MD, PhD, FMedSci, FSB, FRCP, FRCPEd

I have published many articles on the risks of various alternative treatments (see for instance here, here, here, here, here and here) – not because I am alarmist but because I have always felt very strongly that, for a researcher into alternative medicine, the most important issue must be to make sure users of these therapies are as safe as possible. Usually I differentiated between direct and indirect risks. The former relate to the risks of the treatment and include, for instance, liver damage caused by a herbal remedy or stroke due to neck manipulation. The latter are mainly due to the poor, often irresponsible advice given by many therapists.

A recent article adopted the same terminology when reviewing the risks of alternative medicine specifically for cancer patients. As the indirect risks are often neglected, I will here quote the relevant section of this paper in full:

…Health care physicians and oncology experts have an ethical responsibility to initiate the communication regarding the use of complementary therapies with cancer patients. However, according to data obtained from this literature review, oncology doctors and physicians will discuss complementary therapies only when a patient him/herself raises this issue within a consultation. This passive attitude was linked to a lack of sufficient scientific evidence for positive outcomes of complementary therapies found in high quality randomized controlled trials (RCTs). Oncology nurses, on the other hand, sometimes actively promote complementary modalities that they find to correspond with their vision of holistic care.

According to the included studies, complementary providers often differ from conventional health care providers in their understanding of treatment concepts, philosophies and diagnostic procedures. This leads to different models of disease causality (cells, blood, nerves vs. energy, vital force, meridians) and treatment philosophy (reductionism vs. holism). As many complementary providers are philosophically oriented towards personal and spiritual growth, patients may feel guilty if the disease continues to advance despite the patients’ best spiritual and mental efforts. According to Broom and colleagues, such philosophies may also give patients false hope of recovery.

Another indirect risk connected to the combination of conventional and complementary treatment in cancer care is the lack of regulation and standardized education in many countries. Currently, there are, for example, no standard training requirements for complementary providers working in cancer care or any other health care setting in the EU. According to Mackareth et al., complementary providers in England need specific training to learn how to practice safely.

Moreover, there is a need for common medical terminology to bridge the communication gap between health care providers working outside the conventional health care system. Common medical terminology may reduce the existing communication gap between conventional and complementary providers about mutual patients. To minimize communication gap between physicians, oncology experts and complementary providers, a medical complementary record should include a treatment plan with conventional and complementary diagnosis, explanation of terminology, possible treatment interactions, description of the complementary treatment plan and goals. If possible, the quality of any complementary supplement given should be reported.

END OF QUOTE

As I said, I find it important to discuss the indirect risks of alternative medicine, and I am therefore pleased that the authors of this article addressed them. At the same time, I find their text remarkably tame.

Why are they not more open and forceful about what, after all, amounts to a serious public health issue? The answer might be simpler than expected: most of them are affiliated with the ‘National Research Center in Complementary and Alternative Medicine (NAFKAM), UiT The Arctic University of Norway, Tromsø, Norway’. Could it be that open warnings about outright quackery is not what suits this unit?

So, what might be an open and frank approach to discussing the indirect risks of alternative medicine? In my view, it should make several points abundantly clear and transparent:

  • Alternative practitioners (APs) are usually not trained to advise patients responsibly, particularly in cases serious disease.
  • The training of APs is often inadequate and sometimes resembles more to brain-washing than to proper education.
  • Consequently, APs often woefully over-estimate what their therapy can achieve.
  • The patients of APs are often desperate and ready to believe even the tallest tales.
  • APs have a huge conflict of interest – in order to make a living they need to treat as many patients as possible and are therefore not motivated to refer them to more suitable care.
  • APs are frequently in denial when it comes to the risks of their treatments.
  • APs are not educated such that they understand the full complexities of serious illness.
  • As a result, APs far too often misguide their patients to make tragically wrong choices thus putting their health at serious risk.
  • In most countries, the regulators turn a blind eye to this huge problem.

These are by no means trivial  points, and they have nothing to do with a ‘turf war’ between conventional and alternative medicine. They relate to our ethical duty to keep our patients as safe as we can. It has been estimated that, in oncology alone, 1 – 5% of deaths are due to patients opting to have alternative instead of conventional treatments. This amounts to an unbearably high absolute number of patients dying prematurely due to the indirect risks of alternative medicine.

It is high time, I think, that we tackle this issue systematically and seriously.

23 Responses to Indirect risks of alternative therapies for cancer patients – time to tackle them systematically!

  • Eur Spine J. 2008 Apr; 17(Suppl 1): 176–183.
    Published online 2008 Feb 29. doi: 10.1007/s00586-008-0634-9
    PMCID: PMC2271108
    Risk of Vertebrobasilar Stroke and Chiropractic Care
    Results of a Population-Based Case-Control and Case-Crossover Study
    J. David Cassidy,corresponding author1,2,3,4 Eleanor Boyle,1,2 Pierre Côté,1,2,3,4,5 Yaohua He,1,2 Sheilah Hogg-Johnson,3,5 Frank L. Silver,6,7 and Susan J. Bondy

    Arterial Dissections Following Cervical Manipulation:
    The Chiropractic Experience

    Scott Haldeman, Paul Carey, Murray Townsend and Costa Papadopoulos

    It would seem that the incidence of V-B stroke due to VAD with surmised association to cervical SMT is quite nominal. Certainly the matter, however, warrants even more study in the future to determine what specific manipulative techniques might have a greater association with a negative outcome than others.

    • you haven’t read the post, have you?

      • Actually, I agree with much of the thesis of your post. I didn’t favor the subtle, bogus implication that stroke is a common outcome of chiropractic cervical SMT. I’m certain, however, that many of your followers feel quite satiated when they read such references to a competing profession.

        • “implication that stroke is a common outcome of chiropractic cervical SMT”
          where exactly did you see that?

          • It was embedded in your first paragraph. Perhaps you included the neck manipulation/stroke comment as representing a (significant) risk by accident? It is possible you meant to imply that such outcomes were statistically nominal risks and I simply misinterpreted your meaning.

          • this is my 1st paragraph:
            I have published many articles on the risks of various alternative treatments (see for instance here, here, here, here, here and here) – not because I am alarmist but because I have always felt very strongly that, for a researcher into alternative medicine, the most important issue must be to make sure users of these therapies are as safe as possible. Usually I differentiated between direct and indirect risks. The former relate to the risks of the treatment and include, for instance, liver damage caused by a herbal remedy or stroke due to neck manipulation. The latter are mainly due to the poor, often irresponsible advice given by many therapists.
            where exactly did I imply that “that stroke is a common outcome of chiropractic cervical SMT”?

          • So….I take it that you do NOT believe that stroke is a common outcome of chiropractic cervical SMT. Thank you for clarifying that my suspicions (that your inclusion of the SMT/stroke reference was a subtle way of suggesting that such outcomes were typical) were unfounded.

          • your extrapolations were unfounded to start with and do not seem to get better.

    • I’m not clear. Are you saying that “cracking” a neck is a reasonable approach to treating leukemia or multiple myeloma, let’s say? If a chiropractor “Adjusts” the Chiropractic Spine of a cancer patient who is also seeing an oncologist, do you consider this to be “co-management?”

      Hello? 🙂

      Any sense of risk versus benefit is conspicuously absent from your non-sequitur reply to the article: Indirect risks of alternative therapies for cancer patients. Or is this your idea of “tackling” chiropractic imbecility?

      ~TEO.

      • Of course SMT is not reasonable for use in treating leukemia or MM. No co-management by a chiro would be appropriate for such conditions. Where did you come up with such nonsense from what I posted? Please advise, John.

        • OK, let’s take a look at WHERE I came up with what you call “such nonsense.” In case you hadn’t noticed, the article to which you replied is titled: Indirect risks of alternative therapies for cancer patients – time to tackle them systematically!. Read that title again. Now, think about it for a minute before you go on chiromatic and launch your CDS (Chiropractic Defense System). See how it says “risks of alternative therapies for cancer patients?”

          Honestly, it seems you were just guarding your chiropractic nuts by reflexively, out of ALL POSSIBLE alternative medicines, arguing that CHIROpractors don’t cause strokes, at least as much as some people might think. But, that kind of misses the point of the article, doesn’t it, even IF the article was only talking about “chiropractic” and chiropractors. In other words, even if your non-sequitur reference had relevance to the article, just how many strokes at the hands of a chiropractor WOULD be acceptable to you IF they occurred as a RESULT of cracking a neck to TREAT or CO-MANAGE a CANCER? That’s not a “How many chiropractors does it take to screw in a lightbulb” joke. Rather, that’s a scenario that would be much WORSE than “nonsense,” wouldn’t it. At least that gets at what the article is about, though — bad things that happen ON TOP of ministrations of quack medicine. That is why Edzard Ernst wondered right off if you had read the article or even read its title. I wondered, too.

          Hello? 🙂

          So, the only issue here pertains to side-effects incurred by different Alternative Medical practitioners in their efforts to treat cancer — what I would call insult to Alt-Med injury. Do chiropractors treat or CO-MANAGE cancer then? Of course this concern can be broadened to include all treatments that go south when an Alt-Medical practitioner attempts to manage ANY disorder or disease. That’s where risk versus benefit rules the argument and why I brought it up as something that was conspicuously absent from your reflexive reply. Spelling it out, if a treatment is all risk without benefit, then anything bad that results from that empty treatment is, well, worse than just bad.

          So keeping it “chiropractic,” if a chiropractor causes a stroke, let’s say, when treating or co-managing a Chiropractic Subluxation in a patient with cancer, that only adds a terrible INSULT to the PRIMARY injury, which is chiropractic quackery. In other words, I would argue the patient has been injured by the chiropractic quackery preceding “Thuh” Adjustment — hurt by the empty enthusiasm of the chiropractic adherent who believes that no matter what, identifying and treating the Chiropractic Subluxation is a GOOD thing. This notion, incidentally, that adjusting the spine (so all is fine) is the primary neurosis underpinning the Chiropractic Enterprise. YOU might even agree, but apparently haven’t given this much thought. It will occur to you in time, perhaps in need, when you’re in a position to stop protecting your Alt-Medical nuts.

          All that remains then in explaining to the hard of chiropractic hearing how I came up with “such nonsense,” is to give you some sense of chiropractors who DO treat and/or who DO co-manage with MDs, disorders and diseases by “identifying and correcting spinal subluxations” — the PRIMARY nonsense I just mentioned. For this information, I use the National Board of Chiropractic Examiners Practice Analysis of Chiropractic 2015 — chapter 8, which focuses on “Patient Conditions” treated by chiropractors.

          Practice Analysis of Chiropractic 2015

          It’s critical to keep in mind when reading any of this, nothing that is UNIQUELY “chiropractic” —the Chiropractic Subluxation AND any of the so-called “Adjustments” purported to FIX these Spinal Fictions has ever been demonstrated beyond the say-so of chiropractors. Ever. Until chiropractors actually admit they were only kidding about this “chiropractic” —then whatever “bad” sits on top of this PRIMARY “nonsense” is even more tragic and “bad” than it would have otherwise been had chiropractors NOT ministered an empty and arbitrary quack medicine in the first place.

          Keeping chiropractic nonsense in mind then, the chapter 8 charts break down 84 conditions surveyed chiropractors saw in their offices in the prior year and divided each named condition into: 1. Not treated 2. Treated solely AND 3. Co-managed

          So, for a sampling:

          Asthma, emphysema, or COPD: Not treated: 16.1% Treated solely: 5.7% Co-managed: 71.4%

          Osteoporosis/osteomalacia: Not treated: 10.5% Treated solely: 13.0% Co-managed: 71.8%

          Lung/respiratory passage tumor: Not treated: 68.5% Treated solely: 1.0% Co-managed: 26.6%

          The KEY here as far as chiropractic “nonsense” is concerned is to appreciate the chiropractic notion of CO-MANAGEMENT of ANY of the conditions listed — never mind the more serious conditions and cancers. QUOTING from this document so that you can appreciate what is MEANT by CO-MANAGEMENT: “The charts show Co-management of many conditions by chiropractors consists primarily of identifying and correcting spinal subluxations.”

          To wit: IDENTIFYING AND CORRECTING SPINAL SUBLUXATIONS is the primary medical neurosis that has underpinned the Chiropractic Enterprise since 1895. When this claptrap actually informs the basis of a diagnosis and treatment, the chiropractor is touching his or her own chiropractic nose. When a chiropractic patient has a stroke because a chiropractor has rationalized they are “co-managing” a patient with an MD, let’s say, this is the VERY nonsense that makes “COMPLEMENTARY Medicine” such a joke and a public health problem.

          Anyways, I hope this helps you appreciate “Where [I came] up with such nonsense from what [you] posted,” at least enough so that you do not reflexively protect your chiropractic cojones every time you think a chiropractic critic is pointing to your open chiropractic fly.

          Are you a chiropractic student? A recent graduate? A seasoned chiropractor? 🙂

          ~TEO.

          • I admit my post was partially a non-sequitur. However, the mention of an infinitesimally slight risk of stroke post chiropractic cervical SMT did refer some pain to my testicals(nice snipe, lol).

            There is zero justification for attempting to treat or co-manage cancer via manipulation; I stated this previously. Therefore, your erroneous assumption that I was advocating the opposite was misplaced. It certainly would be appropriate for certain forms of chiropractic treatment to be utilized for some sequelae(e.g. musculoskeletal pains) in some cancer patients; but I wouldn’t consider such to be “co-management.”

            There is no such thing as a subluxation. Ergo, treatment strictly for such an ethereal entity would not be justified. In “keeping it chiropractic,” as you stated, please know that I’ve never used “chiropractic subluxation” in my practice or in any professional or patient-specific discourse.

            Regarding some of the disorders you listed as being appropriate for “co-management,” osteoporosis, asthma, emphysema, COPD are conditions I commonly see; the latter three are virtually always referred to me by GP’s as SMT/ancillary procedures are sometimes helpful in alleviating musculoskeletal pain and stiffness; patients often anecdotally claim to have improved chest expansion after SMT, also. I personally wouldn’t refer to such care as co-management, but the obtuse definition of the term as given in the NCBE summary allows for its use. Osteoporosis is pretty simple to identify and, if not severe, is well managed conservatively(not manipulatively). If significant osteoporosis is identified in a patient, he/she is referred to an MD. I personally would not refer to my continued treatment of an osteoporotic patient as co-management of osteoporosis but, rather, to treat the co-morbidity(e.g. musculoskeletal pain) likely attendant to osteoporosis. Again, the definition of “co-management” in the summary allows for its use.

            I will pause now to compliment you on a well written post with nicely documented concerns. Well done! Your comments here are of much higher quality than about any I have read on this blog.

            Regarding the subluxation myth, I have disliked the term for well over 30 years(I’ve been in practice for 30 years). Even in the 1980’s, the term was on its way out as research even in the major chiropractic colleges was discounting, even obviating, its use. Unfortunately, Medicare and Medicaid INSIST upon its use, so DC’s must code a subluxation on their bills for services to be considered for payment; no subluxation code—the bill gets rejected. Go figure! Of course now the term is used by some as a synonym for segmental dysfunction, a condition which can be clinically diagnosed. The term is used by many medical PM&R’s, PT’s, DC’s, and DO’s.

            Chiropractic treatment is relevant for NMS conditions, obviously not for cancer, hepatitis, lymphoma, etc. It is also not effective for testicular pain often inflicted by the many low-info types on this forum who, unlike you, are not very altruistically earnest in their non-countenanced criticisms of my profession.

            Thank you again for your thoughts on this matter, John

          • “…an infinitesimally slight risk of stroke post chiropractic cervical SMT…”
            another extrapolation!
            without some form of surveillance system, nobody knows the size of the risk.
            your arguments continue to be nonsensical.

        • OK, let’s take a look at WHERE I came up with what you call “such nonsense.” In case you hadn’t noticed, the article to which you replied is titled: Indirect risks of alternative therapies for cancer patients – time to tackle them systematically!. Read that title again. Now, think about it for a minute before you go on chiromatic and launch your CDS (Chiropractic Defense System). See how it says “risks of alternative therapies for cancer patients?”

          Honestly, it seems you were just guarding your chiropractic nuts by reflexively, out of ALL POSSIBLE alternative medicines, arguing that CHIROpractors don’t cause strokes, at least as much as some people might think. But, that kind of misses the point of the article, doesn’t it, even IF the article was only talking about “chiropractic” and chiropractors. In other words, even if your non-sequitur reference had relevance to the article, just how many strokes at the hands of a chiropractor WOULD be acceptable to you IF they occurred as a RESULT of cracking a neck to TREAT or CO-MANAGE a CANCER? That’s not a “How many chiropractors does it take to screw in a lightbulb” joke. Rather, that’s a scenario that would be much WORSE than “nonsense,” wouldn’t it. At least that gets at what the article is about, though — bad things that happen ON TOP of ministrations of quack medicine. That is why Edzard Ernst wondered right off if you had read the article or even read its title. I wondered, too.

          Hello? 🙂

          So, the only issue here pertains to side-effects incurred by different Alternative Medical practitioners in their efforts to treat cancer — what I would call insult to Alt-Med injury. Do chiropractors treat or CO-MANAGE cancer then? Of course this concern can be broadened to include all treatments that go south when an Alt-Medical practitioner attempts to manage ANY disorder or disease. That’s where risk versus benefit rules the argument and why I brought it up as something that was conspicuously absent from your reflexive reply. Spelling it out, if a treatment is all risk without benefit, then anything bad that results from that empty treatment is, well, worse than just bad.

          So keeping it “chiropractic,” if a chiropractor causes a stroke, let’s say, when treating or co-managing a Chiropractic Subluxation in a patient with cancer, that only adds a terrible INSULT to the PRIMARY injury, which is chiropractic quackery. In other words, I would argue the patient has been injured by the chiropractic quackery preceding “Thuh” Adjustment — hurt by the empty enthusiasm of the chiropractic adherent who believes that no matter what, identifying and treating the Chiropractic Subluxation is a GOOD thing. This notion, incidentally, that adjusting the spine (so all is fine) is the primary neurosis underpinning the Chiropractic Enterprise. YOU might even agree, but apparently haven’t given this much thought. It will occur to you in time, perhaps in need, when you’re in a position to stop protecting your Alt-Medical nuts.

          All that remains then in explaining to the hard of chiropractic hearing how I came up with “such nonsense,” is to give you some sense of chiropractors who DO treat and/or who DO co-manage with MDs, disorders and diseases by “identifying and correcting spinal subluxations” — the PRIMARY nonsense I just mentioned. For this information, I use the National Board of Chiropractic Examiners Practice Analysis of Chiropractic 2015 — chapter 8, which focuses on “Patient Conditions” treated by chiropractors.

          Practice Analysis of Chiropractic 2015

          It’s critical to keep in mind when reading any of this, nothing that is UNIQUELY “chiropractic” —the Chiropractic Subluxation AND any of the so-called “Adjustments” purported to FIX these Spinal Fictions has ever been demonstrated beyond the say-so of chiropractors. Ever. Until chiropractors actually admit they were only kidding about this “chiropractic” —then whatever “bad” sits on top of this PRIMARY “nonsense” is even more tragic and “bad” than it would have otherwise been had chiropractors NOT ministered an empty and arbitrary quack medicine in the first place.

          Keeping chiropractic nonsense in mind then, the chapter 8 charts break down 84 conditions surveyed chiropractors saw in their offices in the prior year and divided each named condition into: 1. Not treated 2. Treated solely AND 3. Co-managed

          So, for a sampling:

          Asthma, emphysema, or COPD: Not treated: 16.1% Treated solely: 5.7% Co-managed: 71.4%

          Osteoporosis/osteomalacia: Not treated: 10.5% Treated solely: 13.0% Co-managed: 71.8%

          Lung/respiratory passage tumor: Not treated: 68.5% Treated solely: 1.0% Co-managed: 26.6%

          The KEY here as far as chiropractic “nonsense” is concerned is to appreciate the chiropractic notion of CO-MANAGEMENT of ANY of the conditions listed — never mind the more serious conditions and cancers. QUOTING from this document so that you can appreciate what is MEANT by CO-MANAGEMENT: “The charts show Co-management of many conditions by chiropractors consists primarily of identifying and correcting spinal subluxations.”

          To wit: IDENTIFYING AND CORRECTING SPINAL SUBLUXATIONS is the primary medical neurosis that has underpinned the Chiropractic Enterprise since 1895. When this claptrap actually informs the basis of a diagnosis and treatment, the chiropractor is touching his or her own chiropractic nose. When a chiropractic patient has a stroke because a chiropractor has rationalized they are “co-managing” a patient with an MD, let’s say, this is the VERY nonsense that makes “COMPLEMENTARY Medicine” such a joke and a public health problem.

          Anyways, I hope this helps you appreciate “Where [I came] up with such nonsense from what [you] posted,” at least enough so that you do not reflexively protect your chiropractic cojones every time you think a chiropractic critic is pointing to your open chiropractic fly.

          Are you a chiropractic student? A recent graduate? A seasoned chiropractor? 🙂

          ~TEO.

          • I think he is a fairly seasoned chiro, very well-versed in chiro spin-tactics.

          • Edzard cherry-picked one line from my post and called it an extrapolation: brilliant! I note that he failed to comment on the major points in my post. Also noteworthy is that he failed to disprove my statement that strokes allegedly resultant to chiropractic cervical SMT are veerrrryyyy rare. Edzard’s incessantly pervasive spin against almost all paramedical disciplines was again on full display.

            Be well

          • oh dear! you are so predictable [but not rational].

          • Edzard again failed to prove that strokes are not a very rare negative outcome following chiropractic cervical SMT. His “rationale” for deflecting from addressing the point was a “rational” response to his having nothing merit-worthy to state on the subject.

            Be well, Edzard

          • this is as weird as it gets: I don’t need to “prove that strokes are not a very rare negative outcome following chiropractic cervical SMT”, but chiros must prove that strokes are rare!!!
            learn some basic logic man!

          • @Edzard

            I have posted references regarding the rare instance of stroke with cervical SMT. Perhaps you missed them?

  • I posted on the Healthy Holistic Living site after they professed to like the claims of one particular gentleman since he always backed them up with references to papers, research etc.
    I said that 1. This seemed to indicate that his claims were treated rather unusually in this respect, and it
    iimplied that it didn’t matter whether all the other nonsense had any evidence to back it up, and 2. In particular, it didn’t seem to worry them in relation to all the chancers on the site-quacks and quackees- making claims all the time about cancer ‘cures’.
    No reply. But then I do live on Crete, so maybe emails take longer to get here.

  • Logos-Bios: I admit my post was partially a non-sequitur. However, the mention of an infinitesimally slight risk of stroke post chiropractic cervical SMT did refer some pain to my testicals(nice snipe, lol).

    No, Logos-Bios. Your knee-jerk defended reply that “the stroke-count isn’t as bad as it sounds” was not a “partial non-sequitur”; it was totally off the chiropractic wall, in NO way addressing the concerns and issues raised of the article — which remains (for the hard of chiropractic hearing), cancer patients harmed by quackery, and how to “tackle” this problem.

    That would mean for YOU, a CHIROpractor, the article might reference cancer patients who are harmed, NOT by you personally, but by those chiropractic simpletons who rationalize their panoply of spinal interventions based on proprietary concepts of Spinal Health and the Chiropractic Spine as they see it … IOW, those CHIROpractors who inflict their version of “chiropractic” on ANY patient, regardless of entering complaint and diagnosis no matter, because, being the chiropractic peanuts they most assuredly are, they believe in their heart of chiropractic hearts that what they’re doing is a Good Thing. THEIR empty enthusiasm and arbitrary chiropractic diagnoses and therapies put a cancer patient at risk. That’s what the article is about, in case you hadn’t noticed. And, you didn’t, posting your non-sequitur deflection instead.

    I sense that this bears repeating … for some reason. Those chiropractic nuts again, I’m guessing.

    Logos-Bios: There is zero justification for attempting to treat or co-manage cancer via manipulation; I stated this previously. Therefore, your erroneous assumption that I was advocating the opposite was misplaced. It certainly would be appropriate for certain forms of chiropractic treatment to be utilized for some sequelae(e.g. musculoskeletal pains) in some cancer patients; but I wouldn’t consider such to be “co-management.”

    A coupla things: First, we’re not talking about generic manual manipulative therapy. We’re talking about chiropractic “adjustments,” especially those that include proprietary chiropractic spinalisms, chirodigms, and any spinal fiction related to the Chiropractic Subluxation. Seems you already forgot the rationale used by chiropractic meatballs featured in chapter 8 of the National Board of Chiropractic Examiners Practice Analysis of Chiropractic 2015. To remind you what is MEANT by CO-MANAGEMENT: “The charts show Co-management of many conditions by chiropractors consists primarily of identifying and correcting spinal subluxations.” See the part about CORRECTING SPINAL SUBLUXATIONS?

    Time to grow-up, Logos-Bios 🙂

    Which brings me to the next point I see in those chiropractors who find their personal and professional chiropractic choice leaves them caught between a biomedical rock and chiropractic hard place. In short, and I’m talking to you now, the answer to chiropractic quackery and quackery in “chiropractic” is not Logos-Bios is no quack. The article is not about you, even if it did specifically refer to chiropractic quackery. If you do know better or do know how fundamentally empty The Story of the Chiropractic Nerves is, that’s fine. But, relative to what’s relevant to the article about quackery and cancer, you barely rise to the level of a foot-note. Importantly, neither the article nor I am talking TO you or ABOUT you personally. You seem to think we are 🙂

    Logos-Bios: There is no such thing as a subluxation. Ergo, treatment strictly for such an ethereal entity would not be justified. In “keeping it chiropractic,” as you stated, please know that I’ve never used “chiropractic subluxation” in my practice or in any professional or patient-specific discourse.

    Well, there IS such a “thing” as a subluxation — subluxated joints in rheumatoid arthritis and ectopic lentis in Marfan’s Syndrome, for example. AND, in case you hadn’t noticed, there is a whole bunch of CHIROpractic Subluxation — that special spinal fiction about which ONLY your chiropractor can tell you if you’re suffering needlessly from it. You know, the one that allows chiropractors to co-manage literally any entering complaint, disorder or diagnosis.

    Remember?

    And really Logos-Bios, that “[YOU] have never used ‘chiropractic subluxation’ in [your] practice or in any professional or patient-specific discourse” is really not the point, is it. Too many chiropractors do, and not just for billing purposes to Medicare. Your best take-away here is what I just wrote: the answer to chiropractic quackery and quackery in “chiropractic” is not Logos-Bios is no quack.

    After 30 years of practice, I’d say it’s time to grow-up. If you’re not prepared to do that yet, just don’t respond with the usual lame and inept BS I get from the chiropractic peanut gallery whenever I point to an open fly in their profession’s pants: “Sure the chiropractic profession has problems; doesn’t every profession?” You do seem smarter than that. But, maybe not 🙂

    ~TEO.

    • @ John

      Again I must compliment you on a well written rant: just the right amount of snark conflated with some understanding of the material about which you commented. You are several steps above most of the medical dullards on this site. Thank you for your thoughts.

      Quack practices in the treatment of cancer are obviously unethical and bogus. I didn’t read in Edzard’s post where he specifically decried the spinal interventions for cancer that would be considered bogus; he simply generically floated the chiro-stroke canard into his comments because he know it would arouse(you get to guess what definition I’m using for this word!) the copious anti-chiro zealots on this site. My partial non-sequitur regarding this apparently caught your interest.

      Of course subluxations are clinical entities. Since we had been discussing chiropractic subluxations, I assumed, obviously erroneously, that you would have picked up on that fact.

      “The charts show Co-management of many conditions by chiropractors consists primarily of identifying and correcting spinal subluxations.” See the part about CORRECTING SPINAL SUBLUXATIONS(?),” you wrote. You must’ve missed my response that Medicare and Medicaid INSIST upon its use, so DC’s must code a subluxation on their bills for services to be considered for payment; no subluxation code—the bill gets rejected. Go figure! Of course now the term is used by some as a synonym for segmental dysfunction, a condition which can be clinically diagnosed. The term is used by many medical PM&R’s, PT’s, DC’s, and DO’s. Moreover, I know ZERO chiros who claim to treat or to literally co-manage cancer via correcting chiropractic subluxations.

      You stated about the NCBE Practice Analysis document that “The charts show Co-management of many conditions by chiropractors consists primarily of identifying and correcting spinal subluxations.” See the part about CORRECTING SPINAL SUBLUXATIONS?” Well, you must’ve missed my comment regarding the nebulous definition of “co-management” as given in the document. The definition clearly does not specify that chiros deal directly with hematological, CA, G-I, etc. conditions or work in conjunction with specialists via “chiropractic subluxation correction to improve the function of chiropractic nerves.” Besides, the data given in the document show that chiros typically see less than 1 patient per year for such disorders; thus it should be evident that, when chiros identify such conditions while evaluating or treating patients for NMS complaints, those patients are almost inevitably referred out to a medical specialist with essentially no treatment from the chiro.

      I attend many seminars every year. I have met hundreds of DC’s. If a lecturer were to blather on about the “correction of chiropractic subluxations'” having something to do with improved cancer treatment outcomes, he/she would be laughed off the stage and refunds would be demanded. There simply is no science behind such outrageous claims.

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