saw her the next day, another adjustment/cranial methods, more improvement. Face now clearing up. Saw her again and she almost looks like a normal human being. She planned to return to college that day. I might have waited a few more days, but she was ready to resume her life. Her body healed itself. We just help to restore a little law and order and work with the same principles that health is based on. Now we are both seeing eye-to-eye! She and her mother were so happy and relieved.

      Yes, I know, all anecdotal, no RCT study and it didn’t really happen anyway. As you wish. Tell that to the girl and her mother. Not the first one. Had 15 Y.O. also, one of the youngest ever seen to contract shingles, an illness usually seen in 50+. Other kids/adults, no more asthma, ADHD, migraines, reflux, meds, etc. Very gratifying. Got a book full of letters of thanks. According to BW, they are all stupid and have been fooled. As you wish. They might disagree.

      So you see, Thinkin Chiro, as a doctor you see and help lots of different people with different things. You never know who is going to call. As a physio technician who rubs people’s behinds as long as an MD says it is OK, well, you help people also, but why did you bother to go the extra mile to earn a doctorate degree?

      This whole back pain thing is a red herring. What, Thinking Chiro? Blue Wode says you can’t cure a sore back and no way he can recommend it? OMG! He can’t cure it. Most MDs can’t cure it either. Pills work faster, but produce drug-addicts. No cure but you sure do forget about that back pain! Just like taking the batter out of the smoke alarm in the middle of the night and going back to sleep. Not recommended.

      Wode doesn’t like orthodox chiropractic doctors, he doesn’t like unorthodox chiropractic doctors. Hmmm. Wait a minute, I am beginning to see a patter here: He doesn’t like YOU!!

      Thinking Chiro wrote:

      “Help push the reformers that are providing the solution!”

      Yes, Blue Wode, please help us! Please!!! We need your help. Continue to push us over the cliff!

      • SkepdocProf wrote: “What’s wrong with doing non-evidence-based methods to help people?”

        It’s unacceptable when the risks outweigh the benefits (e.g. chiropractic spinal manipulation) and where there are other effective options available. In the case of chiropractic, exercise – which is cheaper and safer – would be a more ethical choice.

        SkepdocProf wrote: “The drug stores are filled with non-evidence-based pharma products.”

        Yes, I can think of relatively risk-free examples such as cough syrups, magnets, copper bracelets, and homeopathic remedies (although I believe that some pharmacies are starting to remove them from their shelves), but pharmacies are also well stocked with evidence based pain relief and symptom relief products, as well as evidence-based life-saving prescription medications such as insulin, anti-hypertensives and antibiotics.

        SkepdocProf wrote: “Did you know that pain clinics run by the allopaths inject steroids into people’s spines to control pain?”

        I understand that there’s quite a bit of controversy about that and expect that the procedure will eventually go the same way as blood-letting and trepanning.

        SkepdocProf wrote about a customer with shingles: “As usual after a very needed adjustment, she sleeps that night the best she has been able to sleep since she got this.”

        Maybe you injured her. Unconsciousness isn’t always a good sign after chiropractic manipulation. You could be looking at a delayed adverse event.

        SkepdocProf wrote: “Also, her eye has opened for the first time in almost two weeks. The pain has decreased by 50%. Saw her the next day, another adjustment/cranial methods, more improvement. Face now clearing up. Saw her again and she almost looks like a normal human being. She planned to return to college that day. I might have waited a few more days, but she was ready to resume her life. Her body healed itself.

        Haven’t you considered that you simply witnessed the end of the natural course of her illness? After all, she did seem to come to you as a last resort.

        SkepdocProf wrote: “She and her mother were so happy and relieved. Yes, I know, all anecdotal, no RCT study and it didn’t really happen anyway. As you wish. Tell that to the girl and her mother.”

        Many patients and CAM practitioners make entirely wrong assumptions about healthcare outcomes. CAM practitioners, including chiropractors, nearly all of whom rely on ‘patient satisfaction’ in order to earn a living, will be particularly averse to learning if it was definitely their intervention that produced a positive result. The late Barry Beyerstein wrote at length about alternative medicine and common errors of reasoning in his classic essay, Social and Judgmental Biases That Seem to Make Inert Treatments Work. It’s worth having a slow read through it:
        http://web.archive.org/web/20050329093720/http://www.sram.org/0302/bias.html

        SkepdocProf wrote: “Wode doesn’t like orthodox chiropractic doctors, he doesn’t like unorthodox chiropractic doctors. Hmmm. Wait a minute, I am beginning to see a patter here: He doesn’t like YOU!!”

        What I don’t like is sloppy thinking and seeing people being duped.

        SkepdocProf wrote: “Yes, Blue Wode, please help us! Please!!! We need your help. Continue to push us over the cliff!”

        Like proverbial lemmings, it’s chiropractors themselves who would be responsible for falling over the cliff.

        • @Skepdocprof
          So, you were a help in these specific circumstances at the time. The question is why? Are you at least open to the possibility that it was a self limiting condition? i.e: something that gets better over time regardless of the intervention and that the adjustments could have produced non specific placebo effects emotionally and physically, therefore, could have been produced by other interventions?

          If we then follow on to a flare up of the same condition in the future (all hypothetical I know) and they come to see you sooner and the symptoms don’t ease. Is it possible that this initial experience could create psychological fear and anxiety that could develop into a worse scenario because of the first interaction?

        • BW wrote:
          “Haven’t you considered that you simply witnessed the end of the natural course of her illness? After all, she did seem to come to you as a last resort.”

          Yes, I did witness the natural course of this illness. Her body does the natural healing whether she takes medicine or gets adjustments or eats good food or sleeps or even has surgery. That is what the medically-oriented folks can’t ever fit into their thinking.

          Some things speed up healing like rest, good food, relieving stress from their body, spine and nerve system from chiropractic adjustments, positive mental attitude, etc. Drugs treat symptoms, which is fine. Sometimes you need that. If I was in a lot of pain, I would want to get out of pain quickly. If I needed a pill, I would take a pill to feel like a normal human being. But we still have to do things that support health. Who would argue with that?

          Because of pharma/drug advertising and allopathic reinforcement, the public and the allopathic trades and their worshippers think that symptoms are the problem. Get rid of the symptoms, problem solved. NOT. The symptoms are the warning signs that there is a problem. It is your body’s way of communicating with you that there is something wrong. Treating the symptoms in the allopath/pharma tradition is like taking the battery out of the smoke alarm when it wakes you up in the middle of the night. Back to bed, tragic ending.

      • @SkepDic(/Doc)Prof

        A most revealing story.
        I can tell another anecdote about the same disease… one I experienced personally, on myself.
        Just like the girl you pretended to treat… or maybe one should say you think you treated as you are obviously fooled by your ignorance and illusion of success, I had shingles of the opthalmic branch of the trigeminal nerve when I was seventeen. It was the most devilish pain for a while but then, as in the girl and all who are hit by this curse, it spontaneously improved. That is the rule with this kind of illness. One night the pain was simply over and it was surely a bliss. The swelling and sores also healed spontaneously. I did not need spinal adjustments or any other type of alternative magic to help nature take its normal course. I missed a month out of college but managed to catch up and a very competent and thorough ophthalmologist saved most of the sight on my left eye.
        I sympathize with the girl and her family who mistakenly believe you are a doctor who provides health care but this story of yours proves to us that you have no or very limited basic medical knowledge and that you are selling make-believe treatments to mis-informed people (I presume your services are not pro bono publico) … I know many people who would call this fraud and you a quack.

  • In reply to Blue Wode:
    “What an appalling cop-out.”
    We have uniform national mandatory informed consent here across all professions and it works. It is checked every year by the regulators on renewal of registration and by the professional indemnity insurers. I have seen resistance to legislation to make it mandatory in the USA and all the Australian chiropractors I know are surprised. Is there similar legislation enforcing informed consent in the UK? If not then it requires reform. http://www.ahpra.gov.au/ It works!
    Health is consumer driven as is all goods and services and I inform my patients so they can make a decision based on all available information and I respect that decision! Have I had a patient refuse care due to informed consent? Yes, once in 20+ years of practice. Consumer driven health also determines a patients chioce of chiropractor.

    Just yesterday I had a very informative conversation with a young chiro who had just returned from New York where he sat the board exams. I now understand better where you are coming from Blue, as every state in the USA has a separate board with varying rules, regulations and standards. It’s as if every board is there to protect their turf and there is no uniformity or minimum standard. Facepalm! Some boards have a very high standard, but it is not universal!

    In reply to SkepdocProf:
    Patient satisfaction and anecdote is not enough!
    If you want to make a claim, then prove it and you will own it (and I would use it)! Cite relevant research and you would silence the critics! If ther is no research the do it!
    Anecdote should lead to one question…Why! That then leads to research, which leads to practice guidelines and best practice.

    “So you studied extra years and extra hard”
    Past tense????????
    I am always studying , it never stops! I am constantly looking for a best practice and the way I practice is constantly changing and evolving so my patients get the best up to date care!

  • Good article showing what can be achieved!
    “Risk Management for Chiropractors and Osteopaths. Informed consent
    A Common Law Requirement”
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2051308/?tool=pmcentrez&report=abstract

    Intersting editorial from a well informed source. Very Relevant! 🙂
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314797/?tool=pmcentrez&report=abstract

    • “So you studied extra years and extra hard”
      Past tense????????

      Thinking Chiro, of course I have continued studying and take many courses for many years. Duh.

      Thinkin’ Chiro wrote:
      “Intersting editorial from a well informed source. ”

      Good grief, man! You know, when you start referencing articles that has EE’s fingerprints on it, I know that you are beyond help. You have drunk the afternoon high KoolAid tea and taken a bite from the rotten Danish with clotted cream. You are one of THEM now. Best of luck, Wikus.

  • Well, gentlemen, your hostility was certainly predictable, as I indicated in my post. And Bjorn, you really impressed me! You have absolutely mastered the insult and put-down segment of your English as a second language course! Well done!

    Don’t know why you had to sink to insults, Bjorn. Very unprofessional. I didn’t write anything insulting or negative about you in the post. Besides, EE doesn’t tolerate insulting other posters here and you may get your nose rapped with a rolled-up copy of the Guardian. So please abstain of future public displays of disaffection. OK?

    Blue Wode wrote:
    “Maybe you injured her. Unconsciousness isn’t always a good sign after chiropractic manipulation. You could be looking at a delayed adverse event.”

    You know I thought of that. Fortunately, that didn’t happen. You may be thinking of the rough, unskilled and imprecise and non-specific manipulations that physio technicians are taught at weekend “seminars” once or twice a year by the osteo trade. Then they go back to their jobs on Monday morning and give it whirl on unsuspecting “patients”. Frightening! Brrrr!!

    Chiropractic doctors receive doctorate degrees from chiropractic universities, studying drug-free methods for four years. Quite a difference from the physio trade schools who get a job working under the orthopedic industry.

    Anyway, her mother came in a few days ago for her monthly adjustment that has enabled her to live a migraine and drug-free life after a life of migraines and powerful and ineffective drugs, and reported that her daughter turned the corner amazingly rapidly after her two visits and is doing fantastically. She has returned to college. Isn’t that wonderful! I have taken care of the father and the brother as well for years. All love their adjustments! Very gratifying!

    • “And Bjorn, you really impressed me! You have absolutely mastered the insult and put-down segment of your English as a second language course! Well done!”

      At least he’s not being malicious.

      http://edzardernst.com/2013/11/ear-acupressure-for-smoking-cessation-false-claims-by-dishonest-therapists/#comment-60083

    • “jm” and “SDP” cry sorely from the slapping of truth in their faces and the stings of undiluted honesty but conveniently forget their own meager attempts at insulting reciprocations.

      • Bjorn wrote:

        “jm” and “SDP” cry sorely from the slapping of truth in their faces and the stings of undiluted honesty but conveniently forget their own meager attempts at insulting reciprocations.

        Very good, Bjorn! Now try this one:
        The rain in Spain falls mainly on the plain.

    • In response to my comment “Maybe you injured her. Unconsciousness isn’t always a good sign after chiropractic manipulation. You could be looking at a delayed adverse event”, SkepdocProf wrote:

      QUOTE
      “You know I thought of that. Fortunately, that didn’t happen.”

      “Fortunately”?? Is that a confession that luck plays a large part when it comes to the safety aspect of your spine cracking interventions? You should know that significant pathologic changes arising from repeated trauma of manipulation might not be immediately apparent. You should also know that there are no reliable pre-manipulation screening methods available to chiropractors. With that in mind, what method(s) did you use to rule out hidden life-threatening changes that would have contraindicated subsequent ‘adjustments’ in your patient?

  • I JUST RECEIVED AN EMAIL FROM A CHIROPRACTOR VIA THIS BLOG WHICH IS TOO CUTE TO KEEP FOR MYSELF:

    You are clearly expressing your uneducated opinion about manipulation for low back pain. Have you ever hear of the British Medical Journal? It appears from your statements that you have not. BMJ is the most prestigious, peer reviewed journal and the compilation clearly states that CHIROPRACTIC MANIPULATION IS THE ONLY THING THAT HAS BEN PROVEN TO BE EFFECTIVE IN THE TREATMENT OF LOW BACK PAIN.
    It is not anecdotal evidence it is evidence gathered from almost every study performed regarding the treatment of low back pain. Unfortunately you medical quacks who do not stay abreast of the most recent literature make idiotic claims such as the ones you made about chiropractic manipulation for low back pain.
    Within the span of three months I caught two, yes two huge screw ups by an orthopedist who identified the problem as a herniated lumbar disc and set this poor man up for low back surgery. Thankfully this man’s wife insisted he get a second opinion by myself, a competent chiropractor, prior to being butchered. Do you medical doctors ever palpate for distal pulses on extremities within your ridiculously brief examinations? Had Dr. Geisle done this he would have noticed that this man, a truck driver, lacked a dorsalis pedis pulse. I sent the ptient out immediately to a vascular surgeon and he had surgery alright, but not on his back but to remove his lower leg. The deep vein thrombosis was present so long that the tissues became gangrenous. The truck driver, Steve M. walked in my office months later and thanked me for saving his life. So who was the quack here? Who almost cost this man his entire right leg and possibly his life? the medical doctor that’s who.
    You’d think the medical doctor would have learned but the same doctor, 3 months later made the same mistake on a younger female. Put your ego up where your knowledge is, on a dusty shelf where it’s not being used.

    Dr. Sloan

    • yes indeed, but also quite funny!
      my favourite bit is ” Have you ever hear of the British Medical Journal? It appears from your statements that you have not. BMJ is the most prestigious, peer reviewed journal..” A quick Medline search reveals that I have published 58 papers in the BMJ, the 1st in 1981.

    • I hope that Dr Sloan furnished you with a reference for “[the BMJ] clearly states that CHIROPRACTIC MANIPULATION IS THE ONLY THING THAT HAS BEEN PROVEN TO BE EFFECTIVE IN THE TREATMENT OF LOW BACK PAIN”.
      (My bold.)

      • sadly not but he likely refers to the BEAM trial

        • For readers not familiar with the BEAM trial (which involved chiropractors, osteopaths, and physiotherapists), here’s what Professor Ernst had to say about its findings:

          QUOTE
          “I have three brief comments on the United Kingdom back pain exercise and manipulation (UK BEAM) trial. My reading of the results is that the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch. If this “devil’s advocate” view is correct, the effects have little to do with spinal manipulation per se.
          It would be relevant to know which of the three professional groups (chiropractors, osteopaths, physiotherapists) generated the largest effect size. This might significantly influence the referral pattern. A post-hoc analysis might answer this question.
          It is regrettable that the study only monitored serious adverse effects. There is compelling data to demonstrate that minor adverse effects occur in about 50% of patients after spinal manipulation. If that is the case, such adverse events might also influence GP’s referrals.”

          Link: http://www.bmj.com/content/330/7492/673.4.extract

  • I always enjoy a good, well written and referenced argument. Blue Wode and Edzard do this and it is what critical thinking is all about! Does that mean that I always agree with everything they write, no, but their critiques are excellent food for thought. Pity when individuals rely upon personal attacks and anecdote as it achieves nothing!
    Thanks for the BEAM trial reference, I had forgotten about that one and it was nice to revisit. It also generated quite a few reviews which were also a good read.

Leave a Reply

Your email address will not be published. Required fields are marked *

Please answer the following: *

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted.


Click here for a comprehensive list of recent comments.

Categories