MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Charlotte Leboeuf-Yde, DC,MPH,PhD, is professor in Clinical Biomechanics at the University of Southern Denmark and works at the French-European Institute of Chiropractic in Paris. She is a chiropractor with extensive research experience, for example, she was one of the first chiropractors to have studied adverse reactions of spinal manipulation.

Charlotte certainly knows a thing or two about adverse effects of spinal manipulation, and I have always found her work interesting. Therefore, I was delighted to find a recent blog post where she discussed the Cassidy study of 2008 and two opposed views on the validity of this much-discussed paper.

One team (Paulus &Thaler) argued, Charlotte explained, that the Cassidy case-control study is faulty, because vertebro-basilar stroke in general was not separated from stroke specifically caused by vertebral artery dissections, the presumed culprit in cervical spinal manipulation. According to Paulus & Thaler, this would potentially result in a dilution of ‘real’ manipulative-related strokes among all other causes of stroke that are much more common. They argue that the Cassidy-analyses therefore were polluted by this misclassification, whereas the other team (Murphy et al) vehemently disagrees.

The final word is clearly not yet pronounced on this issue, Charlotte concluded, and both teams agree that research has to address various methodological challenges to obtain a trustable answer. Nevertheless, without an international collaboration involving prospective cases this seems an almost impossible task, particularly in view of the rarity of the condition; problems in capturing all cases (going from the reversible to the permanent injuries); the likely large anatomical and physiological variations between individuals; and the daunting task of obtaining relevant and precise descriptions of treatments from a multitude of practitioners.

In the meantime, Charlotte concluded, “practitioners and patients have to make a decision, similarly to judging risk in other walks of life, such as, should I take the plane or stay at home?”

I have always thought highly of Charlotte’s work, however, her conclusion made me doubt whether my high opinion of her reasoning was justified.

Should I take the plane or stay at home?

This question is not remotely similar to the question “should I have chiropractic upper neck manipulation or not?”

Here are a the two main reasons why:

  • Taking the plane of demonstrably effective in transporting you from A to B, while neck manipulation is not demonstrably effective for anything.
  • If you want to go from A to B [assuming B is far way], you need to fly. If you have neck pain or other symptoms, you can employ plenty of therapies other than neck manipulations.

Charlotte Leboeuf-Yde, DC,MPH,PhD, may be a professor in Clinical Biomechanics etc., etc., however, logical and critical thinking do not seem to be her forte.

So, how should we deal with the risks of chiropractic neck manipulations? I think, we should deal with them as responsible healthcare professionals deal with any other suspected therapeutic risks: we must ask whether the known risks of the treatment outweigh the known benefits (as they do with spinal manipulation). If that is so, we have an ethical, legal and moral duty not to employ the therapy in question in routine care. At the same time, we must focus or research efforts on producing full clarity about the open questions. It’s called the precautionary principle!

41 Responses to We have an ethical, legal and moral duty to discourage chiropractic neck manipulations

  • I agree with Dr. Leboeuf-Yde’s thoughts and her conclusions. Apparently, so does organized chiropractic in the USA as disclosure-of-risk forms have been suggested for use by DC’s regarding their patients.

    The “precautionary principle” should be followed relative to upper cervical SMT until there is full clarity regarding the treatment, says Edzard. Should “modern medicine” employ the principle to “bungling amateur” bariatric surgeons (quoted from recent post by Geir) to protect the public health? Should it also apply to off-label prescribing?

    There is no convicing evidence to date that SMT poses a significant health risk. Should such evidence ultimately evince a significantly deleterious outcome probability, the profession would cease the use of the particular upper-cervical technique found to have been problematic.

    • “I agree with Dr. Leboeuf-Yde’s thoughts and her conclusions.”
      THAT’S BECAUSE YOUR ABILITY TO THINK CRITICALLY ABOUT CHIRO IS CLOSE TO ZERO.
      “…disclosure-of-risk forms have been suggested…”
      WHY ONLY SUGGESTED?
      Yes, the precautionary principle must be applied to all healthcare!
      “There is no convicing evidence to date that SMT poses a significant health risk.”
      NOT TRUE!

      • “Why only suggested?” you wrote. Unlike collectivist countries, individual responsibility is still encouraged in the US. If a doctor turns a blind eye to patient disclosure of health risks, he does so at his own financial peril. Lawsuits for amlpractice are all-to-common in the US.

        You predictably stated that my critical thinking about chiro is close to zero. You are wrong, as usual. It seems that anyone who shares a different opinion from yours is a dimwit, according to you. As an anti-chiro zealot, your incessant sensationalizing of allegedly significant risks via CAM diminishes your opinion on everything, at least to the open-minded folks who participate in your forum. BTW, if the precautionary principle should apply to all of healthcare, I would expect that you would characterize off-label prescribing as quackery since most applications of it are not supported by hearty RCT’s, only by the flimsiest of “evidence.” Please advise.

        • ” …individual responsibility is still encouraged in the US..”
          yes, if you say so – but why was it not ‘suggested years ago and implemented soon after?
          “anti-chiro zealot”
          I UNDERSTAND THAT YOU HAVE TO CALL ME THIS; it demonstrates perfectly that your ability of critical thinking about chiro is close to zero.
          QED

        • If the precautionary principle should apply to all of healthcare, I would expect that you would characterize off-label prescribing as quackery since most applications of it are not supported by hearty RCT’s, only by the flimsiest of “evidence.” Please advise, Edzard.

        • @Logos-Bios on Thursday 20 April 2017 at 17:20

          “Unlike collectivist countries, individual responsibility is still encouraged in the US.”

          Unlike the US, many other countries have easily managed to incorporate social responsibility along with individual responsibility. They are not mutually exclusive, despite your apparent belief to the contrary.

          “If a doctor turns a blind eye to patient disclosure of health risks, he does so at his own financial peril. Lawsuits for amlpractice are all-to-common in the US.”

          In many other countries, doctors are concerned about risks because they care about patient wellbeing, not the dollar signs the person represents when you walk in the door. They have compassion, here is a link to help you understand what most other humans feel; https://en.wikipedia.org/wiki/Compassion.

          Why do you think Björn Geir, a busy and respected surgeon, contributes to this blog? He isn’t doing for the money, but because he cares for his and other patients, and does not want anyone subjected to dodgy treatments for which there is no or little evidence but risk.

          “You predictably stated that my critical thinking about chiro is close to zero.”

          I know it is a statement of the obvious but someone had to say it. While you know the term cognitive dissonance, because you have it so strongly, you do not appreciate that you embody it.

          “You are wrong, as usual.”

          No, that is yet another example of cognitive dissonance.

          “It seems that anyone who shares a different opinion from yours is a dimwit, according to you.”

          I cannot recall the prof doing as you claim. He has, however, been “guilty” of calling a dimwit a dimwit.

          “As an anti-chiro zealot,”

          The prof is not “anti-chiro”, but he is zealously anti-“anti-science” which I regard as a badge of honour, to stand for reason and logic when fools still believe in fairies and magic (you, on both).

          “your incessant sensationalizing of allegedly significant risks via CAM diminishes your opinion on everything,”

          “sensationalizing” the risks of practices when there is not evidence for its benefits is not what a rational person regards as a slur. Congratulations and thank you once again prof for your tireless efforts.

          “at least to the open-minded folks who participate in your forum.”

          You and all of the other non-meds are far from “open-minded”, given your refusal to accept evidence contrary to your own beliefs.

          “BTW, if the precautionary principle should apply to all of healthcare, I would expect that you would characterize off-label prescribing as quackery since most applications of it are not supported by hearty RCT’s, only by the flimsiest of “evidence.”

          This has been dealt with before, except for those with cognitive dissonance. Again, why do you, seemingly, readily accept such RCTs but ignore all associated with your back faffing?

          “Please advise.”

          Fancy you using the wrong punctuation?

          No wonder you are such an embarrassment to your wife and daughter; people of science having to tolerate the rantings of a egotistical loon must be insufferable.

  • @EE
    “we must ask whether the known risks of the treatment outweigh the known benefits (as they do with spinal manipulation).”
    Good question and how does the risk benefit and cost benefit compare to other interventions?
    Recent paper by Cassidy, Cote, Haldeman et al.
    Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study.
    https://www.ncbi.nlm.nih.gov/pubmed/27884458
    This recent paper by Neurosurgeons does have a title guaranteed to stir the pot. If chiro’s had said the same imagine the outcry.
    Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation
    http://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation
    What also has to be taken into account is the view of the critics that chiropractic is a single intervention which is far from how the majority of chiropractors practice.
    Having said that do I routinely adjust the upper cervical spine? NO. There has to be a valid clinical reason and mythical subluxations is not one of them. Chiropractors who routinely adjust the upper cervical spine like with “Blair” technique are referred to as “hole-in-one” chiro’s and that is definitely not a complement in chiropractic circles.
    Here are the two papers Charlotte refers to for those interested.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097434/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097396/

    • isn’t it a bit daft to cite Cassidy in a post that casts doubt about Cassidy?
      besides I wrote “we should deal with them as responsible healthcare professionals deal with any other suspected therapeutic risks”
      would you say that there is not even a suspicion of risk?

    • “Chiropractors who routinely adjust the upper cervical spine like with “Blair” technique are referred to as “hole-in-one” chiro’s and that is definitely not a complement in chiropractic circles.”

      Leaving aside the issue that people engaged in complementary medicine typically can’t differentiate ‘complement’ and ‘compliment’, this statement confirms my insistence that, by analogy with the ‘no true Scotsman’ fallacy, there is no true chiropractor.

    • @CC

      Recent paper by Cassidy, Cote, Haldeman et al.
      Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study.
      https://www.ncbi.nlm.nih.gov/pubmed/27884458

      This paper is specifically about Carotid stroke, not Vertebral artery dissections so it is not applicable in a debate about the risks of VAD from HVLA neck-wringing.

      This recent paper by Neurosurgeons does have a title guaranteed to stir the pot. If chiro’s had said the same imagine the outcry.
      Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation
      http://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation

      Did you read the paper? It says the research scrutinised is of very low quality and they cannot confirm a causal relationship. Move on folks, nothing new to see here!

      What also has to be taken into account is the view of the critics that chiropractic is a single intervention which is far from how the majority of chiropractors practice.

      Do you have evidence for the claim that “the majority” of chiropractors do not stretch the vertebral arteries as part of their theatrical act? Mine did, insisting it was good for me even if I have never felt any problem up there. Preventing problems he claimed.

      • Here is an interesting article in the context of the paper by a group of neurosurgeons CC referred to. The last author of the paper , Dr. Harbaugh is quoted there. He is rightfully careful to make a judgement and infers from the lack of evidence of causality that cases of young VAD sufferers presenting after neck manipulation most likely had a preexisting intimal lesion or ongoing dissection.
        I am inclined to believe he is mistaken. It is likely that for a dissection to occur post manipulation or other trauma, there needs to be a predisposing factor i.e. intimal weakening, whether acquired or hereditary. But that does not change anything in this respect because such predisposition can not be detected and avoided, least of all does this fact justify unnecessary willful manipulation that may exert a trauma to the vertebral arteries. On the contrary it should preclude it altogether.
        Whether symptoms that lead someone to consult a chiropractor or other neck wringers stem from an ongoing dissection or not is irrelevant. There are certainly thousands more who get their neck wrung for non-VAD symptoms but have a predisposition for dissection. If the manipulation manages to stretch the VA, the risk is severely aggravated. It may not lead to full dissection in all cases but the risk is unacceptable any which way.

        In my mind there is no excuse ever to manipulate someone’s neck in such a way that the VA’s might be stretched.

        There is no, or at least not more than infinitesimal benefit from such neck wringing so the risk/benefit ratio is somewhere out in space approaching infinity. The minute possible benefit of neck wringing does not warrant any risk and musculoskeletal or neurological cervical symptoms can be better and more safely managed by other means.

        The theory Harbaugh adheres to, that most if not all cases of manipulation-associated VAD’s have a preexisting dissection, is purely speculative. The quality of evidence is low overall and the incidence of the problem is so scarce that studies inevitably lack power to detect a causative effect.

        Even if Harbaugh is right, there are still the cases where an intimal weakening or beginning dissection has not started to give symptoms. There are cases of chiropractic associated VAD where no cervical symptoms have been established. Of course it is almost always difficult to reconstruct exactly the pre-morbid situation.

        It is likely that cases of spontaneous or non-manipulation-associated dissection do not all progress to full dissection and stroke-causing blockage or embolism. There is overwhelming likelihood that some cases heal again without sequelae… if left alone and not manipulated to death.

        Never let anyone manipulate your neck. It is not worth the terrifying, albeit very small risk

        • @EE
          “isn’t it a bit daft to cite Cassidy in a post that casts doubt about Cassidy?
          besides I wrote “we should deal with them as responsible healthcare professionals deal with any other suspected therapeutic risks”
          would you say that there is not even a suspicion of risk?”
          Due to the extremely rare incidence Canada with its nationalized health is ideally positioned to do these studies mining their databases. The more recent Cassidy paper looks at the relative risk and the conclusion is applicable.
          “The final word is clearly not yet pronounced on this issue”
          I agree with Charlotte Leboeuf-Yde on this. Until conclusively proven otherwise there is a suspicion of risk and it is part of my written informed consent. Additionally, I have over the years there have been many times I have refused to manipulate of mobilize or adjust a patients neck due to red flags in the history. I explain why and the patient is appreciative. I also verbally go through the consent 4 -5 times prior to treating the neck on every patient, during the examination, written consent and just prior to treating. I also repeat it on regular reviews and on discharge.

          @BG
          “In my mind there is no excuse ever to manipulate someone’s neck in such a way that the VA’s might be stretched.”
          Agreed and I am diligent to not rotate the spine. Everything is P to A and I employ “other means” as standard in a multi-modal approach.
          “Do you have evidence for the claim that “the majority” of chiropractors do not stretch the vertebral arteries”
          For research into this topic see Walter Herzog:
          https://www.ncbi.nlm.nih.gov/pubmed/?term=Herzog%20W%5BAuthor%5D&cauthor=true&cauthor_uid=25457973

          @Frank Odds
          Quibbling over spelling yet again.

          “Of course it is almost always difficult to reconstruct exactly the pre-morbid situation.”

          • ” there is a suspicion of risk and it is part of my written informed consent.”
            THIS IS NOT ABOUT YOU; IT’S ABOUT THE CHIRO PROFESSIONS WORLDWIDE

          • @EE
            AND THE WAY I PRACTICE IS THE SAME AS THE MAJORITY OF THE PROFESSION WORLDWIDE.
            (First time I have ever shouted back with upper case online. That was fun.)
            There are many active chiropractic reformers and researchers worldwide and its about time you balanced your criticism with support. Pointing out the BS is necessary as is pointing out reform/reformers/researchers etc who are providing the solution.
            It is about me as I am a chiropractor and the BS merchants are MY problem as well and the solution must come from within the profession.

            “Charlotte certainly knows a thing or two about adverse effects of spinal manipulation, and I have always found her work interesting.”
            So why have you not supported her work over the years? I have cited her many times on this blog and it has been met with silence. Dr Leboeuf-Yde as well as her fellow researchers in Denmark are the solution. Have a look at her ResearchGate profile:
            https://www.researchgate.net/profile/Charlotte_Leboeuf-Yde

          • @Critical_Chiro on Monday 24 April 2017 at 07:45

            “AND THE WAY I PRACTICE IS THE SAME AS THE MAJORITY OF THE PROFESSION WORLDWIDE.”

            How would you know?

    • @Critical_Chiro on Friday 21 April 2017 at 07:26

      Still posting the usual crap I see.

      Suggestions; learn to read, as in process the text, not in light of your total emotional and financial investment; learn to spell, hard I know, and; get some treatment for your cognitive dissonance. You and that bonehead, L-B, are sides of the same coin. You have a pretense of rationality, something he lacks entirely, but the thin veneer is transparent.

      • @FC
        Still posting the usual carpet bombing I see.
        You are as deeply entrenched and resistant to change as the worst Subbie and both of you are a problem when it comes to reform.

        @BG
        “Of course it is almost always difficult to reconstruct exactly the pre-morbid situation.”
        I hear that research is well underway in the development of an adverse event reporting form to collect all the relevant information accurately. The researcher is on my watch list.

        • “I hear that research is well underway in the development of an adverse event reporting form to collect all the relevant information accurately. ”
          EVEN IF TRUE, THIS TOO LATE AND FAR TOO SLOW

          • We tried pushing for it a couple of years ago here and it fizzled due to resistance from the doctors in the hospitals.
            It is NEVER TOO LATE and it may prompt the physio’s/GP’s etc to follow suit and adopt it. Why confine it to just chiro’s.

        • @Critical_Chiro on Monday 24 April 2017 at 04:09

          “@FC
          Still posting the usual carpet bombing I see.
          You are as deeply entrenched and resistant to change as the worst Subbie and both of you are a problem when it comes to reform.”

          While you are engaged in a totally useless pastime, discredited around the world, started by a conman and thief, rooted in the mystical, without any evidence, and which appropriates (that is, steals) from legitimate professions in order to try to legitimise itself.

          By-the-way, would you please learn s little about logical fallacies so you may appear less of a moron?

  • Don’t overlook that chiropractic works as do all CAMs – by type I effects of patients being in a constructive therapeutic relationship with an empathic practitioner (TLC, placebo effects, ego massage – often mutual and cumulative) – and, conceivably, type II effects of the actual therapy – the pillule, pricking, preturnatural power, pushing, pumelling, what have you.

    It seems some chiros find their abilities to engender helpful type I effects, to care, are enhanced by putting their hands on and manipulating the spine. And the only part of the spine amenable to significant manipulation is the cervical.
    I know, I’ve had to use considerable force and bone levers when operating – even on the cervical spine.

    DD Palmer gave up his ‘magnetic’ techniques when he found, to his satisfaction, he got better results by hands on techniques.

    My point is, that if chiros gave up on manipulation, they would have nothing to sell but counselling.
    Commercially – a disadvantage.
    Likewise, any who use a palmed ‘clicker’ to create the illusion something has ‘been done’ when manipulating will be chary about being found out and having to desist.

    That’s the nature of chiropractic, why it is not part of ‘medicine’ and why it is so hard to carry out meaningful research. Indeed, Palmer intended chiropractic was ‘different from medicine’.

    Patients must give fully informed consent to any treatment.

    • My point, Richard, is that you ignore what differentiates a DC from a PT: DC’s are trained to evaluate and diagnose the whole patient as a portal-of-entry provider. Mainstream DC’s perform the same basic services in their offices as PT’s for NMS disorders but they also have the responsibility to diagnose conditions which require referral or those that might require treatment in their own offices which might not require manipulation. Your implicit characterization of a DC’s skills as being limited to only the technical component(SMT), which you like to criticize, is not representative of reality. A PM&R is not simply a trigger-point injection peddler; he is also a diagnostician.

      • @Logos-Bios on Friday 21 April 2017 at 23:36

        What you don’t seem to understand is that chiros are wholly unnecessary in the the medical process. If someone needs a diagnosis, they can see a doctor who can, not only, diagnose, but treat and/or refer. Chiros are only a speed-hump in the way of proper diagnoses and treatment, and are not qualified for either.

        • Chiros are only a speed-hump in the way of proper diagnoses and treatment, and are not qualified for either.

          Well put.

          Just think of all the billions who do not ever seek chiropractic manipulation. How do they get by without regular adjustments?? How did they survive after birth without being adjusted?

          My back was starting to act up the other day. I did not go to the chiropractor but I was already better the day after. Does that then mean that if I have a lumbago, I should avoid chiropractors?

          If the tenets of chiropractic were true, the genus Homo would probably have died out with ‘Homo erectus’
          (Due to the terrible onslaught of subluxations as a result of developing an upright posture with a spine developed for horisontal position and a four legged gait)

          Chiropractic was invented by DD Palmer as a more lucrative con than waving magnets.

          • @BG
            Are you aware of the depth of MSK diagnosis and differential diagnosis taught to chiropractors in the Universities?
            Here it is a core subject and is taught to a high standard. Differential diagnosis and when to refer to a doctor is also taught by doctors.
            “If the tenets of chiropractic were true, the genus Homo would probably have died out with ‘Homo erectus’” and “How did they survive after birth without being adjusted?”
            Love it. When debating the subbies over the years I have used similar words many times.
            I also like to equate subluxation to “original sin”. Scare parents and the congregation to come back to their church every week and place a donation on the plate while having subluxation religious beliefs shoved down their throats from the pulpit.
            Nice to know we agree on something Björn.

            @FC
            “What you don’t seem to understand is that chiros are wholly unnecessary in the the medical process. If someone needs a diagnosis, they can see a doctor who can, not only, diagnose, but treat and/or refer. Chiros are only a speed-hump in the way of proper diagnoses and treatment, and are not qualified for either.”
            So you think the average GP is up to speed when it comes to MSK conditions?
            Chronic pain management in medical education: a disastrous omission
            http://www.tandfonline.com/doi/full/10.1080/00325481.2017.1297668
            Adequacy of education in musculoskeletal medicine.
            https://www.ncbi.nlm.nih.gov/pubmed/15687152
            The inadequacy of musculoskeletal knowledge after foundation training in the United Kingdom.
            https://www.ncbi.nlm.nih.gov/pubmed/19880882
            The inadequacy of musculoskeletal knowledge in graduating medical students in the United Kingdom.
            https://www.ncbi.nlm.nih.gov/pubmed/25834088
            When it comes to chronic back pain medicine has stuffed up.

          • @CC
            I am still baffled why you continue to call yourself “Chiropractor”. 😉

          • @Critical_Chiro on Monday 24 April 2017 at 04:01

            “So you think the average GP is up to speed when it comes to MSK conditions?”

            I don’t know, however, that is why there are medical specialties and physiotherapists. That does not provide any justification for chiros, less in fact because it elongates the diagnostic process for no patient benefit.

          • @Björn Geir on Monday 24 April 2017 at 12:35

            “I am still baffled why you continue to call yourself “Chiropractor”. 😉”

            Money and stupidity. It is impossible to claim any moral high ground when no morality is displayed.

          • @BG
            Love you too Björn. 😉

            @FC
            GP’s are the first line Tx so applicable when comparing to chiro and physio for that matter.
            GP’s dislike seeing chronic backs in their practice and feel that they lack sufficient knowledge to treat. There was a large survey done in the US years ago that asked these questions and this was the response. Will have to dig it up for you.
            As for you second response. Up yours! 😉

          • @Critical_Chiro on Wednesday 26 April 2017 at 08:16

            Just because doctors may not like treating low back pain does not mean or infer Chiros provide anything useful, apart from dealing with, predominantly, whingers who want a quick fix when nothing will work that way.

            All you do is provide a time buffer to allow for regression to the mean or the progression of a self-limiting condition. You are, in effect, a human homeopathic sugar pill; doing nothing but allowing nature to take its course. You a pill, who would have thought? It is a pity you aren’t smart enough to realise this.

          • @FC
            We have long detailed conversations on chiro forums and at seminars in regards to these topics like regression to the mean, etc.
            Any treatment be it chiro, osteo, physio or medical if it creates a toxic dependency in the patient AND practitioner then it is unacceptable. The goal of all my care it to help patients become resilient, self reliant and independent. Then I discharge them. I focus on chronic pain and spend a large amount of time de-medicalizing and de-catastrophizing patients. Ones that come in referred by a doctor with a thick wad of CT’s, MRI’s and imaging going back years who have been through the medical mill.
            You hear the word chiropractor and think we are all con artists and subscribe to the high church of subluxation. You resistance to accepting chiropractic reform and change just shows your deeply held your beliefs are and how much time you have invested in them.
            Medicine has stuffed up when it comes to chronic back pain. Chiro’s and physio’s who follow the evidence and provide best practice are the solution and should be the first line care. I happily work with physio’s, OT’s, psychologists, pain medicine doctors, neurosurgeons and orthopods and they make up 80% of my patient referrals. The majority of chiro’s I know work in a similar way.

            “How would you know?”
            I read the research. You should try it some time instead of nurturing your cherished beliefs. Just make sure you read the whole paper and not base your views just on the abstract.

          • @Critical_Chiro on Thursday 27 April 2017 at 05:59

            I’ll wait for a response that makes sense and reads as if written by more than a 14 year old. One that doesn’t comprise rationalisations, non sequiturs, logical fallacies, self-justification, and an irrational belief that chiro has any substance apart from it has stolen from medical-based professions, such as physiotherapy. I won’t hold my breath though.

          • @Frank Collins on Friday 28 April 2017 at 01:10
            I have cited research, researchers, best evidence, best practice, practice guidelines etc over the years on this site yet you seem to be blind to the evidence and hold on to you beliefs. Instead you attack the individual. What is that called? You truly are set in you ways and fond of making sweeping statements and generalizations when it comes to the chiropractic profession.
            As for “apart from it has stolen from medical-based professions, such as physiotherapy.”
            Forgive me for laughing.
            You really should start reading the literature.
            Are you aware of the largest post-grad course for physio’s in North America? Its Called “Osteopractors”. Do a google search. Also check physio forums and see what they think of James Dunning and this course.
            I follow research and evidence and the way I practice is constantly changing. I admire and follow physio researchers like Chris Maher (ranked #3 pain researcher in the world last year), Gwen Jull, Paul Hodges, Mary O Keefe, Lorimer Mosely and Chiro researchers like Jan Hartvigsen (Ranked #1 MSK researcher in the world this year), C Leboeuf-Yde, Grek Kawchuk, Kim Humphries, Joel Pikar, Martin Descarreaux and Andre Brussieres to name a few. Ultimately if chiro’s and physio’s follow the evidence we should be heading down the same path. The resistance to change and reform from dinosaurs in both professions is an issue. Dinosaur critics like yourself who fail to acknowledge reform are also an issue.
            You really should start following the evidence and read the research.

  • On Monday 24 April 2017 at 07:45 Critical_Chiro shouted: “THE WAY I PRACTICE IS THE SAME AS THE MAJORITY OF THE PROFESSION WORLDWIDE.”

    @ Critical_Chiro

    Then it follows that you must practice unethically unless you have better data than those provided here:
    http://edzardernst.com/2016/04/are-most-chiropractors-behaving-unethically/#comment-76941

    Critical_Chiro wrote: “the BS merchants are MY problem as well and the solution must come from within the profession”

    What is the solution? Why have the regulators been asleep at the wheel for decades?

    _______________________________________________________________________

    “Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”

    Björn Geir Leifsson, MD

    • @BW
      “Then it follows that you must practice unethically unless you have better data than those provided here”
      You know how I practice Blue. Nice try. 😉
      I have repeatedly cited research from Australia, US, Europe and Canada on this Blue and it consistently shows the BS merchants to make up 15-18% of the profession.
      The solution is the BS merchants being forced to reform or being excised.
      The regulators are not asleep at the wheel. They are frustratingly slow to act across all professions. Just look at how glacially slow they are at disciplining shonky surgeons. One took 10 years here with him threatening hospital staff, the college etc. He retired before they got him. Surgeons in his specialty were aware of the issues with him, pity the patients were not aware.
      The regulators within chiropractic in Australia drew a line in the sand last year and they then had to wait for a moron to cross it. On did recently and he was just prosecuted. Complaints about him were submitted by chiropractors.

  • How many do the neck-wringers need to destroy before health care authorities wake up?

    http://www.kwwl.com/story/35214577/2017/04/Friday/young-mom-in-critical-condition-after-stroke

    • Assuming the dissection was caused before the visit to the Chiropractor, neck manipulation was the last thing the patient needed. Assuming the manipulation caused the dissection, manipulation was the last thing the patient needed.

      Why are chiropractors allowed to do it?

  • Leboeuf-Yde lacks a firm moral backbone.

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