MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS).

Patients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool. Descriptive statistics, utilization, and costs were examined on the basis of timing of referral to physical therapy and adherence to practice guidelines over a 2-year period. Utilization outcomes (advanced imaging, lumbar injections or surgery, and opioid use) were compared using adjusted odds ratios with 99% confidence intervals. Total LBP-related health care costs over the 2-year follow-up were compared using linear regression models.

753,450 eligible patients with a primary care visit for LBP between 18-60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment. Early referral to guideline adherent physical therapy was associated with significantly lower utilization for all outcomes and 60% lower total LBP-related costs.

The authors concluded that the potential for cost savings in the MHS from early guideline adherent physical therapy may be substantial. These results also extend the findings from similar studies in civilian settings by demonstrating an association between early guideline adherent care and utilization and costs in a single payer health system. Future research is necessary to examine which patients with LBP benefit early physical therapy and determine strategies for providing early guideline adherent care.

These are certainly interesting data. Because LBP is such a common condition, it costs us all dearly. Measures to reduce this burden in suffering and expense are urgently needed. The question is whether early referral to a physiotherapist is such a measure. The present data show that this is possible but they do not prove it.

I applaud the authors for realising this point and discussing it at length: The results of this study should be examined in light of the following limitations. Given the favorable natural history of LBP, many patients improve regardless of treatment. Those referred to physical therapy early are also more likely to have a shorter duration of pain, thus the potential for selection bias to have influenced these results. We accounted for a number of co-morbidities available in the data set and excluded patients with prior visits for LBP to mitigate against this possibility. However, the retrospective observational design of this study imposes limitations on extending the associations we observed to causation. Although we attempted to exclude patients with a specific spinal pathology, it is possible that a few patients may have been inadvertently included in the data set, in which case advanced imaging may be indicated. Additionally, although our results support that early physical therapy which adheres to practice guidelines may be less resource intense, we cannot conclude without patient-centered clinical outcomes (i.e., pain, function, disability, satisfaction, etc.) that the care was more cost effective. Further, it may be that the standard we used to judge adherence to practice guidelines (CPT codes) was not sufficiently sensitive to determine whether care is consistent with clinical practice guidelines. We also did not account for indirect or out-of-pocket costs for treatments such as complementary care, which is common for LBP. However, it is likely that the observed effects on total costs would have been even larger had these costs been considered.

I was originally alerted to this paper through a tweet claiming that these results demonstrate that chiropractic has an important role in LBP. However, the study does not even imply such a conclusion. It is, of course, true that many chiropractors use physical therapies. But they do not have the same training as physiotherapists and they tend to use spinal manipulations far more frequently. Virtually every LBP-patient consulting a chiropractor would be treated with spinal manipulations. As this approach is neither based on sound evidence nor free of risks, the conclusion, in my view, cannot be to see chiropractors for LBP; it must be to consult a physiotherapist.

117 Responses to Suffering from low back pain? See a physiotherapist and not a chiropractor!

  • Chiropractic is not simply a physical therapy and it is misleading to present it as such.
    Its originator D. D. Palmer said: “I believe, in fact know, that the universe consists of Intelligence and Matter. This intelligence is known to the Christian world as God. A correct understanding of these principles and the practice of them constitute the religion of chiropractic.”

    Palmer also made clear: “Chiropractic is founded upon different principles than those of medicine.”

    Chiropractic claims its techniques adjust vertebrae and this allows ‘innate intellegence’ to flow more feely and thus heal.
    Patients who want their ‘innate intellegence’ un-blocked might reasonably turn to a chiropractor, but otherwise chiropractors should not practice on members of the armed forces who are obliged to accept the referrals their medical officers make and do not give consent with a full understanding of what chiropractic involves.

    Chiropractors who wish move on, set aside outmoded ideas and practice physical therapies shorn of metaphysics should qualify as physiotherapists.
    Meanwhile, chiropractors should get their metaphorical tanks off the parade ground.

    • @ Richard

      I would point out that Edzard said Chiropractors use Physical Therapies i.e use physical therapy techniques such as mobilisations not that Chiropractic is a Physical therapy ie just a technique.

      But i do agree with you that Chiropractic was / is based on, for want of a better phrase “mumbo-jumbo”

      @ Edzard

      Can you prove that physios have different training to chiropractors with regards musculoskeletal conditions? If so, how is the training different?

      Also, doesn’t this study show that the majority of physios are not being adherent to practice guidelines and using active treatments? This could mean that physios may not be using spinal manipulations all the time but they could using other passive treatments such as mobilisations. Would that mean it is not good to see a physio either? Better to see your GP then.

      • “Can you prove that physios have different training to chiropractors with regards musculoskeletal conditions? If so, how is the training different?”

        As an osteopath who has retrained as a physiotherapist I found that the differences are that physiotherapy offers; less obsolete historical ideological baggage, more critical thinking, less indoctrination that the profession is separate and superior to medicine, more openness and honesty about what the profession is and does, better integration into the healthcare system (osteopathy and chiropractic are dead end jobs).

        Personally I think that if the original goal of osteopathy and chiropractic has failed (which was to replace medicine) then what is the point of their continued existence?

        • @James
          This is the best comment I’ve seen in a long time. Sums up perfectly what’s wrong with the whole altmed industry. “less obsolete historical ideological baggage, more critical thinking, less indoctrination that the profession is separate and superior to medicine”: hits the nail perfectly on the head!

        • @ James

          Thanks for the reply. What would you say are the differences between osteopathy and physiotherapy when treating low back pain – use of techniques, emphasis on treatment etc?

          Do you think that osteopathy, chiropractic and physiotherapy could be combined into a single profession, if the dogma was dropped by chiros and osteos?

        • James provides a most welcome and insightful comment.

          I have worked with a physiotherapist who also trained as an osteopath. Her additional skills were certainly of value and I recommend all physiotherapists lean more about spinal manipulation in addition to the more gentle ‘mobilisation’.

          As James has pointed out – osteopathy and chiropractic developed as alternatives (and rivals) to ‘medicine’ (a profession which continues to develop and evolve). O&C have had their day. Their beliefs about pathology and therapeutics have not withstood scientific scrutiny and practitioners with integrity should accept that and move on. Perhaps by becoming physiotherapists, perhaps doctors, nurses or counsellors (which are careers they should have followed in the first place).

          I get the impression that students entering osteopathy and chiropractic do not really understand what it is they are subscribing to. All need to answer why they wish to become an osteopath and not a chiropractor (or vica versa). Or indeed, not a physiotherapist or doctor.

          I suspect that many do not really care, they just fancy being an ‘autonomous health professional’ and then become trapped in the sunk cost fallacy – having spent time and money on training they need to recoup and fallaciously maintain their professional pretence. Patients need to know that.

          • Hello to everyone!

            This is an interesting article, however, in the comments, at least for European reality there are some points I would like to make.

            i’m currently training as an osteopath and to answer some comments here, in my particular case i would have rather started with physiotherapy instead of osteopathy, but since I already have a degeee in business and I’m currently working and no degrees in physio are available after work, I had no chance at all to start there, however, this doesn’t take credit from osteopathy at all.

            First of all, here, at least, altough I’m sure some do, most don’t claim osteopathy is an alternative medicine, most consider it to be a complementary medicine or, to be even more accurate, therapy. Osteopathy isn’t viewed as a cure all therapy, instead it’s viewed as a good system to treat disfunctions in the musculo skeletal structure, that may prevent a proper function of the structure. Most claim it to be holistic as opposed to medicine, however, that is changing and I, for one, don’t think that osteopathy is anymore holistic than medicine is, we would be in poor condition if doctors didn’t actually get the whole picture.

            Also we don’t perform medical acts nor do we dabble or try to cure pathologies, instead, we merely try to understand where is the primary source of the disfunction and correct it, allowing the body to return to it’s more efficient function. Case in point, if, for instances you have a ciatic nerve compressed by a muscle that won’t relax it’ll cause pain, so we treat this by getting the muscle to relax and to return to it’s proper function. If, however, you have an inflamation on the never, it’s not structural problema that is causing your pain, so it’s not for us, we gladly refer it to a doctor for treatment.

            We are also taught our limits of practice and what is within our scope of work, if it isn’t for us, the best we can do is to refer the patient to another health professional or doctor. out of the three barriers, the physiological, the anatomical and the pathological, our scope of work is within the first to, we try to provide better quality of life and better mobility and well being by approximating the patient’s physiological barrier to the anatomical one. Pathology, in our field, is for physios and doctors, not for us.

            More over, most of the diagnotic tests we use are from neurology and physiotherapy, and we learn, heavilly, anatomy, physiology, bio mechanics, since this is our bread and butter, Our most common bibliography is Seeley, Grey’s, Kapandji, Meyer’s anatomy trails etc.

            When I finish this, I’m hoping to change my career and start a career in health care, however, I know that we can’t stand still and I haven’t taken of the table the possibility of enrolling in a physio degree, if I have the time for it, since it’s the perfect match. Also, in the future I think that most likely physio will absorb osteopathy since combining the 2 makes for a better overall professional, more insightful and with more tools to treat patients. In my school there are several physio and even nurses taking the degree.

            I hope this helps to bring some light to the discussion. As it is, I consider osteopathy as a proto science, good scientific basis altough hard to take away the placebo effect from the studies due to the fact it’s a hands on therapy, the patients view will always be skewed by that, unlike chaging pills for skittles.

            Thank you,

    • Levitation is based on different principles than aviation but magic carpets fly, or they don’t. I suspect there are good reasons why we have airports with airplanes, and not a single one with magic carpets. And no, I don’t think there is a conspiracy here. No one can prevent carpets to fly if they so choose.

      Chiropractic is nonsense, there is no good evidence that it works, and it is dangerous to the point of killing people. Who cares about the principles, if it doesn’t work?

      • I have read that your work is funded by Pfizer, the pharmaceutical company, and this is a paid blog.
        I had also read that you had been disqualified from teaching.
        I suspect some of that to be rational ans the views here are very stark and unbalanced in presentation.

        • “this is a paid blog” ???
          what makes you think that?
          the only one who pays for it is I; and I get no funding from anywhere.
          sorry to disappoint you.

        • I have read that the witch attempted to fatten up Hansel and Gretel by inviting them to eat her house.
          I suspect that you have not the slightest bit of evidence to back up your claims.
          I find your views stark and unbalanced and highly dishonest.
          I have evidence that you are a coward.
          I suspect you of being a quack.

          And yes, this blog is paid. I have never heard of unpaid blogs. Someone is always paying one way or the other. In this case, it is Professor Ernst who pays for it. It is his blog after all.

          • I suggest we quote Christopher Hitichins and tell him: “WE WOULD CHALLENGE YOU TO A BATTLE OF INTELLECTS, BUT WE SEE THAT YOU ARE UNARMED.”

          • Unarmed indeed! The bad part would be that the unarmed have no qualms about fighting: they have nothing to lose, which may well explain the level of enthusiasm with which they spout their unthinking nonsense. They are like spammers: there will also be a sucker who falls for it.

        • @Professor James Burg

          LOL! You are funny!

          But I don’t suppose you’d care to tell us where you read all that nonsense?

        • Professor of Poe’s law, I presume.

        • @Associate Professor James Burg,
          If this is who you are (https://www.ipfw.edu/departments/cepp/depts/professional-studies/about/burg.html), how did you ever get a PhD with such illogical and unfounded thinking?

          “I suspect some of that to be rational ans the views here are very stark and unbalanced in presentation.”
          I suspect you have someone close, maybe a family member, who is a witchdoctor (aka chiropractor) and your first response is to attack those who “attack” that person’s”profession”? I wonder how that accords with your alleged area of expertise?

      • Bart, please provide references for this statement, “there is no good evidence that it works….”

        • Bart, please provide references for this statement, “there is no good evidence that it works….”

          This should give you a good starting point: https://en.wikipedia.org/wiki/Levitation_(paranormal)

          Absence of evidence is evidence of absence, but not proof of absence. Proving that levitation is impossible or does not exist, is an impossibility, as there is always the tiniest of possibilities that someone somewhere sometime somehow levitated, but as long as there is no credible evidence of this, it – for all intents and purposes – does not exist.

  • The problem you create here is that you completely ignore or discount the experiences of millions of people who have actually benefitted from seeing a chiropractor. You are saying they are either stupid, and unable to ascertain the level of pain they themselves suffer, or have been somehow seduced into believing that they received benefit.
    Most of these people initially saw a physiotherapist.
    This article is again profession bashing from someone who should be less obsessed with what others do and instead do some good himself. It is also about saving money for the MHS. It’s not about quality of care or patient experience.
    In the end, the market decides.
    No, I’m not a chiropractor, but I certainly had my back pain fixed, permanently so far, by one. Physio was rubbish.

    • @the professor
      I seem to recollect that seven out of ten people couldn’t tell Stork margarine from butter.

    • @the professor,
      “The problem you create here is that you completely ignore or discount the experiences of millions of people who have actually benefitted from seeing a chiropractor”
      The problem you create here is that of the Logical Fallacy; in this instance, Argument from Numbers. Many people have been wrong before in sometimes tragic circumstances. It also ignores the Placebo Effect, without which chiropractors would not have a business (with which to fleece people, ooops, treat patients).

      “You are saying they are either stupid, and unable to ascertain the level of pain they themselves suffer, or have been somehow seduced into believing that they received benefit.”
      Yep, that’s right. It also demonstrates someone’s lack of understanding of humans. At least, medical researchers understand it and intentionally try to exclude its effects from studies.

      “This article is again profession bashing from someone who should be less obsessed with what others do and instead do some good himself. It is also about saving money for the MHS. It’s not about quality of care or patient experience.”
      Then you haven’t digested this article or many others, or read the prof’s bio. (Please proofread before you post this crap – oops, considered response.)

      “In the end, the market decides.”
      How quaint; letting the “market” decide what constitutes proper healthcare. Many people swallowed the nonsense Jenny McCarthy peddled about MMR and autism so why not stop MMR vaccines? After all, she has a marvellous resume in medicine, if getting her tits out in Playboy counts as “medicine”?

      “No, I’m not a chiropractor, but I certainly had my back pain fixed, permanently so far, by one. Physio was rubbish.”
      Of course, the only thing that counts in healthcare is a few anecdotes from people who wouldn’t know medicine from their own arse. How helpful for the rest of humanity.

      BTW, did you read that Australian researchers may have found an answer for rheumatoid arthritis; a vaccine that disables the immune system in that circumstance? I wonder if they relied on a couple of personal anecdotes?

  • On June 5th Daniel commented on his training as an osteopath (though this thread is about chiropractic).
    I certainly wish him well but am concerned he has been misled and taught falsehoods.

    Daniel tells us:
    “First of all, here, at least, altough I’m sure some do, most don’t claim osteopathy is an alternative medicine, most consider it to be a complementary medicine or, to be even more accurate, therapy…Also we don’t perform medical acts nor do we dabble or try to cure pathologies, instead, we merely try to understand where is the primary source of the disfunction and correct it, allowing the body to return to it’s more efficient function.”

    He also says: “Moreover, most of the diagnotic tests we use are from neurology and physiotherapy, and we learn, heavilly, anatomy, physiology, bio mechanics, since this is our bread and butter.”

    Now hang on. If osteopaths make diagnoses and carry out treatments – they are practicing medicine (albeit not as licensed doctors). And that’s the point.
    Andrew Taylor Still developed ‘Osteopathy’ precisely as an alternative to the conventional medical profession which he had been unable to enter. (He started his healing career as a ‘magnetic practitioner’).
    Or hasn’t Daniel been taught that?
    If not, he should ask his school for his money back.

    Daniel says: “We are also taught our limits of practice and what is within our scope of work, if it isn’t for us, the best we can do is to refer the patient to another health professional or doctor.”

    This is of course a requirement for all health professionals (including doctors). Indeed, criminal charges might result if this practice is not followed.

    A T Still clearly stated what osteopathy is:
    “The fundamental principles of osteopathy are different from those of any other system. The cause of disease is considered from one standpoint, viz.: disease is the result of anatomical abnormalities followed by physiological discord. The rule of the artery is absolute, universal, and must be unobstructed or disease will result.”

    If you don’t believe that Daniel, and are not learning how to ‘unobstruct’ anatomy and avoid diseases (cure pathologies), I am bemused as to why you are studying osteopathy, but best wishes and may the wu be with you.
    (Wu: Chinese – ‘nothingness’).

  • @ Richard Rawlings
    Your comments about AT Stills are a little silly. at the time AT Stills wrote his books (late 1800’s & early 1900s) medical doctors were still prescribing sulphur, leadum, opiates and mercury and bleeding and leeches were common. AT Stills was a MD and a surgeon, he also did a lot of human dissections to study anatomy. Not everything he wrote is relevant today as we have had a hugh amount of research done since then. From looking at Osteopathic course outlines in Australia it looks like the courses are 3 years premed followed by 2 years physical manipulation & joint mobilisation training.
    I would also like to point out that really you are holding up physio as a profession that is dedicated to evidenced based medicine however this is not true. The cochrane reviews on both ultrasound & TENS machines clearly demonstrate that neither work better than the placebo treatment, yet Australian universities keep training physios in the use of these devices and health rebates are claimed by physios for time spent using these forms of therapy. The original study doesn’t compare the outcomes of physio to chiropractic so really the whole blog is twisting the science to fit a bias perspective held by the author.

    Here is a quote from the cochrane review on ultrasound for LBP

    We did not find any convincing evidence that ultrasound is an effective treatment for low-back pain. There was no high-quality evidence that ultrasound improves pain or quality of life.

    We did find some evidence that ultrasound may improve back-related function—the ability of people to use their backs. But those effects were so small they may not make any difference to patients’ lives.

    http://www.cochrane.org/CD009169/BACK_therapeutic-ultrasound-for-chronic-low-back-pain

    • @Rob,
      “Your comments about AT Stills are a little silly.”
      From the comments from osteopaths on this blog, Still is still referenced in osteopathy. If osteopathy courses stopped this, you would have a valid point but………………………………

      “From looking at Osteopathic course outlines in Australia it looks like the courses are 3 years premed followed by 2 years physical manipulation & joint mobilisation training.”
      When has there ever been something in Australia as “premed”?

      Osteopathy, by what I’ve read, still has the idea that it is clearing “obstructions”. While this metaphysical nonsense is countenanced, why would anyone take it seriously? Does it mean that I, as an atheist, would not benefit because I have no such belief?

    • Rob,
      You are correct that in the 1880s conventional medicine was not up to much. But surely you acknowledge that under the impetus of the scientific method, progress has been , and is still being made.
      That has to be contrasted with osteopathy which has not made comparable progress and is still wedded to the anchronistic metaphysiscs of AT Still. That is why osteopathy remains ‘alternative’.

      I am concerned that you have misunderstood or even been deliberately misled. Still had no MD degree (unlike his father). He was a medical attendant in the army. Whilst the title of ‘surgeon’ has no legal protection, by conventional usage Still was not a ‘surgeon’ and never operated by surgical techniques on any one. He may have carried out dissections, but drew conclusions which could not be substantiated by orthodox anatomists. He never found a ‘subluxation’. Presumably if he had, he would have become a chiropractor!

      Yes, physiotherapy is an evidence based profession. As with medicine, that evidence is often poor, but physiotherapists are taught scientific principles, (eventually) abandon techniques which have been shown to have no benefit and make progress on that basis.

      Many have started to study osteopathy (though why they would choose to do so I cannot imagine), but surely, many have given up after realising the issues with that system. There are no records. Schools are coy about their drop out rate, and no register of qualified osteopaths identifies those who give up practice (before standard retirement age). They should.

  • “What is the difference between chiropractic and physiotherapy?” is a common theme throughout the above comments. I would have to reply “the only difference is chiropractic has external critics who point out the BS within the profession”. This helps the reform process, though the sweeping statements, generalizations and deeply entrenched views that all chiropractors subscribe to an outdated dogma and that it is taught at all chiropractic colleges and universities is frustrating.
    I regularly communicate with physiotherapists who are critical of the expanding BS within their profession and despair of business as usual. The largest provides of post graduate courses to physio’s in North America is for “Osteopractors (TM)” who are also into dry needling. Some physio’s are unimpressed, the external critics are silent yet physio’s flock to their courses!
    Stephen Perle is a chiropractor who has been critical of the BS within chiropractic for decades. He has had the true believers threaten his job and send their attack lawyers after him on one side, while the external critics hammer him for not being critical enough on the other side. His restraint is remarkable!
    Ultimately, any reform of the chiropractic profession must come from within and it is occuring. The recent position statement from the chiropractic schools in Europe was good. Tellingly the only institutions who didn’t sign it were Barcelona and McTimmony who have been denied accreditation. The subluxationists are complaining about how they are being marginalized, so good result!
    As I have repeatedly said in previous threads on this forum, pointing out the BS is fine as it ultimately pushes he reform process forward, but carpet bombing the profession has the chiropractic reformers as unacceptable collateral damage.

    • @Thinking_Chiro
      Many people who finds themselves working in a business that carries a huge burden of negative history either strike out on their own with an entirely new enterprise, or at least change the name of the business. Whatever one may say against D.D. Palmer and his son B.J. (founders of chiropractic), they at least had the balls to pronounce their nonsense as a new alternative to conventional medicine, stand by it and promote it. You, on the other hand, keep coming along to complain of “carpet bombing” from those who recognize pseudo-medical idiocy for what it is, and insisting there are lots of people in the “profession” who are as rational and sensible as the best among scientific medical practitioners.
       
      The presumption is that you don’t have the entrepreneurship or the guts to rid yourself of the baggage of the joke called chiropractic and strike out for something better with a new name. In reality, physiotherapy is one of the least evidence-based of medical therapeutic approaches, while chiropractic and osteopathy are even worse because they’re based on obsolete philosophies that don’t stand up to scrutiny.
       
      So please, T_C, recruit the chiro colleagues you talk of who reject the old philosophies; add some osteopaths and physios of the same mindset and set up a new approach. Call yourselves perhaps “manipulative therapists” and build up a medical subdiscipline in which you set out to provide an evidence base for specific bone-and-muscle-twanging techniques you can prove confer genuine benefits to patients. You could end up achieving great fame and riches.
       
      Meanwhile, you appear content to benefit from the pecuniary advantage of the positive anecdotal reputation of chiropratic, presenting yourself as a force for good because there are bits of the philosophy you recognize as daffy.

    • Why do ‘the reformers’ want to reform?
      What is it they wish to have reformed?
      Why do they not simply leave the profession and convert to physiotherapy or medicine (or, conceivably, Reiki, osteopathy etc.)?

      When the Church in England reformed and became Protestant, the fundemental belief system remained.
      Those who gave up on those fundemental beliefs had the moral compunction to convert to other religions, or none (on pain of death in some cases).

      But chiropractic is a belief system applied to healthcare.
      No belief? No healthcare from that system.
      Get over it.

  • @FrankO and @RichardRawlins:
    Have moved on, jettisoned/never acquired the baggage/bits of philosophy before entering uni, have built up a large medical referral base over the last 25 years. I work within the healthcare system, practice in a medical centre and the doctors who refer are well aware of the differences within chiropractic and refer accordingly. Additionally, I am engaged with like minded physio’s who are frustrated with business as usual and are pushing reform. I enjoy coming onto forums such as this so that both sides of the argument are placed in the public record. That furthers reform!
    I have also talked to some of my chiropractic collegues about coming onto this forum and the response is “why bother they will never change”. The critics are often as deeply entrenched, biased and resistant to change as the most hard core subluxationists with views set in concrete. You ring the chiropractic bell and they respond in a predictable way! Unfortunately, this response is chiropractic’s own fault and we need to communicate with the critics.
    As for “specific bone-and-muscle-twanging techniques” I utilize that less and less and I am more focused on chronic pain management and rehab.
    Good question “Why have I not converted to physio or medicine?” Grew up in a medical family and was never interested.

    • @TC,
      All of the above looks as rationalisation for not taking a stance on something you claim to be fervent about.

      The problems of chiropractic are too great to consider it part of medicine, despite the seemingly cosy relationships you have. If chiropractic can’t decide what it is, why would anyone externally have any confidence in it? Haunted, as it is, by metaphysical nonsense does not augur for evidence-based advancement, despite “borrowing” techniques from mainstream.

      Why not be a “spinal manipulative therapist”? Is the title “doctor” too precious with which to part?

    • @Thinking(sic)_Chiro

      Good question “Why have I not converted to physio or medicine?” Grew up in a medical family and was never interested.

      Then why on earth do you dabble in something defined as a “health profession” or “alternative medicine”? How can you be interested in an alternative if you’re not interested in medicine per se?
       
      You claim to have doctors who are well aware of the differences within chiropractic, suggesting (without evidence) that the things you do are somehow better than the practice of obsolete-philosophy chiros. So why not abandon the name of chiropractor (it has a stinking reputation among people who truly think), accept that your medical family knew what they were doing, and consign yourself to a medical subdiscipline.
       
      Chiropractic can’t be considered a medical subdiscipline because it claims to have the tools to cure all disease. That’s why it has to be classed as an alternative medicine, and why your claims to be smarter than your colleagues fall on deaf ears. How do you know the people referred to you are not all just heart-sink cases?

      • RR, references please for these statements…”Yes, physiotherapy is an evidence based profession”.
        “physiotherapists are taught scientific principles, (eventually) abandon techniques which have been shown to have no benefit and make progress on that basis”

  • @Frank Collins
    Good points! In communicating with doctors I have dealt with the metaphysical nonsense and have positioned myself as the go to guy for chronic difficult backs. Whether the doctors have confidence in what I do or whether they are just happy to offload frustrating patients thet they dread seeing is hard to say. Probably a bit of both.
    The chiropractic profession needs to publicly bury subluxation. The recent position statement from the European schools doing just that is a good move and long overdue! The failure of Barcelone and McTimony to add their name is not surprising as both have failed to gain accreditation!
    http://vertebre.com/charte-pour-l-education-chiropratique-en-europe-8163
    This follows on from similar statements from the General Chiropractic Council in the UK and COCA in Australia.
    Will we ever be completely rid of the subluxationists? Probably not! But marginalizing them and reducing their numbers/percentage to the lowest single digit possible, Yes!
    @FrankO
    I am interested in health care, just not all the rubbish and stress of medicine that I have heard over the dinner table growing up, though this didn’t stop my brother from becoming a surgeon. My oldest son, who is currently in 1st year engineering at uni, considered doing medicine 2 years ago and all 4 surgeons and GP in the family and all the GP’s in the medical centre where I work all advised against it! There was universal pessimistic about where medicine is headed!
    Just like subluxation, the cure all rubbish needs to be excised, and the above position statement does just that!

    • To Mr Thinking Chiro:
      I am still bemused as to why any ‘thinking Chiro’ would persist with such an outmoded ‘healing modality’ – especially when they have given up on subluxations and metaphysical theories.
      What else is there?
      A few techniques to mobilise the spine.
      Fair enough.
      But continuing to present oneself as a ‘chiropractor’ when clearly one is not, is simply a marketing device, lacks integrity and is rendolent of quackery.
      Please Mr TC, get over it and develop a career as a physiotherapist, doctor, nurse, healthcare journalist, author or blogist!
      Alchemists, astrologers, blood letters, polypharmacists have (by and large) accepted that human knowledge has moved on, and so have they.
      Good luck, and retain your integrity.

      • @Richard Rawlins
        I have developed a career as a chiropractor and educated doctors on how I practice. Working fine!

        • “I have developed a career as a chiropractor and educated doctors on how I practice. Working fine!”
          Why do you bother to read posts and pretend to accept what is well-intentioned criticism and advice?

          I also don’t know why you bother to pretend to want to “reform” chiropractic when you quite happily accept its many shortcomings and the commensurate income? Despite all of the Cochrane reports, you wheel out platitude after platitude about change. Well, there is one change which you can give effect; you.

          I can’t see it and I, for one, have had enough of your BS. In many respects, you aren’t so different to many alt-meds, including that loosehead jm, who make grandiose claims then fall far short when you fail to act.
          I’m done.

          • A shame we don’t know who TC is – it’s hard to judge his (her) integrity.
            We now know he/she does not believe in subluxations nor chiropractic metaphysics about innate intellegence, but seems to have appropriated the title of chiropractor to assist branding and marketing.
            Some might regard that as the behaviour of a quack.
            I join Frank who is ‘done’ on this thread.

    • “The chiropractic profession needs to publicly bury subluxation. The recent position statement from the European schools doing just that is a good move and long overdue! The failure of Barcelone and McTimony to add their name is not surprising as both have failed to gain accreditation!
      http://vertebre.com/charte-pour-l-education-chiropratique-en-europe-8163

      Thanks for posting this. I had not heard of this change in attitude before. Personally I am quite impressed by the honesty of the position statement. Admitting mistakes is not easy for anyone. If one of the characteristics of science is the capacity to identify and correct the mistakes of previous generations then I think the Chiropractic profession should be applauded for (almost) admitting that it was historically based on ideas that were wrong. I think this shows Chiropractic to be mature and forward thinking. That is something I never thought I would say.

      Osteopathy is not yet at a stage of development where it can publicly acknowledge past mistakes. It still prefers obfuscation and defensiveness to humility and progressive ideas.

  • P.S. Don’t use the title “doctor”, don’t want it, have not earned it, creates confusion with patients and pisses off medico’s big time! It created barriers! Even “doctor of chiropractic” is a load of BS!

  • We differ! You think chiropractic is beyond reform, while I am up to my neck in the reform process! Thanks for the good luck! Time will tell!

  • Note that SOFEC, web address quoted by Thinking Chiro and then James above, is still “dedicated to Chiropractic”, even though it seems to have rejected subluxations and the practice of ‘high volume’ care (milking the punters).
    So, what remains of chiropractic?

    “SOFEC: Société Scientifique dédiée à la Chiropraxie,
    aux thérapies manuelles et aux traitements conservateurs de la colonne vertébrale et des articulations periphériques.”

    Charter: “5. The teaching of vertebral subluxation complex as a vitalistic construct that claims that it is the cause of disease is unsupported by evidence. Its inclusion in a modern chiropractic curriculum in anything other than an historical context is therefore inappropriate and unnecessary.

    6. Chiropractic education should reflect ethical practice and professional standards throughout the curriculum. Upon graduation, students must understand their responsibilities to their patients, their communities and to the profession.

    7. Practice styles promoting preset ‘high volume’ chiropractic care models as wellness care, which may contribute to inappropriate patient dependence, compromise patient confidentiality or require repeated exposure to ionising radiation are not part of an undergraduate chiropractic curriculum. Students should be taught to recognise that such approaches are not acceptable in terms of the best interests of patients or the chiropractic profession.”

    It would appear that this group of schools (under SOFEC) are still desperate to promote their courses and practices as unlicenced doctors and physiotherapists.
    Intending students should be aware they are entering a philosophical black hole and should seriously consider medicine, nursing or physiotherapy.
    Chiropractic has been left behind by advances in the orthodox professions.
    If students want an ‘alternative’ to medicine or physiotherapy – good luck. But I do hope they obtain fully informed consent from their patients and tell them why, exactly, they did take up chiropractic and not a regular profession.

    Chiropractic RIP. Get over it.

  • @Richard Rawlins
    Showing your bias!
    The SOFEC statement is about necessary reform and still you attack it because it has the word chiropractic attached to it! I would have expected you to show at least guarded support!
    As for “So, what remains of chiropractic?” I have been consistent on this forum in regard to that topic!

    • @TC,
      But have failed to read and digest all of what has been written.

      RR has been entirely consistent in his criticisms. I repeat my question; “why call yourself a chiropractor when chiropractors cannot agree about the core concepts”? How can you “reform” an area of alt-med when a great many believe in the metaphysical?

      Palmer and Hubbard were both clear in the ambitions; the creation of a religion is the only way to propagate a nonsense and sell it to the gullible (and make a quid (dollar) in the process).

      • @Frank Collins
        Research in the US, Europe and Australia put the subluxation fringe at 15-18%. There are definitely factions within chiropractic so I have consistently branded myself to my referring doctors and patients as the go to guy for chronic difficult backs. That is one thing doctors have not had to do as their branding and marketing is done for them. Just look at the number of TV shows related to medicine. Chiropractic does not own metaphysical, wellness, health, sport, prevention etc. In the eyes of the public we own one word “spine”. That is what I brand and market to my doctors. A focused message is far more effective than an ill defined universal panacea.

        • “Research in the US, Europe and Australia put the subluxation fringe at 15-18%.”

          Why then is subluxation still taught at many schools?

          “There are definitely factions within chiropractic so I have consistently branded myself to my referring doctors and patients as the go to guy for chronic difficult backs. That is one thing doctors have not had to do as their branding and marketing is done for them. Just look at the number of TV shows related to medicine.”

          And what evidence do you have, apart from anecdotes that what you do is of benefit (apart from to your pocket)?
          Your assertion about “branding and marketing” for medicine gives an insight into the commercial mind of a chiropractor. Doctors and medicine are not “branded”; they are there for people who are sick and who want to restore their health. Do you want similar “branding” so consumers will think you can be a first port of health call?

          “Chiropractic does not own metaphysical, wellness, health, sport, prevention etc. In the eyes of the public we own one word “spine”. That is what I brand and market to my doctors. A focused message is far more effective than an ill defined universal panacea.”

          The public is misinformed and it isn’t the first time. Palmer was certainly right about one thing; the public is gullible.

  • @Frank Collins
    “Doctors and medicine are not “branded”; they are there for people who are sick and who want to restore their health.”
    Medicine is a huge brand, big business and they spend a fortune on marketing!
    When I communicate with doctors am I not marketing what I do to them? When they communicate with me are they not marketing what they do to me? This then influences who we refer to and how we build a referral network!
    My brand is spine and for my doctors that means difficult chronic backs. Simple!

    • “Medicine is a huge brand, big business and they spend a fortune on marketing!”

      If you believe that, you are seriously deluded and definitely in the alt-med camp, peering over the fence at real medicine in dark green envy.

      • @ Frank

        So, pharmaceuticals (which are part of medicine) are not branded or marketed to people? I will also say that supplements and other products are also heavy marketed.
        Finally, I think Ben Goldacre has shown that this marketing of drugs and other products can have an influence on how people practice, whether they are Doctors or Osteopaths

        • @An Other,
          As expected, you have AnOther problem with context.

          “So, pharmaceuticals (which are part of medicine) are not branded or marketed to people? I will also say that supplements and other products are also heavy marketed.”

          *********************************************************************************
          medicine
          ˈmɛds(ə)n,ˈmɛdɪsɪn/Submit
          noun
          noun: medicine; plural noun: medicines
          1.
          the science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery).
          “he made distinguished contributions to pathology and medicine”
          synonyms: medical science, practice of medicine, healing, therapeutics, therapy, treatment, healing art
          “the remarkable achievements of modern medicine”
          2.
          a drug or other preparation for the treatment or prevention of disease.
          “give her some medicine”
          synonyms: medication, medicament, remedy, cure, nostrum, patent medicine, quack remedy, panacea, cure-all, placebo, drug, prescription, dose, treatment; More
          3.
          (among North American Indians and some other peoples) a spell, charm, or fetish believed to have healing, protective, or other power.
          “Fleur was murdering him by use of bad medicine”
          Origin

          Middle English: via Old French from Latin medicina, from medicus ‘physician’.
          *********************************************************************************

          I could use the term “dunny brush” in a generic sense but it doesn’t mean I am marketing brushes for a toilet. If, however, I used the brand name of a dunny brush in conversation, I might be construed to be “marketing” that product.
          (Jesus H. Christ!, how simplistic does an explanation have to be before you understand it?)

          “Finally, I think Ben Goldacre has shown that this marketing of drugs and other products can have an influence on how people practice, whether they are Doctors or Osteopaths”

          That is why it is called “marketing”.

          An Other, I’ve asked before and not received an answer; are you a nurse?

          • @Frank

            No I am not a nurse. So will you answer my question about spinal manipulation and thoracic spine pain?

            And no you have not answered it.

          • Yes, when I get around to it. I’m not all that predisposed to some one who asks questions, as you did above, and, when it is exposed as a nonsense, trots out something else.

            Are you jm posting under another guise?

          • @ Frank

            If the context of your view is that medicine (using definition number 1 on your list) has no branding or marketing then you are possibly correct.

            However if you believe that there is no branding or marketing in medicine (using definition number 2) then you are seriously deluded.

            Therefore, considering the use of the term medicine, as shown by your definitions, can mean multiple things it is easy to have misunderstandings.

            Also, if i used the term “hoover” it could mean that i am talking about a generic vacuum cleaner or i could also be referring to the brand. Therefore, medicine (a drug) could be a generic term that is also associated with branded products.

          • @An Other,
            I do enjoy your attempts at comedy.

            “If the context of your view is that medicine (using definition number 1 on your list) has no branding or marketing then you are possibly correct.”
            Thank you, though you not would see the irony.

            “However if you believe that there is no branding or marketing in medicine (using definition number 2) then you are seriously deluded.”
            I knew it would happen; Tu Quoque, you just can’t help yourself (are you sure you aren’t jm, similar mindset?).
            Context? The use of the term “medicine in the second definition refers to the colloquial term for a, usually pharmacist dispensed item. Even then, it is a generic term and is not brand or application specific. http://www.thefreedictionary.com/To+draw+the+longbow

            “Therefore, considering the use of the term medicine, as shown by your definitions, can mean multiple things it is easy to have misunderstandings.”

            For you, yes. http://www.thefreedictionary.com/To+draw+the+longbow

            “Also, if i used the term “hoover” it could mean that i am talking about a generic vacuum cleaner or i could also be referring to the brand. Therefore, medicine (a drug) could be a generic term that is also associated with branded products.”

            Oh dear. http://www.thefreedictionary.com/To+draw+the+longbow

          • @ Frank

            I was just following your example of a tu quoque posted earlier.

            Many medications (medicine) have two names because more than one version of the medicine is available.

            The brand name is the name given to a medicine by the pharmaceutical company that makes it. This is also called the “proprietary name”.
            The generic or scientific name is the term given to the active ingredient in the medicine that is decided by an expert committee and is understood internationally. This is also called the “non-proprietary name”.

            Also for your reading pleasure:

            http://www.businessinsider.com/how-mayo-clinic-became-the-best-brand-in-medicine-2013-2?IR=T

          • @AN Other,
            The non-steroidal analgesic and anti-inflammatory drug, ibuprofen, is available under a variety of trade names, including Advil, Motrin, and Nurofen. In the UK, I have not yet encountered a NHS GP who writes prescriptions for a particular trade name instead of the generic pharmaceutical name (unless, of course, there existed only one supplier who had registered the pharmaceutical name as a trade name).

            You wrote: “Also, if i used the term ‘hoover’ it could mean that i am talking about a generic vacuum cleaner or i could also be referring to the brand.” With your level of bastardization of English, you would be correct. Those who make even the slightest attempt to learn English would clearly delineate their meaning by selecting between the words “hoover” [generic colloquialism] and “Hoover” [the trade name].

          • @ Pete

            So, is there branding or marketing in medicine?

        • So, pharmaceuticals (which are part of medicine) are not branded or marketed to people

          Not in countries that have reached some level of sophistication. They are in the US, and to some smaller extent in Canada.

          I will also say that supplements and other products are also heavy marketed.

          Yes, they are. It is a disgrace. While there is a legitimate use for some supplements in medicine, most supplements are marketed by ruthless quacks who don’t give a rodent’s exit hole about the health of their victims, only about their money and only when it is flowing in the direction of their despicable selves.

          Finally, I think Ben Goldacre has shown that this marketing of drugs and other products can have an influence on how people practice, whether they are Doctors or Osteopaths

          And you need Ben Goldacre to reveal this stunning information? It’s called marketing for a reason, and there is a good reason why countries that are rising out of the slums usually attempt to limit this type of marketing.

          • @ Bart

            Ben Goldacre did write about the use of marketing and how it can influence practice of medicine in a chapter of his book. If he felt it was necessary to explain this, I would suggest that it is not as obvious as you think it is.

          • @ Bart

            Also I would say that all countries have branded drugs of some sort. The marketing of drugs do vary from country to country with USA being one of the worst for its marketing of drugs.

          • Again, but in English:

            Also, I would say all countries have branded drugs of some sort. The marketing of drugs does vary from country to country, with USA being one of the worst.

            If you are going to pretend to be intelligent, at least write as one.

          • Ben Goldacre did write about the use of marketing and how it can influence practice of medicine in a chapter of his book. If he felt it was necessary to explain this, I would suggest that it is not as obvious as you think it is.

            I just checked on Google for “how to eat an apple”. It gave me 1,950,000 results. Given the level of highly developed and refined skills the eating of an apple requires, I submit that the probability that your reasoning might be the tiniest bit off may not be entirely equal to zero.

    • As a resident of the UK it is hard for me to tell whether your financial focus and interest in commercial marketing and branding is because you are a chiropractor or because you are American. Either way it sounds extremely unappealing.

      Maybe professional reform is impossible and chiropractors will always be a blot on the healthcare landscape.

  • @Frank Collins
    Medicine not branded and marketed? To use your own word, are you deluded!
    A sample of Medical Branding:
    http://www.brandsoftheworld.com/logos/categories/medical
    Medical Marketing:
    https://www.google.com.au/?gws_rd=ssl#q=medical+marketing
    https://www.google.com.au/search?q=medical+marketing&biw=1366&bih=608&tbm=isch&tbo=u&source=univ&sa=X&ei=Q6GDVeGJM-XamgX9w4Eg&ved=0CFEQ7Ak&dpr=1
    I work in a medical centre and we get 3-5 drug reps coming in every week.
    I work within the system and know how it works! If I do a good job then I get more referrals, if I promote BS or stuff up then the doctors would cut me off at the knees in a heart beat. Its about accountability and patient centred care. If I get that right then the finances look after themselves!

    • “I work in a medical centre and we get 3-5 drug reps coming in every week.”
      We? Have you taken to dispensing drugs as well, or just carried away with the self-proclaimed Dr title?

      “I work within the system and know how it works!”
      Why are there no chiros in hospitals? Simply put, they don’t open themselves up to full scrutiny.

      • Frank chiropractors do work in hospitals see http://www.stmichaelshospital.com/programs/chiropractic/
        and there are other examples!

        • It is an extremely worrying trend, and it is altogether incomprehensible that a health system that is in trouble, spends money on outright quackery that, on the whole, does indeed make a difference, by making patients worse.

          In the link you gave, Clinical Ethics sits just below Chiropractic. It is a disgrace. The only positive I can see, is that when something bad happens, genuine doctors are nearby, to give real care, and rescue the patient from the clutches of the chiropractor, if the priests don’t get to the patient first. As they say, they are faith-based. Since quackery is faith-based, those in power at the hospital may not understand why there would be an ethical problem.

          If given the choice between dying in peace and being treated there, I think I prefer the first choice.

          What’s next? Deepak Chopra as minister of health?

          • Bart, is what you are saying peer review referenced, comparative to other health care providers (G.P.’s, physiotherapists, orthopaedic surgeons, neurologists) or just your opinion. The following statements really do need proper referencing
            e.g. “spends money on outright quackery that, on the whole, does indeed make a difference, by making patients worse”

          • @GibleyGibley,
            Are you a chiropractor?

          • Well then, GibleyGibley, you are in the right place, are you not? I suggest you click on the chiropractic link you find on this page. You will find more high-quality information than anywhere.

        • @Andy,
          I stand corrected. It seems the Canadians are more susceptible to wu than my country. There are no chiropractors in Australian hospitals, and happily so.

          Let’s have a look at this example.
          *************************************************************
          http://www.stmichaelshospital.com/programs/chiropractic/
          Support / Professional Services
          Chiropractic Services
          Image for the Chiropractic program

          Our chiropractic services are held within one of Canada’s first hospital-based chiropractic care clinics. Using a variety of treatment approaches, including spinal and joint manipulation, soft tissue therapies, modalities, active rehabilitation and exercise, we treat several conditions:
          back pain
          neck pain
          headaches
          limb pain
          carpal tunnel syndrome
          workplace, motor vehicle and sports injuries
          reduced or impaired range of motion
          other complaints relating to the neuro-muscloskeletal system
          Our chiropractors are primary contact healthcare providers who see patients referred by the Hospital’s network of family physicians, the positive care clinic, and the employee health unit. They include chiropractors Dr. Deborah Kopansky-Giles and Dr. Igor Steiman, both affiliated with the Canadian Memorial Chiropractic College.

          The St. Michael’s Hospital department of family and community medicine welcomed the clinic into the Hospital in April 2004. The initiative was made possible thanks to the Ontario Ministry of Health and Long-Term Care Primary Care Health Transition Fund.
          *************************************************************

          Chiropractors treating Carpal Tunnel Syndrome, a wrist condition, and sports injuries? Do you not find that odd? It is like DD Palmer curing the deaf man; ridiculous and totally implausible.

          The two chiros graduated from Canadian Memorial Chiropractic College, the memorial relates to in memory of DD Palmer. This is what CSI had to say about it;

          http://www.csicop.org/si/show/universitys_struggle_with_chiropractic
          More than three-quarters of licensed chiropractors in Canada have graduated from CMCC (Kopansky-Giles and Papadopoulos, 1997) and less than 19 percent “rejects traditional chiropractic philosophy as espoused by D.D. and B.J. Palmer and emphasize the scientific validation of chiropractic concepts and methods” (Biggs, Hay, and Mierau 1997).

          From this website, I have copied two subjects from the course. (I refuse to refer to it as a degree so as not to insult real degrees.)
          http://cmcc.ca/page.aspx?pid=311

          CP 2410 Chiropractic Practice: Clinical Theories, Ideologies and Therapies
          A variety of chiropractic techniques are presented from the perspective of the historical development, the philosophy of the techniques, their diagnostic methodologies and treatment protocols. Other complementary and alternative health care disciplines and their potential benefit to patient care are also reviewed. Students are encouraged throughout the course to critically appraise the techniques and the systems of healing.

          CD 3408 Chiropractic Practice: Special Populations: Paediatric Patient
          The diagnosis and management of selected conditions affecting infants and preschool children are presented, including disorders of birth, child development, the neuromusculoskeletal system, orthopaedics, infectious diseases and common malignancies. Distinguishing those conditions that require referral and those that are amenable to chiropractic care is emphasized. Special emphasis is placed on prevention and correction of structural problems.

          The CMCC is clearly rooted in metaphysical so it is as wacky as it gets. Note the reference to “Other complementary and alternative health care disciplines”, so it also clearly places itself in the alt-med camp.

          I agree with Bart; St Michael’s should be ashamed of itself.

          • “…..Chiropractors treating Carpal Tunnel Syndrome, a wrist condition, and sports injuries? Do you not find that odd? ……………. ridiculous and totally implausible.”

            Why do you find it odd, ridiculous and totally implausible?

          • I followed yiour link —-> http://cmcc.ca/page.aspx?pid=311

            It looks to be a VERY rigorous first year….sure to weed out the weak.
            Thanks for the info. The subsequent years of courses are equally rigorous/impressive !

          • @nobs,
            “Why do you find it odd, ridiculous and totally implausible?”

            What does Carpal Tunnel Syndrome have to do with the spine? “Carpal tunnel syndrome (CTS) is a medical condition in which the median nerve is compressed as it travels through the wrist at the carpal tunnel and causes pain, numbness and tingling, in the part of the hand that receives sensation from the median nerve.” from https://en.wikipedia.org/wiki/Carpal_tunnel_syndrome

            As for sports injuries, how many have to do with the spine? If chiros are branching out into physiotherapy, why not study physio in the first place, instead of trying to steal from a medically affiliated discipline?

          • @nobs,
            “It looks to be a VERY rigorous first year….sure to weed out the weak.
            Thanks for the info. The subsequent years of courses are equally rigorous/impressive !”

            So rigorous they include first class nonsense?
            “More than three-quarters of licensed chiropractors in Canada have graduated from CMCC (Kopansky-Giles and Papadopoulos, 1997) and less than 19 percent “rejects traditional chiropractic philosophy as espoused by D.D. and B.J. Palmer and emphasize the scientific validation of chiropractic concepts and methods” (Biggs, Hay, and Mierau 1997).”

            It seems you are a chiropractor troll who has selective perception.

        • I sent the following message to St Michael’s on their contact web page.

          ***************************************************************
          I am shocked to see that your hospital has a chiropractic clinic.

          The Mission Statement says ‘Fostering a culture of discovery in all of our activities and supporting exemplary health sciences research” and I would like to know how you have reconciled medical science with the metaphysical associated with chiropractic.

          The reason, if it needs to be said, that nearly every other hospital in the world does NOT have chiropractors on staff is that they have investigated the research (Cochrane, if that needs to be said) and rejected chiropractic as unscientific and potentially dangerous.

          Why does your hospital reject scientific research in favor of unsubstantiated alternative medicine?
          ***************************************************************

          • St Michael’s is not the only Canadian hospital to have staff DCs.

            For example:
            https://www.mountsinai.org/patient-care/service-areas/spine/meet-our-team

            https://www.mountsinai.org/profiles/bradley-h-grossman

            There are many more.

          • @nobs,
            “St Michael’s is not the only Canadian hospital to have staff DCs.”

            It seems that other hospitals have succumbed to witchcraft too. Let’s have a look at this situation then.

            “Dr” Grossman has a private clinic too. He offers a range of services which includes acupuncture and treatment for osteoporosis and migraines.
            http://www.bradleygrossman.com/library/4000/HeadachesMigraines.html
            Headaches/Migraines
            Some recent studies have shown that patients suffering from chronic headaches and migraines may benefit more from long-term chiropractic care than drug therapy alone.

            How Grossman treats osteoporosis is stated.

            He graduated from the New York Chiropractic College which also offers courses in acupuncture and Oriental medicine. It says students will “Benefit from a holistic educational approach with shared emphases on the science, art and philosophy of chiropractic and Oriental medicine”.
            http://www.nycc.edu/why_Integration.htm

            It looks as though Grossman is well versed in many aspects of wu. How a hospital let him and his quackery through the door is a mystery and poorly reflects on that institution.

            Where I live, the government website (http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Carpal_tunnel_syndrome) advocates treatments that do include witchcraft chiropractic.

          • “The Milan Lab is where careers are boosted and prolonged. It is the secret behind AC Milan’s success and one of the reasons why their ageing squad arrive at Old Trafford tomorrow hoping to stay in the Champions League, despite trailing 3-2 from the first leg.
            It is where neurology, biochemistry, psychology, dentistry and chiropractic are used to maintain fitness and to detect potential injuries.
            Sportsmail’s MICHAEL WALKER explores the background to the state-of-the art training facility which is the envy of world football . . .”

            “The man behind this is a 63-year-old Belgian chiropractor called Jean-Pierre Meersseman, and the likes of Paolo Maldini and David Beckham have testified on behalf of Meersseman’s methods. “

          • do you have a point?

          • Tiger Woods

            Winner of 10 majors before the age of 30, and the second player of all time to win three major championships in a calendar year. “I’ve been going to Chiropractors for as long as I can remember. It’s as important to my training as practicing my swing.” Many people don’t know that Tiger Woods rode upon a Chiropractic Float in the 1995 Pasadena Tournament of Roses Parade.

          • in case you have not noticed: medicine has moved on from the stage where anecdotes were acceptable as evidence [more than 100 years ago!].

          • does that prove that chiropractic care produces adulterers?

          • does that prove that chiropractic care produces adulterers?

            I think Professor Ernst is on to something here. The connection is undeniable. Could this be a side effect of chiropractic?

          • well, we need further studies, of course, but by chiro standards the evidence looks fairly compelling, I’d say.

          • I can’t help but wonder about the mechanism. Could it be that they X-rayed his pelvis and saw that there were subluxations in his penis bone(r) that needed some gentle adjustments?

          • @fedup,
            Is there any reason you can’t write properly? (I could ask, snidely, whether you are a chiropractor because that would explain your detachment from reality. That, however, would be unseemly.)

            When will people learn a post is only valid if it addresses the the substance of the discussion, and not use the Logical Fallacy, Argument from Authority. Who cares what Tiger Woods did? Hopefully, the seven iron his ex-wife used on him may have knocked some sense into him, rather than running around with scrubbers, such as the one he turned up in Australia a few years ago, hoping his wife would not notice.

  • @Frank Collins
    I have repeatedly made my position on the abuse of the Dr title clear on this blog. Medicine is the ultimate team sport. In my medical centre we have a meeting every morning over cappuccino’s where we discuss patients, approaches to care etc. Drug reps also enter the conversation and what the doctors say is not very flattering! I have a healthy cynicism towards chiropractic that seems to match the levels of cynicism the doctors display towards medicine. The discussions are very frank and open.

    @James
    The whole of medicine is branded and marketed to a level that no other industry can match. An Orthopedic surgeon is constantly marketing his brand to his referring doctors and that brand is Dr John Smith Orthopod. He is marketing his skills and reputation. His bottom line is send the next hip replacement to me and not the orthopod around the corner who is also very good. It is the same with me. I have spent decades building my reputation in the local medical community and I work on it constantly. I have the reputation for helping chronic difficult backs. Referral networks are at the heart of medicine and gaining that trust is not easy. Doctors are very careful about who they refer to as it reflects straight back on them. There is a high level of accountability which is important. It should not be unappealing, it is recognising the dynamics of this referral relationship and communication clearly with the doctors who hold me to account!

  • Prof Ernst, I merely pointed out the error in this statement.

    “As for sports injuries, how many have to do with the spine? If chiros are branching out into physiotherapy, why not study physio in the first place, instead of trying to steal from a medically affiliated discipline?”

  • Frank Collins, it was all copied and pasted, non of it my words. Take it up with the journalist that wrote it. You are probably an expert on that aswell.
    As for adulterers, well I expected more from you prof. What about the whole ac milan team?

    • right. you convinced me completely! the WHOLE AC MILAN CANNOT POSSIBLY BE WRONG.

      • I meant, are they adulterers also?

        nice straw man by the way.

        • @fedup,
          “I meant, are they adulterers also?

          nice straw man by the way.”

          It wasn’t a strawman; the prof was taking the piss out of a moron.

          • @frank
            It was a straw man and you show how intelligent you are with your ad hominem attack.

            “Ad hominems are used by immature and/or unintelligent people”

          • @fedup,
            ******************************************************
            “@frank
            It was a straw man and you show how intelligent you are with your ad hominem attack.

            “Ad hominems are used by immature and/or unintelligent people””
            ******************************************************

            You might see it as an ad hominem, I see it as an observation of your intellectual capacity based on several observations;
            Inability to write properly, with capitals, grammar and sentence structure,
            Failure to attribute a quote,
            Illogical ramblings,
            Abstruse comments, and
            Posting without an explanation for the reason.

            Some may disagree with my assessment (but I don’t think many).

          • Your version of the ad hominem claim is just another name for the “I am offended!” excuse. Everybody makes mistakes, but only immature and/or unintelligent and/or dishonest people take offence when they are pointed out to them.

            “I am offended!” is not a valid point of discussion, because it is irrelevant. It reminds me of people objecting to being called “abnormal” and insisting on being called “special”. I think it is childish and shallow.

            You made a few mistakes. Get over it. It won’t kill you. Your chiro practice might. Yelling and screaming bloody murder won’t change your mistakes into statements of fact.

        • I meant, are they adulterers also?

          That’s why we need more research, but it’s highly likely. You should be happy. Thanks to professor Ernst, we now have compelling evidence that chiropractic has exciting effects.

          “I’ve been going to Chiropractors for as long as I can remember. It’s as important to my training as practicing my swing.”

          And as we know, Tiger Woods would never dare to tell a lie.

          • @ fedup

            I understand that it was the shareholders of AC Milan football club who entrusted the position of head of medical facility to the chiropractor, J. P. Meeserman. Interestingly, Meeserman was a member of the panel that developed the WHO Guidelines on Basic Training and Safety in Chiropractic. Section 1.2 of the guidelines is quite revealing:

            Quote:
            “The concepts and principles that distinguish and differentiate the philosophy of chiropractic from other health care professions are of major significance to most chiropractors and strongly influence their attitude and approach towards health care. A majority of practitioners within the profession would maintain that the philosophy of chiropractic includes, but is not limited to, concepts of holism, vitalism, naturalism, conservatism, critical rationalism, humanism and ethics (9).”

            Apparently Meeserman implemented a non-medical, chiropractic approach for AC Milan just after he was appointed. However, it has to be asked: would we have seen any difference in the team’s performance if he had handed each player a lucky rabbit’s foot instead? IOW, can you prove that any improvement in the team was due to his philosophy?

            BTW, remember that 51-year-old golf star, Colin Montgomerie, relies on chiropractors and osteopaths, but unlike Tiger Woods he has never won a major.

    • @fedup,
      “it was all copied and pasted, non of it my words”

      Where is the attribution? Also, is English your first language?

  • “I can’t help but wonder about the mechanism. Could it be that they X-rayed his pelvis and saw that there were subluxations in his penis bone(r) that needed some gentle adjustments?”

    Wow, you should take up comedy. I haven’t laughed so much in ages.

  • @ Edzard,

    I would love to read your thoughts on the following article:

    http://www.chiromt.com/content/23/1/19

    • Hardly conclusive.

      http://www.chiromt.com/content/23/1/19
      Conclusions
      Our findings should be viewed in the context of the body of knowledge concerning the risk of VBA stroke. In contrast to several other case–control studies, we found no significant association between exposure to chiropractic care and the risk of VBA stroke. Our secondary analysis clearly showed that manipulation may or may not have been reported at every chiropractic visit. Therefore, the use of chiropractic visits as a proxy for manipulation may not be reliable. Our results add weight to the view that chiropractic care is an unlikely cause of VBA strokes. However, the current study does not exclude cervical manipulation as a possible cause or contributory factor in the occurrence of VBA stroke.

      Drawing AnOther long bow?

      • @ Frank

        Can you explain how asking for the thoughts of Prof Ernst on a article is drawing the longbow (to exaggerate)?

        Also by writing “Drawing AnOther long bow?”, does this mean you don’t know if i am exaggerating? If, so I think you are assuming too much about my views about the content of the article. I have not mentioned an opinion about the article and I don’t think i have written anything about the topics within the article that could be framed that i am either for or against the conclusion of the article.

        p.s. you wrote that you would look for evidence for spinal manipulation for thoracic spine pain. Have you done this yet? It seem to be taking you a long time to find the evidence.

        p.p.s Just to remind you when i asked you about you search for evidence for spinal manipulation for thoracic spine pain, you said “Yes, when I get around to it.” That was on 18th June. Most people on here seem to be able to find evidence within 24 hours or less, where as you have taken 6 days so far. I have answered your questions, it is now time for you to answer the question i have asked you to answer many times (and no you have not answered it)

        • An Other,
          As tiresome as you are, here is the explanation that, I thought, would be reasonably apparent; (I will take it in steps so EVERYTHING is blindingly obvious. Points also space separated to avoid confusion.)

          1. This thread is entitled; “Suffering from low back pain? See a physiotherapist and not a chiropractor!”

          2. The link (http://www.chiromt.com/content/23/1/19) questions whether chiropractic is the cause of a potentially lethal condition the prof has raised because there is some evidence it is attributable, in part, to a chiropractic “treatment”

          3. The conclusion of the study is what I posted

          4. The final conclusion says, “Our results add weight to the view that chiropractic care is an unlikely cause of VBA strokes. However, the current study does not exclude cervical manipulation as a possible cause or contributory factor in the occurrence of VBA stroke.”

          5. The primary conclusion read thus;
          Conclusions
          We found no significant association between exposure to chiropractic care and the risk of VBA stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result in unreliable estimates of the strength of association with the occurrence of VBA stroke.

          6. The study was conducted thus; “Chiropractic care and the risk of vertebrobasilar stroke: results of a case–control study in U.S. commercial and Medicare Advantage populations”, from a population that can afford and choose their method of health care.

          7. The people conducting the study were all chiropractors (I can’t find information about Bannister so that is an assumption). While this may sound prejudiced, when chiropractors accept ALL of science, any such studies may have more credibility, despite the seeming scientific trappings.

          8. You asked about a study which is unrelated to the thread.

          QED

          As for the rest, I couldn’t give a stuff what you you think. Ask as many times as you like; when you become you the epitome of reason, I might just do it.

          • @ Frank

            No confusion, but you still haven’t answered any of the questions in my last post and your only reason not to answer is because you don’t want to. Would you say that is a logical approach to take?

            Also, the article i referred to in my post can be argued to be related to the current thread as manipulation is used by chiropractors to treat low back pain. Prof Ernst concludes that “As this approach (using manipulation for every low back pain patient) is neither based on sound evidence nor free of risks, the conclusion, in my view, cannot be to see chiropractors for LBP; it must be to consult a physiotherapist.”

            The article i refer to discuss one of the risks associated with spinal manipulation and i am sure it has been argued on this forum before that chiropractors can and do use cervical spine manipulation when treating low back pain patients.

            So, the article i referred to has a relationship to this thread.

            Finally, you could have not bothered to reply to my post (as it was addressed to Edzard) but it seems you couldn’t help yourself.

            p.s. The reason why i posted the article was to see what Prof Ernst would write about the conclusions made. I respect the work of Prof Ernst, even though i may not agree with how he sometimes phrases it. Therefore, I hope he does have time to comment on this article.

          • @ Frank

            Also only two of the authors of the study were chiropractors, the other two were mathematician and statistician.

          • @AnOther Long Bow Drawn,
            “The article i refer to discuss one of the risks associated with spinal manipulation and i am sure it has been argued on this forum before that chiropractors can and do use cervical spine manipulation when treating low back pain patients.”

            Since the good prof hasn’t commented, maybe he won’t because it is unrelated. This thread is about low back pain while the study is about about chiropractic treatment of the cervical spine. Post it in appropriate thread and you may get an answer, though I doubt that too because the conclusion from the study is inconclusive. What do you want the prof to say; the study is inconclusive and I agree?

            As for the rest, let me reiterate;
            “As for the rest, I couldn’t give a stuff what you you think. Ask as many times as you like; when you become you the epitome of reason, I might just do it.”

            I just made my own button just for you. I wonder if the prof could add this facility to his blog?

            ***********
            * IGNORE *
            ***********

          • @ Frank

            I stated a reason why the article i posted is related to this thread but you seem to have ignored it. Therefore i will state it again – the study i posted is about the a particular risk associated with cervical spine manipulation. Chiropractors can and do use cervical spine manipulation when treating low back pain. So, don’t see a chiropractor (or any other therapist) who use cervical spine manipulation when treating low back pain. This logic works with the conclusion of this thread, which is to see a physio rather than a chiro when suffering from LBP.

            I am sure Prof Ernst has argued this point specifically that because chiros can use cervical spine manipulation when treating low back pain and the risk associated with cervical spine manipulation – this alone would be a good reason not to see a chiro for LBP.

            If you think i am exaggerating then you must also think Prof Ernst is exaggerating too because we are drawing both the same conclusion.

            Finally, how about showing that you are better than jm and fed_up and actually reply to a very simple question

          • You are missing the point. All that article shows, is that there are also other causes for vertebrobasilar stroke. Nobody has ever claimed that most are cause by chiropractic, only that some are. In view of the fact that chiropractic has no benefits to speak of, every single one is one too many. Chiropractic is nonsense, and it can seriously harm you. Is that not reason enough to warn people against it?

          • @AN Other

            A while back, a commenter asked Frank a question. Frank had answered this person earlier, on a different thread. Frank basically called them stupid for not remembering the (trivial & irrelevant to the thread) specifics of a minor interaction.

            The same day, he asked me a simple question – that he had asked before, and I answered. Twice, actually, on two different threads. (also trivial & irrelevant to the threads, so I wouldn’t expect him to remember) But I thought the timing was quite amusing, and was curious how long Frank would continue to ask the same irrelevant question we’d had two conversations about.

            On the other hand, I don’t believe he’s answered your question (which actually IS relevant) at all. He’s done some very agile sidestepping though.

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