MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

A recent comment by a chiropractor told us this:

“If the critics do not take step 2 [point out what’s right and support] then they are entrenched carpet bombers who see reform and reformers as acceptable collateral damage. That makes them just as much a part of the problem when it comes to reform as the subbies.”

Similar words have been posted many times before.

So, are we critics of chiropractic carpet bombers?

Personally, I find the term very distasteful and misplaced. But let’s not be petty and forget about the terminology.

The question is: should I be more supportive of chiropractors who claim to be reformers?

I feel that the claim to be a reformer is hardly enough for gaining my support. I prefer to support clinicians who do the right things. And what would that be?

Here is a list; clinicians would receive my  support, if they:

  • adhere to the principles of evidence-based medicine;
  • follow the rules of medical ethics.

What does that mean in relation to chiropractic?

I think it means that clinicians should:

  • use interventions that demonstrably do more good than harm,
  • make no false claims,
  • advocate the best available treatments for their patients,
  • abstain from treating patients for which their therapy is not demonstrably effective,
  • obtain fully informed consent from their patients which includes information about the nature of the condition, about the risks of their treatments, about other therapeutic options.

As soon as I see a chiropractor or a group of chiropractors who fit these criteria, I will support them by publicly stating that they are doing alright (as should be normal for responsible healthcare practitioners). Until this time, I reject being called a carpet bomber and call such name-calling a stupid defence of quackery.

103 Responses to Are critics of chiropractic ‘carpet bombers’?

  • For the second time today, I am reminded of what John Stuart Mill wrote 250 years ago: “Bad men need nothing more to compass their ends, than that good men should look on and do nothing.”

    With that in mind, Edzard, I don’t think your criteria go far enough. If there are indeed chiropractors who adhere to the five criteria you suggest, I suggest that this further criterion should be added before they are worthy of support:

    * Dissociate themselves from, and conspicuously vilfy, those chiropractors who do not adhere to the previous criteria

  • The problem is the indifferent regulators. Their job is to protect the title ‘chiropractor’, ensure they have a process for dealing with customer complaints and that the training establishments tick the right boxes. They are fundamentally not about ensuring that chiros are trained to evidence-based standards. In the UK, there is no definition of what chiropractic is, so it is not possible to differentiate a chiro from one of the spectrum for another at the opposite end, never mind actually do anything about the problem. Yes, the UK’s regulator has put out a memo about the mythical subluxation, but they plod along only doing the job the legislation says they must do: that’s all they can do, of course, so it is the fault of the writers of that legislation (who were only concerned with the prestige that obtaining statutory regulation would bring) and the current incumbents and politicians who are either not aware of the problem or who couldn’t care less.

    But chiros as a whole will not change unless and until the regulators force them.

    • I cannot agree more!! No use to try and convince the mafia that they are wrong, it is in the hands of the politicians and regulators.

    • Alan Henness wrote: “…they [the regulators] plod along only doing the job the legislation says they must do…it is the fault of the writers of that legislation (who were only concerned with the prestige that obtaining statutory regulation would bring)”

      So true. For example, in the UK…

      “In spite of strong mutual suspicion and distrust, the profession united under a group formed specifically to pursue regulation and secured the Chiropractors Act (1994)…..Regulation for a new profession will literally ‘legitimise it’, establishing its members within the community, making them feel more valued. In turn, this brings greater opportunity for more clients and a healthier bank balance.”

      Michael C. Copland-Griffiths, former Chairman of the General Chiropractic Council (European Journal of Oriental Medicine, Vol.2 No.6, 2004)

      Ref: http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1437-statutory-regulation-the-chiropractic-experience.html

      In other words, the regulation of chiropractors seems to be all about chiropractors’ livelihoods rather than good patient care.

  • I would add a sixth requirement, which most good medical clinicians follow:

    ° Keep proper records, follow up cases and perform regular audits to measure both adverse and favourable outcome.

  • @ Edzard

    Does Sam Homola pass the criteria set out in your post?

  • Being an atheist, suggestions of ‘reforms’ to religious traditions, dogmatic beliefs or interpretations of ‘holy’ writ interest me not. As you can’t reform lunacy except to move it AWAY from the lunacy to which it is entrenched and towards science and reality. Individuals can make this move, the “organizations” rarely will.
    And if that happens it undermines the entirety of the unique-selling-proposition and essence which was created to sell and perpetuate it in the first place….thus ending its outsider-reign as it becomes assimilated into the existing world of real science where it is required to compete in facts (and as Luther opined: logic is the devils mistress).

    Chiropractic ‘reform’ simply involves the removal of Chiropractic along with their lunatic educational-propositions, historic-anchors and arcane and pointless interventions (eloquently discribed as ‘DD Palmers’ parlor tricks’)…and this will never happen….it will only be sporadically at an individual level….never will it happen throughout the entirety of the profession….too many frauds and hacks are on the gravy train.
    An occasional new quart of oil into a dirty crankcase won’t reform the old oil.

  • Chiropractic cannot ‘reform’.
    As DD Palmer clearly stated: “Chiropractic is founded upon different principles from those of medicine. Chiropractic is an outgrowth of magnetic healing.”

    And his son, BJ Palmer (Joseph Bartlett on his birth-certificate) said: ” We chiropractors work with the subtle substance of the soul. We release the prisoned impulses, a tiny rivulet of force that emanates from the mind and flows over the nerves to the cells and stirs them to life.
    We deal with the magic power that transforms common food into living, loving, thinking clay; that robes the earth with beauty, and hues and scents the flowers with the glory of the air.”

    Fair enough. If that what a practitioner sincerely believes, let them practice their faith (a belief not based on rational analysis).
    But ‘chiropractic’ can never integrate with, and nor should associate with, rational modern medical practice based on plausible evidence obtained through rigorous application of scientific methods (which are sometimes not good enough, but let us press on).

    Chiropractors have to decide (and should have done so before seeking training in the first place) whether they want to practice their imagininative but anachronistic system which has always been ‘different from medicine’, (and in which many do not sincerely believe, but become trapped by the sunk cost fallacy) – or retrain as doctors, physiotherapists, nurses, counsellors…or accountants!

    In the UK there is only one set of standards expected, required, and regulated for a medical practitioner (a ‘doctor’) – those provided by the GMC. That is how patients are protected from those who are not qualified to those standards.
    Why other countries/states are content to have more than one standard is for them to explain.

    As a wise doctor once said: “If you can’t stand the heat, get out of the consulting room.”

    • I applaud the UK standards, but how do the Prince and other followers of alternative magic perpetrate their agenda of fake health care with only one set of standards?

      • With difficulty, hilarity even.
        Only this week a very naughty TV show ‘The Windsors’ had ‘HRH’ lampooned unmercifully about his support for ‘the Homeopathy Society’.
        And just as in the US, we do support free, if misguided, speech.
        Sigh.

        And as a magician, I know how some of Palmer’s effects can be reproduced. And I demonstrate them in my much acclaimed talk: ‘The Magic of Alternative Medicine.’
        Click!

  • I’m a chiropractic patient – I suffer from upper back pain and Manual therapy really helps, my other alternative is pain killers. I’m an avid reader of your blog. For me chiropractic works – I tried other manual Therapies at PTs but it was not helpful. I think Chiros mastered Spinal manipulations and they are great at it – of course some chiros are conspiracy theorist and anti-Vax which I find it terrible.

    I really wish my MD knew how to do spinal manipulation – and I never understood why manual therapies are not part of the main stream medicine – and most DOs are not great in manual therapies since they are really MDs and don’t have the focus on SMT.

    The other point – Edzard mentioned before that this is a blog – so a blog contains a subjective take on things and maybe being harsh or the writing style is his Go-To-Market strategy to increase traffic to his blog and sell more books – Since I clearly believe nothing is for free.

    If Chiros were charlatans and that expensive I don’t think they would have lasted all this time. you can fool people some of the time but you cannot fool them all the time.

    Maybe instead of trying the continuous jabs on Chiropractor why don’t you design a study or guidelines asking chiros to adhere to it – i firmly believe constructive criticism is way more productive.

    just my two cents.

    • This is an interesting clinical comment and one experience that needs further analysis. Certainly some patients improve with tincture of time and basic back care instructions, with all the chiro, PT, meds, massage, etc. just going along for the ride, and help deal with the pain until it resolves on its own. Many with subacute back syndromes will improve with time and some hands on compassionate touch/placebo effects, and the repeat visits help establish a therapeutic bond. All cases are different, but as an MD and back patient myself, I have found and seen patients improve within a wide spectrum of times with same approaches, so whoever is advising or treating them at the time the condition improves, often spontaneously, the therapist of the day gets the credit. We’re talking nonsurgical, nonmalignant, nonvisceral back pain, which is mechanical and musculoskeletal, and not pathologic, such as an anurysm or renal colic, or a herniated disc, or cancer, etc.. So other similar patients to Bilal find improvement from MD’s or PT’s also, but it seems that chiros a more likely to advise chronic followup and “prophylactic” “adjustments” to “ensure healthy backs” and many other unrelated health concerns or potential problems. Once they reel you in they do not remove the hook!!

      • @ S Cox

        I wonder what your thoughts on the following article:

        http://www.nejm.org/doi/full/10.1056/NEJMicm1511194

        • I think, and I could be wrong, that ‘article’ is technically called a case report.
          Interesting account of the natural history of disc herniation well known to all surgeons, and. I imagine, all doctors.
          And what would this patient have done had the condition not improved and even worsened?

          • @ Richard

            What would you have done if it had got worse or if the conditon didn’t improve? Also, what would you define as the condition getting worse i.e. signs and symptoms

          • Anny,
            I would recommend surgery because it has now given me, and many others, years of pain-free active life, in my case 33 years. BTW, I was wrong about having an MRI, but what do you expect from someone who was crippled by the pain of sciatica?

            I know that won’t satisfy because you like to critique real medicine in support of whatever non-med of which you are a part.

          • @ Frank

            It is good to see that you can admit you were wrong – a healthy step forward.

            As you an advocate for evidence based medicine, it is interesting that you base your recommendation on your own personal experience rather than the evidence. In a Cochrane* review on “the effects of surgical treatments for individuals with ‘slipped’ lumbar discs” it states that “90% of acute attacks of sciatica settle with non-surgical management”. So, it is possible at the time, you may have been in the 10% who could have required surgery. But you could have been a case that may have just required time.

            The Cochrane review also states that “Despite the critical importance of knowing whether surgery is beneficial, only three trials directly compared discectomy with non-surgical approaches. These provide suggestive rather than conclusive results” However, the conclusion does state “Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management”

            So, surgery has its role in the management of low back pain with nerve root irritation (sciatica) but maybe not in all cases of sciatica.

            *http://www.cochrane.org/CD001350/BACK_the-effects-of-surgical-treatments-for-individuals-with-slipped-lumbar-discs

          • Anny, (AN Other on Friday 25 August 2017 at 13:25)

            How is that rock you hide under in anonymity? It is apparent why you need it, unlike the rational people on this blog.

            “It is good to see that you can admit you were wrong – a healthy step forward.”

            I was half way through asking why you are a smartarse, then my recollection returned that you are always a smartarse, but not smart. If I’m wrong, I am happy to admit it; can you offer the same?

            “So, it is possible at the time, you may have been in the 10% who could have required surgery. But you could have been a case that may have just required time.”

            How kindly condescending of you. The disc was prolapsed in two places and both had protrusions deep into the nerve canal. Do you suppose that might be the reason I could not stand or walk, and spent all the time curled up in a ball? Surprising as it seems, I took the advice of the neurosurgeon, not some half-arsed quack supporter like you.

            “The Cochrane review also states that “Despite the critical importance of knowing whether surgery is beneficial, only three trials directly compared discectomy with non-surgical approaches. These provide suggestive rather than conclusive results” However, the conclusion does state “Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management””

            I didn’t have a discectomy, but you would know that because I’ve mentioned it to you several times before. Did the last sentence not make sense to you?

            “So, surgery has its role in the management of low back pain with nerve root irritation (sciatica) but maybe not in all cases of sciatica.
            *http://www.cochrane.org/CD001350/BACK_the-effects-of-surgical-treatments-for-individuals-with-slipped-lumbar-discs”

            Do you have anything more than banally stating the obvious? You are such a dreary, tawdry troll.

          • @ Frank

            Why does anonymity matter so much to you? – no one else seems to be bothered by it.

            The point of my post was to highlight you open ended recommendation for surgery when people have low back pain with nerve root irritation. However, the evidence indicates that it should only be used in certain selected cases but your statement doesn’t seem to take account of the evidence and is just an anecdote.

            Sorry, I forgot you had a laminectomy at L5/S1 but i was just pointing out that there isn’t much evidence for certain types of surgery when compared to non-conservative care.

            I presume you must know that pain is purely a subjective experience, I wouldn’t know how much pain you were experiencing at the time. Also pain is dependent on a number of factors and not just the amount of tissue damage. Have a read of this:

            http://www.pain-ed.com/blog/2015/06/08/what-about-my-protruding-or-bulging-disc/

            If you can provide evidence to the contrary – I would love to see this. Remember your experience is not evidence.

            Also do you mean you had two discs which had prolapses ie. one prolapse at L4/L5 and another prolapse at L5/S1 or did you mean two prolapses at the same disc? If it is the latter I would love to see the evidence for this (maybe your CT scan report) because i have never heard of this before.

          • @Anny on Saturday 26 August 2017 at 12:24

            “Why does anonymity matter so much to you? – no one else seems to be bothered by it.”

            You are hiding your affiliation with non-med under the guise of questioning. It is the inherent shiftiness of it and you I find disturbing.

            The rest of your post is the typical tawdry, smartarse, bullshit which it isn’t worth addressing. Make sense and I might response, troll.

            Don’t the receptionist duties at the chiro and natural health clinic keep you busy enough?

          • @ Frank

            You said “The rest of your post is the typical tawdry, smartarse, bullshit which it isn’t worth addressing”.

            Well, that article i referenced to in my post comes from a website developed by a Professor in Physiotherapy (based in Australia) and if you think is tawdry, samrtarse, bullshit, I think that speak a lot about you.

            Also, your failure to critically engage with what I wrote shows that I am right because if I was wrong you should be able to prove I am (maybe with evidence)

          • Anny on Monday 28 August 2017 at 10:31

            “You said “The rest of your post is the typical tawdry, smartarse, bullshit which it isn’t worth addressing”.

            Well, that article i referenced to in my post comes from a website developed by a Professor in Physiotherapy (based in Australia) and if you think is tawdry, samrtarse, bullshit, I think that speak a lot about you.”

            As the Prof, and many others, have pointed out, you have a real problem with comprehension, you tawdry little troll. I was not referring to the article, as any reasonably intelligent person would surmise, but your writing. Gawd, you are even dopier than you first appeared.

            “Also, your failure to critically engage with what I wrote shows that I am right because if I was wrong you should be able to prove I am (maybe with evidence)”

            If you have an argument, would you please make it intelligibly, that is, without all of the dross and passive-aggressive nonsense?

          • @ Frank

            Hope this is simple enough for you.

            You made a recommendation for surgery and I pointed out that the evidence shows that surgery is only recommended in select cases. Therefore your recommendation should have said surgery worked for me but it may not work in all cases.
            Therefore your statement is not a reflection of the evidence available. So, as a person who says he is a follower of evidence based medicine your statement is flawed.

          • Anny on Tuesday 29 August 2017 at 08:18

            “Hope this is simple enough for you.”

            More passive-aggressive crap from someone who does not the self-awareness to understand the observation. I am starting to thing you are a chiro; no one can be so abstruse and still take themself so seriously.

            “You made a recommendation for surgery and I pointed out that the evidence shows that surgery is only recommended in select cases. Therefore your recommendation should have said surgery worked for me but it may not work in all cases.
            Therefore your statement is not a reflection of the evidence available. So, as a person who says he is a follower of evidence based medicine your statement is flawed.”

            Thank you, Captain Obvious. You do excel even your own tawdry, low-level standards. My “recommendation’ for surgery is, of course, based on my own very successful experience. It can, of course, only be a personal recommendation, not one premised on a study; that much is so astoundingly obvious, even you should understand it. My intention is/was to publicly acknowledge that surgery is not a dreaded fate from which the only outcome is misery. For that, you need chiro.

            Is that it? You made such a big deal about that? Gawd, you are stupid; a passive-aggressive stupid acknowledged by several others on this forum.

          • @ Frank

            Yes that is it (well done *pat on head*). You have criticized people in the past for using an anecdote for a recommendation of a treatment instead of evidence. But when it comes to yourself the same criticism does not apply!

          • @Anny on Tuesday 29 August 2017 at 15:04

            “Yes that is it (well done *pat on head*). You have criticized people in the past for using an anecdote for a recommendation of a treatment instead of evidence. But when it comes to yourself the same criticism does not apply!”

            Edzard, among many others, was and is right in observing your lack of comprehension of basic prose, illustrated again by this banal effort. Nonetheless, you think you are clever, even if it is only person to think this. Here is a link to help you with an attempt at self-awareness; https://en.wikipedia.org/wiki/Passive-aggressive_behavior

            As you are Australian, would you please spell words, such as “criticized”, with an “s’, not an American “z”?
            Now, tawdry troll, do you have and substantive point to make?

          • @ Frank

            I like to think you are smart but I have my doubts. So, to prove your superior intelligence answer this simple question:

            What did Edzard mean when he wrote “a book is not necessarily evidence”? The answer must take into account the context in which the phrase was stated.

          • @Anny on Wednesday 30 August 2017 at 09:28

            “I like to think you are smart but I have my doubts. So, to prove your superior intelligence answer this simple question:

            What did Edzard mean when he wrote “a book is not necessarily evidence”? The answer must take into account the context in which the phrase was stated.”

            Oh dear, a passive-aggressive troll who doesn’t understand Tu Quoque. Why don’t you take Björn Geir’s advice and stick to a level where you may have some competence? Equally, the Prof clearly thinks you understand what he meant, so ask him again.

            The problem with the intellectually bereft is they aren’t capable of understanding it. Did you read the reference I posted about passive-aggressive behaviour in order for you to try to understand your own behaviour?

        • to AN: There are specific criteria for diskectomy for a herniated disc, including loss of motor strength, atrophy of muscles innervated, uncontrolled pain after 8 weeks(duration may have changed) of conservative treatments, progressive neurological deficits, cauda equina syndrome, etc. , including shorter duration of pain if severe, which usually is determined by the patient , much as when to have cataracts removed(when the loss of vision is severe enough for the patient to want it fixed.)

          • @ S Cox

            Thanks for the reply. Do you still think that a disc herniation is a pathology even though a disc herniation can occur in people without LBP or leg pain?

            I would love to read your thoughts on this post:

            http://www.pain-ed.com/blog/2015/06/08/what-about-my-protruding-or-bulging-disc/

          • Do you still think that a disc herniation is a pathology even though a disc herniation can occur in people without LBP or leg pain?

            What do you mean? Dr. Cox just taught you the main indications for intervention for disc herniation and you write as if you have no idea what you are talking about. One wonders what they teach you all these years in chiro-school.
            Of course disc herniation is a ‘pathology’, in the meaning a pathological condition i.e.
            an anatomic and physiological deviation from the normal that constitutes a disease or characterizes a particular disease.
            Disc herniation is a disease, whether you like it or not. Whether and when it always causes symptoms and whether diagnostic procedures and interventions are warranted is another matter. That some doctors overtreat it does not mean that chiropractors or PT’s with grandiose delusions are any better.

          • @ Bjorn

            Here is a quote from a study – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/

            “Our study suggests that imaging findings of degenerative changes such as disk degeneration, disk signal loss, disk height loss, disk protrusion, and facet arthropathy are generally part of the normal aging process rather than pathologic processes requiring intervention”

          • @AN Other

            You can cite cherry picked opinionated quotes till you drop. It will not change medical facts.
            Disc degeneration is of course more common with increasing age but even younger persons can suffer from it. You can choose to look on it as part of getting old but that does not make it part of healthy aging. Herniated discs do not always give symptoms as has been oft repeated here, but it does often lead to significant health problems and disability. Therefore it should be and is (by real doctors at least) considered a pathological disorder (one meaning of the term ‘pathology’) when that is the case. We doctors do not look for it in uncomplicated LBP or just out of curiosity (Well, some doctors in countries where every procedure ordered means money in their account – “If it hurts, X-Ray it!”). We in the less money-governed parts of the medical world look for it only when there is a chance of finding something that might be fixed.

            Let’s say you yourself would get terrible sciatic pain, with numbness in your leg and perhaps even problems emptying your bladder. You reluctantly go to a doctor because it just kept getting worse, even if your chiro’ repeatedly thumped and wrung your spine (My ER buddies get such cases crawling in through the doors regularly). The doctor orders an MRI and tells you this is because a herniated disc is protruding into your spine and pressing against nerves. Now which would you prefer? That the doctor agrees with your (in this discussion expressed) opinion that a herniated disc is only part of the normal aging process and is not to be considered pathological and therefore not to be worried about? Do you want him (her?) to only put in a catheter so you urine can get out so you do not get uremic kidney failure and then send you home to suffer on until it gets better on its own – hopefully?
            Or would you like the doctor to offer you an operation for your “non-pathological aging process” to significantly increase your chances of speedy recovery and lessen the risk of needing a permanent urostomy?

            Your call 😉

          • As an orthopaedic surgeon who operated on backs, and as a Recognised Clinical Teacher, Cambridge University, I taught that a radiograph only indicates where to operate (which level), it does not indicate whether to (diagnosis and treatment plan).

            In other words, only order a radiograph when you’ve decided an operation is necessary (for LBP being discussed in this thread).
            A slight aphoristic exaggeration of course, but trainees get the point.
            So should chiropractors.

            Oh, and none of us ‘order/carry out/do, X-rays’. They are invisible. The clue is in the name.

          • @ Bjorn
            You can choose to ignore evidence if you want to (in this case a systematic literature review by MD’s) but I would say that your medical fact is not as clear cut as you would like to see it (http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1808-18512015000200144).

            Considering 84% of asymptomatic 80 years old can have disc bulges, I think that disc bulges (herniations) are part of healthy aging. Some people (Timothy Flynn PT and Professor Peter O’Sullivan) would describe disc herniations are like wrinkles of the skin, something that happens as you get older and not necessarily a cause of pain or a pathology (see videos – https://www.youtube.com/watch?v=OjZaN0s26xo & https://www.youtube.com/watch?v=u3EK9h4JQlo & https://www.youtube.com/watch?v=dlSQLUE4brQ – please watch the videos).

            However, when a disc herniation presses on a nerve that can lead to a pathological condition of that nerve. At that point, when there are signs and symptoms of nerve function being compromised, surgery can be an option (so I do agree with Dr Cox).

            Obviously, in the case you described (cauda equina) surgery is mandatory because of the severity of the pathological process that has happened to the nerve. So the disc herniation may have happened from healthy aging but its effect on the nerves is causing the pathology or as you put it “i.e.
            an anatomic and physiological deviation from the normal that constitutes a disease or characterizes a particular disease.”

            Just a side note, it is interesting that everyone think I am a chiro, just because I am challenging people’s assertions on this blog. However, no one has seemed to notice that all the studies I have quoted have been by physiotherapists and MD’s.

          • @ AN other

            I have made no assumption as to your background other than ascertaining that it is clearly evident that you do not have medical education or training. If your education/training is indeed that of a physiotherapist, then why are you arguing outside your scope and not using the skills that PT’s should master? This discussion is way ouside your competence as can be seen e.g. in your confusion of terms and obvious lack of understanding of the pertinent anatomy and pathology. I admire your interest and perseverance but you have to understand that you do not have the prerequisite knowledge of the matter at hand. Your attempts to select arguments from published articles fail because you are simply not capable of professionally analysing their contextual validity. Try following the discussion in this blog for a while and you might discover that critical thinking opens new avenues for understanding how things really work.
            I suggest you put down your pen or restrict your efforts to discussing only that which is on par with your level of education and training.

          • @ Bjorn

            What are your thoughts on the videos I posted then as you seem to be dismissing the work of a Professor of Physiotherapy and a physiotherapist with a PhD?

            Also what are the skills PT’s should master in your opinion?

          • @ Bjorn

            you said “One wonders what they teach you all these years in chiro-school.”

            Is that not an assumption of my background?

          • @ Bjorn

            Here is a reply from a senior lecturer at a Department of Primary Health Care and General Practice about our conversation:

            Thank you for your message. It seems to be that you and the surgeon are slightly talking at cross-purposes and this may be behind some of the difference of opinion.

            In terms of ‘healthy’, I like the definition of health proposed by Huber et al. (2011) – The ability to adapt and to self-manage, in the face of social, physical and emotional challenges. This puts the focus on the response to the challenge rather than the challenge itself (in this case a change in disc morphology). I would say that disc changes can be associated with challenges to health, although often these are not. For example, challenges can be apparent when disc changes impact on surrounding nervous tissue, particularly the cauda equina. In these instances, removal of the problematic disc material may well improve health (although often these may resolve without surgery, such as with many radiculopathies). I would disagree with your colleague’s assertion herniated discs often lead to significant health problems and disability, because these are so prevalent in people who have no symptoms, but I agree that herniated discs may impact health.

            Secondly, I would look at the term ‘pathological’ as meaning something is part of a disease process, whereas I would consider a change in disc appearance to be a morphologic change that is not pathological unless it is contributing to a pathological disorder such as cauda equina syndrome.

            Thirdly, the question of whether disc herniation is part of ageing. If you look at the table below from Brinjikji et al. (2015), these changes occur asymptomatically across the age spectrum with a relatively similar incidence (amongst those disease-free at the start of an age band). So the longer you live the more likely you are to have these findings, but I would hypothesise that these changes are a normal part of life rather than ageing per se (i.e 10% of the population who do not already have a disc bulge, experience a disc bulge each year – so the older you are, the more likely you are to have a disc bulge but these may not have occurred as a consequence of getting old). As such, I would view these as being akin to the cuts, scrapes, and grazes that are seen as asymptomatic scars on our skin. These are evidence of a life lived but not necessarily a sign of ageing or pathology (but that’s not to say that you cannot cut something important like an artery or nerve and have associated health challenges).

            So in summary, I would say that changes in disc structure and shape (morphology) are a normal part of life that usually do not impact on health.

          • @AN Other

            Your perseverance and enterprise in summoning the help of a medically qualified ally should be applauded. But it would have helped if your friend had been better versed and more experienced in the clinical features and epidemiology of spinal pathology and related clinical problems and less willing to tie multiple knots onto his line of reasoning in an attempt to be forthcoming to his friends (your) wishes for confirmation of his (your) beliefs. I ado not wish to belittle your (or your medically qualified friends) efforts but this argument is pointless.
            The fact is that the human spine was not originally designed for continuous upright posture. Further, the human body was much less meant to last for more than four to five decades. This, together with genetically determined variations in connective tissue quality and hence varying predisposition for age related connective tissue failure, is the reason that a very significant number of our brethren suffer from the incapacitating consequences of intervertebral disc failure.
            Your original argumentation, if I recall correctly, was to the effect that because disc protrusions/herniations are regularly found in asymptomatic persons, this means disc herniation is a normal occurrence and should therefore be considered a non-problematic (non-pathological) condition, right?
            This is a nonsensical and counter-productive attitude.
            The fact that many symptom free disc protrusions or herniations are discovered when advanced imaging techniques are either overused, misapplied or lead to incidental findings when looking for other problems, does not alter the fact that when such disc deviations cause significant sequelae, this needs to be classified as a health problem, i.e. a ‘pathological’ condition. whether you like it or not. This is the practically important application of the terms involved, otherwise we (health care providers) would be unable to react to such problems in a meaningful manner.
            Tautology around the terminology of this field is pointless. When a patient has a problem that affects his life, safety and well being, be it an inflamed appendix, an elevated blood pressure or a herniated disc causing pressure on a nerve root and consequent suffering and debility, then it is a health problem, nothing less, nothing more. A health problem that needs to be dealt with.

            If we now can settle down to the origin and purpose of the present thread of discussion…

            I am a critic of chiropractic. Am I a carpet-bombing critic or a focused and objective critic?
            I ask that the discussion be focused on the essence of chiropractic, not on some chiropractors’ (mis-)appropriation of treatment methods originating in other fields such as physiotherapy. I look upon the term chiropractic as the correct term for a set of trickery devised by one DD Palmer in the late nineteenth century and further commercialised by his son and their subsequent disciples. I do not criticise the application and intermix of proper lifestyle advice or sensible nutritional guidance. I criticise the application of theatrical thumping and clicking (with silly apparatus) on different parts of the spine claiming the correction of non-existent anatomical deviations generally known as “subluxations”. I criticise claims that these never confirmed anatomical deviations cause never demonstrated effects on anatomically and neurologically unrelated organs and thereby purported beneficial effects on a plethora of improbable problems ranging from Appendicitis to Zoster.

            By this long-winded composition I am simply trying to demonstrate that I am in no way a carpet-bombing critic but a focused and objective analyst and advocate speaking against a system of deceitful health care imitation devised solely for monetary gain.

            Now…
            …my wife is asking why I am engaged in a meaningless, obtuse argument about medical matters with a complete novice instead of looking lovingly in her eyes and asking how her day was. I have to agree with her,I could have spent the past half-hour or so much better. At any rate this was yet another opportunity for polishing my English writing skills 🙂

            Disclaimer: Despite the somewhat poor structure, overly jovial sentiment and frivolous frequency of words, the preceding prose was written under the influence of not more than one single glass of rather cheap white wine. Good night, gentlemen and ladies.

      • First of all Thank you for your input. Sure. In any profession there are abusers. Chiropractors for endless follow-up, MDs involved in the Opioid epidemic in the US which is probably was worst than endless adjustments….. and the list goes on…
        All i’m saying and maybe this is wishful thinking that all medical professions needs to work together with patient as the end game…

    • You have a similar experience to mine of years ago – I was referred (with sciatica) to a Sports Injuries clinic who had a consultant orthopedic surgeon, physiotherapists, chiropractors and osteopaths. Being before the days of the internet I had little opportunity to find out that the last two of those four might be woo-peddlers, and naively assumed that the other two wouldn’t associate themselves with quacks. As it turned out, the chiropractor they assigned me to never mentioned subluxation or any of the other rubbish, insisted on an x-ray and then more x-rays before he started treatment, and over about six appointments and a good deal of advice about exercise, posture, shoes etc., succeeded in reducing my pain a lot. So in other words he, like your chiropractor, didn’t behave like a woo-peddler, but a lot more like a physiotherapist. Your experience and mine just go to reinforce the point: the only good chiropractors are those who don’t behave like chiropractors: they ignore all the bs, practice the same care about diagnosis as a doctor and use similar techniques to physiotherapists.

    • @Steve Tonkin
      The Canadian Chiropractic Association have set out clear practice guidelines. See here:
      https://www.chiropractic.ca/guidelines-best-practice/practitioners/resources/
      While the Ontario Chiropractic Association has gone further have disaccociated themselves from the subluxation belief system and they are currently seeing 22% of the population.
      We do vilify the vitalists. We call them “TORons”.

      @Alan Henness
      Agree with so much of what you say Alan.
      Reform comes from the universities and regulators who advocate for the patient. The third party payers also are dictating care and here in Australia they are auditing chiropractors. If you are not guideline compliant they are cutting you off financially. Some vitalists here have gone cash only so they don’t get audited but ultimately this will hurt their practice.
      The SOFEC statement from chiropractic universities will be of interest.
      http://vertebre.com/charte-pour-l-education-chiropratique-en-europe-8163
      Several more like Macquarie University have since signed up.

      @Blue Wode
      The regulators advocate for the patients while the associations advocate for chiropractors. Here the regulator for all health professions is AHPRA https://www.ahpra.gov.au/ I admit that they are slow to discipline but that goes for all the AHPRA boards.
      The associations used to have vitalists holding down key positions to protect their belief systems but that is changing with the Chiropractic Association of Australia purging itself of many vitalists. They are also now talking to the other association, Chiropractic Australia, so the momentum for reform is growing.

      @Björn Geir
      Johnathan Field in the UK has set up the “Care Response” website where patient reported outcome measures (PROMs) are automatically generated and allow you to measure your patient outcomes to other chiropractors. There are currently 414 chiro’s in the UK subscribed and it is gaining traction here.
      http://chiropracticaustralia.org.au/care-response/
      I use it and it is very helpful. I also use other outcome measures and this site is a great resource for all health practitioners.
      http://www.rehabmeasures.org/rehabweb/allmeasures.aspx?PageView=Shared

      @ Richard Rawlins
      “Chiropractic cannot ‘reform’.”
      What would be more accurate is “some chiropractors cannot ‘reform’.
      You demand rigorous application of scientific method and I agree. The chiropractors in Denmark years ago decided that a % of every consultation would go into a research fund. The University of Odense now has 15 chiropractic researchers ranked in the top 60 musculockeletal researchers and Jan Hartvigsen is ranked #1. You also now have the CARL initiative supporting early career chiropractic researchers. See their initial newslatter here:
      http://www.nikkb.dk/images/CARL/CARL-Newsletter-Issue-1_Final1.pdf

      @Edzard Ernst
      “Carpet Bombing” is a very apt term. The critics are happy to bomb the whole profession just to get the vitalists. That is like bombing a whole city just to hit the rail yards in the centre of town.
      I have said this over and over. Criticism is essential for reform both within and without the profession, but if it is not balanced by support for reform and the reformers like I have cited above then then its carpet bombing where the reformers and reform are acceptable collateral damage. So I will ask this question are the critics prepared to support the reformers like those cited above? If the answer is No then you are a carpet bomber. If the answer is yes then support the reformers.
      P.S. I have been using informed consent since 1995 and it has been a common law requirement here for all health care professions since 2000.

      • “are the critics prepared to support the reformers like those cited above?”
        I do not see them complying with all my criteria.
        if you chose ot refer to criticism as BOMBING, you have not understood the vital role of criticism.

        • How many times have I said over the years that criticism both within and without the profession is absolutely necessary for reform. But it needs to be balanced with SUPPORT FOR REFORM otherwise reform and the reformers become unacceptable collateral damage.
          Does this sound familiar. How many times have I said:
          Step 1. Point out the BS and criticize it.
          Step 2. Support reform and the reformers.
          Classic example is your post on Charlotte LeBoeuf-Yde earlier in the year. I have cited her along with other key researchers many times and it has been met with silence. Then you write:
          “I have always thought highly of Charlotte’s work, however, her conclusion made me doubt whether my high opinion of her reasoning was justified.”
          Really, so you think highly her work but have remained silent then take offense at one sentence she wrote so:
          “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.”
          Cherry pick one sentence to support your bias, discount everything else and Carpet Bomb.
          “I do not see them complying with all my criteria.”
          The subluxationists, yes I agree.
          The reformers are compliant and actively pushing all these criteria. Unfortunately you think all chiropractors are the same.

          • When you finish reforming you will be a doctor, physiotherapist, nurse, biomedical scientist – depending on your inclination and ability and effort you put in to your studies.
            Good luck. Welcome to the 21st century.

          • @Richard Rawlins
            “When you finish reforming”.
            There is no such thing. Only an ongoing process. It not about a neat set of tick boxes/criteria to fill and only support once all are done as Edzard stipulated above. Many on this forum would be more accurately described as cynical rather than critical. In the mean time I will still pose the question:
            Edzard are you prepared to support reform?

          • @Crackpot_Chiro on Friday 25 August 2017 at 03:22

            Seriously, you have either a severe form of cognitive dissonance or are incapable of written comprehension, perhaps both?

            This what Richard said, in his normal rational manner;
            “When you finish reforming you will be a doctor, physiotherapist, nurse, biomedical scientist – depending on your inclination and ability and effort you put in to your studies.
            Good luck. Welcome to the 21st century.”

            To which you relied;
            “@Richard Rawlins
            “When you finish reforming”.
            There is no such thing. Only an ongoing process. It not about a neat set of tick boxes/criteria to fill and only support once all are done as Edzard stipulated above. Many on this forum would be more accurately described as cynical rather than critical.”

            I do not understand how you are not able to see the text, absorb it visually, process the squiggly bits, reason what the text is meaning to convey, and finalise processing it in your extraordinarily thick bonce?

            As many have said, including me, there is nothing to reform because chiro is BS nonsense. Reform yourself by becoming a real health professional, not a back faffer. Perhaps, you might put aside your martyr complex for just a second and realise you are not a champion of some great social cause. All you are is a chiro, a practitioner of some bullshit invented by a convicted conman and stolen from another charlatan (Still), and are one of a group of quacks that are outside medicine for the very best reason, and you claim to want to reform this quackery into what?

            REFORM YOURSELF, or eff off. Your nonsense is really starting to grate with rational people.

          • @Frank Collins
            Ring the chiropractic bell and you respond in a very predictable way. You are incapable of supporting reform and think all chiropractors adhere to the high church of the mythical subluxation.
            You are as much a part of the problem as the vitalists.
            ” there is nothing to reform because chiro is BS nonsense.”
            You are stuck in 1895 with the vitalists.

          • @Crackpot_Chiro on Tuesday 29 August 2017 at 07:36

            “Ring the chiropractic bell and you respond in a very predictable way. You are incapable of supporting reform and think all chiropractors adhere to the high church of the mythical subluxation.
            You are as much a part of the problem as the vitalists.”

            ” there is nothing to reform because chiro is BS nonsense.”

            What is it about reason, logic, and rationality you do not understand? It seems everything.
            You line up with all other chiros; not very smart, fixated on being a chiro, rationalising every criticism of your own form of chiro as unfounded, unable to justify the existence of chiro, but, in your case, stealing bits of physio, without attribution, and calling yourself a progressive and “reformer”.

            Once again, for the profoundly stupid, there is nothing to reform. Put lipstick on a pig and it is still a pig. Using some physio techniques does not make chiro medical of mainstream, it only makes you an unethical thief peddling the same nonsense, though cosmetically different (a pig with lipstick).

            “You are stuck in 1895 with the vitalists.”

            Errrh no, that is you, only with a different form of vitalism, and the arrogant misbelief that chiro is REAL medicine. Take your pretend martyrdom and shove it; your are fooling no one but yourself.

          • @Frank Collins
            ” but, in your case, stealing bits of physio, without attribution”
            Scroll down the page and look at the chiro and physio researchers I cite. Next read the research. OMG chiro’s and physio’s collaborating on research. Shock horror. Hmm it must be the chiro’s “stealing bits of physio”.
            Time to read and cite the research Frank because
            “Crackpot_Chiro”
            “Shove it”
            “eff off”
            are not winning arguments.

      • Critical_Chiro you wrote:

        The Canadian Chiropractic Association have set out clear practice guidelines. See here:
        https://www.chiropractic.ca/guidelines-best-practice/practitioners/resources/

        This link does not address the substantive point I made. Odd, that.

        While the Ontario Chiropractic Association has gone further have disaccociated themselves from the subluxation belief system

        Curiously, you chose not to provide evidence for that assertion. Do you have any?

        We do vilify the vitalists.

        Do you? However, as you already know, that does not address the point I made. Can you provide evidence that any chiropractors have vilified other chiropractors that have not met Edzard’s five criteria? I’m guessing not, but would be happy to be shown to be wrong.

        • @ Steve Tonkin

          In answer to your question “Can you provide evidence that any chiropractors have vilified other chiropractors that have not met Edzard’s five criteria? ” – I would suggest the chiropractors Preston H Long and Sam Homola

          • neither of these 2 work as chiros any longer, as far as I know.

          • AN Other: I asked if he could provide evidence. You responded by providing names. Can you really not tell the difference?

          • @ Steve Tonkin

            Those chiropractors both wrote books criticizing chiropractors – I presume that would count as evidence, if you had bothered to search for it

          • a book is not necessarily evidence.

          • @AN Other:

            If you are claiming that these chiropractors have vilified other chiropractors that have not met Edzard’s five criteria, the onus is on you to provide that evidence, not on me to search for it. If you are telling the truth and these chiropractors did criticise other chiropractors for not having met Edzard’s five criteria, how about quoting and citing where they have done so?

          • @Steve Tonkin on Friday 25 August 2017 at 15:28

            “AN Other: I asked if he could provide evidence. You responded by providing names. Can you really not tell the difference?”

            The short answer is; NO.
            Don’t hold your breath waiting for a rational response from this bonehead. She/he/it pops up from time-to-time trying to convey an impression of some worldliness, intelligence, knowledge, and sophistication; as you have seen, the impression fades rather quickly.

          • @ Steve Tonkin

            Here is an example of Preston H Long criticising chiropractors and chiropractic:

            http://edzardernst.com/2013/10/twenty-things-most-chiropractors-wont-tell-you/

            and here is a list of articles by Sam Homola doing the same thing:

            https://sciencebasedmedicine.org/author/sam-homola/

          • @ Edzard

            So, “a book is not necessarily evidence”?

            In this case this is a book (Chiropractic Abuse – A chiropractor’s lament), which you described as “well worth reading” by an author who was a guest poster on your blog (Preston H Long) being used as evidence to prove “that any chiropractors have vilified other chiropractors that have not met Edzard’s five criteria?”
            Also within that book he has referenced work by you. So, in this case, do you still think that this book is not necessarily evidence for the question highlighted above?

          • you clearly have no idea what I was talking about.

          • @ Edzard

            Your comment of “a book is not necessarily evidence” can be interpreted in a wide variety of ways. The reason I replied as I did was because i used evidence in the context of the dictionary definition, which is “The available body of facts or information indicating whether a belief or proposition is true or valid”.

            Please can you explain what you meant by your comment and how it relates to the question raised by Steve Tonkin?

          • “Here is an example of Preston H Long criticising… […] … a list of articles by Sam Homola.”

            Thank you. So, we have evidence of one former chiropractor and one (possibly) currently practicing one who might meet the criteria. Out of how many chiropractors worldwide is that? Does not really strike me as an impressive proportion. Do you think it may be so low because, as Richard Rawlins has implied, a reformed chiropractor is no longer a chiropractor?

          • @ Steve Tonkin

            No, it is not an impressive proportion. But considering you thought that there wouldn’t be any, I am surprised you are not happier!

          • @AN Other, you wrote: “But considering you thought that there wouldn’t be any…”

            When did you add “Spectacularly inept mindreader” to your CV? (You clearly have no clue what I think.)

        • @ Steve Tonkin

          you wrote “Can you provide evidence that any chiropractors have vilified other chiropractors that have not met Edzard’s five criteria? I’m guessing not, but would be happy to be shown to be wrong.”

          My interpretation of “I’m guessing not” is that you thought that there would be no chiropractors who have vilified other chiropractors that have not met Edzard’s five criteria”

          If you are able to, explain to me how this does not equate to “you thought that there wouldn’t be any”, I would love to hear it.

          • @AN Other

            #1 Which bit of “Can you provide evidence..?” are you pretending to have misunderstood? I guessed that @Critical_Chiro would be unable to provide evidence. So far, s/he has not provided it, so I guess that my guess may have been correct.
            #2 Why are you pretending that “guess” means the same as “thought”?

            I find that responding to what others actually write is more productive than responding to what I wish they had written. YMMV.

          • @ Steve Tonkin

            #1 – I have provided evidence. It doesn’t matter who has provided it. As you can see in replies above people state a question to one person and it can be answered by someone else.

            #2 A synonym of guess is think. The definitions of thought are:

            Past tense and past participle of think.

            the act or process of thinking; cogitation.

            A product of thinking.

            Seems to me that there is a connection between guess and thought

          • @AN Other

            Are you really as thick as you present yourself here? If so, I apologise unreservedly, but it seems as though you are just a time-waster. But, just in case:

            #1. My guess was that Critical_Chiro would be unable to provide evidence. So far, that guess seems to have been a correct one.

            #2. Many things that are connected are not the same. There is a difference between thinking one’s way to the solution of a sudoku puzzle and guessing the solution. Guessing and thinking are not, as you pretend, synonyms.

            If that was too difficult for you to understand, try this: The orifice through which you should speak is connected (by your alimentary canal) to the orifice through which you seem to speak. Does that make them synonyms of each other?

            (Oh drat! I’ve just realised that I may have inadvertently proved your point…)

          • @AN Other

            “https://www.collinsdictionary.com/dictionary/english-thesaurus/guess – have a look, if you dare!”

            Ah. So you find a thesaurus that gives two options the synonym and, in full knowledge that I was using the word in the “predict” sense, disingenuously pretend that I was using it in the “think” sense, despite my telling you several times that I was not using it in that sense. Classy! Is that the best argument you can offer to support the substantive point, i.e. that your pretence that my prediction (guess) that @Critical_Chiro would not provide evidence (which, so far, is a correct guess) is the same as your inane fabrication that I “thought that there wouldn’t be any” evidence?

            You are clearly not a “good faith” debater and are merely, as you are in the other conversations on this page, wasting time. I’m done here.

            http://astunit.com/images/troll.jpg

      • The notion of a “critical Chiro” is enigmatic to me….like a critical Christian or Muslim. By ‘adopting’ a set of standards which are by design NOT based in deducing critical-assessment of reality you are not eligible for the title critical. A critical chiropractor is NOT a Chiropractor, why (except your financial stability) do you persist in trying to have scientific standards envelope ‘Chiropractic’ and still maintain the name??
        IF Chiropractic adopts comprehensively-critical standards it would become NOT-Chiropractic….not “science-based Chiropractic”.
        I’ve been to 12 DCs and excepting they were adept showman and salesmen (and had excellent personalities to hook patients) they ALL were nuts. If I could have infiltrated their brains I know they were simply trying to bullshit me with nonsense….at root they had no more idea than I did as to what was wrong, and what to do. Some were “specific”, some not, some used adjuncts some not….all had posters about the “root of my problem”: some form of subluxation.
        They all shared a basic paradigm: perpetuating a parsimonious solution to a chimerical problem, i.e. a religious core disguised as science.
        I ceased going and my pain(s) always go away anyway….just like they did with the ‘treatments’.

        • I have never posted before but just had to after reading Michael Kenny’s reply. I am a PT and I can not agree more, thank you. Your statement was elegantly and rationally well said.

          • +1

          • Chris. Phyiotherapy is one of the most un-scientific health care (sic?) professions in the mileau. No other profession bases its whole rationale on non-evidence based care. Modalities such as ultrasound, TENS and massage have been proven to be useless in the treatment of low back pain (as an example). Specific back exercises are no better than advising the patient to stay as busy and active as possible. Traction has been proven to be of no benefit as has conditioning exercises, ice, heat, shortwave diathermy etc. Just look at the NZ ACC clinical practice guidelines into the treatment of low back pain, and tell me where the “Shake, bake and fake” of modern physiotherapy is relevant.
            What does physio have to offer? Nothing.

          • ‘Tu quoque’ is a logical fallacy.
            Physiotherapy leaves much to be desired, and certainly should pull its research socks up. But all the physiotherapists I know are honest and have integrity. They do not claim they have discovered or utilise ‘subluxations’; vital forces’; ‘innate intellegence’.
            That’s the point. Let’s stick to the point. Chiropractic has no basis in reality and its founder stated clearly that it is “a different system to medicine.”
            End of.
            Thanks for all the fish.
            (Hitchhikers’ Guide to the Universe.)

          • @Richard Rawlins
            DD and BJ were BS merchants. Except for the vitalist fringe who still kow tow at the high altar of subluxation the rest of the profession has moved on. Time to start reading the research of the likes of Jan Hartvigsen, Alice Kongstead, Gert Bronfort, Simon French, Bruce Walker, Greg Kawchuk, Charlotte Leboeuf-Yde, Martin Descareaux, Lynton Giles, Phillip Bolton, Kim Humphries to name a handful of chiropractic researchers.
            Some physio researchers who are challenging their status quo and business as usual:
            Chris Maher, Mark Hancock, Gwen Jull, Paul Hodges, Lorimer Mosely (all these are Australian), Mary O’ Keeffe, Keiran O’Sullivan, Neil O’Sullivan, Adriaan Louw to name a few off the top of my head who’s research I follow.
            There is also a good cohort of PhD candidates coming through the universities.
            Reform is being driven by the universities and the researchers. Vitalist lobby groups like The Rubicon Group just don’t get this. These researchers are a good starting point when supporting reform.

          • some of your heroes are a bit dodgy, I think. see for instance here (http://edzardernst.com/2013/08/evidence-based-chiropractic-is-an-oxymoron/)

          • @Critical-chiro.
            It is not possible to ‘reform medicine’, because ‘medicine’ is not a formed faith, it is a corpus of knowledge, as good as we can get, about pathology, healthcare and the practices associated with resolving ailments – and continually reinvents ‘itself’ in the light of further and better particulars, and experience, and evidence.

            It is not possible to ‘reform’ chiropractic, as if practitioners were to give up subluxations and vital forces they would have nothing left to practice, exept as un-licenced medical practitioners.

            That is why chiropractors who are sincere about ‘reform’ should train as doctors, physiotherapists, nurses or whatever – (indeed, they already should have done so instead of studying ‘chiropractic’).

            That is the ‘reform of chiropractors’ we need to see. ‘Chiropractic’ has clearly had its day.
            (Reference: Critical_Chiro’s references he/she so honestly provided!)

          • “A critical chiropractor is NOT a Chiropractor”
            “IF Chiropractic adopts comprehensively-critical standards it would become NOT-Chiropractic….not “science-based Chiropractic”.”
            “It is not possible to ‘reform’ chiropractic, as if practitioners were to give up subluxations and vital forces they would have nothing left to practice, exept as un-licenced medical practitioners.”
            “Chiropractic has no basis in reality and its founder stated clearly that it is “a different system to medicine.”
            “That is why chiropractors who are sincere about ‘reform’ should train as doctors, physiotherapists, nurses or whatever – (indeed, they already should have done so instead of studying ‘chiropractic’). ”
            “@CC: if as you say you ‘practice’ a mish-mosh of other-researchers work (and NOT anything looking like traditional Chiropractic) why persist in calling yourself a Chiropractor?”
            “The ‘vitilists’ are not a fringe, they are the profession….u may well be an outlier, but I doubt it.”
            So many sweeping statements and Carpet Bombing I have to have to laugh.
            @MK
            “Are you unaware that somewhere around 70% of DCs ‘use’ an Activator or similar adjusting ‘instrument’?”
            Interesting question Michael so I will ask you a a question.
            How many of those actually actually follow activator methods protocols?
            A 2012 study found that 82% of UK chiropractors possessed an activator yet only 2% used activator methods.
            What I find very interesting is that I intentionally incorrectly named one of the physio researchers and no one on this blog picked it up. For those interested here are their correct names and Researchgate profiles.
            https://www.researchgate.net/profile/Peter_OSullivan2
            https://www.researchgate.net/profile/Neil_Oconnell2
            You really should start critically reading the research before commenting and if you do then ensure that its not just the abstract.
            @Edzard
            “some of your heroes are a bit dodgy, I think. see for instance here”
            Read any of his latest research?
            https://www.researchgate.net/profile/Gert_Bronfort
            You are aware that Jan Hartvigsen was just ranked #1 musculoskeletal researcher in the world?
            https://www.researchgate.net/profile/Jan_Hartvigsen/publications
            So according to the carpet bombing statements above he must not be a chiropractor. Forgive me if I cannot stop myself from giggling.
            So to restate a point that I have made many many times on this site. I am all for criticism both from within and without the profession as it is very important for reform. But it must be balanced with support for reform and the reformers otherwise it is just carpet bombing where reform and reformers are looked on as being acceptable collateral damage.

          • You are aware that Jan Hartvigsen was just ranked #1 musculoskeletal researcher in the world?

            Yep; by the Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB). Jan Hartvigsen is both Nordic and a chiropractor. Hmm… no possible biases, then.

          • @Frank Collins
            Jan Hartvigsen was recently ranked #1 musculoskeletal researcher in the world and 12 of the top 60 places are held by researchers from NIKKB. You really should keep up with the research otherwise you just look ignorant. So let me use your own words. Time to “REFORM YOURSELF” Frank. (The next three words you used here http://edzardernst.com/2017/08/are-critics-of-chiropractic-carpet-bombers/#comment-93884 I will not use). Its called common courtesy.

  • @AN sounds suspiciously like a DC…however the AN may stand for an “associates-degree-in-nonsense” as well.
    Tu Quoque is STILL a logical fallacy this week. There have been many observational studies (Waddell, Nachemson and others) that have pretty well proven disc herniation is a self limiting/self-healing entity in virtually 90% of cases over the course of a year. Thus as Mackenzie pointed out: adept manual therapists can “claim” a 90% sucesss rate IF they simply keep a patient under care long enough (a Chiropractic specialty)….thus the literature’s suggestion that “conservative care” is a ‘better’ option than surgical interventions for the 90%.
    However some conservative methods I would think may curtail, not enhance the healing process (in my case I contend manipulation and deep-tissue BS KEPT ME from healing on my own natural-time-frame).
    Since the vast majority of conservative care probly offers little “real” benefits to the self-limiting/self-healing 90% WHAT prey tell would they have to offer the truly recalcitrant patient?? NADA.
    So as much as surgery has a dark side (like defibrillation) it ain’t always pretty, comfortable OR successful but WTF else is available for those pushed into a corner by outrageous fortune?
    Eventually someone has to offer more than a placebo….

    • Michael, I do not know how accurate the 90 % self resolution is , but agree with all you say. As a Family Physician married to a PT, who both have treated many LBP’s, I suffered an HNP in 2001, and did everything I could to avoid surgury, including oral steroid tapers, epidural steroid injections x 2, PT, loads of back care instructions and back care, and even a stupid trip to an acupuncturist at the advice of a misinformed colleague(since I had and since never referred a patient to one), but the MRI and my persistent sciatica showed no reduction of the herniation or clinical improvement of the herniated disc that was large and sitting on the L5-S1 nerve root. After 8 weeks of constant pain in spite of around the clock narcotics so I could function, I consulted a Neurosurgeon and the diskectomy resulted in immediate relief. So yes, surgery is necessary for some but should meet certain criteria that most good back surgeons follow. You may have noted that I did not include a chiropractor in my care, and have never referred a patient to one. nor would I. They are just glorified PT’s that perform a great deal of voodoo, claiming to treat conditions unrelated to the spine, and I doubt they offer much if anything to spinal disorders, in spite of their chicanery and self promotion. Actually, PT’s do much more for the public in many areas, including orthopedic surgery and musculoskeletal injury rehab, stroke rehab, balance and strength training in elderly and others proven to help prevent falls, etc., which I certainly would not trust a chiro to do.

    • @ Michael Kenny

      Please can you point out where you disagree with the evidence I have presented which is very similar to your observational studies reference to 90% of disc herniations will get better over time?

  • @CC: if as you say you ‘practice’ a mish-mosh of other-researchers work (and NOT anything looking like traditional Chiropractic) why persist in calling yourself a Chiropractor?
    Why not just open a gym, get a certificate in personal training and voila’….you have just started real Chiropractic-reform. Nothing to which you seem to ‘believe in’ or prescribe to in physical medicine requires a DC degree (except to ride the dogmatic-coat tails of a hundred year old fake doctor profession to confuse the gullible).

    Are you unaware that somewhere around 70% of DCs ‘use’ an Activator or similar adjusting ‘instrument’? Whose ONLY underlying premise, with their untenable leg-checks and junk science, is an inter-vertebral ‘subluxation’…or whatever other idiotic moniker they use to sell the treatment to those without a high school diploma.
    The ‘vitilists’ are not a fringe, they are the profession….u may well be an outlier, but I doubt it.
    As real science eviserates most ‘treatments’ DCs are circling their dogma wagons and embracing non-sense in numbers that would make BJ proud.

    • Michaels Kenny, are you referring to one of these instruments?

      http://www.backcare-clinic.com/treatment/physiotherapy-instrument-mobilisation

      • @GG:
        Tu Quoque….
        and Voila’ you expect to dispense with the perspicacity of any rational critique aimed at your preferred non-sense.
        Every rational adult recognizes ‘anyone’ can fall prey to religion and pseudoscience based on emotions, mis-perceived need and irrational mis-direction….but especially money.
        My point was based on CC’s suggestion Chiropractic ‘reform’ is plausible since only a very small % of Chiros are ‘subluxation-based/vitalists’.
        However The Activator, drop-table, motion-palpation, upper-cervical, intervertebral-fixation’, foot-on-a-hose, thermomograghy, AK, leg-check, death-and-decay-by-subluxation-and-we/I-am-the-only-solution…..IS the Chiropractic profession. And IF ALL of these ‘tests and determinants-for-treatment’ disappeared WHAT would the profession look like vs. an exercise physiologist, biomechanist, kinesiologist or DPT???
        I’d go to the PT with the ‘gun’ 1000 times before setting foot in a Chiropractic clinic offering it.
        There’s my dogma

        • MK, “dogma” no, “ignorance” by you, “yes”.

          • @GibleyGibley on Wednesday 30 August 2017 at 23:10

            “MK, “dogma” no, “ignorance” by you, “yes”.”

            As always, your responses are marked by childishness. You should follow the old adage; better for people to think you are an idiot than open your mouth (post) and prove it.

    • I don’t think this comment is worthy of a reply…nothing to see here..

  • It’s always fascinating when defenders of a particular brand of ‘inexplicability’ (one they invariably have financial propinquity with) never seem to voice overt criticism(s) toward other ‘nonsense’ when its suggested analogous e.g. homeopathy, Scientology, sharia law, acupuncture, moxibustion, iridology, tea leaves, coffee enemas, non-touch therapy, Christian Science, drinking urine, faith-healing, fung shui, palm reading, astrology….to just name a few. Certainly their alignment with OR distancing from these other inexplicable-contrivances could give insight into a general logical malaise(?)
    Do they only have ‘private reservations’ regarding some of those “other” oddities?? Or will critiquing them necessitate more thorough and critical optics in their own glass house? And carpet bombs these others deserve land too close-to-home?
    Are ‘subluxationalists’ the extent of the name-calling and denigration issued by the “lofty” DCs? Could we not be entertained by the critical-reasoning they’d levy on “REAL” pseudoscience endeavors? That could be of big help in the exposing of the hypocrisy and endemic fallacious reasoning ‘skills’ of the ‘modern-Chiropractor’.
    there seem many similarities between Chiropractic and these other branches of the nut-tree….and not too surprisingly offered regularly in many D.C. Clinics worldwide.

  • Carpet bomb or precision bomb???
    J Chiropractic Med/Nat’l university of health sciences Jun7(2) 59-65. 2008. comparing Biofreeze with Chiropractic adjustment and Chiropractic adjustment WITHOUT Biofreeze (the control group).
    Here’s the fascination, NOT that it may be an inexplicable biased study not-so-subtly denigrating “Chiropractic” done at a Chiropractic college to promote a lucrative sponsor; Biofreeze (as untenable as THAT seems)…
    BUT the result puts into question how a $150,000.00, 4 year program granting a “doctorate degree” could possibly be worth the papyrus it’s written on when a $10.00 tube of menthol works equally well OR better than the core-of-the-curriculum??? Talk about your carpet bombs!!!!
    Their conclusions: Biofreeze with a Chiropractic ‘adjustment’ relieved back pain temporarily….however the “control group” only got a Chiropractic adjustment…,,,AND:
    “Biofreeze combined with chiropractic adjustment showed significant reduction in LBP.
    It was surprising that the chiropractic adjustment group did not show significant pain relief after 4 weeks of care”.
    Of course NOT a surprise to those of use having graduated from high school…..
    And this was 9 years ago….the sheep-skin is assuredly MORE expensive and still without commensurate value….but Biofreeze is now available at Walmart!!
    Why bother waiting for an appointment, risking a stroke or spending money pointlessly????

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