On his website, Christopher Kent describes himself as a chiropractor and an attorney. He is the owner of On Purpose, LLC, and the president of the ‘Foundation for Vertebral Subluxation’. This organisation states on their website the following:
The chiropractic profession is in the midst of deep and serious changes. These changes are taking place in the larger context of health care and an even larger socio-cultural worldview that is not necessarily congruent with the founding principles and tenets of the chiropractic profession. In other cases some of the original premises of the chiropractic profession are being co-opted by others as they come to see the value in the niche that chiropractic has carved out for itself. During this tumultuous time it is ever more important that the profession hold fast to its unique and distinguishing features for these are all we really have claim to. Beyond holding ground already gained there is a sense of urgency that the profession must seriously advance itself in the area of vertebral subluxation. The identification and care for this pathophysiological process is uniquely chiropractic and through research, education, policy and service we must ensure that we remain at the forefront of its elucidation. Through research, science, education, policy and service the mission of the Foundation is to advocate for and advance the founding principles and tenets of the chiropractic profession in the area of vertebral subluxation. A sick and suffering humanity needs us and we need you to join us on this mission.
A 1973 graduate of Palmer College of Chiropractic, Kent is also a Diplomate and Fellow of the ICA College of Chiropractic Imaging. Dr. Kent, as he likes to call himself, is known within the chiropractic profession for his dedication to integrating the science, art, and philosophy of chiropractic for doctors and students of chiropractic. He was awarded Life University’s first Lifetime Achievement Award in 2007. Dr. Kent is former chair of the United Nations NGO Health Committee, the first chiropractor elected to that office.
It is easy to see that Kent one of the most rampant subluxationist one is likely to come across. He is alarmed by any fellow chiro who might be in the slightest critical about subluxation. On his blog, he writes about THE CANCER OF SUBLUXATION DENIALISM:
A position paper has been produced by a group of six European chiropractic programs which states, in part: “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.” This follows a similar statement issued by the General Chiropractic Council on the United Kingdom. Both statements are the latest manifestations of a growing movement of subluxation denialism. Logical fallacies and inherent contradictions are the currency used to propagate these positions… A disturbing trend is the willingness of some chiropractic academicians and researchers to abandon chiropractic terminology as well as chiropractic analytical strategies… One example is the suggestion that the terms vertebral subluxation, joint fixation, joint dysfunction are interchangeable. They are not the same thing. There are significant operational and epistemological differences. Implicit in the term vertebral subluxation are both biomechanical and neurological elements. Vertebral subluxation is a relational neurological process that impacts the human experience, not merely a fixated joint. A fixated or tender joint might represent one manifestation of vertebral subluxation, not a synonym for vertebral subluxation. The notion that they are the same leads to confusion and ambiguity—a denialist’s best friends. Research designs based upon the haphazard application of ill-defined interventions selected by utilizing examination procedures whose reliability has not been established cannot be considered “scientific.” What fruit has been borne by the allopathic research programs currently underway? The aberrant perception by students and some chiropractors that chiropractic is a subset of medicine, and that adjusting is a subset of manipulation? The perception that chiropractic care is temporary analgesia at best, and placebo therapy at worst? A pernicious consequence of failing to use chiropractic terms, such as subluxation and adjustment in article titles, abstracts, and key words is that when a scholar, journalist, researcher, or lay person searches databases for these words, the papers purporting to support subluxation will not show up as “hits.” One researcher has stated that she uses terms such as manipulation and joint fixation because subluxation and adjustment are not MESH terms. Therefore, some purportedly “high impact” journals will not allow them as key words. The fix is simple: include them in the title and abstract. Failure to do so will result in “no impact” when the papers cannot be found when searching using chiropractic terms. Rest assured denialists know this. Search PubMed using the terms “chiropractic” and “subluxation.” Up will pop denialist opinion pieces. Conspicuously absent will be papers purportedly supportive of subluxation, but use terms such as manipulation or joint fixation. The value of chiropractic research lies in its potential to improve our clinical strategies, and to provide us with a scientifically sound basis for making claims to the public and the scientific community. We cannot dismiss meaningful differences in culture and objectives as “just words.”
On this blog and elsewhere, people have been pointing out that
- subluxation is at the heart of chiropractic ‘philosophy’,
- subluxation, as understood in the realm of chiropractic, is a myth,
- yet it has kept chiropractors in clover from the day DD Palmer allegedly cured his janitor of his deafness,
- since several years, some rationalists within the chiropractic profession have started working towards abandoning this term and the concept behind it,
- in recent months, these efforts have yielded some limited success,
- one could therefore hope that progress is taking hold and the chiropractic profession might finally stop adhering to myths.
Reading what Kent and the many like-minded chiropractors have to say about these issues makes me less hopeful. Progress, it seems, is in the way of a healthy cash-flow, and therefore it must be vilified. A cult can tolerate neither criticism nor the progress that might come from it.
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Professor Ernst wrote: “Progress, it seems, is in the way of a healthy cash-flow, and therefore it must be vilified. A cult can tolerate neither criticism nor the progress that might come from it.”
Talking of cults, there was a great thread called ‘The Seven Stages of Chiropractic Deprogramming’ that appeared in May 2005 on the skeptical chiropractic forum, Chirotalk, (which chiropractors managed to have taken off line – irony anyone?). The thread could originally be found here:
http://chirotalk.proboards3.com/index.cgi?board=indoctrination2&action=display&thread=1111961211&page=1
QUOTE
“From time to time I have discussed the subject of how chiropractors struggle to emerge from indoctrination and misinformation. A general theme that has come up is called cognitive dissonance. This is where someone observes something that contradicts their beliefs which then causes them to question them. The dilemma with chiropractic is that the entire profession is based on false beliefs about health with liberal amounts of excuses to explain inconsistencies. So when this occurs there is a chain reaction that concludes with the elimination of the practitioner’s very reason for working in the field. When the thing you purport to treat doesn’t exist then your role in the healthcare system becomes futile and frustrating.
Chiropractic institutions are well aware of the threat and utilize classic cult techniques of thought stopping, large group awareness training (assembly chanting, motivational exercises), limitations of matter excuses, loaded language (false biomechanical and ethical terms), threats and extensive propaganda to insulate practitioners from realizing inconsistency.
The most powerful catalyst for change is failure, whether monetary or in clinical outcomes. There is nothing like the experience of injuring a patient using a favorite technique, failing to diagnose an underlying complaint, or inducing a stroke to give a chiropractor a good scare and break through the programming.
Progress comes in stages. Here are my observations of the process:
Stage 1: Skepticism towards chiropractic philosophy
Stage 2: Acceptance of physical therapy modalities to treat pain
Stage 3: Rejection of specific chiropractic techniques as debunked
Stage 4: Rejection of visceral health claims for manipulation
Stage 5: Rejection of chiropractic subluxation as a cause of pathology
Stage 6: Frustration at the limited scope of evidence based chiropractic
Stage 7: Abandonment of the field
These stages are useful in understanding where different people are in the process.”
I suspect that most chiropractors don’t reach stage 7 because of the huge financial consequences of a complete career change. It’s a pity the chiropractic institutions can’t be closed down and replaced with physiotherapy colleges.
I don’t agree with the last sentence.
Chiropractors would not make good physiotherapists – they do not seem to have the necessary insights and abilities to apply critical thinking.
Just close down the schools (as Flexner’s report did for many schools of Eclectic medicine, Homeopathic medicine etc).
Intending students will have to enter medicine, physiotherapy, or another profession (in the US, possibly osteopathy which has in many states, up to a point, amalgamated with medicine).
The new home of Chirotalk is here: http://chirotalk.hyperboards.com/
It used to be accessible to anyone, but a login is required now, I’m guessing due to advertising spam. I’m not a member so I don’t know what it looks like these days.
@ Kyle C
Thanks. Sadly, the new forum has lost around a decade’s worth of original and very valuable content due to chilling by chiropractors.
BW: New Zealand ACC Clinical practice guidelines into the treatment of acute low back pain do not support your limited observations.
http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_communications/documents/guide/prd_ctrb112930.pdf
Page 13 outlines what works and doesn’t.
Physical Therapy modalities have either been proven not to work, or there is insufficient evidence to say that they do work. Spinal Manual Therapy is one of the few treatments of choice. If the NZ ACC guidelines are wrong, please inform us why, and provide some decent peer review references. Why should chiropractors take that giant leap backwards into the “Shake, Bake and Fake”, that represents physiotherapy today?
GibleyGibley wrote: “If the NZ ACC guidelines are wrong, please inform us why and provide some decent peer review references”
Similar to the UK NICE guidelines for back pain, the NZ ACC guidelines suggest “manipulation – in the first 4-6 weeks only”. Sadly, like the UK NICE guidelines, the NZ ACC appears to have fallen for the chiropractic bait and switch:
http://www.dcscience.net/2009/05/25/nice-falls-for-bait-and-switch-by-acupuncturists-and-chiropractors-it-has-let-down-the-public-and-itself/
The guidelines really should be revised as soon as possible (not least because the New Zealand College of Chiropractic has very strong vitalistic leanings):
http://edzardernst.com/2013/04/time-to-re-write-the-guidelines-on-spinal-manipulation-for-acute-low-back-pain/
The guidelines are worthless; they include acupuncture, another form of witchcraft (as distinct from the chiropractic form of witchcraft). Another example of public servants writing guidelines and seeking to include “all stakeholders” (who invents these stupid terms?) despite not knowing anything about any of them.
“Why should chiropractors take that giant leap backwards into the “Shake, Bake and Fake”, that represents physiotherapy today?”
A great step “backwards” into a profession aligned to modern medicine, or continue with vitalism and the great subluxation scam? Only people like you, camel, can’t see the difference.
Dear Ernst and Richard,
For some reason I came across this tweet on the ACA website today. I usually don’t waste time reading nor responding to such criticism but you got my blood boiling. I agree there are a select few in both of our professions that exhibit such behavior that doesn’t align them with the rest of the profession. How can you tear down one’s profession based upon the findings of Dr Kent? Many of us have solid evidence based practices!! Get your facts straight!!!!
Dr E
@ Dr E on Wednesday 17 February 2016 at 18:13,
When you find this evidence, please post it here? For over 20 years, the good prof hasn’t been able to find any.
By evidence, I mean reall evidence, not some anecdotes.
My apologies, I should have addressed you simply as E, given your disrespectful reference to the prof.
I am optimistic that my presence here provides the critics with some hope! 😉
No, what on earth would give you that idea? All you do is make excuses and rationalise.
That pointless reporting “system” by Newell (not a chiropractor or a doctor) is emblematic of what is wrong with chiropractic. It is a half-baked attempt to deflect criticism while doing nothing. Please tell us, what is the penalty for failure to report an incident?
@Frank Collins
I had a similar discussion here in March 2014 with the doctors on the need for an adverse event reporting system by all professions (chiro, physio, osteo, GP’s etc) in the Medical Journal of Australia! The orthopedic surgeon John Cunningham made a very good proposal, read the comments section! I asked a senior doctor just before christmas if it had progressed. He replied that there was snivellling from the hospitals on who would pay for it and it went no further.
https://www.mja.com.au/insight/2014/7/support-chiropractor-reporting
The CPiRLS reporting system is the right idea, wrong organization. The association that advocates for chiropractors is not the appropriate body. The registration board that advocated for patients should be doing it!
Far from deflecting the critics, who are vital to the reform process, I have consistently called for a more targeted approach. Carpet bombing the profession results in the reformers within the profession becoming unacceptable collateral damage and this does not further the reform process!
“Please tell us, what is the penalty for failure to report an incident?”
Here the AHPRA guidelines are identical for all health professions. See here for Dr’s and Chiro’s:
http://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx
http://www.chiropracticboard.gov.au/Codes-guidelines/Code-of-conduct.aspx
The actual penalties are tabulated here for all professions:
http://www.ahpra.gov.au/Publications/Panel-Decisions.aspx
Identical standards, identical penalties!
CC,
Same old nonsense dragged out again to justify the unjustifiable.
“The Medical Board guidelines say;
2.2 Good patient care
Maintaining a high level of medical competence and professional conduct is essential for good patient care. Good medical practice involves:
Recognising and working within the limits of your competence and scope of practice.
Providing treatment options based on the best available information”
That very effectively excludes chiropractic.
The problem for chiro also is that it doesn’t see the negative outcomes of their faffing. When it gets serious, people go to emergency departments of hospitals, and, in some cases, the “patient” is buried without an adverse incident being noted.
@Frank Collins
“Same old nonsense dragged out again to justify the unjustifiable.”
Have never defended or justified the fringe and have actively campaigned against them my entire cereer, so you are Carpet Bombing!
“That very effectively excludes chiropractic.”
Well as set out in those guidelines that is how Myself and 82-85% of the profession practice!
To equate the shortcomings of the 15-18% fringe as the norm for the entire profession is Carpet Bombing!
Ignoring the researchers and reformers within the profession or dismissing them as irrelevant is Carpet Bombing!
“The problem for chiro also is that it doesn’t see the negative outcomes of their faffing.”
Constantly on the look out for latest papers and it is a standard part of my informed consent (which is a common law requirement for ALL health professions here). It is also a major part of the university curriculum here!
As discussed below there is no adverse event reporting for physio’s, chiro’s, osteo’s, GP’s in private practice etc. Accurate reporting is also necessary by Dr’s reporting adverse events as is also discussed by the orthopod here:
https://www.mja.com.au/insight/2014/7/support-chiropractor-reporting
“Have never defended or justified the fringe and have actively campaigned against them my entire cereer, so you are Carpet Bombing!”
To repeat a post in another thread;
“Do you not read any of the prof’s posts? If so, you would have seen in clear type the evidence available to validate chiropractic as a form of treatment.
As you either didn’t read it or your (read, all chiro’s) subliminal cherry-picking meant it bypassed your cognitive brain, I will repeat it;
THERE IS NO EVIDENCE TO SUPPORT THE EXISTENCE OF CHIROPRACTIC.”
“Well as set out in those guidelines that is how Myself and 82-85% of the profession practice!”
Please write in English? ‘Myself”? Seriously?
There are many chiros like that loon Sipser in Melbourne who believes vaccinations are the cause of disease and autism, and chiropractic can solve most health problems. 82-85%? Unless there is real evidence, please desist?
Tassell seems to suggest it isn’t really necessary;
“While Dr Tassell said the establishment of such a system was important to ensure quality control, he believed adverse events were uncommon in chiropractic.”
How would he know without a proper reporting system?
I do wish you read and be cognisant of what people like John Cunningham say, including;
“A problem with serious adverse events is that they will most likely not present to their treating professional, but to a hospital. A simple and inexpensive reporting system would be a simple question when a patient is admitted to the Emergency Department, “have you been treated by a let health practitioner in the last four weeks?”. This would be a screening test. If the later diagnostic codes matched the profession (eg: chiro/stroke, chinese med/poinsoning), then a more detailed examination of the practitioners notes could be made. Who knows, we might find a particular manouver that is more dangerous than others?
Additionally, it is not the CAA who should be doing this. It is simply not their responsibility. It should be the CBA – the supervisory organisation – and not an industry group like the CAA. Any adverse event register run by the CAA would be immediately tainted, much like if the AMA ran one for doctors.”
Critical_Chiro wrote: “To equate the shortcomings of the 15-18% fringe as the norm for the entire profession is Carpet Bombing!”
The carpet bombing is required. That figure of 15-18% comes from this paper http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-14-51 and doesn’t say what Critical_Chiro think it says.
For example, it states: “As with any investigation, this study has limitations. First, although the response rate was good at 68%, it remains unclear what practice perspectives and behaviours are associated with non-participants. Also, although the sample was randomly selected and stratified according to the number of licensed practitioners in each province, the sample represented only approximately 12 percent of practitioners from each province. As always, there is the possibility that despite the randomization scheme, a unique sample was selected, and generalizability is a possible concern.”
Certainly, the results do seem somewhat inconsistent with the other available data:
http://tinyurl.com/pts2ns5
Most significantly, McGregor et al’s 1st, 3rd, 4th, 5th, and 6th subgroup descriptions don’t seem to exclude the unethical chiropractor element. IOW, 5 of the 6 subgroups could easily indulge in chiroquackery – (1) “Wellness”, (3) “general probs”, (4) “organic-visceral”, and (5/6) “subluxations”.
Indeed, according to Science Based Medicine author, Jann Bellamy: “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.”
Further, here in the UK the chiropractor fringe is *at least* 30% – i.e. the subluxation-based United Chiropractic Association has c. 250 members, the subluxation-based Scottish Chiropractic Association has c. 250 members, and the subluxation-based McTimoney Chiropractic Association has c. 550 members. So, of c. 3,000 UK chiropractors, c. 1050 are ‘out’ about their pseudoscientific style of practice. However, I suspect that many others have similar leanings, but tend to keep quiet about them through deliberate avoidance of the use of the word ‘subluxation’ – e.g. a 2007 survey of UK chiropractors revealed that traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of respondents, with 63% considering the subluxation to be central to chiropractic intervention:
http://wansbeckchiropractors.co.uk/pdf/Nov02.pdf
I’d like to know if Critical_Chiro has any better, more recent data.
“I’d like to know if Critical_Chiro has any better, more recent data.” I assume this is rhetorical.
@BW
The McGregor paper discusses the different sub groups in particular the correlation between subluxation/straight and anti-vaccination unorthodox views which were consistent. It also discusses the focus on this dissident group by the critics.
Some recent papers on evidence based practice and practice patterns:
US chiropractors’ attitudes, skills and use of evidence-based practice: A cross-sectional national survey
http://chiromt.biomedcentral.com/articles/10.1186/s12998-015-0060-0
Management of patients with low back pain: a survey of French chiropractors
http://chiromt.biomedcentral.com/articles/10.1186/2045-709X-22-13
The chiropractic profession in Norway 2011
http://chiromt.biomedcentral.com/articles/10.1186/s12998-014-0044-5
Are Swiss chiropractors different than other chiropractors? Results of the job analysis survey 2009.
http://www.ncbi.nlm.nih.gov/pubmed/20937430
Self-reported attitudes, skills and use of evidence-based practice among Canadian doctors of chiropractic: a national survey
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711333/
The chiropractic profession in Denmark 2010–2014: a descriptive report
http://chiromt.biomedcentral.com/articles/10.1186/s12998-015-0072-9
Diagnostic and treatment methods used by chiropractors: A random sample survey of Canada’s English-speaking provinces
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4593039/
Chiropractic Attitudes and Utilization of Evidence-Based Practice: The Use of the EBASE Questionnaire.
http://www.ncbi.nlm.nih.gov/pubmed/26231303
Current preventative and health promotional care offered to patients by chiropractors in the United Kingdom: a survey
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353665/
This study of North American students has 1/3 believing in Subluxation and VSC and also EBP:
Chiropractic identity, role and future: a survey of North American chiropractic students
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313466/
I did ask one of the authors if there was a breakdown of results based on institution but unfortunately that was not available.
@FC
Warren Sipser was diciplined/warned and his website has changed. Whether he has changed his tune while in with patients behind closed doors, I don’t know!
Laurrie Tassel from what I hear is one of the prime movers in an attempt to set up a private subluxation based college in Adelaide. The CAA National President has denied any support for a separate/private college, but with Tassell still on the board, I am skeptical. Several friends who have been long time members of CAA have recently left in disgust.
I am cognisant with what John Cunningham has been saying and have had direct communication with him. He is in agreement on an Adverse Event reporting system for ALL professions, not just chiropractic combined with Accurate Reporting and investigation by the relevant board, not just assumptions! Executives from Friends of Science in Medicine have also voiced support for reform. Anne Blake has also cheered on our reform initiatives and sent messages of support.
The critics here point out the BS merchants AND support reform and the reformers. It is much appreciated! You could learn from them!
I agree with John in regards to who should run the AE reporting System. I recently followed up on that MJA article with a well connected doctor to inquire on how it had progressed and he replied that there was “snivelling” from the hospitals on who would pay for it and it went no further. All the AHPRA boards should come on board and finance such a system and I have sent them a letter.
Finally, as for “THERE IS NO EVIDENCE TO SUPPORT THE EXISTENCE OF CHIROPRACTIC.” Please look at all my posts where I have patiently cited the research.
Rhetoric now concluded by “Myself”. 😉
@ Critical_Chiro
Your citations are far from impressive.
[1] US chiropractors’ attitudes, skills and use of evidence-based practice: A cross-sectional national survey
http://chiromt.biomedcentral.com/articles/10.1186/s12998-015-0060-0
“The results of this survey also indicate that there are serious gaps in the uptake of research evidence into chiropractic practice, with nearly half reporting only a very small proportion of what they do in their clinical practice is based on research evidence…almost half of DCs indicated that the two biggest barriers to EBP uptake were ‘lack of time’ and ‘lack of clinical evidence in CAM’.”
[2] Management of patients with low back pain: a survey of French chiropractors
http://chiromt.biomedcentral.com/articles/10.1186/2045-709X-22-13
That survey would have been more useful if it had looked at the chiropractic ‘bait and switch’.
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.
[3] The chiropractic profession in Norway 2011
http://chiromt.biomedcentral.com/articles/10.1186/s12998-014-0044-5
Holding up chiropractic in Norway as a sign of professional respectability cannot be taken seriously due to the beliefs of Norwegian chiropractor, Øystein Ogre. Currently, he is President of the European Chiropractors Union, and is heavily involved in developing chiropractic education throughout Europe. In that capacity, he has claimed that a successful chiropractor “is being that person, the spinal expert in your area, that parents will consult when they are worried about their sick child”. See from 2:30 in here:
https://www.facebook.com/permalink.php?story_fbid=685575191468899&id=391254640900957
[4] Are Swiss chiropractors different than other chiropractors? Results of the job analysis survey 2009.
http://www.ncbi.nlm.nih.gov/pubmed/20937430
Doesn’t tell us very much when you boil it all down.
[5] Self-reported attitudes, skills and use of evidence-based practice among Canadian doctors of chiropractic: a national survey
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4711333/
“Our findings should be interpreted cautiously due to the low response rate.”
[6] The chiropractic profession in Denmark 2010–2014: a descriptive report
http://chiromt.biomedcentral.com/articles/10.1186/s12998-015-0072-9
“Virtually all Danish chiropractors use manipulation as one of their treatment modalities.”
And yet they are staring this in the face:
http://edzardernst.com/2015/08/chiropractic-spinal-manipulation-placebo/
http://www.bodyinmind.org/spinal-manipulative-therapy-a-slow-death-by-data/
[7] Diagnostic and treatment methods used by chiropractors: A random sample survey of Canada’s English-speaking provinces
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4593039/
“…the most common methods used to determine the site to apply manipulation are consistent with current scientific literature.”
But are those measures reproducible? See http://www.ncbi.nlm.nih.gov/pubmed/10820295?dopt=Abstract
[8] Chiropractic Attitudes and Utilization of Evidence-Based Practice: The Use of the EBASE Questionnaire.
http://www.ncbi.nlm.nih.gov/pubmed/26231303
“…barriers to evidence-based practice were lack of time and lack of clinical evidence.”
[9] Current preventative and health promotional care offered to patients by chiropractors in the United Kingdom: a survey
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353665/
Nothing uniquely chiropractic there.
[10] Chiropractic identity, role and future: a survey of North American chiropractic students
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313466/
“The chiropractic students in this study showed a preference for participating in mainstream health care, report an exposure to evidence-based practice, and desire to hold to traditional chiropractic theories and practices. The majority of students would like to see an emphasis on correction of vertebral subluxation, while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance. Or perhaps some students want to hold on to traditional theory (e.g., subluxation-centered practice) while recognizing the need for further research to fully explore these theories. Further research on this topic is needed.”
I think when those students enter the real world of chiropractic practice they’ll stick with the pseudoscience, otherwise…
Quote
“If a chiropractor limited his practice to musculoskeletal conditions such as simple backaches, if he were able to determine which patients are appropriate for him to treat, if he consulted and referred to medical doctors when he couldn’t handle a problem, if he were not overly vigorous in his manipulations, if he minimized the use of x-rays, and if he encouraged the use of proven public health measures, his patients would be relatively safe. But he might not be able to earn a living.”
Ref: Spine Salesmen’ chapter of the book, ‘The Health Robbers: A Close Look At Quackery In America’
http://www.chirobase.org/12Hx/hr76.html
One repetitive comment from Edzard and you all is that it is not up to you to move the profession forward, it is up to us. I agree. When the likes of many in the profession are attempting to do that, sometimes at considerable personal and professional cost, including the @ Critical_Chiro, whose patience and persistence with some of you, particularly Frank, is sometimes Herculean, it’s encouraging that somewhere in the debate a recognition that it is nonsensical to tar an entire profession with the brush representing a minority is emerging. I don’t expect this for Frank as clearly there is more than an intellectual engine to his irrational hostility. But I hope that as the profession tries to move forward some of you may acknowledge that indeed progress can and is being made. You might find this paper an interesting addition to the debate going on within the profession as a contrast to Kent et al. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299614/pdf/2045-709X-20-1.pdf
An in honour of Frank and to avoid stoking his clearly over emotional reaction to the outrageous use of my qualification I have removed the title of Dr……..I hope it somewhat calms his fetid brow and contributes to a lighter more reflective demeanour……Is that Pink Floyds Animals I hear…..what a band!! .
@ Dave (not a chiro or a medical doctor)
“move the profession forward, it is up to us”
A profession of what? Something that wants to move chameleon-like and stealthily into areas already occupied by professions that don’t have vitalistic leanings, or a belief in a condition that does not exist? The sentiments in the quote seem high-minded until scrutinised more closely.
“whose patience and persistence with some of you, particularly Frank, is sometimes Herculean”
Have you ever considered that it may be more Herculean reading the same meaningless tripe repeatedly?
“I don’t expect this for Frank as clearly there is more than an intellectual engine to his irrational hostility.”
Irrational? Only in the eyes of chiros and chiro supporters, who see any criticisms as unfounded, whereas rational others see chiro as unfounded (only because of the lack of evidence and which has not been forthcoming for 121 years).
Simpson’s paper is a sop for chiropractic and I wasted my time reading it. Doubtless, chiros and you chiro supporters love it but it is a lot of words for very little meaningful.
“An in honour of Frank and to avoid stoking his clearly over emotional reaction to the outrageous use of my qualification I have removed the title of Dr”
Your problems with comprehension surface again.
“I hope it somewhat calms his fetid brow and contributes to a lighter more reflective demeanour”
What makes you think I have a stinking lower forehead, or are you trying to be too clever by half, Just Dave?
Articulate as always Frank…can’t help but just luv ya..x
Just Dave wrote: “You might find this paper an interesting addition to the debate going on within the profession as a contrast to Kent et al. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299614/pdf/2045-709X-20-1.pdf ”
From the Abstract:
“This article examines the chiropractic profession’s history by dividing it into five Eras and suggests that there are three options available for the future of the profession.
One: maintaining the status quo.
Two: uniting under an evidence based scientific approach as partners in the health care delivery system that has buried the “one-cause, one-cure” sacred cow. The steps required to achieve this outcome are outlined.
Three: openly dividing the profession into evidence based practitioners and subluxation based practitioners. Adopting this option would allow each branch of the profession to move forward in the health care delivery system unhindered by the other.
It is unclear which option the profession will choose and whether the profession is mature enough to follow option two remains to be seen. What is evident is that the time to act is now.”
@ Just Dave
I think you are in denial about the real problems that chiropractic faces. My money’s on the continuation of scenario 2, Hard Times & Civil War, as predicted in Chiropractic Futures for 2025:
QUOTE
“The economy improves…but the market for chiropractors does not rebound. Millions of patients enroll in high-deductible catastrophic care plans, and stressed families struggle to support their health. Only clear and compelling value can sustain chiropractic practices. Yet the scarce base of comparative effectiveness research for chiropractic hurts DCs. The variability in quality and outcomes among solo and small practice practitioners also causes DCs to be overlooked by ACOs and PCMHs. Instead, chiropractors are on a “hamster wheel” of many, ever-shorter visits and lowering their expenses enough to make a living. Most visible to the public is the noisy civil war between the broad-scope chiropractors seeking expanded practice rights and the vehement opposition of focused-scope chiropractors in every state where expanded rights are sought. Ten chiropractic colleges close and many chiropractors are driven from the field.
Ref: http://www.altfutures.org/chiropracticfutures
I would also draw your attention to Scenario 2, the Downward Spiral, on p.50 of this report, The Future of Chiropractic Revisited: 2005 to 2015
QUOTE
“The cost squeeze in healthcare pushes many chiropractors to the brink. Consumer demand falls and managed care removes even more chiropractic coverage from their plans. Standards of care fall, insurance fraud is common, and many chiropractors turn to unethical behavior to sustain their practices. Simultaneously, serious malpractice cases involving missed and ignored diagnosis of serious illnesses by super straight chiropractors become major media stories. By 2015, the evidence base for chiropractic effectiveness advances little over the limited indications where chiropractors had been proven effective in 2005. Other providers offer spinal manipulation for lower back, neck, and chronic pain. DPTs and massage therapists take over a large percentage of the cash market for back pain. The remaining chiropractors fight over the declining number of “true believer” patients who have had positive previous experiences with chiropractic and can afford to pay out-of-pocket.”
Ref: https://web[DOT]archive.org/web/20120324005637/http://www.altfutures.com/pubs/health/Future%20of%20Chiropractic%20Revisted%20v1.pdf
Oh for heavens’ sake, Prof, you might have warned us that “Christopher Kent DC, ESQ” likes to pose in photos as if he were Iron Man. I nearly spilt me tea laughing.
@Frank Collins
You continue to carpet bomb. I get the feeling that you are as resistant to acknowledging reform as the hard core subbies are to reform. Reforming both is worth the effort.
@Blue Wode
When it comes to reform are you just looking for a finished product? Reform is an ongoing process that is never finished. Unlike Frank you do read the articles and conduct a good debate! Much appreciated and very enjoyable! You do cherry pick and put your spin on things as do I, so its balanced. We are also further down the reform path than you realise in some countries and regretably less in others. As for some states in the US, Frustrated Facepalm!
That chiropractic futures document should be mandatory reading for all practicing chiropractors and chiropractic students. Right now I see factions in all four senario’s. How many chiro’s are in each is up for debate! How far down each path are we? Not sure. I have been up to my eyeballs in senario 3 for 25+ years!
Øystein Ogre has worked for years on legislation, reform, educational standards and research, yet you tear him down and whole profession in Norway! Hate to say this Blue but…….Carpet Bombing!
“Reform is an ongoing process that is never finished.” True, and applicable to most aspects of life. Now please point us to any form of purported medical therapy that began life as nonsense and has become reformed into something that makes sense. Something that continues to be employed under the same name, with its own profession still bearing that name.
CC
“You continue to carpet bomb.”
According to you, chiropractic is a profession that is needed and requires reforming; the evidence says otherwise.
“I get the feeling that you are as resistant to acknowledging reform as the hard core subbies are to reform.”
A Tu Quoque is useless in all circumstances but totally pointless here.
“Reforming both is worth the effort.”
As a contrast, imagine a situation where a medical doctor promoted some mystical woo as an alternative to surgery. What do you think would happen? Now, take chiropractic; many colleges still teach subluxations and a huge number of chiropractors still flog this delusion to the unsuspecting public. What happens? Nothing, because chiro does not a consistent body of knowledge that would allow it to be called a profession. It is a cult, exactly as the crook Palmer said here; http://www.chiro.org/Plus/History/Persons/PalmerDD/PalmerDD's_Religion-of-Chiro.pdf
He also said this of his “discovery” of chiro, “The knowledge and philosophy given me by Dr. Jim Atkinson, an intelligent spiritual being,”. Seriously? Yet you do do, despite the lack of evidence. Your anecdotes are just as worthless as anyone elses.
“Unlike Frank you do read the articles and conduct a good debate!”
I do read most of the articles but, as Blue says, they are rubbish and not worth posting. If that is your idea of evidence, it is little wonder you don’t understand why rational people are so critical of chiro.
“You do cherry pick and put your spin on things as do I, so its balanced.
Alternately cherry-picking is not balance, nor do I think Blue cherry-picks. Another Tu Quoque and I begin to wonder if you are rational.
“How far down each path are we? Not sure. I have been up to my eyeballs in senario 3 for 25+ years!”
And to what end? Has the number of subluxxers decreased substantially? Is there a core of chiro that has good evidence? Does chiro cure anything?
@Frank Collins
Its not a Tu Quoque Frank I have pointed out the researchers and reformers within the chiropractic profession many times in the past and you have dismissed or ignored them and paint us all as vitalistic subbies!
As for what would happen to doctors if they promoted mystical woo well here is a group of 400+ here in Australia:
https://www.acnem.org/
We all know the damage one doctor can do just look at Wakefield, so how much damage can 400+ do? The rational doctors here are unimpressed with this organization yet they are still here! So what happened? Nothing!
As for Kent he is a dinosaur and does not represent the whole profession.
The majority of the profession has moved on from DD and BJ Palmer and the subbie numbers are diminishing and they feel threatened. The rise in their shouting recently is a good indicator. That cult and belief system is being actively criticised within chiropractic and the advances in countries like Switzerland, Denmark, Norway South Africa and Australia scares the shit out of them!
Any criticism needs to be balanced by support for reform and the reformers within the profession. You could learn from a recent interview with Dr Michael Vagg on a morning TV show here:
https://www.9now.com.au/today/2016/clip-cil8pl8qo007fs3nnmunggwoh/b86e4809-12aa-46c6-b558-62964b24b04a
Blue Wode certainly does cherry pick and carpet bomb the profession taking the actions of one rogue chiro and extrapolating it to the whole profession! That would be like comparing all dortors to Burzynski!
Time to stop carpet bombing Frank and support reform. Criticizing the BS is important to the reform process but it has to be balanced with support for the reform otherwise the reformers become unacceptable collateral damage.
Physician, heal thyself.Chiro, reform thyself. Disassociate with something so brim full of nonsense.Critical_Chiro said:
Where does he do that?
CC,
“Its not a Tu Quoque Frank I have pointed out the researchers and reformers within the chiropractic profession many times in the past and you have dismissed or ignored them and paint us all as vitalistic subbies!”
No, I happen to believe the prof when he says there is no justification for the existence of chiro. That is not carpet-bombing or cherry-picking; it is acknowledgement of the pointlessness of chiro. Therefore, what is the point of “reforming” it?
“As for what would happen to doctors if they promoted mystical woo well here is a group of 400+ here in Australia:
https://www.acnem.org/”
I emailed this lot this morning. I see that one of their number was disciplined for unethical (and illegal) behaviour.
The most important thing Vagg said was between 3:10 and 3:18, when he said chiro is on a par with physio and osteo for treating uncomplicated back conditions. Reason again for chiro not to exist.
“Criticizing the BS is important to the reform process but it has to be balanced with support for the reform otherwise the reformers become unacceptable collateral damage.”
Yep, I hope for the last bit. If there were no chiros, what disadvantage would there be to the world? short answer; NONE.
@FC
Wow, so you admit damaging reform is acceptable! Your happy to carpet bomb and don’t care who you hit!
Did you listen to Dr Vaggs full interview? Balanced! Still pissed off the subbies though!
Check out this article where doctors discuss the ACNEM providing a continuing education anti vaccination course to doctors. The RACGP were not impressed:
http://www.australiandoctor.com.au/news/news-review/are-gps-being-sold-dodgy-cdp-courses?t=635931330676484694&z=410.40686531157365
https://www.facebook.com/stopavn/posts/10201370086148577
@FO
“Chiro, reform thyself. Disassociate with something so brim full of nonsense.”
I agree that it is up to the profession. The nonsense is under sustained attack/criticism/disassociation within the profession and the universities here do not teach it. The subbies are trying to set up a private vitalistic college in Adelaide because they have lost the uni’s! Due to lack of support from within Australia they have invited a Guru from the US (Liam Schubel) to help them finance it. (Facepalm) They put the proposal to a vote at the association (CAA) a few years back and it was rejected by the members. We thought that was the end of it but they came out of the shadows in Febuary this year! Key players are still on the executive of CAA National and CAA South Australia. So it seems to be a case of giving the members the finger and going ahead anyway on the sly while CAA publicly makes the right noises! To say that the majority of the profession is annoyed would be an understatement.
We are fighting this rubbish in Adelaide but carpet bombing the profession just makes our job harder! The subbies have an attitude of “gee the doctors are attacking us so we must be doing something right!” They think that doctors criticizing them some how validates their position. As Frank Odds says chiropractic reform thyself and to the critics I say “critics support thy reformers!”
C_C, maybe you’d like to answer a question I posed elsewhere, earlier. Please point us to any medical ‘profession’ that originated in nonsense and has become reformed to something based on evidence that it works. You seem to think the objections from myself (and others) are solely to what you call ‘subbies’. They’re not. They come from the absence of evidence in favour of any aspect of chiropractic. That’s why I don’t support your idea of reform. First show there’s a factual basis to support any part of what you do beyond a theatrical placebo. Then there may be something to reform or rechristen.
@ Frank
Osteopaths in the US.
Do they do surgery? If so, how are they osteopaths?
@ Frank Collins
They do surgery and they do a degree on osteopathic medicine. Therefore an osteopath.
“@FC
Wow, so you admit damaging reform is acceptable!”
No, read what I wrote, not some imagination so typical of your lack of understanding. May I put this in a form that, not even you can not understand; chiropractic is complete b*llshit. There is nothing your faffing does that some other group can’t do equally or better.
Chiro does not have some special skill or understanding lacking in others. It is based on nonsense and has not evolved into into better. In other words, it is complete and total crap, without a shred of evidence to support its existence. This is a reiteration of what I, and so many others, have said, and let me repeat; chiro is nonsense.
It doesn’t matter what you want to do with your “reform”, chiro is baseless, b*llshit, fairy science, and completely lacking in any evidence based on credible studies. Why do you persist with pursuing something lacking in any credibility, except among the loons in society? Oh yes, $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$.
@FC
Carpet Bombing! As I said you are incapable of accepting that there is reform and reformers!
You could learn from the Friends of Science in Medicine and Dr Mick Vagg here in Australia! Their critiques are balanced!
@ Critical_Chiro on Wednesday 16 March 2016 at 06:10
You read what you want to see, not the content of the words. Chiro is b#llshit and nothing you can say will make it otherwise. Reread what I wrote, this time LOOKING at the words I used, not some imaginary construct you put on it.
“You could learn from the Friends of Science in Medicine and Dr Mick Vagg here in Australia! Their critiques are balanced!”
I saw Vagg’s video and was underwhelmed. He is taking a soft middle ground. It is as if he thinks he can’t get rid of chiros so is taking the soft option of hoping they will be less damaging. I also don’t think Vagg is as well versed in the intricacies (read; b#llshit) of chiro as he likes to pretend.
Balanced? Your idea of balance is a view that supports chiro. Get a real degree and drop the chiro nonsense.
@FC
http://www.painmatrix.com.au/about-us/our-team/pain-specialists/dr-michael-vagg
Far better versed than you are prepared to give credit!
Your words are unambiguous as is you conditioned response. Ring the chiropractic bell and you salivate in a very predictable way!
My idea of balance is tear into the BS subluxationists and support the chiropractors that follow best evidence, do the research, teach best practice and who DO DO NOT SUPPORT THE SUBLUXATIONISTS! I do not and will never tolerate the vitalist fringe. I have made this abundantly clear for years! I also will not remain silent for the sake of peace and quiet as this is a form of endorsement that I will not tolerate! The CAA here calling for “Unity with Diversity” really raises my hackles!
If you want to shift a balance to the right side you add weight to that side (support reform) while removing weight from the other (Attacking the BS).
CC (aka chiro crackpot)
“http://www.painmatrix.com.au/about-us/our-team/pain-specialists/dr-michael-vagg
Far better versed than you are prepared to give credit!”
You only quote when it suits you. Vagg is a pain specialist, meaning he is (surprise, surprise) a medical specialist in alleviating, ameliorating and, hopefully, ending pain experienced by patients. He doesn’t say he is a specialist in medical research. Unsurprisingly, the fellow who runs this blog is one such person. ( I am going to write to Vagg about this. I have two senior medical specialists who live around the corner who crap on as well.)
Now, I could suggest the prof is an incompetent fool, devoid of any sense, and lacking in research skills OR I might take heed of the recognition he is given in his research endeavours by very competent people in that field. Either the prof is a complete idiot or his considerable research has revealed the pointlessness of chiro. Any guesses where my money is, if I was betting person?
“Your words are unambiguous as is you conditioned response. Ring the chiropractic bell and you salivate in a very predictable way!”
Oh gawd, are you really going to drag out Pavlov? Admittedly, I am, and was, a fan of the band but is this cliche central?
“My idea of balance is tear into the BS subluxationists and support the chiropractors that follow best evidence, do the research, teach best practice and who DO DO NOT SUPPORT THE SUBLUXATIONISTS! I do not and will never tolerate the vitalist fringe. I have made this abundantly clear for years! I also will not remain silent for the sake of peace and quiet as this is a form of endorsement that I will not tolerate! The CAA here calling for “Unity with Diversity” really raises my hackles!”
When will you realise that chiro is bullsh!t, founded on some stupid vitalistic notion, based on “curing” a deaf man whose aural nerves (and everyone else’s) don’t go through the spine? As much as you harp on about evidence, all you base your evidence on is anecdotes of the silly b@stards who come through your door and, of whom, you alleviate their wallet. Your “evidence” is as baseless as the rest of chiro.
When it comes to a summary of your situation, you are no different to the subbies; you also have no evidence but less vitalism. Where does that exonerate you from the same witchcraft?
“If you want to shift a balance to the right side you add weight to that side (support reform) while removing weight from the other (Attacking the BS).”
Again; reform what?
Frank Odds wrote: “Please point us to any medical ‘profession’ that originated in nonsense and has become reformed to something based on evidence that it works”
@ AN Other
I think that “based on evidence that it works” are the key words here. Osteopaths in the US are mainstream – essentially medical doctors with an interest in evidence based manual interventions. IMO, they should drop the osteopath title in favour of a more appropriate one now that the emerging data are increasingly showing ‘osteopathy’ in a very unfavourable light…
http://edzardernst.com/2013/06/osteopathy-based-on-little-more-than-wishful-thinking/
@ Blue Wode
Osteopaths started out has a people who used manual therapies. Now, they are medically qualified people who use “evidence based manual interventions”. Therefore, they used manual interventions on the basis of a now discredited theory. Where now they use “evidence based manual interventions”.
This to me shows a profession that originated in nonsense and has become reformed to something based on evidence that it works. (Please note i am referring to the manual interventions being applied for nonsense and now they are, as you put it, “evidence based manual interventions” being applied for evidence based reasons)
P.s. please describe and/or name what you think are “evidence based manual interventions”.
AN Other wrote: “This to me shows a profession that originated in nonsense and has become reformed to something based on evidence that it works.”
I disagree. They have not ‘reformed’ or evolved. U.S. osteopaths became mainstream by *making the switch* to being medical doctors with an interest in evidence based manual interventions.
AN Other wrote: “please describe and/or name what you think are “evidence based manual interventions”
Ones that do not have their origins in pseudoscience and that give predictable results for MSK conditions – basically, physiotherapy.
@ Blue Wode
Can you explain to me the difference between reformed and making the switch? – seems like the same thing to me!
Can you give me an example of a manual intervention that does not have its origins in pseudoscience?
Also can you explain the difference between dry needling and acupuncture?
@ AN Other wrote: “Can you explain to me the difference between reformed and making the switch? – seems like the same thing to me!”
@ AN Other
Remember, Frank Odds originally asked “Please point us to any medical ‘profession’ that originated in nonsense and has become reformed to something based on evidence that it works”.
You admitted that osteopaths started out using “manual interventions on the basis of a now discredited theory”. So, now that what was unique to osteopathy (i.e. its theory) has been discredited, it is impossible for it to have been ‘reformed’ to something based on evidence that *it* works.
What did happened was that U.S. osteopaths trained to be recognised as being on a par with medical doctors (i.e. made a definite switch), with an interest in evidence-based manual therapy. They have not adopted anything that is *uniquely* osteopathic. IOW, what ‘works’ for present-day U.S. osteopaths is conventional medicine plus physiotherapy.
Personally, I find it strange that they have retained the title ‘osteopath’.
@ AN Other wrote: “Can you give me an example of a manual intervention that does not have its origins in pseudoscience?”
Physiotherapy is a pretty good one. For thousands of years a good massage and exercise have known to be therapeutic and neither have anything to do with pseudoscience.
@ AN Other wrote: “Also can you explain the difference between dry needling and acupuncture?”
From the scientific evidence, I understand that traditional acupuncture is quackery, and dry needling is roughly the equivalent of a good nip, the stimulus of which *might* temporarily relax painful, tense muscles.
@ Blue Wode,
I agree that the theory devised by AT Still was unique to osteopathy. However, the current curriculum indicated they do 200 hrs of osteopathic manipulative medicine, which i would say is something that is uniquely osteopathic i.e. techniques that were developed by osteopaths.
Also the definition of reformed is to improve by the removal of faults. Therefore, i would say the osteopaths in the US removed the faults (the theory) and added more appropriate theories (evidence based ones). They did not switch to medicine with an interest in evidence based manual therapies. In fact, they started with osteopathic manipulative treatment and then added medicine (please read http://www.aacom.org/docs/default-source/become-a-do/aacom-omm-one-pager-aacomas_v7-%281%29.pdf?sfvrsn=2 and http://www.aacom.org/docs/default-source/default-document-library/infographic-osteo13.pdf?sfvrsn=18.)
I would also say that this is not medicine plus physiotherapy (at least not in a historical context)
A manual intervention is normally a hands-on treatment and i would say that exercise is not a hands on treatment. Massage is a hands-on treatment but it is mired in pseudoscience (please see http://skepdic.com/massage.html). Massage is like manipulation (and mobilisation), both legitimate techniques that are associated with pseudoscience.
Please can you explain what you mean by a “good nip”? Acupuncture and dry needling are the same thing on a technique level. They both involve the insertion of needles into the body. The difference is one has more pseudoscience around it than the other.#nonsencewithneedles
AN Other wrote: “the current curriculum indicated they do 200 hrs of osteopathic manipulative medicine, which i would say is something that is uniquely osteopathic i.e. techniques that were developed by osteopaths.”
Modern-day U.S. osteopaths are essentially medical doctors. 200 hours of manipulative medicine amounts to about four weeks’ worth of study.
AN Other wrote: “Also the definition of reformed is to improve by the removal of faults. Therefore, i would say the osteopaths in the US removed the faults (the theory) and added more appropriate theories (evidence based ones). They did not switch to medicine with an interest in evidence based manual therapies. In fact, they started with osteopathic manipulative treatment and then added medicine”
Since U.S. osteopaths are on a par with medical doctors, medicine is by far the most important aspect of their training. Indeed, U.S. osteopaths sound very similar to German medical doctors. Currently, German medicall doctors can undertake around four weeks of training and study in manipulation as part of their CPD in order to practice what they term ‘chirotherapy’.
AN Other wrote: “A manual intervention is normally a hands-on treatment and i would say that exercise is not a hands on treatment. Massage is a hands-on treatment but it is mired in pseudoscience (please see http://skepdic.com/massage.html). Massage is like manipulation (and mobilisation), both legitimate techniques that are associated with pseudoscience.”
Hands on treatments such as manipulative therapy look set to become redundant…
http://www.bodyinmind.org/spinal-manipulative-therapy-a-slow-death-by-data/
http://edzardernst.com/2015/08/chiropractic-spinal-manipulation-placebo/
…therefore, massage (without the quackery) and exercise will take priority over it.
AN Other wrote: “Please can you explain what you mean by a “good nip”? Acupuncture and dry needling are the same thing on a technique level. They both involve the insertion of needles into the body. The difference is one has more pseudoscience around it than the other.”
Dry needling is thought to inhibit the transmission of pain, although mechanism isn’t fully understood. Evidently, some form of distraction would have to be at play. However, as good nip also serves as a distraction, but isn’t invasive – i.e. won’t cause serious harm like introducing an infection – it’s preferable. It’s also more convenient, comes free-of-charge, and isn’t associated with pseudoscience.
@ Blue Wode,
I would still say the most important point is that they are still using osteopathic manipulation, even if it is a small part of their course.
Massage is also a hands on treatment and I would say that it could be redundant too.
http://www.cochrane.org/CD001929/BACK_massage-low-back-pain
http://www.cochrane.org/CD004871/BACK_massage-for-mechanical-neck-pain
http://www.ncbi.nlm.nih.gov/pubmed/24480940 – this study was also looking at physical therapies, which i would presume to include massage.
Exercise and advice could be the only treatments that will be left with a positive evidence base i.e. it can help with MSK conditions.
Dry needling is invasive – https://en.wikipedia.org/wiki/Dry_needling. Also, the Cochrane review put acupuncture and dry needling in the same systematic review for low back pain. This, i would suggest, that they are viewed as the same thing (technique wise).
In addition, dry needling was thought to be a term devised by Janet Travell. She was describing a treatment for trigger points. Now trigger points are a controversial topic and the underlying hypothesis has been challenged – http://www.bodyinmind.org/trigger-point-evaluation/ This could mean that dry needling is pointless.
p.s. how is dry needling more convenient and how and why is it free of charge?
“I agree that the theory devised by AT Still was unique to osteopathy.”
I would call it a hypothesis, founded on vitalism and unfounded on reality. Whether such ideas are unique to osteopathy is also open to question; similar “life force” notions have been around since humankind began. Acupuncture is but one example. Palmer later stole it to start his own religion. The list of such charlatans, medicine or religion or both, is very long.
“they started with osteopathic manipulative treatment and then added medicine”
In the same way chiro wants to legitimise by stealth, stealing from science-based medicine to show it is “real”, rather than some alt-med that knows it is nonsense and wants to weasel its way into real medicine.
“I would also say that this is not medicine plus physiotherapy (at least not in a historical context)”
No, it isn’t. It is pseudo-science wanting ito the real game and doing it by stealth, rather than admitting the original premise is nonsense.
@ Frank Collins
Thanks for the comments.
It seems your views are in direct opposition to a fellow skeptic (see Blue Wode). Is this a concern for you or Blue Wode? Also who is right you or Blue Wode? #Skepticwars
AN Other wrote: “I would still say the most important point is that they are still using osteopathic manipulation, even if it is a small part of their course.”
If it’s a *small part* of their course (i.e. four weeks), and the evidence for manipulation isn’t looking good, then I don’t see how it can be “the most important point”.
In essence, you have failed to provide Frank Odds with an example of a medical ‘profession’ that originated in nonsense and has become reformed to something based on evidence that *it* works.
AN Other wrote: “Exercise and advice could be the only treatments that will be left with a positive evidence base i.e. it can help with MSK conditions.”
A medical doctor could easily deal with that, especially since they can refer to physiotherapists (if necessary).
AN Other wrote: “dry needling [could be] pointless”
I agree. Note that I said that dry needling is *thought* to inhibit the transmission of pain. The compelling evidence isn’t in.
AN Other wrote: “how is dry needling more convenient and how and why is it free of charge?”
I didn’t say that. What I said was: “a good nip also serves as a distraction, but isn’t invasive – i.e. won’t cause serious harm like introducing an infection – [so] it’s preferable. It’s also more convenient, comes free-of-charge, and isn’t associated with pseudoscience.”
AN Other wrote to Frank Collins: “It seems your views are in direct opposition to a fellow skeptic (see Blue Wode). Is this a concern for you or Blue Wode? Also who is right you or Blue Wode? #Skepticwars”
Frank Collins and I are on the same page. He’s just a little more forceful.
@ blue wode
I think we are going to agree to disagree. I think I have provided Frank Odds with an example of a profession that has reformed. You view it as a switch, I view it as an evolution. Also, I think the fact that they still use osteopathic manipulation is important. To me this means they are using technique techniques that were developed by osteopaths not physios.
It seems you failed to acknowledge that dry needling is invasive and differs very little from acupuncture. Also, that the hypothesis for using dry needling has not been proven and is completely lacking evidence. #nonsensewithneedles
Finally, Frank Collins views osteopaths in the USA as frauds, trying to legitimise by stealth. You view them as on par with medical doctors. If that is on the same page I doubt your ability to see a difference in opinion. #skepticwars
AN Other wrote: “I think I have provided Frank Odds with an example of a profession that has reformed. You view it as a switch, I view it as an evolution. Also, I think the fact that they still use osteopathic manipulation is important. To me this means they are using technique techniques that were developed by osteopaths not physios.”
That they still use osteopathic manipulation is of little importance in the long run for the reasons I have already highlighted. U.S. osteopaths are basically medical doctors (by stealth).
AN Other wrote: “It seems you failed to acknowledge that dry needling is invasive and differs very little from acupuncture. Also, that the hypothesis for using dry needling has not been proven and is completely lacking evidence.”
Huh? What did I say to make you think that?
AN Other wrote: “Finally, Frank Collins views osteopaths in the USA as frauds, trying to legitimise by stealth. You view them as on par with medical doctors. If that is on the same page I doubt your ability to see a difference in opinion.”
By stealth, they have become medical doctors, i.e. they are not osteopaths. To continue to use the title ‘osteopath’ is dishonest and deceives the public, not least because osteopaths outside the U.S. have diminishing evidence for their practices (which are usually laden with quackery):
http://edzardernst.com/2013/06/osteopathy-based-on-little-more-than-wishful-thinking/
Interestingly, on page 132 of her book, Suckers; How Alternative Medicine Makes Fools of Us All, author Rose Shapiro describes the inventors of osteopathy and chiropractic (Andrew Taylor Still and Daniel David Palmer) as “chancers and fantasists who had tried and failed to make their fortunes in a variety of jobs and get-rich-quick schemes.”
So it’s easy to see why U.S. osteopaths became medical doctors. All they need to do now is to call themselves that. As for U.S. chiropractors, they may have gone the conventional medicine route too if it hadn’t been for Daniel David Palmer’s ruthless, business-minded son, B. J. Palmer.
@ Blue Wode
As I said I think we are going to have to agree to disagree regarding osteopaths in the US. You may feel that it is of little importance that osteopaths still use osteopathic manipulation. But, the schools that train osteopaths in the US seem to me to express a great importance that they teach osteopathic manipulation.
Blue Wode wrote:
“From the scientific evidence, I understand that traditional acupuncture is quackery, and dry needling is roughly the equivalent of a good nip, the stimulus of which *might* temporarily relax painful, tense muscles.”
I would say that dry needling is no where near the equivalent of a good nip (or pinch). Dry needing is invasive, where as a nip is not invasive (unless it cause a break in the skin). Also, that the hypothesis for using dry needling has not been proven and is completely lacking evidence, similar to acupuncture.
AN Other wrote: “I would say that dry needling is no where near the equivalent of a good nip (or pinch). Dry needing is invasive, where as a nip is not invasive (unless it cause a break in the skin). Also, that the hypothesis for using dry needling has not been proven and is completely lacking evidence, similar to acupuncture.
What I meant by “dry needling is roughly the equivalent of a good nip, the stimulus of which might temporarily relax painful, tense muscles” was that dry needling *may offer the same perceived therapeutic effect* (possibly by releasing endorphins) as a good nip.
AN Other, do you understand now? If you don’t, then I can’t help you any further.
@ Blue Wode
Thank you for clarifying your statement. But you also seem to be saying that dry needling is ok and acupuncture isn’t. In relation to the technique used i.e. the insertion of needles, they are the same thing. Also the underlying hypotheses for acupuncture and dry needling have not been proved.
So, why do you say ” From the scientific evidence, I understand that traditional acupuncture is quackery, and dry needling is roughly the equivalent of a good nip”, when in fact they are the same technique wise and both have unproven hypotheses?
@ AN Other
Acupuncture is based on the quack notion of sticking needles into imaginary meridian lines. Dry needling is used to treat the musculoskeletal and nervous systems based on modern neuro-anatomy science (although there isn’t any compelling evidence for it).
So, yes, acupuncture and dry needling both involve the insertion of needles, but for very different reasons – i.e. they are not the same technique. It is important to highlight the difference (which I did when I originally said that I understood that “traditional” acupuncture was quackery).
@ Blue wode
Technique is how you do something not the reason why you do something. Acupuncture and dry needling are therefore the same technique (how it is done) but for different reasons.
Also, the reason why dry needling is done i.e. to treat trigger points in muscles doesn’t have much basis in science. The fact that the underlying hypothesis for trigger points has not been proved, it could be said that dry needling is sticking needles into an imaginary problem. – http://www.bodyinmind.org/trigger-point-evaluation/
Why do you accept dry needling when there isn’t any compelling evidence for it? That is not really evidence based medicine is it?
@ AN Other
You started this discussion on 10th March at 16:11 by asking me if I could explain “the difference between” dry needling and acupuncture.
My reply was: “From the scientific evidence, I understand that traditional acupuncture is quackery, and dry needling is roughly the equivalent of a good nip, the stimulus of which *might* temporarily relax painful, tense muscles.”
In your next post you said ” Acupuncture and dry needling are the same thing on a technique level. They both involve the insertion of needles into the body.”
At that time I hadn’t disputed your ‘technique’ side of the issue – i.e. that both interventions require the insertion of needles into the body. Nevertheless, I would say that because the insertion of needles are not based on the same premise, then it could be that there are subtle insertion differences. But I don’t know the answer to that.
So, you might be right and I might be wrong when I claimed subsequently that “acupuncture and dry needling both involve the insertion of needles, but for very different reasons – i.e. they are not the same technique”.
However, I have answered your initial question by explaining, to the best of my ability, *the difference between* dry needling and acupuncture.
AN Other wrote: “Why do you accept dry needling when there isn’t any compelling evidence for it? That is not really evidence based medicine is it?”
It would appear that the evidence for dry needling is similar to the evidence for spinal manipulative therapy – i.e. it’s likely a placebo, but it’s not accepted as definite yet:
http://www.bodyinmind.org/spinal-manipulative-therapy-a-slow-death-by-data/
@ Blue Wode
Thank you for answering my questions in a reasonable and courteous manner. I just wanted to understand where you were exactly coming from – details and clarity are important. I apologise if i have not been clear in my writing.
All the best
@ Blue Wode
It seems that you have concluded that there is no evidence for dry needling – when did you come to that conclusion and what evidence helped you come to that decision?
@ Blue Wode
Ah Shi acupuncture and dry needling have the same premise, but needle insertion/removal are sometimes different (technique-wise, depending on training). FWIW.
“AN Other, do you understand now? If you don’t, then I can’t help you any further.”
No surprise from me.
AN Other wrote: “It seems that you have concluded that there is no evidence for dry needling – when did you come to that conclusion and what evidence helped you come to that decision?”
My view on dry needling is that it will ultimately be seen as acupuncture by another name…
QUOTE
“In China, especially in the East, the term dry needling (干针, gan zhen in Chinese pin yin) has been a folk name for acupuncture since Western medicine arrived in China in the late 1800s, when the term of dry needling was created in order to differentiate it from the needles used for injections by Western trained doctors. Many people in China still refer to acupuncture as dry needling, especially after acupuncture point injection therapy and aquapuncture therapy were developed in China in the early 1950s. The term dry needling (gan zhen) has already become a synonym for acupuncture used by many Chinese practitioners.”
Ref: http://aim.bmj.com/content/early/2015/12/15/acupmed-2015-011010.full
…and, as we now know, acupuncture is a theatrical placebo:
http://www.ebm-first.com/acupuncture.html