MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

We use too many opioids; some experts even speak of an epidemic of opioid over-use. This is a serious problem not least because opioids are addictive and have other serious adverse-effects. But what can be done about it? Currently many experts are trying to answer this very questions.

It must be clear to any observer of the ‘alternative medicine scene’ that charlatans of all types would sooner or later try to jump on the ‘opioid band-waggon’.  And indeed exactly this has already happened!

In particular, chiropractors have been busy in this respect. For instance, Alison Dantas, CEO, Canadian Chiropractic Association (CCA) has been quoted in a press-release by the CCA stating that “Chiropractic services are an important alternative to opioid prescribing… We are committed to working collaboratively to develop referral tools and guidelines for prescribing professions that can help to prioritize non-pharmacological approaches for pain management and reduce the pressure to prescribe… We are looking to build an understanding of how to better integrate care that is already available in communities across Canada… Integrating chiropractors into interprofessional care teams has been shown to reduce the use of pharmacotherapies and improve overall health outcomes. This effort is even more important now because the new draft Canadian prescribing guidelines strongly discourage first use of opioids.”

I find it hard to call this by any other name than ‘CHIROPRACTIC MEGALOMANIA’.

Do chiropractors really believe that their spinal manipulations can serve as an ‘alternative to opioid prescribing’?

Do they not know that there is considerable doubt over the efficacy of chiropractic manipulation for back pain?

Do they not know that, for all other indications, the evidence is even worse or non-existent?

Do they really think they are in a position to ‘develop referral tools and guidelines for prescribing professions’?

Do they forget that their profession has never had prescribing rights, understands almost nothing about pharmacology, and is staunchly against drugs of all kinds?

Do they really believe there is good evidence showing that ‘integrating chiropractors into interprofessional care teams… reduce(s) the use of pharmacotherapies and improve overall health outcomes’?

Personally, I cannot imagine so.

Personally, I fear that, if they do believe all this, they suffer from megalomania.

Personally, I think, however, that their posturing is little more than yet another attempt to increase their cash-flow.

Personally, I get the impression that they rate their income too far above public health.

 

131 Responses to Opioid over-use, chiropractic megalomania, and six probing questions

  • It should be noted that Doctors of Chiropractic are commissioned officers in the USA military and are integrated into the USA Department of Veterans Affairs. Chiropractors using physical and radio graphic imaging provide expertise in the diagnosis of presenting musculoskeletal conditions and if appropriate recommend spinal manipulation, exercise and traction for the management of qantifiable spinal displacements.
    The more registered professionals that communicate in real time, the better it is for the public patient. Trust I am clear.

    • “Trust I am clear.” no, not at all!

      • Dr Michael Epstein wrote: “It should be noted that Doctors of Chiropractic are commissioned officers in the USA military and are integrated into the USA Department of Veterans Affairs.”

        Fortunately, for us here the UK, the Ministry of Defence won’t even accept free care from chiropractors:
        http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/2067-hands-for-heroes-ministry-of-defence-refuses-free-chiropractic-care-worth-p45-million-for-veterans.html

        • @Wode

          Fortunately for us in the USA, Dr. Wm. Moreau served as the MEDICAL DIRECTOR for Team USA during its record-setting efforts at the Olympic Games. The greatest military and the greatest Olympic team in the world have incorporated chiropractic care quite successfully into their template for maximizing soldier/athlete performance and effectively treating common athletic injuries….and have enjoyed spectacular results.

          Now what were you stating about the policies regarding chiropractic in the UK, Wode?

          • I do wonder: what has all this to do with the nonsense from chiros which I disclosed in my post?

          • @Edzard

            Apologies….I was merely responding to Wode’s comments.

          • who was merely responding to a rather strange comment from a chiro!

          • It seems to me that Dr. Epstein was pointing out that integration of chiropractic into interprofessional care teams is already transpiring(in the US military). His comment might have been a bit askew to the thesis of your post, but it wasn’t as strange or as unrelated to your post as was the comment by Richard regarding 19th Century regulatory systems. Richard’s comment, in the context of this thread, was indeed strange, although no doubt pleasing to your eyes.

          • I for one am not impressed as to what is ‘transpiring’ in the US since a while!

          • and your “esteemed medical director for team USA” was not a legitimate medical director since he has no medical training. Like others, those who chose him were misinformed about the difference in DC and MD, as the chiro world has conned their way into health care. Now I understand why Michael Phelps was persuaded to use and proselytize the ridiculous and fraudulent cupping treatment during the games. This sounds like something a non medical alternative guru would support and likely recommend.

          • @Cox

            Dr. Moreau performed his medical director duties admirably, and with fantastic results. It’s unfortunate that jealousy of Dr. Moreau’s success jades your appreciation of his achievement. BTW, it is not your decision to decide what Team USA calls its health professionals.

            Regarding cupping, it is too early to state that it works; but it’s also too early to state it doesn’t. It is an apparently safe procedure so, if it is ultimately determined to be a placebo, there is no harm and no foul. There are also Olympic medals, at least for Phelps.

    • “It should be noted that Doctors of Chiropractic are commissioned officers in the USA military and are integrated into the USA Department of Veterans Affairs.”

      This is the type of chiropractic self-aggrandisement that serves only to irritate those of us who imagine medicine is best operated by reliance on a firm evidence base. Commissioned officers in the US Military include many civilians, including scientists, lawyers and others who work in senior (non-military, non-medical) government-funded positions. But they do indeed tend to be senior positions. And “integrated into the VA system” translates as “some VA hospitals have allowed in chiropractors”. The question remains: does any culture actually require two conceptually different systems of medicine operating side by side?

      It is neither news nor surprising that, in the USA, various forms of Big Snakeoil have succeeded in pushing themselves into positions of some power. You need only to consider the bastardization of the once-prestigious NIH by the inclusion of the National Center for Complementary and Integrative Health as the supreme triumph of lunacy over reason.

      But then, at the present time, the USA’s status as a banana republic and a political joke needs no special emphasis.

      • @Frank Odd

        “This is the type of chiropractic self-aggrandisement that serves only to irritate those of us who imagine medicine is best operated by reliance on a firm evidence base,” you wrote.

        I’m intrigued by your use of “firm evidence base” to describe “modern medicine.” I think you overestimate your honorable profession relative to the firmness of the evidence upon which its doctors rely. “Can any medical-research studies be trusted”? Dr. John Ioannidis has posited this question.

        That question has been central to Ioannidis’s career. He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed. His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there’s a problem.

        Such is the case with some, and you, in the medical profession: you refer to the lunacy of adding a CAM consultancy service to the NIH. Yet you ignore the thesis of Edzard’s post regarding the epidemic of opioid overuse. Would you care to offer any statistics as to how many patients have died as a result of prescription opoids as compared to even the “wicked” chiropractic, cervical SMT? Silence from Frank…..

        • @L-B

          I don’t often bother to respond to your posts, Logos-Bios, but this one (though raising, as ever, the inevitable tu quoque about mainstream medicine) is relatively non-provocative and worth discussing, so no “silence from Frank” this time, though I can’t promise to repeat.

          “I think you overestimate your honorable profession relative to the firmness of the evidence upon which its doctors rely.” I’ve now stated a few times, elsewhere on this blog: I am not a member of the medical profession, I’m a biomedical scientist.

          I’m aware of Ioannidis. You wrote: “he’s become one of the world’s foremost experts on the credibility of medical research.” You can’t resist a logical fallacy, can you? Arguing from authority to justify cherry-picking a sound-bite from someone who glibly overstates the case. His question “Can any medical-research studies be trusted?” is so self-evidently grossly hyperbolic it doesn’t even merit consideration. This sweeping generalization would negate, among other items, the discovery of insulin, microbes and vitamins, the development of in-vitro fertilization, the demonstration of HIV as the cause of AIDS and the consequent discovery of anti-retroviral drugs, even the double-helical structure of DNA, a finding that has revolutionized the past 60 years of biological research.

          No, many medical research studies can most definitely be trusted. And the authors’ original conclusions tend to be far more subdued that you’re implying: “…when they advise us to consume more fiber or less meat…” those recommendations are usually the exaggerations resulting from the spin of research press releases, screwed up and amplified by the media, and given a final twist by self-appointed experts in nutrition, new wavers and other nutjobs.

          What is wrong with prescribing antibiotics? Curing infectious diseases has greatly contributed to he list of measures proved to postpone death. I’m not surprised that you include antibiotics in your suggested untrustworthy research — that probably reflects a kink in your thinking that stems from chiropractic’s underpinnings in vitalism. But if your mention of antibiotic prescribing alludes to the demonstrably inappropriate overuse of these drugs by physicians giving in to patients’ demands, I totally agree. But then, the dangers of antibiotic overprescribing were revealed by basic and epidemiological research into rates of resistance development by bacteria and if, as you imply by association with Ioannides, all medical research studies can’t be trusted… Oh dear, I smell a Catch 22 here, somewhere!

          All blood-pressure medication wrong? Nope. There’s another one to add to the list of death-postponing measures. You wrote “when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong”, actually, surgery for heart disease is very often the only possibility of postponing someone’s death: you’re probably on firmer ground with recommendations for surgery to relieve back pain: I don’t know and I’m not going to bother to read the literature. There are excellent surgeons who regularly read this blog and I’ll leave that one to them.

          I don’t regard Ioannidis as “one of the most influential scientists alive”. He draws attention to medical complacency (a particularly high risk in US medicine which is so severely distorted on all fronts by the profit motive). For goodness’ sake, if a country permits drug companies to advertise their products directly to the public, how can you not have a situation in which doctors respond to psychological pressures from their patients resulting in prescription abuse?!

          “Such is the case with some, and you, in the medical profession [1]: you refer to the lunacy of adding a CAM consultancy service to the NIH [2]. Yet you ignore the thesis of Edzard’s post regarding the epidemic of opioid overuse. Would you care to offer any statistics as to how many patients have died as a result of prescription opoids [3] as compared to even the “wicked” chiropractic, cervical SMT [4]?”

          I’ll borrow Edzard’s footnote system to deal with this almost manically flawed paragraph.

          1. I’m not a member of the medical profession.

          2. CAM consultancy?! Good grief! The NCCIH began life as an attempt to provide NIH-quality research evidence demonstrating the efficacy of CAM. When, after several years, it had been able to provide no support it changed tack to providing grants in support of CAM education and CAM units. If it’s now a CAM ‘consultancy’ unit things are worse than I thought.

          3. Patients who die on prescription opioids die of self-administered overdoses, because they become addicted. Most western countries can provide reliable statistics on these deaths.

          4. We have no idea of the death rates attributable to chiros manipulating cervical spines, because there’s no-one keeping adequate records, unlike mainstream medicine, which works hard to discover and rectify its errors.

          Just about every post from Logos-Bios (readers please note that he stills prefers to post under a pseudonym rather than reveal his true spots) is an effort to say, in effect, how do Ernst and others have the gall to attack camists on this blog when mainstream medicine shares so many or all of the faults of CAM? I’m not a religious person but I seem to recall a line somewhere in the bible about beams and motes. The answer is because most, or a lot, or some of real medicine (take your pick) has positive curative effects, and documents its problems and failures: it is therefore possible to calculate its risk:benefit ratio in any clinical situation. By contrast the evidence that any branch of CAM has positive curative effects and it doesn’t document its problems and failures. Therefore its risk:benefit ratio is incalculable.

          Please don’t expect me to respond again to your worn-out tu quoque.

          • Sorry: third from last sentence should have read: “By contrast the evidence that any branch of CAM has positive curative effects is slender and it doesn’t document its problems and failures.”

          • @Frank Odd

            It was delightful to read a serious post from you for a change; a camedic you were not while typing your thoughts on this matter. Thank you!

            Since you are apparently fond of pointing out logical fallacies, perhaps you might wish to classify the exact type of logical fallacy Edzard utilized in the last three sentences of his original post? Perhaps you might also enjoy those posted by Richard (utilizes logical fallacies seriatim) which I noted in an earlier response to him? BTW, your beam-mote reference was from the Gospel of Matthew, and it does indeed reflect the comments of most of the camedics on this site; thank you for mentioning it.

            Would you care to offer any serious evidence that chiropractic cervical SMT has a significant death rate associated with it? You allege that “inadequate records” render the death rate incalculable; how convenient! Prove your point! Whenever anyone dies post SMT, it often is front-page news; the medical profession appears almost titlilated when it reads of such tragedies. It has been established that non-reporting or under-reporting of adverse events occurs in much of medical research, examples of which I’ve reported in the realm of bariatric surgery, for example. As such, it is NOT, as you claim, possible to calculate the risk-benefit ratio of “real medicine” in ANY (emphasis added) clinical situation.

            Regarding patient deaths, addiction, and overdoses, you might want to reference the US Surgeon General’s lament regarding the prescriptions of these drugs as being the motive force behind the deaths associated with them.

          • L-B,

            Why not ask your wife and your daughter why they do what they do, rather than what you do; instead of ridiculing, on this website, others who decided to do what the two of them do: practise science- and evidence-based medicine, rather than your quackery.

            Note to camists: The lack of a “?” was not a grammatical error.

          • @Pete

            I appreciated your ad hominem; such a response is common from posters who have little to add to a topic about which they know squat.

            My wife and daughter do what they do to help sick/injured people get well. I’m proud of what they do. They know that there is nothing pseudo-scientific about my mainstream chiropractic practice which incorporates proper diagnosis, appropriate chiropractic manipulation, physiotherapy, and many other services to help the patients we see, many of whom are referred by MD’s, PM&R’s, and PT’s. Of course you know nothing of my practice, Pete; your goal is simply to insult me and my profession. Camedics such as you should inform themselves about what they post before they post it. Otherwise, you simply appear foolish.

          • L-B,

            “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.” — Björn Geir Leifsson, MD.

            I happen to be far more familiar than I would like to be with the business model deployed in the empire of chiropractic.

            I also happen to be far more familiar than I would like to be with whole empire of alternative-to-medicine, aka: quackery; sCAM.

          • @Pete

            “Business model employed by the empire of chiropractic”? You must have strained your imagination to its limit to contrive such a ridiculous statement. What do you mean by it?

            I appreciated your failed attempt at insulting mainstream chiropractic; such a response is common from posters who have little to add to a topic about which they know squat.

          • L-B,

            Your comments on this website are typical for a so-called chiropractor who needs to hide behind a pseudonym.

            Mainstream chiropractic insults itself; and you have been doing an excellent job of destroying its, and your own, credibility.
            http://www.ebm-first.com/chiropractic.html
            https://sciencebasedmedicine.org/category/chiropractic/

  • And do they not recall that DD Palmer quite clearly stated that his ‘chiropractic’ provided a system of therapy which was “a different system to medicine”?

    And would they like to explain why, if they are so interested in diagnosing and treating patients, they have not trained and qualified as doctors (MD/MB BS) in the first place – before going on to learn specific methods of spinal manipulation as post-graduates?
    Or, if they are unable to gain entry to medical school, why they have not qualified as physiotherapists?

    And how ‘integrating’ pseudo-science with science can possibly help science based medicine?

    And whether or not they recognise that regulatory systems for the professions of medicine, nursing and physiotherapy) were developed in the nineteenth century precisely to protect patients from quacks, charlatans, fraudsters and the those who are hard of thinking?

    • @Richard

      “And do they not recall that DD Palmer quite clearly stated that his ‘chiropractic’ provided a system of therapy which was “a different system to medicine”?

      The current year is 2017, not 1895. Please get with the times. You’re welcome!

  • @Richard

    It’s astonishing how many times Richard must be reminded that DC’s in the USA are required by law in most states to diagnose(and not only NMS disorders).

    It seems as though PT’s are attempting to train as DC’s via seminars which pruportedly teach SMT. Go figure!

    Integerating pseudo-science with science is not akin to incorporating chiropractic care into medical algorithms for treating NMS disorders and injuries. Alas, Richard has resorted to a logical fallacy (i.e. faulty analagy) in his biased rant.

    Protection from quacks and charlatans in the 19th century? I again remind Richard that we are living in 2017 CE, not the 1800’s. Furthermore, he has injected yet another logical fallacy (i.e. ignorantio elenchi) into his anti-chiropractic diatribe by suggesting that mainstream, modern chiropractice bears much resemblance to that of 1895.

    • Most of us have indeed moved on from 1865. Sadly, not all.
      And the answers to the questions are?

      I am not ‘anti-chiropractic’.
      I am pro EBM (imperfect though it is).

      I ask again, what is the unique selling point of ‘chiropractic’ which attracts students to study that modality of therapy rather than medicine (in its manifest forms), physiotherapy, nursing?
      (My guess is that it can only be a faith in ‘innate intelligence’ and its affects on biological systems. QED.)

      • The selling points are education in diagnosis, conservative treatments of NMS conditions, radiological interpretation, physiotherapy, SMT, and society’s blatant ebb toward providers whose treatments might help certain disorders sans invasive medical interventions. A chiropractic doctor is seen by prospective students as an amalgam of diagnostician and conservative-care therapist. I submit these to you as my opinions.

  • Richard Rawlings, The physiotherapy you advocate as a profession is little more than un-scientific “Hands on Homeopathy”. They keep the patient occupied, themselves entertained whilst nature takes its course in healing (or not).

    • are you sure?
      if so some references would be nice

    • The physiotherapist I saw treated a trapped nerve, and gave me exercises to stop it happening again which have been effective (when I use them, I soon remember how effective they are when I don’t!) for over twenty years now at keeping my right arm perceptive and pain free. The things the physiotherapist did and the exercises I still do were based on the structure and relationship of the nerves, muscles and bones in my shoulder. How is that ‘hands on homeopathy’?

  • The Merepeza systematic review upon which Edzard apparently relied in his post was, in fact, a good, albeit limited, study; Edzard apparently thinks so or else he wouldn’t have cited it, right? Note that the author of the review himself correctly stated:

    “These studies offer a glimpse of the literature available in general and suggest that there does not appear to be clear answers or conclusive evidence as to which treatment, spinal manipulation or exercise, is more effective in treating CLBP. Perhaps the difficulties in finding conclusive evidence may lay in the entity of CLBP itself. It is by nature a heterogeneous entity that comprises a myriad of clinical signs and symptoms to offer different clinical scenarios in which a practitioner chooses an algorithm to diagnose CLBP. Then, the treatment choices are also a multitude of components that comprise exercise, manual therapy and spinal manipulation or ANY PERMUTATION OF THESE.

    Furthermore, spinal manipulation or spinal manipulation therapy is not necessarily clear and uniform across the literature on what it exactly entails. In many cases it may include high-velocity thrust techniques or manual mobilization of the involved anatomical structures. In other cases, such as in one of the studies included in this review, it did not provide sufficient detail on what manual therapy procedures are.

    Another difficulty when dealing with spinal manipulation or spinal manipulation therapy, is that it is not an exact science and it cannot be measured directly, and as such it offers variability on its delivery and therefore the potential for error in measurement of effects. This is made more so by the fact that it is delivered by a variety of health care practitioners that have different training and different modes of delivery. This may make the study of the effects of spinal manipulation on CLBP more challenging especially when comparing studies in a systematic review.

    This is in fact a major limitation of this review that the variables of spinal manipulation and exercise differ and vary significantly from each of the studies. This non-uniformity of variables makes it difficult to compare the studies or generalize on the results. More comprehensive studies are required with more rigorous design, better defined sub-groups of CLBP patients, clearly defined interventions including cost-effectiveness in order for us to provide better evidence to guide practice.”

    It’s unclear why Edzard omitted the mentioning of these excerpts from the review. Perhaps it’s because they reveal that chiropractice involves many more things than merely SMT and this review specifically studied only manipulation(or was it mobilization, or was it Activator-placebo “therapy,” or was it non-cavitational “manipulation,” etc.? No one knows for sure. The author clearly stated the limitations of this review regarding CHRONIC LBP(unspecified dx) yet Edzard blithely imputed the study’s results to represent “considerable doubt” as to the efficacy of chiropractic SMT for “back pain” in general. Edzard can’t resist authoring “hit pieces” on chiropractice even when he knows that DC’s utilize more than SMT in prosecuting their treatment plans.

  • “It should be noted that Doctors of Chiropractic are commissioned officers in the USA military and are integrated into the USA Department of Veterans Affairs.”

    Hehe… It should be noted, that the recent presidential election proves that a fool with delusions of grandeur can elbow itself into any position in the US. 😀

    • Hee, hee. It should be noted that Icelanders perhaps should not be too quick to criticize the US since Iceland can’t even pay its fair share to the NATO Alliance for its own protection: Iceland pays only .1% of its GDP to the Alliance and primarily relies on the US to protect it. Iceland should be paying 2%, but it doesn’t. Yep, the US certainly should accept criticism by Icelanders for alleged profligate policies in selecting its leaders.

      Apologies to the moderator for this response to Geir’s off-topic comments.

    • Excellent fact Bjorn, and trust me, many of us in the US are embarassed to be represented by such a fraud and con artist. It is not surprising that his fellow dishonest scam artists would support such a despicable person. As a former officer in the USAF I certainly do not support alternative practices in the military. Certainly not all alternatives are despicable like Trump, but have at minimum been brainwashed by alternative nonsense or choose to deny reality since they have paid for such an expensive misleading education.

      • I actually find my minor quip on how the citizens of the US let clowns into important positions like health-care and presidency, far more relevant to the discussion at hand, than this out of context irrelevant and misleading factoid.
        I am of course tearfully remorseful for having disturbed an irate, troll watching Breitbart news, which seems to be its and Donald Drumpf’s main window to the world. 😀

        • Of course Geir was referring to me in his most recent post. As usual, Geir was erroneous when he averred that I watch Breitbart News. I have never once ever watched it.

          Regarding Geir’s opinion that his “minor quip” was even tangentially relevant to this thread, I view such a conclusion to be about as accurate as most things he states about paramedical disciplines; that is, not very accurate!

  • Working with doctors in a multidisciplinary setting! I have been doing that for the last 20 years!
    @EE
    “Do chiropractors really believe that their spinal manipulations can serve as an ‘alternative to opioid prescribing’?”
    CCA last sentence:
    “This effort is even more important now because the new draft Canadian prescribing guidelines strongly discourage first use of opioids.”
    Do you recommend opioids as first line treatment?
    Also add NSAID’s with this latest systematic review and meta analysis that has been gaining a lot of press coverage:
    http://ard.bmj.com/content/early/2017/01/20/annrheumdis-2016-210597
    The Dr responded to this with anecdotes! They also implied that there may be sub-groups that respond to NSAID’s! Possibly and a good point but I have not read any articles!
    “Do they not know that there is considerable doubt over the efficacy of chiropractic manipulation for back pain?”
    You quote the NICE guidelines! I will let Blue Wode respond to this:
    http://edzardernst.com/2016/03/nice-no-longer-recommends-acupuncture-chiropractic-or-osteopathy-for-low-back-pain/#comment-75919
    and my response to Blue:
    http://edzardernst.com/2016/03/nice-no-longer-recommends-acupuncture-chiropractic-or-osteopathy-for-low-back-pain/#comment-75941
    “Do they not know that, for all other indications, the evidence is even worse or non-existent?”
    If you refer to the mythical subluxation then I agree!
    “Do they really think they are in a position to ‘develop referral tools and guidelines for prescribing professions’?”
    Recent study from Australia:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5217252
    “In terms of professional referral relationships, the chiropractors report sending and/or receiving referrals from GPs (55.1%) followed by podiatrists (38.5%), and physiotherapists (30.5%)”
    This is a national survey with a response from 2005 chiropractors! 55.1% of chiro’s refer to and get referrals from GP’s!
    “Do they forget that their profession has never had prescribing rights, understands almost nothing about pharmacology, and is staunchly against drugs of all kinds?”
    55.1% working with doctors! If a patient needs a prescription or medical care I refer to a doctor and the majority of chiro’s here do the same!
    “Do they really believe there is good evidence showing that ‘integrating chiropractors into interprofessional care teams… reduce(s) the use of pharmacotherapies and improve overall health outcomes’?”
    Good question! Some interesting recent papers on this topic from my library:
    https://www.ncbi.nlm.nih.gov/pubmed/20889389
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4186903
    http://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1251-0
    https://www.ncbi.nlm.nih.gov/pubmed/26288262
    https://www.ncbi.nlm.nih.gov/pubmed/27288324
    https://www.ncbi.nlm.nih.gov/pubmed/28082277
    The last four of your points!
    Sweeping generalizations and carpet bombing!

    • Critical_Chiro wrote: “You quote the NICE guidelines! I will let Blue Wode respond to this:
      http://edzardernst.com/2016/03/nice-no-longer-recommends-acupuncture-chiropractic-or-osteopathy-for-low-back-pain/#comment-75919
      and my response to Blue:
      http://edzardernst.com/2016/03/nice-no-longer-recommends-acupuncture-chiropractic-or-osteopathy-for-low-back-pain/#comment-75941

      My response to Critical_Chiro:
      http://edzardernst.com/2016/03/nice-no-longer-recommends-acupuncture-chiropractic-or-osteopathy-for-low-back-pain/#comment-75951

      Further, there are very big problems re the NICE guidelines for chiropractors in the UK…
      https://complementaryandalternative.wordpress.com/2016/12/06/nice-guidelines-for-low-back-pain-and-sciatica-a-clarification/

      ______________________________________________________________________

      “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
      Björn Geir Leifsson, MD

      • Why do you respond to scientific literature with BLOGS?

        One is actually part of the evidence based pyramid, the other is hot air.

        • what a strange comment! scientific evidence usually comes in the form of peer-reviewed articles. blogs are a means of discussing and disseminating this evidence. the only thing that is just ‘hot air’ here is your comment, it seems to me.

          • What is strange is countering peer-reviewed scientific evidence with blogs. Are you suggesting that blogs are somehow equal to peer reviewed publications?

          • What is strange is countering peer-reviewed scientific evidence with blogs.
            WHERE HAVE I DONE THIS?
            Are you suggesting that blogs are somehow equal to peer reviewed publications?
            NO. WHERE HAVE I SUGGESTED THIS?

    • Can anyone be certain that the term “referral” is used in the context of the physician’s choice rather than the demands of patients? I suspect not. It is not uncommon for patients to request referrals from their physicians so that insurance will cover the costs. Some physicians will refuse such referrals, while others will not.

      • Before my own experience and later study of the history and nature of chiropractic, I actually “referred” a few people to try it for uncomplicated lower back pain, which was said to be a confirmed indication for chiropractic. When I referred myself on this indication, I found out firsthand what chiropractic was all about. I later started reading and following discussions on it and have formed what I consider a very well-informed opinion of it.
        When I went for it myself, I decided to give it a chance, to go all the way, so to speak. As I found it to get more and more absurd, I realized the only effect it had was on the chiropractors economy. Even if I felt suspicious of the shitty x-ray’s, the technically unlikely gizmo measuring thing he ran up and down my back every visit (One of my hobbies is electronics) and then the lecture about how chiropractic adjustments could fix everything from the appendix to the zygoma, I still continued to go. I was being led like a donkey after a carrot, by a smooth talking and very confidence-invoking man. I realised later I was being trapped in a strange feeling of being indebted to him – to being indebted to follow his advice. I even had a slight feeling of guilt when I stopped going for the repeat adjustments that were the real goal of the theatrical shows of the first visits, a money-making machine. Each re-visit took all of two minutes on a “conveyor-belt” system of weekly or even bi-weekly “Wham-bam-thank-you-ma’m” adjustments that were not cheap.

        Physicians who refer patients for chiropractic are either fools or have not looked into the reality of chiropractic.

        • ” •

          At the hospital referral region level, we found that per-capita supply of doctors of chiropractic and per-capita Medicare spending on chiropractic manipulative therapy were inversely associated with any use of opioids.

          Per-capita supply and spending on chiropractic manipulative therapy were not associated with the mean daily dosage of opioids among patients who obtained opioid prescriptions.”

          http://www.jmptonline.org/article/S0161-4754(16)00063-4/fulltext

          PI is an MD.

        • @Geir

          I’m sorry for your poor experience. I suspect that if you had come to my office for care that you would have an entirely different opinion of mainstream chiropractice. No gizmos, no poor quality x-rays, no discussion of subluxations…only a thorough exam and a sharing of my findings with a medical professional such as you. There would, of course, be recommendations based on those exam findings with treatment options which might well NOT include SMT, if such would be contraindicated. You might also be surprised, were you to present with activity-related leg pain, to undergo blood-pressure differential oscillometric testing of your lower extremities to help determine if your claudication were neurogenic or vascular-ischemic. You would be surprised that with a dx of vascular claudication, I would refer you to a vascular surgeon for further eveluation; that is, I would not treat your “subluxation” 30 times to eliminate the “nerve interference” which is purportedly the “root cause of all disease.”

          Frankly, I don’t think you would have been turned off by your experience in my office. In fact, I think you would have come away with the impression that I care more for my patients than I do for their health insurance as evinced by the fact that I practice in one of the few rural villages in my geographic area. My income is much less than it would be had I chosen to practice in a large city to, as Edzard stated, improve my cash-flow.

          Please note that I am attempting to have a pleasant conversation with you at this time.

          • @Logos-Bios on Thursday 09 February 2017 at 01:04

            Why would Björn even consider seeing you when he can see a real doctor and circumvent a pointless exercise? I cannot understand your logic, if indeed there is any? He would be much better off seeing your daughter who IS a real doctor.

          • @Frank Collins

            It doesn’t surprise me in the least that you can’t follow logic. You have demonstrated such befuddlement seriatim. My post to Geir was in direct response to a negative experience he had in a DC’s office…not too difficult to follow for most, I would surmise.

          • @Frak Collins

            Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies.

            At this time moderate evidence evinces SMT to be as effective as PT for generic(i.e. not specifically dxd as to pain generator) LBP; limited evidence suggests it is superior to generic medical care in a GP’s office. Therefore, I believe it is prudent for GP’s who have tried ineffectually on their patients NSAIDS, tramadone, gabapentin, etc. to refer them for assessment with a DC.

          • @Logos-Bios on Thursday 09 February 2017 at 16:23

            “It doesn’t surprise me in the least that you can’t follow logic. You have demonstrated such befuddlement seriatim. My post to Geir was in direct response to a negative experience he had in a DC’s office…not too difficult to follow for most, I would surmise.”

            How many times do you have to be told before it gets through your thick chiro head; DR (a real doctor) Geir made the unfortunate mistake of trying a chiro and found out it is nonsense. Why would he want to see someone who is NOT a doctor to be diagnosed, quite possibly incorrectly, and waste his time and money?

          • @Logos-Bios on Thursday 09 February 2017 at 20:47

            “Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies.

            At this time moderate evidence evinces SMT to be as effective as PT for generic(i.e. not specifically dxd as to pain generator) LBP; limited evidence suggests it is superior to generic medical care in a GP’s office. Therefore, I believe it is prudent for GP’s who have tried ineffectually on their patients NSAIDS, tramadone, gabapentin, etc. to refer them for assessment with a DC.”

            As you didn’t read the prof’s blog at the top of the page, I repeat;
            ****************************************************************************
            Do chiropractors really believe that their spinal manipulations can serve as an ‘alternative to opioid prescribing’?

            Do they not know that there is considerable doubt over the efficacy of chiropractic manipulation for back pain?

            Do they not know that, for all other indications, the evidence is even worse or non-existent?

            Do they really think they are in a position to ‘develop referral tools and guidelines for prescribing professions’?

            Do they forget that their profession has never had prescribing rights, understands almost nothing about pharmacology, and is staunchly against drugs of all kinds?

            Do they really believe there is good evidence showing that ‘integrating chiropractors into interprofessional care teams… reduce(s) the use of pharmacotherapies and improve overall health outcomes’?
            **************************************************************************

            Speaking, anecdotally of course, from my experience, I did see a chiro about 33 years ago for right sciatica. I can only thank the chiro for one thing; she damaged my back badly enough I was forced to see a neurosurgeon who operated and has given me now more than 32 years of not only pain free life but allowed me to do anything I’ve wanted. I’ve built a house, played sports, piggybacked two teenage children at the same time, picked up and carried heavy objects, and very successfully resisted the efforts of a bully to “punch me ever so hard”. Now, what can I really thank chiro for?

          • @Frak Collins

            Please read my comments more fastidiously. I already have answered your question regarding my post to Geir. Read them s l o w l y if such is necessary to aid your comprehension.

          • @Logos-Bios on Thursday 09 February 2017 at 20:47

            “At this time moderate evidence evinces SMT to be as effective as PT for generic(i.e. not specifically dxd as to pain generator) LBP; limited evidence suggests it is superior to generic medical care in a GP’s office. Therefore, I believe it is prudent for GP’s who have tried ineffectually on their patients NSAIDS, tramadone, gabapentin, etc. to refer them for assessment with a DC.”

            You might believe it prudent but that is unsupported by evidence.

            You can also insult me as much as you like with your pathetic, immature name-calling but it only tars one of us. It is a pity you aren’t as intelligent as your spouse and daughter, or as sensible.

          • @Frank Collins

            Your story regarding your singular experience is, as you admitted, anecdotal; I also doubt your fable. I do not doubt that a good neurosurgeon was able to help you with what I presume was a HNP. It’s surprising to me that a man of your “indominable strength of mind” would induce that all chiros are worthless because you allegedly had a single bad experience with one.

            Anecdotally speaking, one of my patients saw an orthopedic surgeon at my request for OA of his right hip. This surgeon was and is my first referral for such procedures because he literally is brilliant and fantastically talented. Unfortunately, the surgeon nicked a nerve during the procedure and now the patient has permanent foot drop. I would hope that the patient would not “swear off” orthopedists as worthless quacks because his singular experience with one was disastrous for him.

            I wish you would actually think before you post, Frank. You might appear more sensible.

          • Logos-Bios on Friday 10 February 2017 at 23:34

            “Your story regarding your singular experience is, as you admitted, anecdotal;”

            Erh yes, that is what it, self-evidently, is. (Shakes head in bewilderment at the perceived necessity to state the blindingly obvious.)

            “I also doubt your fable.”

            Who gives a stuff what you believe or otherwise. I have photos, but that wouldn’t be enough for you because evidence, or lack of it, doesn’t matter to you.

            “I do not doubt that a good neurosurgeon was able to help you with what I presume was a HNP.”

            Again the self-evident, though I have said it several times.

            “It’s surprising to me that a man of your “indominable strength of mind” would induce that all chiros are worthless because you allegedly had a single bad experience with one.”

            That would be “indomitable”, not what ever word you used. (You really aren’t as bright as you think you are; your wife and daughter are much smarter and have real professions.)

            Anyway (after much chortling at your love of self), you don’t seem to take much in. It wasn’t the first experience, which I didn’t even realise was a sham and nonsense at the time, that caused me to see chiro for what it is. It was only after reviewing the events and, subsequent extensive reading, that I realised the nonsense of chiro. Premised on the ramblings of a convicted thief and charlatan, chiro is in the same category as homeopathy, astrology, tarot, navel gazing and all of the other pre-scientific superstitions humans have concocted.

            “Anecdotally speaking, one of my patients saw an orthopedic surgeon at my request for OA of his right hip. This surgeon was and is my first referral for such procedures because he literally is brilliant and fantastically talented. Unfortunately, the surgeon nicked a nerve during the procedure and now the patient has permanent foot drop. I would hope that the patient would not “swear off” orthopedists as worthless quacks because his singular experience with one was disastrous for him.”

            Pointless anecdote, based on an incorrect assumption, of which you are so fond.

            “I wish you would actually think before you post, Frank. You might appear more sensible.”

            Advice from you? How quaint? Any mirrors in your place, or are they there to feed your enormous misplaced ego. You must be such an embarrassment to your family. No wonder you don’t post your identity, otherwise your suffering family would see what you do under the cowardly guise of anonymity.

      • @Blue Wode
        And the following 2 responses:
        http://edzardernst.com/2016/03/nice-no-longer-recommends-acupuncture-chiropractic-or-osteopathy-for-low-back-pain/#comment-76093
        A Cochrane Review looks at a single approach! The 2008 Special Supplement of the Spine Journal that I cited has papers on 25 approaches for the treatment of low back pain and then Scott Haldeman tabulated and compared the evidence bases!
        “Further, there are very big problems re the NICE guidelines for chiropractors in the UK…”
        Only if you are a vitalist and are not up to date with best practice and the evidence based guidelines! Then again when it comes to exercise it is very much a case of “which branch of the religion do you belong to”. Chris Maher, head of the Musculoskeletal division at the George Institute said this and its spot on!! I have had some enjoyable conversations with physio’s, chiro’s and exercise physiologists about this and the number of guru’s and latest fads is ridiculous!
        The latest Cochrane Review on physical activity and exercise for chronic pain (I like to cite research, not blogs that are inherently biased):
        https://www.ncbi.nlm.nih.gov/pubmed/28087891
        So where does this leave us? What is the optimal multi-modal approach? Which are the best exercises? What is the best graded approach? What is the best advice? Are there sub-groups that respond differently and how do we identify them? I have been asking these questions my whole career Blue, constantly change what I do and I still haven’t found the answers!

        “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
        Björn Geir Leifsson, MD”
        1910?? Your stuck in the past with the vitalists!

        @Lighthorse
        Good question!
        Yes initially the referral can be at the patients request! Looking at my clinic stats around 20% of my medical referrals are at the patients request! But I still send off a thank you for referring letter and follow up letters and keep the doctor informed! Once they are happy with me then they continue to refer! Its all about clear communication! The local medical community also know how I practice! I recently had a referral from a Doctor who I had never had a referral from before. He drew a map from his practice to mine for the patient and they came straight to me! No one practices in isolation any more!

        • @ Critical_Chiro

          What you say is irrelevant.

          The bottom line is that there are no directories available to the public and healthcare professionals to which they can turn to find chiropractors who read good, scientific journals, do not treat subluxations, and who look for best evidence and apply it.

          The fact that a chiropractor (Jason Busse) was prominent in developing the CND opioid guidelines shows very clearly that the chiropractic bait and switch continues to be ignored by authorities who should know better.
          https://sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/

          ______________________________________________________________________
          “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
          Björn Geir Leifsson, MD

          • @ Blue Wode,

            Just out of interest can you point to directories available to the public and healthcare professionals to which they can turn to find physiotherapists or osteopaths who read good, scientific journals and who look for best evidence and apply it?

          • for doctors, this is an ethical, moral and legal obligation

          • @AN

            Good question you asked Blue. Expect no response to it.

          • Busse has a PhD from McMaster and is mostly publishing outside of chiropractic nowadays. https://fhs.mcmaster.ca/ceb/faculty_member_busse.htm.

            His reputation is stellar and no one on the CDN opioid guidelines, including the MD PhDs had any issue with him being the chair and the primary author.

            So, if his co-workers have no issues with him in this context, who are also physicians, why should we care about the uninformed opinion of bloggers?

          • @AN Other on Thursday 09 February 2017 at 12:13

            “Just out of interest can you point to directories available to the public and healthcare professionals to which they can turn to find physiotherapists or osteopaths who read good, scientific journals and who look for best evidence and apply it?”

            Dear Annie (receptionist),
            I have two questions;
            Why would anyone want to see an osteo, premised as it is on the same nonsense as chiro?
            Why do you keeping asking stupid questions? Are you familiar with Tu Quoque?

            Now, get back to the new victim and answer that phone? Alternatively, You could disclose what skin you have in the alt-med game?

        • … Your stuck in the past with the vitalists!

          So are you, as long as you call yourself “chiropractors”.

        • @Critical_Chiro on Wednesday 08 February 2017 at 23:07

          “Your stuck in the past with the vitalists!”

          Your?

          “Yes initially the referral can be at the patients request! Looking at my clinic stats around 20% of my medical referrals are at the patients request! But I still send off a thank you for referring letter and follow up letters and keep the doctor informed! Once they are happy with me then they continue to refer! Its all about clear communication! The local medical community also know how I practice! I recently had a referral from a Doctor who I had never had a referral from before. He drew a map from his practice to mine for the patient and they came straight to me! No one practices in isolation any more!”

          I quote this whole as an example of your thought processes. Putting aside the awful grammar, it causes me to wonder why I ever engaged with you, believing, very wrongly, you have any intelligence. I am embarrassed to think I made such an unsound judgement; you are a prized goose with as many scruples as the usual thief, erh, chiro.

  • @Edzard Ernst
    “Chiropractic Megalomania!”
    In the press release:
    “Canada is the second-highest consumer of prescription opioids in the world and half of all annual drug-related deaths in this country are prescription opioid-related. Recognizing the important role of chiropractors as a means to address this, Health Canada asked the profession to be part of Canada’s opioid action plan late last year. The federal government; seven provincial health ministries; medicine, nursing, pharmacy, and dentistry associations; and 30 other partner organizations that have a role in reducing the impact of opioids have signed this plan.”
    So the chiro’s were INVITED as were all the other organizations and your response is…..??
    Your bias is showing again!

    The Canadian governments:
    “Joint Statement of Action to Address the Opioid Crisis”
    https://www.canada.ca/en/health-canada/services/substance-abuse/opioid-conference/joint-statement-action-address-opioid-crisis.html?_ga=1.64833647.1902687051.1479770407
    Every organization contributed.
    The chiropractic professions committment:
    “The Canadian Chiropractic Association commits to:
    By June 2017: Developing evidence‐based professional practice recommendations and guidelines to facilitate the appropriate triage and referral of Canadians suffering from chronic and acute musculoskeletal conditions and reduce reliance on opioids. The recommendations will aim to:
    *better understand the burden of pain related to musculoskeletal conditions;
    *develop key recommendations for the appropriate role of chiropractic care (in anticipation of similar efforts for other key alternatives to opioids); and
    *facilitate dissemination of key recommendations.
    Allison Dantas, Chief Executive Officer

    • @Clown_Chiro on Thursday 09 February 2017 at 02:20

      “Your bias is showing again!”

      What, the prof is “biased” against your, and every other, brand of witchcraft? Who would have thought?

      What do you think he has been doing for the last 30 years? Perhaps looking for evidence?

      Gawd, you are a prize dill.

      • @Frank Collons

        Please state the definitions of both witchcraft and modern, mainstream chiropractice and then intelligentlty prove why you think the two are one and the same. I wonder, if one were to list the ramifications of for-profit, medical quack research which has led to many iatrogenic deaths at the hands of “modern medicine,” how “witchcraft-ish” it would appear to unbiased readers? The thalidomide disaster and the more recent Paxil/GSK quack-scam come to mind as giant warts on the medical establishment which are imbued with the pox of pseudo-science. Both of these individual incidents have killed more patients than chiropractic has allegedly killed since the 1800’s.

        • @Logos-Bios on Thursday 09 February 2017 at 16:46

          Do you ever have an original thought? These allegations have been made and dispensed with many times before. Chiro deals with the worried well while medicine concerns itself with real illnesses, many potentially life threatening.

          I wonder whether it is because you are nowhere near as intelligent as your wife and daughter?

          • @Frak Collins

            I have attempted to be as polite as possible in responding to your snide comments which offer little-to-zero insight into most topics. “Dispensed with” generally means to have resolved a matter adequately; simply because you have tried and failed in the past to “dispense with” truths about “modern medicine” does not mean that you have produced a convincing argument to have literally put the matter to rest; hint….you haven’t! I even posted a reference for you as to why an MD might refer (many do) to a DC. You conveniently ignored it (surprise!).

            I still have yet to decide for myself whether you cannot, or simply choose not to comprehend clearly written comments.

          • @Logos-Bios on Friday 10 February 2017 at 01:05

            “I have attempted to be as polite as possible in responding to your snide comments which offer little-to-zero insight into most topics.”

            Bullshit, you have been a snide name-caller from the outset. Who used “Frankentool” a long time ago? I was willing to be charitable but now realise you are nothing but a liar.

            ” “Dispensed with” generally means to have resolved a matter adequately; simply because you have tried and failed in the past to “dispense with” truths about “modern medicine” does not mean that you have produced a convincing argument to have literally put the matter to rest; hint….you haven’t! I even posted a reference for you as to why an MD might refer (many do) to a DC. You conveniently ignored it (surprise!).”

            I answered the question, that is, it is totally unnecessary to involve a non-medical person in medical treatment.

            “I still have yet to decide for myself whether you cannot, or simply choose not to comprehend clearly written comments.”

            To Quoque or, in your case, the spelling of the second word should be crass to reflect your character, or lack of it.

          • @Frank Collins

            I believe I recall that “Frankentool” was proffered about the same time as you referred to me as “detestable scum.” I believe such an attack reflects negatively on your character.

            I wonder why you have as yet been unable to comprehend the initial countenance I provided by way of a reference regarding why a GP might refer to a chiropractic professional. Either you’re too stubborn to acknowledge it or you’re simply unable to intellectually assimilate it. Either way, your statements on this issue are merit-less.

            I love it when I read your Tu Quoque claims regarding various comments; I admit that the claims are sometimes substantiated. I find it interesting, however, that you inject more logical fallacies of various types into your posts than just about anyone on this site….and you retreat into apoplexy when you are called on them. Priceless!

          • @Logos-Bios on Saturday 11 February 2017 at 01:42

            “you referred to me as “detestable scum.””

            Only because you are………….detestable scum. By-the-way, the full stop should be outside the quotation marks. Oh, what an envious little knob you are; wife a PT and daughter a real doctor. lol

    • Critical_Chiro wrote on Thursday 09 February 2017 at 02:20 : “Recognizing the important role of chiropractors…Health Canada asked the profession to be part of Canada’s opioid action plan late last year…So the chiro’s were INVITED as were all the other organizations and your response is…..??

      @ Critical_Chiro and @ evidencebasedDC

      What is it that you don’t understand about this: “The fact that a chiropractor (Jason Busse) was prominent in developing the CND opioid guidelines *shows very clearly that the chiropractic bait and switch continues to be ignored by authorities who should know better*.” ??
      https://sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/

      ______________________________________________________________________
      “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
      Björn Geir Leifsson, MD

    • @Frank Collins

      It’s interesting that you imply disgust with snide name-calling yet you have referred to Critical_chiro as Clown Chiro. You really need to contemplate what you write before you click on “POST REPLY.” Your blatant hypocrisy would be less evident.

  • I’ve had severe chronic neck/head pain for over a decade, and it took three or so years of visits to doctors and physical therapists before I was prescribed an opiod, and it was the only thing that decreased my pain somewhat. Before this, I tried more than a dozen different types of alternative medicine with chiropractic being the main one having done that for most of my life (it was unavoidable being raised by a chiropractor who believed that you should get adjustments at least weekly and also believed in everything from homeopathy to cranial sacral therapy and rolfing). I sometimes wonder if the frequent neck adjustments is what caused my pain, but I also sometimes think it could be due to an anxiety disorder. Anyway, I no longer do any sort of alternative medicine, but I would be open to any sort of non-drug evidence based treatments if they exist. I’ve already tried trigger point injections and occipital nerve blocks with no success. Also did several months of physical therapy. One neurologist I saw recently recommended mediation, which I had tried before, but it didn’t ever help with my pain and anxiety, but I don’t know a lot about it, so it’s possible I did it incorrectly. My suspicion about meditation is that it’s no better than other forms of relaxation and could greatly vary depending on the individual. The same neurologist also recommended Botox, but it just got declined by my insurance.

    But anyway, back to opioids. I often wonder why people are overdosing. It’s hard for me to picture since I’m not addicted and know that you shouldn’t play around with drugs. Are they doing it because they’re ignorant of the danger of drugs at a higher dosage? Or is the pain so unbearable that they think they can’t manage without a higher dose?

    • not so much over-dosing as over-using!

    • I have chronic pain from adhesions, four or five times a year it gets really bad and the temptation to overuse is very strong, I just want the pain to stop. I know perfectly well that opioids are dangerous, that I need to be on the lowest dose possible of the weakest opioid that will control the pain when I am not in extreme pain. When I am in extreme pain it gets far more difficult to be rational as the pain interferes with my ablity to think, to hold onto a thought long enough to finish it. I don’t think I’ll overdose on opioids as being in the UK they all come in foils so you have to get them out one at a time making it harder to absentmindedly take too many, however the lack of concentration means I can’t always remember when I last took painkillers and if I haven’t written it down that can be a problem. As I said I try to take the minimum amount of the weakest dose to be effective so as the pain varies from day to day the dose varies and sometimes I don’t need to take any, but that means I don’t have regular specific times to take the pills. I don’t think I’m at high risk of overdosing by taking too many in too short a time, but the niggling doubt that I might is there.

      With regard to the meditation, it isn’t all the same. I did a Compassion in Pain course run by a local NHS Pain Clinic that included meditation not as a way of trying to stop the pain, but as a way of becoming very aware of what your body was doing so if it was eg hunching up you could adjust your posture which would ease the pain a little. It is surprisingly easy to become tense without realising it and that usually exacerbates pain. It can also be a way of taking a break from the constant fretting about gettig things done with reduced capacity that many people find comes with chronic pain. The whole course was aimed at people whose pain can not be resolved, to try to help us live well despite the pain.

    • Definitely an increase in deaths due to overdose.

      “The United States is experiencing an epidemic of drug overdose (poisoning) deaths. Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids (opioid pain relievers and heroin). CDC analyzed recent multiple cause-of-death mortality data to examine current trends and characteristics of drug overdose deaths, including the types of opioids associated with drug overdose deaths. During 2014, a total of 47,055 drug overdose deaths occurred in the United States, representing a 1-year increase of 6.5%, from 13.8 per 100,000 persons in 2013 to 14.7 per 100,000 persons in 2014″

      ” Opioid pain reliever prescribing has quadrupled since 1999 and has increased in parallel with overdoses involving the most commonly used opioid pain relievers (1). CDC has developed a draft guideline for the prescribing of opioids for chronic pain to address this need.¶”

      https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm.

      Alison Dantas, and the CCA, which were invited by Health Canada to be part of the solution to the opioid crisis. The Canadian Chiropractic Association said they could contribute in the areas of spine and musculoskeletal pain. This is within the scope and expertise of Canadian chiropractors who are educated and trained as MSK experts.

      • @ evidencebasedDC

        Those are quite comprehensive stats. Do chiropractors and other alternative medicine providers supply similar? Here’s a snippet from Death by Medicine, FYI:

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

        ______________________________________________________________________
        “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
        Björn Geir Leifsson, MD

      • Hmmmm…….Blue couldn’t refute your position so he changed the subject. Not surprising.

        • @ Logos-Bios

          I’m not sure if you deliberately ignored the point I was making, or whether you failed to understand it. Here it is again anyway:

          “The ironic thing is that all the statistics these doctor-bashers have accumulated come from the medical literature that those bashed doctors have written themselves. Scientific medicine constantly criticizes itself and publishes the critiques for all to see. There is NOTHING comparable in the world of alternative medicine.”

          ______________________________________________________________________
          “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
          Björn Geir Leifsson, MD

          • @Blue

            I see that you still haven’t rebutted Evidence’s position.

            Regarding the CDC articles you listed, it’s surprising that you didn’t grasp that they were statistic-gathering affairs which were calculated and authored by lawyers, PhD’s, and forensic accountants, primarily. I couldn’t find any acknowledgement of funding for the data by any medical associations, individual MD’s, or medical schools. Therefore, I’m curious as to why you listed them as exemplars of “modern medicine’s” self-policing.

            In fact, the CDC involves itself admirably in infectious disease research, global health concerns, and D.O.D. matters; it also investigates over-prescribing of opioids and the negative effects therein. Note that the researchers within CDC, whether medical or statistical(e.g. the currently discussed results regarding opioids), are paid employees. CDC is primarily funded by Congressional appropriations, the State Dept, and USAID. In other words, “modern medicine” is not funding the statistical research you referred to in your post; and most of the work done to compile the statistics was not even done by MD’s.

            There is nothing hypocritical about any doctor, or any person, who would access CDC information which has been acquired and compiled with taxpayer dollars. The data has been provided for use by everyone. Why do you conflate alleged “self-criticism” (within medicine) in this opioid discussion with a purported lack of same within paramedical literature? Your conflation exemplifies a logical fallacy(i.e. faulty analogy)……surprise!

  • AN Other wrote on Thursday 09 February 2017 at 12:13 : “Just out of interest can you point to directories available to the public and healthcare professionals to which they can turn to find physiotherapists or osteopaths who read good, scientific journals and who look for best evidence and apply it?”

    @ A N Other

    Are you saying that the far less severe shortcomings of osteopathy and physiotherapy excuse the chiropractic ‘bait and switch’? Because let’s get real here: despite regulation, millions of chiropractic customers are being duped out of their time and money. Additionally, some are being harmed, and not just through injuries caused by manipulation – there’s also psychologic harm related to unnecessary treatment [nocebo effect], psychologic harm caused by exposure to false chiropractic beliefs about ‘subluxations’, and children are being harmed through misinformation given to parents about vaccinations.

    For readers who may be unaware, it’s worth remembering that osteopathy in the U.S. has moved on (osteopaths there have been on a par with medical doctors for many years), and physiotherapists are far less mired in quackery than chiropractors – e.g. in the UK, around 12 % practice acupuncture. Furthermore, physiotherapists and osteopaths are far more judicious when it comes to using neck manipulation. See Fig.2 here:
    http://web.archive [DOT] org/web/20070225062100/http://www.ptjournal.org/cgi/content/full/79/1/50

    ______________________________________________________________________
    “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
    Björn Geir Leifsson, MD

    • There is no evidence that cervical manipulation causes stroke or that seeing a chiropractor increases the risk of stroke.
      The adverse events with manipulation are similar to exercise, transient stiffness a bit of pain.

      The “injuries” caused by manipulation are virtually non existent, unlike injuries secondary to opioids, NSAIDs, surgeries or injections, other treatments for neck pain.

      Evidence based guidelines recommend manipulation for both acute and chronic neck pain. This applies to any profession who has manipulation as part of their scope of practice.

      Lastly, there is MORE strain on the cervical arteries checking cervical rotation or doing a shoulder check while driving and playing sports. Should we stop playing sports and checking ROM or doing shoulder checks since there are more forces on the arteries than a typical cervical manipulation?

      • @evidencebasedDC on Thursday 09 February 2017 at 23:29

        As the prof can’t find the evidence to which you refer, would you be kind enough to provide the RCTs which support your claims?

      • evidencebasedDC wrote: “There is no evidence that cervical manipulation causes stroke or that seeing a chiropractor increases the risk of stroke.”

        @ evidencebasedDC

        The Cassidy study, to which you seem to be referring, was fatally flawed:
        http://edzardernst.com/2015/01/chiropractic-neck-manipulation-can-cause-stroke/

        Here are some valuable links for you on the subject of complications arising from neck manipulation which cannot be denied by chiropractors…

        Dozens of published case reports in the scientific literature (covering c. 70 years):
        http://www.vertebralarterydissection.com/VAD-research/chiropractic-stroke-and-death.pdf

        A loose directory of reports of other deaths and catastrophic injuries associated with neck manipulation:
        http://www.ebm-first.com/chiropractic/risks.html

        Evidence that inappropriate neck manipulations are rife:

        QUOTE
        “Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them (11). And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment.”
        Ref: Spinal manipulation for the early management of persistent non-specific low back pain — a critique of the recent NICE guidelines, Edzard Ernst, Int J Clin Pract (18th August 2009). Reference (11) is Ernst E. Chiropractic: a critical evaluation. J Pain Sympt Man 2008; 35: 544–62. Page 6 of the paper mentions a report that indicates that only 11% of all cervical manipulations are “appropriate” and gives the reference Coulter I, Hurwitz E, Adams A, et al. The appropriateness of manipulation and mobilization of the cervical spine. Santa Monica, CA: RAND, 1996:18e43.
        (In fact, spinal manipulations in general don’t seem to be appropriate: http://edzardernst.com/2015/08/chiropractic-spinal-manipulation-placebo/ )

        U.S. chiropractors have no patient adverse event reporting systems due to a loophole:
        http://www.ebm-first.com/chiropractic/risks/1842-letter-from-britt-harwe-president-chiropractic-stroke-awareness-group-csag.html

        A summary of the only, and largely useless, chiropractic adverse event monitoring systems that are currently in place:
        http://tinyurl.com/6dhcxdc

        A chiropractor confesses: if [I] were to tell patients that “I can kill you”, then “half of them would walk out”
        http://www.ebm-first.com/chiropractic/risks/464-amani-oakleys-closing-in-the-lana-dale-lewis-inquest.html

        Readers might also be interested to know that reports of deaths after chiropractic treatment are “about three times the number of deaths from trovafloxacin, an excellent antibiotic abandoned in the U.S. as too dangerous”…
        https://www.sciencebasedmedicine.org/compare-and-contrast/

        In essence:

        “there is evidence to support a strong enough probability of causation to constitute a good reason to avoid neck manipulation”

        Link: https://www.sciencebasedmedicine.org/chiropractic-and-stroke-no-evidence-for-causation-but-still-reason-for-concern/

        ______________________________________________________________________
        “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
        Björn Geir Leifsson, MD

        • @Blue Wode
          I would have to disagree with you there Blue! You are confusing association and causation.
          Please have a read of the latest research paper from Cassidy and Cote here:
          http://www.strokejournal.org/article/S1052-3057(16)30434-7/abstract
          Reading the literature its association which cannot be ruled out!

          As for Adverse Event reporting systems there are none for Chiro, Physio, Ostoe or GP’s!
          I’m all for establishing such a system for all professions! There was a push for such a system to be established in hospital Emergency departments here but the doctors “Sniveled” over the cost and it went no further!

          • @ Critical_Chiro

            QUOTE
            “Conclusions
            We found no excess risk of carotid artery stroke after chiropractic care. Associations between chiropractic and PCP visits and stroke were similar and likely due to patients with early dissection-related symptoms seeking care prior to developing their strokes.”

            The risk is there, and the bottom line is that the (perceived) benefit of chiropractic care does not outweigh that risk.

            IOW, with no reliable methods to screen for patients who might be predisposed to a dissection, and given that the paper says “Patients with carotid artery dissection can present with neck pain and/or headache before experiencing a stroke. These are common symptoms seen by both chiropractors…”, chiropractors should be leaving customers with neck pain and/or headaches well alone.

            ______________________________________________________________________
            “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
            Björn Geir Leifsson, MD

          • @Blue

            You stated, “The risk is there” and that the perceived benefit of chiropractic care does not outweigh the risk. Yet you have produced no hard evidence to support your claim and have still failed to acknowledge the references I previously posted which render dubious your position on this matter of negative/fatal ramifications of chiropractic care.

            I have reported a number of times about the mortality risks regarding bariatric surgery which are hugely greater than those of Chiropractic cervical SMT. Patients who undergo bariatric surgery face a higher risk of death related to the procedure than previously thought, and elderly patients have a particularly high risk, according to a study published in the Journal of the American Medical Association, the Washington Post reported. Researchers led by David Flum, an associate professor of surgery at the University of Washington, analyzed data from 16,155 Medicare beneficiaries who underwent any kind of bariatric surgery between 1997 and 2002. The patients had an average age of 48. According to the study, 2% of participants died in the first month after surgery, while nearly 3% died in the first three months and 5% in the first year after the procedure (Stein, Washington Post, 10/19). Men who underwent the weight-loss procedure faced double the mortality risk of women; 3.7% of men died within the first 30 days following surgery, compared with 1.5% of women. In addition, the study says that 7.5% of men died within a year, compared with 3.7% of women (Rabin, Long Island Newsday, 10/18).

            Flum said the study results are “a reality check for those patients who are considering these operations.” He added that previous research on bariatric surgery — which found death rates to less than 1% — were based on “reports from the best surgeons reporting their best results.” Only the BEST SURGEONS? Not “average” surgeons? It seems that bariatric surgery advocates are playing the game of “hide the mole” in their quest to squelch the dissemination of their procedures’ negative outcomes. Why do you have no concern about this, Blue? If you fancy yourself a critic (er, camedic), please at least be consistent in your criticisms relative to the risks of various procedures.

          • Logos-Bios wrote: “I have reported a number of times about the mortality risks regarding bariatric surgery which are hugely greater than those of Chiropractic cervical SMT. Patients who undergo bariatric surgery face a higher risk of death related to the procedure than previously thought, and elderly patients have a particularly high risk, according to a study published in the Journal of the American Medical Association, the Washington Post reported. Researchers led by David Flum, an associate professor of surgery at the University of Washington, analyzed data from 16,155 Medicare beneficiaries who underwent any kind of bariatric surgery between 1997 and 2002.

            Logos-Bios repeatedly tells off critics on this blog for several things. One is for living in the past (as if Big Snakeoil exponents never proffers arguments from antiquity!). Well, I’ve got news for L-B. The current year is 2017, and data from 1997–2002 look kind of outdated. A very quick search turned up This more recent review from the same Journal of the American Medical Association favoured by L-B. Please note the surgery-attributable (30-day) mortality in this huge meta analysis was 0.08% and mortality rate after 30 days was 0.31%. Please update your data, Logos-Bios. You’re coughing from your colon with your antique numbers. (And you’re still failing to acknowledge that most patients who are candidates for bariatric surgery are at enormous risk of death, unlike people consulting chiros.)

            Another thing Logos-Bios complains of is that data on medical risks are compiled by mere “lawyers, PhD’s [sic], and forensic accountants” at the CDC. “…most of the work done to compile the statistics was not even done by MD’s [sic]”. Apart from getting over his use of greengrocers’ apostrophes and citing obsolete data, L-B might like to contemplate (a) that CDC doesn’t compile any statistics on risks of bariatric surgery, and (b) that the study he cites was funded by National Institute of Diabetes and Digestive and Kidney Diseases grants, which come from Congressional appropriations, so by his criteria they can’t have anything to do with ‘modern medicine’.

            L-B may retort that the authors of the study I cited also includes two mere PhDs and a mere MPH (Master of Public Health, not a reference to a velocity) as well as three MDs; and it was funded mainly by a grant from NIH (Congressional appropriations), therefore it can’t have anything to do with ‘modern medicine’. Alternatively, he might expand his blinkered thinking to recognize that ‘modern medicine’ has broader horizons than he can conceive of from his narrow chirocentric viewpoint, encompassing all the medical, scientific and statistical staff at CDC. (The hint is in the name: Centers for Disease Control and Prevention.)

          • @Frank Odds

            Living in the past, eh? 20 years is a bit different than 122 years relative to healthcare practices, wouldn’t (even) you agree? I wonder if the results of your cited bariatric surgical study were cherry-picked from those of only the “best” surgeons” as were those noted by Dr. Flum? Perhaps I’ll review the study and offer further comments.

            Where did I state that the CDC compiles stats on bariatric surgery or that the study I mentioned regarding same had anything to do with the CDC? Focus, Frank…..you are confusing Blue’s and my discussions of opioid adverse-effects reporting and my concerns about the fatality risks of bariatric surgery relative to chiropractic cervical SMT.

            I agree that medicine in general has broad horizons, certainly broader than those within limited-scope chiropractic, PT, psychology. etc. Furthermore, I have acknowledged that the CDC is thankfully involved in disease understanding and control. However, your mention of same regarding my conversation with Blue represents a big, whopping LOGICAL FALLACY (red herring). The function of the CDC as I’ve clearly been discussing it is in regard to data collection on opioid fatalities; I have not dissed the CDC in any way. Why do you think otherwise?

            I note that you admitted the NIH funded the study you cited; not individual MD’s, not hospitals, not MCO’s, not Big Pharma, and not “modern medicine(defined here as PCP’s and specialists).” The NIH PAID various professionals to do the research with taxpayer dollars. Admittedly, the NIH also funds some chiropractic research but the size of the chiropractic grants relative to medical ones are analogous(humor intended) to the size of a Jetta compared to the size of Mars. Do you suppose the study would have been undertaken if the surgeons had been required to fund it themselves?

          • @Blue Wode
            There was no difference in incidence between patients seeing a chiro and a PCP doctor!
            The paper stated:
            “Another potential explanation of our results is that both DC and PCP care increase the risk of these strokes. However, because PCPs do not usually manipulate the cervical spine, or provide other care that significantly increases the risk of stroke in young people, this explanation is unlikely. It is likely that the weak associations seen between PCP care and stroke in older individuals are due to comorbid disease, as sicker, older individuals are more likely to consult a PCP than a DC.”

    • @Blue

      You are correct that US osteopathic doctors are now the equivalent of medical doctors. Some of the history regarding osteopaths’ “acceptance” by “modern medicine” as viable members of the US healthcare team bears mention.

      Consider medicine and osteopathy in the early part of the last millenium and into the 1960’s. MD’s in the late 50’s and in 1960 referred to DO’s as quacks, quacksters, rabid dogs, uneducated zealots, and killers; of course they claimed that such descriptors were based on science. Interestingly, the true political nature of organized medicine’s “turf protection” was exposed when the medical profession acquired the COP&S to benefit itself financially and, as a quid pro quo, offered DO’s the opportunity to simply exchange their DO degrees for MD degrees. Of course this blatantly expedient action exposed medicine as hypocritical, political, and self-serving. Think of it: medicine stated that osteopaths were quacks in 1960 but then conferred to osteopaths MD degrees in 1961 simply to advantage itself. Surely “modern medicine” must always be viewed as altruistic! lol Medical and osteopathic docs were ostensibly part of the same profession but political motivations and individual prejudices by so-called objective medical physicians prevented practitioners of the professions from co-practicing, or even associating with each other.

      • @Logos-Bios on Friday 10 February 2017 at 01:14

        That so-called “turf war” was waged by the quacks based on anti-competitive laws, not whether or nor osteopaths were valid healthcare providers. Trust you to twist it.

        • Prove your point, Frank. I don’t trust YOUR interpretation of the matter. Besides, your use of the term “quacks”(presumably referring to DO’s) implies that you still bear pre-1961 bias against osteopathic physicans. I never would have guessed that you were biased or opinionated.

          • @Logos-Bios on Saturday 11 February 2017 at 01:52

            Why the need to prove what is clear from the judicial decision? I’m not going to re-write for the simpletons among us.

      • In the UK, it’s important to be aware that osteopaths are very similar to chiropractors. They both use treatments that have little or no evidence base. (This is different to the situation in the US.)

        NICE is very clear that exercise is the first-line treatment for low back pain and sciatica and that manipulation can only be considered as an add on to exercise because there is lack of evidence of benefit when used alone: https://www.nice.org.uk/news/article/nice-publishes-updated-advice-on-treating-low-back-pain This means that osteopaths and chiropractors are very poorly placed to treat someone with back pain or to help in the reduction of opioid use.

      • Logos-Bios wrote: “medicine stated that osteopaths were quacks in 1960 but then conferred to osteopaths MD degrees in 1961”

        @ Logos-Bios

        But, unlike chiropractors, osteopaths in the U.S. have cleaned up their act. It’s worth remembering that the American Medical Association also viewed chiropractors as quacks in the 1960s…
        https://www.chirobase.org/08Legal/AT/at00.html …and that seems to have stuck. (No prizes for guessing why.)

        BTW, Logos-Bios, you still haven’t answered my “do you have any better data?” question that I put to you in October last year:
        http://edzardernst.com/2016/10/top-model-died-as-a-result-of-visiting-a-chiropractor/#comment-83306

        Frank Collins commented to Logos-Bios: “you have been a snide name-caller from the outset. Who used “Frankentool” a long time ago?”

        I think this is a good time to remind readers of this post by Professor Ernst:
        http://edzardernst.com/2016/10/the-12-defences-of-charlatanry/

        Snippet:

        THEY WILL TRY TO RIDICULE THE CRITIC. Readers of this blog will have noticed how some commentators belittle their opponents by giving them laughable nicknames thus undermining their authority. The obvious aim is to make them look less than credible. Charlatans are like little children.

        THEY WILL CLAIM THAT IN OTHER AREAS OF HEALTHCARE THE EVIDENCE IS ALSO NOT CONVINCING. The ‘tu quoque’ fallacy is popular for distracting from the embarrassingly negative evidence in quackery – never mind that problems in the aviation industry are no argument for using flying carpets.

        ______________________________________________________________________
        “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
        Björn Geir Leifsson, MD

        • @Blue

          I smile whenever you quote Geir regarding just about anything chiropractic; camedics’ aphorisms don’t make for foundational references, FYI.

          Regarding the model who allegedly was killed via cervical SMT; I don’t believe that the case has been fully, or perhaps even initially, litigated. I did produce reference relative to alleged chiropractic cervical SMT fatalities. Feel free to research Edzard’s older threads.

          Edzard authored his egoistic, fictional “Defenses of Charlatanry” in regards to homeopathy, not chiropractic. You should know subject of the material you reference before you post it. Furthermore, it’s a dubious practice to try to prove your points by referencing opinion posts or comments on a blog.

          “Ridiculing the critic by giving them laughable nicknames……” So true: I have been called Log, Logos-Bias, Detestable scum, etc. when I have noted the hypocrisy of some folks on this site.

          Tu Quoque fallacies? There are plenty of logical fallacies promulgated by camedics (comedic critics) on this site and I have pointed out some of the culprits in this and other threads.

          LMAO at your analogy of aviation-industry problems’ not arguing for flying carpets. Aviation industries are actual entities; flying carpets do NOT exist. Please note that bogus, profit-driven, corrupt research conclusions by drug companies(example: Paxil/GSK), and the dissemination of such conclusions to MD’s cost patient lives, and these charlatan-esque deceptions do exist. Chiropractic DOES exist. Your false analogy of disparates evinces poor literary understanding and renders it impotent at best, laughably ludicrous at worst. Just sayin’………

          • @ Logos-Bios

            Your arguments are embarrassingly feeble. For example:

            QUOTE
            ““Ridiculing the critic by giving them laughable nicknames……” So true: I have been called Log, Logos-Bias, Detestable scum, etc. when I have noted the hypocrisy of some folks on this site.”

            I wonder why you have called me ‘Blue Wad’ in the past even although I have always addressed you as Logos-Bios:
            http://edzardernst.com/2016/10/top-model-died-as-a-result-of-visiting-a-chiropractor/#comment-82966

            Was there a good reason for that?

            Also, I repeat once again, you still haven’t given a direct answer to my “do you have any better data?” question that I put to you in October last year:
            http://edzardernst.com/2016/10/top-model-died-as-a-result-of-visiting-a-chiropractor/#comment-83306

            ______________________________________________________________________
            “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
            Björn Geir Leifsson, MD

          • The Blue Wad comment? Would you believe it was merely a typo? I’m sorry if it insulted you.

            Do you consider your recurrent parroting of Geir’s derogatory statements about modern, mainstream chiropractice as being related to 1800’s chiropractic to be a polite inclusion during conversation?

            Feeble arguments from me, you claimed. You have been unable to rebut them so either my arguments were adequate or you simply don’t have the chops to counter them. Which is it?

            Again I state, I have provided research relative to deaths from chiropractic cervical SMT. You may research it and get back to me with any questions you might have.

  • Logos-Bios wrote: “The Blue Wad comment? Would you believe it was merely a typo?”

    No, I don’t believe that it was.

    Logos-Bios wrote: “Do you consider your recurrent parroting of Geir’s derogatory statements about modern, mainstream chiropractice as being related to 1800’s chiropractic to be a polite inclusion during conversation?”

    His statement is neither derogatory nor impolite. It simply gets to the heart of the matter and, evidently, it hits a nerve with you.

    ______________________________________________________________________
    “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
    Björn Geir Leifsson, MD

    • Geir’s parroted comment doesn’t bother me; it’s easy to laugh it off considering who its original author is. The fact that you include it in your posts while implying that I have treated you irreverantly is hypocritical on your part.

      • …considering who its original author is…

        It happens I have a look at your comments L-B, but only if they are short and include my middle name, which you seem to have a particular affection for. This one made me so proud you deserve this personal note of gratitude. Now back to ignoring established ineptitude…

        • Geir stated, “This one made me so proud you deserve this personal note of gratitude……” You’re welcome, Geir.

          Geir also stated, “Now back to ignoring established ineptitude….” I appreciate this latter thought as it applies to much of what I read by camedics on this blog.

  • Logos-Bios wrote: “Note that the researchers within CDC, whether medical or statistical (e.g. the currently discussed results regarding opioids), are paid employees. CDC is primarily funded by Congressional appropriations, the State Dept, and USAID. In other words, “modern medicine” is not funding the statistical research you referred to in your post; and most of the work done to compile the statistics was not even done by MD’s [sic].”

    @ Logos-Bios

    The fact remains that there is NOTHING comparable in the world of alternative medicine.

    ______________________________________________________________________
    “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
    Björn Geir Leifsson, MD

    • @Blue

      You have had a rough go of it in this thread, Bluesy. Your overt jealously of Dr. Moreau, highly successful Medical Director of Team USA, was exposed; also evident was your hesitance to admit his excellence simply because he is a chiropractic, not a medical, physician.

      You criticized the lack of publications/directories available to the public that would document which DC’s read good, scientific journals, yet you failed to provide AN with an answer to his question about such directories which would apply to DO’s and PT’s. Hypocrisy on your part?

      You implied that chiropractic/paramedical disciplines do not fund or engage in research such as that provided by the CDC. You stated, “The ironic thing is that all the statistics these doctor-bashers have accumulated come from the medical literature that those bashed doctors have written themselves. Scientific medicine constantly criticizes itself and publishes the critiques for all to see. There is NOTHING comparable in the world of alternative medicine.” Unfortunately, your allegation that “modern medicine” had funded this research was exposed as bogus. I’ll re-state my objection to your position on this matter.

      Regarding the CDC articles you listed, it’s surprising that you didn’t grasp that they were statistic-gathering affairs which were calculated and authored by lawyers, PhD’s, and forensic accountants, primarily. I couldn’t find any acknowledgement of funding for the data by any medical associations, individual MD’s, or medical schools. Therefore, I’m curious as to why you listed them as exemplars of “modern medicine’s” self-policing.

      In fact, the CDC involves itself admirably in infectious disease research, global health concerns, and D.O.D. matters; it also investigates over-prescribing of opioids and the negative effects therein. Note that the researchers within CDC, whether medical or statistical(e.g. the currently discussed results regarding opioids), are paid employees. CDC is primarily funded by Congressional appropriations, the State Dept, and USAID. In other words, “modern medicine” is not funding the statistical research you referred to in your post; and most of the work done to compile the statistics was not even done by MD’s.

      There is nothing hypocritical about any doctor, or any person, who would access CDC information which has been acquired and compiled with taxpayer dollars. The data has been provided for use by everyone. Why do you conflate alleged “self-criticism” (within medicine) in this opioid discussion with a purported lack of same within paramedical literature? Your conflation exemplifies a logical fallacy(i.e. faulty analogy)……surprise!

      You demonstrated literary incompetence by proffering an analogy of disparates (aviation industry vs. flying carpet) in your attempt to diss chiropractice; I was happy to inform you of your error for the purpose of education only (You’re welcome!).

      You still haven’t answered AN’s question, have you? BTW, I would also enjoy reading any comments on the number of documented chiropractic cervical SMT deaths/morbidity compared to similar iatrogenic ramifications of the Paxil/GSK medical quack-scam. Camedics don’t appreciate inconvenient truths, I’ve been told.

      • @Logos-Bios

        Just curious. Where do the CDC statisticians get their incidence and mortality data from? Most countries have similar, government-funded agencies to compile medical data centrally, but, assuming the statisticians don’t invent their numbers, just who might be supplying them?

        • Most of the data on opioid deaths are mined by taxpayer-paid forensic accountants’ reviews of death certificates and by taxpayer-funded and publicly elected coroners who submit reports. Just curious, but you’re not attempting to imply that “modern medicine” itself is funding and performing these investigations, are you?

          • Oh dear goodness! This is going to become tedious!

            Who writes the death certificates? And can any mental defective be elected to the position of coroner in the USA? Or do they need to be qualified as an MD?

            To cut to the chase: these ‘taxpayer-funded and publicly elected’ minions you seem to deprecate are processing data supplied from MDs. Is it appropriate for MDs to spend time compiling their own statistics? Few have been trained for the purpose. But the ramifications of ‘modern medicine’ spread over a vast network of individuals who play supporting roles. For which they have appropriate qualifications. (These do not include pseudo-scientific charlatans who practise ‘alternative’ approaches to medicine that lack an evidence base.)

          • @Frank Odds

            Let’s do cut to the chase, Frank. You have taken Blue’s and my conversation on a slight tangent, but I would like to clarify my points a bit more. Recall that Blue averred that the mentioned opioid stats and other major research results were only available in medical literature and I pointed out that such was not accurate. You may wish to refresh your memory and review my comments on the matter.

            Please state what YOU believe is “the medical literature.” Is it Big Pharma studies(phase 1,2,3, or 4), Big Pharma tox studies, clinical studies, epidemiological studies. medical-device physical lab studies/clinical studies? Are studies of medical procedures, ethics, prescribing patterns, spinal manipulation, or even physicians’ mental heath assessments part of the medical literature even when such do not involve medical physicians? I could go on, but you probably get the point. My point to Blue was that the CDC stats we were discussing did not really speak to self-policing by “modern medicine.” Ergo, I stated that he could not claim or imply that medicine was responsible for them since it neither paid for or participated significantly to their publication.

          • Dear Logos-Bios,

            My comments are related not specifically to any discussion between you and Blue Wode. I read all the comments in a thread that interests me. This discussion began, in fact, on 07 Feb when, in part of a comment addressed to you, I wrote: “We have no idea of the death rates attributable to chiros manipulating cervical spines, because there’s no-one keeping adequate records, unlike mainstream medicine, which works hard to discover and rectify its errors.” These are general points, not specific ones.

            On 10 Feb Blue Wode responded to evidencebasedDC with: “The ironic thing is that all the statistics these doctor-bashers have accumulated come from the medical literature that those bashed doctors have written themselves. Scientific medicine constantly criticizes itself and publishes the critiques for all to see. There is NOTHING comparable in the world of alternative medicine.” General points, once again.

            Instead of sticking to the general point about medical self-criticism vs. altmed non-self-criticism raised thus far, on 11 Feb you shifted the goalposts to make the issue about the detail of the CDC and sources of funding: “Regarding the CDC articles you listed, it’s surprising that you didn’t grasp that they were statistic-gathering affairs which were calculated and authored by lawyers, PhD’s, and forensic accountants, primarily. I couldn’t find any acknowledgement of funding for the data by any medical associations, individual MD’s, or medical schools. Therefore, I’m curious as to why you listed them as exemplars of “modern medicine’s” self-policing.”

            In my comments I have endeavoured to make two main general points. The first is that while doctors (and their patients) in most civilized countries have systems in place for both mandatory and voluntary reporting of deaths and adverse events, camistry offers nothing comparable.

            The second is that ‘modern medicine’ includes a far greater diversity of specialities and talent than you seem to appreciate. You ask what I believe is “the medical literature”. That’s easy: everything that’s covered by Ovid Medline (and Index Medicus, which dates back to 1879). That includes most basic biological research, as well as clinical research, epidemiology, public health and a lot more besides. If a medical practitioner is unaware of the fundamental biological science underpinning the function of the human body then, ethically, we ought not to be practising medicine. This stuff is taught extensively in medical schools, so I know I’m not alone in regarding it as an essential part of ‘modern medicine’.

            After all, without this basic science training, a medic just might come up with bizarre notions that people have an innate, inborn intelligence that controls every aspect of the body, including self-healing: that (unspecified) spinal manipulations can cure back pains and many diseases besides: that substances (including bits of the Berlin Wall and moonbeams) can be serially diluted beyond the point that any molecule of the original substance remains (with banging on a leather-bound book at every dilution stage) and thus be turned into potent cures for every disease: that certain crystals release healing energies that cure diseases, and so on and so forth.

            This thread is about chiropractic, and I recognize that my list is heading off-post, but I’m trying to convey to you the simple thought that what you do in your chiropractic work is, by definition, anti-science, while the current direction of genuine clinical practice is to embrace the value of science as a tool to tell the difference between what works and what doesn’t. And please don’t tell us your version of chiropractic is not vitalistic and not based on unproven spinal manipulation unless you link us to your website so we can see just what the mysterious Logos-Bios does practise. We already know there is ‘no true chiropractor’.

          • @Frank Odds

            Thank you for your most recent post, all but the last two paragraphs of which stated your opinions clearly and reasonably. The last two paragraphs were hooey. Virtually everyone in my chiropractic graduating class had Bachelors degrees in the sciences; I double-majored in biology and chemistry. Furthermore, there was extensive basic science education as part of the chiropractic curriculum and these rigorous courses were taught by PhD’s and MD’s. Innate intelligence was NOT part of my curriculum and diluted substances’ healing properties were never even discussed. In fact, I had never even heard of homeopathy until I had been in practice for a couple of years.

            Your opinion that chiropractic is anti-science is ridiculous. We’ve discussed this point in the past ad nauseum so there’s no reason to rehash it tonight. Camedics on this site enjoy pointing out perceived flaws in research and opinion pieces authored by some DC’s and then ascribing the alleged taint to all of the profession. This is no more fair than dissing all medical research based on the Paxil/GSK scam. We will have to agree to disagree on this topic tonight.

            Thank you for your time in providing your thoughts, Frank.

      • Logos-Bios wrote: “Your overt jealously of Dr. Moreau, highly successful Medical Director of Team USA, was exposed; also evident was your hesitance to admit his excellence simply because he is a chiropractic, not a medical, physician.”

        @ Logos-Bios

        I think that real Dr Cox in the comments here put it very well in his insightful summation of your “esteemed medical director for team USA”. For readers who may have missed it, Dr Cox informed us that Team USA’s medical director was…

        QUOTE
        “…not a legitimate medical director since he has no medical training. Like others, those who chose him were misinformed about the difference in DC and MD, as the chiro world has conned their way into health care. Now I understand why Michael Phelps was persuaded to use and proselytize the ridiculous and fraudulent cupping treatment during the games. This sounds like something a non medical alternative guru would support and likely recommend.”

        I agree.

        Logos-Bios wrote: “You criticized the lack of publications/directories available to the public that would document which DC’s [sic] read good, scientific journals, yet you failed to provide AN with an answer to his question about such directories which would apply to DO’s [sic] and PT’s [sic].”

        The requirement for such directories for osteopaths (NB. equivalent to MDs in the U.S.) and physical therapists are far less important to the point of being unnecessary. On the other hand, chiropractic can be viewed as a healthcare cult which has, as someone once described it, a cult within a cult – and a rather sizeable one at that. Joseph Keating Jr highlights the problem very succinctly in the following quote which is taken from his article, ‘The Meanings of Innate’ (ref. Journal of the Canadian Chiropractic Association, 46,1, 2002, p.10.):

        “…we surely stick out like a sore thumb among professions which claim to be scientifically based by our unrelenting commitment to vitalism. So long as we propound the ‘one cause, one cure’ rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can’t have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time.”

        It’s a pity that the general public isn’t more aware of the problem.

        Logos-Bios wrote: “You implied that chiropractic/paramedical disciplines do not fund or engage in research such as that provided by the CDC…I’ll re-state my objection to your position on this matter.”

        And I’ll restate my position: There is NOTHING comparable in the world of alternative medicine (no matter who conducts the research).

        I’ll also restate a couple of Professor Ernst’s observations from his original post above:

        • Do they [chiropractors] not know that there is considerable doubt over the efficacy of chiropractic manipulation for back pain?
        • Do they [chiropractors] not know that, for all other indications, the evidence is even worse or non-existent?

        IOW, with no standardisation, with a flimsy, diminishing evidence base, and with serious adverse events (including deaths) on record, the risks of chiropractic ‘care’ outweigh any of its perceived benefits.

        ___________________________________________________________

        “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
        Björn Geir Leifsson, MD

        • @Blue

          It’s seldom I read a post as vacuous of anything more than deflection than this latest compsition of yours. You failed to show that Dr. Moreau was anything less than excellent as Team USA’s medical director. Your comment regarding a directory for PT’s and DO’s who read journals stated exactly NOTHING, other than your spurious opinion that DC’s require such directories while others don’t. I did have to smile at your Keating reference which was not germane to the subject at hand; you are desperate to win at least one point in this thread, aren’t you? Sorry to disappoint. lol

          It’s good to see you retreat from your claim about “modern medicine” and its accumulation of data regarding the opiate over-prescribing by MD’s and ramifications (e.g. deaths) deaths of patients. Are you suggesting that DC’s would be incapable of performing the type of research required to actuarially account for negative health outcomes? One doesn’t even have to be a doctor of anything to perform such data collection. You are conflating the protagonists(funders and data miners) of this type of research such that they appear(to you, at least) to be “modern medicine” actors when, in reality, they are forensic accountants and stat collectors; “modern medicine” has little to do with funding such oversight of its practices relative to overdoses. The CDC pays employees to perform such duties; yet here you are implying that “modern medicine,” in its encompassing altruism, has virtually all of its doctors funding, performing, and reporting these outcomes for the benefit of community health. Earth to Blue: taxpayers generally fund the CDC, not “modern medicine.”

          • Logos-Bios wrote: “Are you suggesting that DC’s [sic] would be incapable of performing the type of research required to actuarially account for negative health outcomes?”

            @ Logos-Bios

            Yes.

            For example, in this prospective study ( http://www.ncbi.nlm.nih.gov/pubmed/17906581 Thiel HW, Bolton JE, Docherty S, Portlock JC – Safety of chiropractic manipulation of the cervical spine: a prospective national survey. Spine 2007 Oct; 32(21): 2375-8), over 50,000 neck manipulations were followed up and, apparently, none was found to have caused any serious sided effects. However, Professor Ernst questioned the study’s methodology:

            QUOTE
            “The sample of this survey was sizeable but not large enough to exclude rare events. Thus the authors can only state that, at worst, the risk of serious adverse events within 7 days after manipulation is 2 per 10 000 treatment consultations. If the average patient has a series of 10 treatments, this risk could therefore be as high as 1 in 500 per patient. Given the nature of the risk, i.e. stroke or death, this is by no means negligible.
            The picture gets more complicated when considering the 698 treatment consultations of patients who failed to return for their next treatment. Theoretically some or most or all of these patients could have died of a stroke. Overlooking even one single serious adverse event would change the estimated incidence rates from this study quite dramatically. In my view, the most confusing aspect about the results of this survey is the fact that the incidence of minor adverse events is so low. Previous studies have repeatedly shown it to be around 50%. The discrepancy requires an explanation. There could be several but mine goes as follows: the participating chiropractors were highly self-selected. Thus they were sufficiently experienced to select low-risk patients (in violation of the protocol). This explains the low rate of minor adverse events and begs the question whether the incidence of serious adverse events is reliable.
            Studies of this nature are very difficult to conduct such that we can trust the results. One of the problems is that one has to rely on the honesty of the participating therapists who could have a very strong interest in generating a reassuring yet unreliable picture about the safety of their intervention.”
            [Ref. Ernst, E. Focus Altern Complement Ther 2008; 13: 41–2]

            Interestingly, in their response, two of the survey’s authors, HW Thiel and JE Bolton (both of the Anglo European College of Chiropractic), claimed that, in the UK alone, there were an estimated *four* million manipulations of the neck carried out by chiropractors each year. Yet, six months earlier, in October 2007, in a letter to the Journal of the Royal Society of Medicine, they claimed that the figure was “estimated to be well over *two* million cervical spine manipulations”. How that estimate could double in under six months is anyone’s guess, but it leaves them open to accusations that they may have been trying to play down the risks.

            (HW Thiel, DC, the study’s lead author, is now Principal of the Anglo European College of Chiropractic.)

            ___________________________________________________________

            “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
            Björn Geir Leifsson, MD

          • @Blue

            Your mention of Edzard’s speculations relative to reported risks in the study you mentioned represent a logical fallacy (irrelevant appeal). Not only does his opinion regarding three researchers not pertain to my claim that DC’s obviously can perform data collection regarding adverse effects of opioid overprescribing (or of just about any negative outcomes of various procedures), it also makes one wonder why you would use as an example doctors who actually performed research and made conclusions about it. After all, my point was that DC’s can actuarially data- mine.

            Assuming that your dates were correct as to when the researchers you mentioned proffered, according to you, conflicting estimates of the number of cervical spine manipulations per year in the UK, it seems to me that 4 million IS “well over two million….” Am I incorrect in this conclusion?

  • @ Logos-Bios @ Critical_Chiro

    You both continue to be in denial about the realities of chiropractic. As I have previously pointed out, with no standardisation, with a flimsy, diminishing evidence base, and with serious adverse events (including deaths) on record, the risks of chiropractic ‘care’ outweigh any of its perceived benefits.

    Why could that be?

    The answer appears to lie in Professor Ernst’s conclusion in his post above:

    QUOTE

    “…their posturing is little more than yet another attempt to increase their cash-flow. Personally, I get the impression that they rate their income too far above public health.”

    I am now joining Björn Geir in ignoring the established ineptitude of some of the posters on this blog.

    ____________________________________________________________________

    “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
    Björn Geir Leifsson, MD

  • Fresh off the press:

    https://www.ncbi.nlm.nih.gov/pubmed/28171776

    (Haven’t had time to obtain the full paper)

    • @Geir

      What has this paper to do with opioid over-prescribing by MD’s and resultant patient deaths? Are you still flumoxed regarding Dr Flum’s comments about bariatric surgery fatalities and of dubious under-reporting/misrepresenting of same?

      I, too, look forward to reviewing the paper you mentioned even though it is unrelated to the topic of this thread.

    • Regarding Edzard’s impression that DC’s “value their income too far above public health,” I submit the following:

      “LOSE WEIGHT WITH THE LAP-BAND! SAFE 1 HOUR, FDA APPROVED; 1-800-GET-THIN; 1-800-953-5000; PPO INSURANCE; FREE INSURANCE VERIFICATION”

      I was also appalled at another bariatric surgery ad which
      reads as follows:

      “Dieting Sucks”
      Get the BAND for weight loss
      PPO Insurance/Financing

      High fatality risk (vs. SMT) coupled with aesthetic bariatric surgery doesn’t serve the public very well, only the pockets of bariatric surgeons.

      • One cannot but wonder where this misguided, incessant obsession with bashing bariatric surgery comes from. Cannot be solely personal animosity towards me, can it? Or perhaps I’ve stepped on a couple of sore toes??
        Some of us even pointed out evidence from many parts of the world refuting the erroneous „high fatality risk“ mantra, but doesn’t seem to want to hear or understand. Keeps on echoing the same nonsense. Strange…

        • It should be readily apparent to readers that alleged “valuing of income above public health” can be applied to doctors of varying discliplines.

          Why would Geir think that anyone would have animosity toward him? He’s a wonderful, fair-minded fellow, albeit a bit overly defensive about some of the practices within, and risks of, his chosen specialty.

          Curious……..

  • Meanwhile…

    QUOTE
    “…the danger of sending patients to chiropractor: the wide range of useless pseudo-medicines that are often incorporated into the chiropractic practice along with a propensity for anti-vaccine rhetoric…chiropractic manipulation has no foundation in basic science, its placebo effects are minimal and transient at best, it is dangerous, costly and time consuming for the patient”

    Ref: https://sciencebasedmedicine.org/spinal-manipulation-for-back-and-neck-pain-does-it-work-annotated/

    _______________________________________________________________________

    “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
    Björn Geir Leifsson, MD

    • @Blue

      Chiros who sell bogus pseudo-medicines and dispense anto-vax rhetoric should be shunned; ditto bariatric surgeons who market weight-loss “miracles” to otherwise healthy people who are psychologically compromised because they don’t look like Beyonce or Brad Pitt. The latter of these doctors is much more dangerous due to the previously reported high fatality rates associated with their procedures.

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