MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

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    by james winterborn - Wednesday 13 December 2017 14:09
    I'm a physio who used to be an osteopath. I retrained because I hated working in alternative medicine, because osteopathy (and chiropractic) is so badly integrated into the wider medical system and because I wanted a more science based approach to clinical practice. You're right that time is the best healer for MSK pain. Tissues heal themselves. But what physios understand and you apparently don't is that tissues heal without the need for half baked pseudoscience and flaky mysticism. Most manual therapy including chiropractic manipulation is a placebo. It reduces anxiety while the body heals itself. The role for physio in the treatment of MSK pain is to screen for red flags and psychosocial yellow flags, assess for muscle weakness and joint stiffness which will benefit from specific rehab and give the person reassurance and encouragement to gradually increase their tolerance to movement. No subluxation correction is required.

    by Critical_Chiro - Wednesday 13 December 2017 01:30
    @MK If you follow the evidence there should be little difference between the professions treating NMS conditions Michael. To quote Jason Silvernail fron Soma Simple "Combine the professionals, not the professions". The subluxationists are being marginalized and feel threatened. The Rubicon groupis a prime example. In physiotherapy the likes of Barret Dorko who has been fighting the good fight for over 20+ years lament that they are a lone voice in the wilderness and face apathy and hubris from within physiotherapy and an institutionalized resistance to change. Do the physiotherapists have vocal external critics? Just look at the tags above. The referenced article is in regards to physio's, osteo's and chiro's manual therapy (which is a very broard), yet Edzard tags this blog: " alternative therapist, back pain, chiropractic, evidence, medical ethics, osteopathy, pain, politics, progress, risk/benefit, spinal manipulation, systematic review" which speaks volumes. The pain specialist who I meet to discuss cases admits that they are practicing more and more like a chiropractor short of adjusting (and like a physio for that matter). The only difference is they primarily see motor vehicle insurance and workers compensation cases where once a patient enters the compensation system and gets a lawyer the prognosis deteriorates rapidly. Some of their case presentations are exercises in frustration with ridiculous amounts of paperwork. Maybe its time doctors start retraining as chiro's and physio's. That would be a first.

    by GibleyGibley - Tuesday 12 December 2017 18:46
    To reiterate. The primary thing thing a physiotherapist does for neuro-musculo-skeletal disorders is to prescribe an exercise. No one exercise is better than another. The patient may as well rake the lawn, polish the floor or clean the windows. To think that patients and insurance companies (NHS) are wasting their money, paying a physio for advice that is useless is a travesty. It is time that the physio profession took a damn good look at itself and realised that what they do doesn't work. Time is the great healer in their field and that all a physio exercise does is keep the patient occupied, the practitioner amused and entertained, whilst nature takes its course and heals the problem.

    by UK Homeopathy Regulation - Tuesday 12 December 2017 14:11
    I believe that the fear of Brexit means that seasonal workers from other EU countries have decided not to come pick fruit and vegetables in the UK from media reports. I believe that many CAM practitioners are well qualified for these kinds of roles. They have long experience of cherry-picking...

    by S. Cox, MD - Tuesday 12 December 2017 12:21
    Yes, in the US Osteopaths train with MD's in the same internships and residencies. I never understood this or why have Osteopathic schools. Why don't they just go to medical school rather than osteo school?

    by Frank Odds - Tuesday 12 December 2017 09:53
    Thanks. I accept that the clue is in the name on the tin. But read this from Wikipedia: "In the 21st century, the training of osteopathic medical physicians in the United States is equivalent to the training of Doctors of Medicine (M.D.s).[8] Osteopathic medical physicians attend four years of medical school followed by an internship and a minimum two years of residency. They use all conventional methods of diagnosis and treatment. Though still trained in osteopathic manipulative treatment (OMT),[9] the modern derivative of Still's techniques,[10][11] they work in all specialties of medicine. Discussions about the future of modern medicine frequently debate the utility of maintaining separate, distinct pathways for educating physicians in the United States.[6][12]" From comments on other threads on this blog I had certainly gained the impression reflected in the Wikipedia article (https://en.wikipedia.org/wiki/Osteopathic_medicine_in_the_United_States) and that's the basis of my original (semantically incorrect) comment.

    by Richard Rawlins - Tuesday 12 December 2017 09:24
    No. In the US, osteopaths are fully trained DOs, not MDs The clue is in the name on the tin!

    by Richard Rawlins - Tuesday 12 December 2017 09:22
    Indeed! That is why we have moved on! And I go further - that is why we trained in medicine to be doctors in the first place, rather than cop out and be inveigled into training in condimentary medicine (adds spice and flavour, but no other essential effect). The first step would be for the regulating authorities of the GOC and GCC to combine (as the Nightingale Collaboration suggests). Then there might be a chance that an ethical profession could develop which was capable of supporting patients with musculo-skeletal problems. There is precious little difference between either faith/doctrine (a set of beliefs incapable of verification). No chiropractic web site explains how chiropractic differs from osteopathy; and vice versa . For those of you who like your vice versa , this could be important! That would beg the question as to why the osteopaths/chiropractors had not qualified as physiotherapists - but that would be for them to explain! I knew a good physiotherapist who then qualified as a chiropractor: "There was more money in it!" But if money making is the principle or only factor in career decision making, patients must be told.

    by GibleyGibley - Monday 11 December 2017 22:25
    Exercises are great, but it doesn't matter what you do, from gardening, walking, cycling, gym, what ever, it is irrelevant what you do. So, why is there an industry of "shake, bake and fake physiotherapy", that has exercises as the only method of treatment that is vaguely evidence based. We all know that ultrasound (still used in the U.K. and taught in physio schools in the U.K.) is non-evidence. We know that TENS, corsets, biofeedback, pilates (all standard physio treatments) do not work and that has been proven. One could go so far as to say that physiotherapy is no more effective than homeopathy, and in some quarters is correctly referred to as, "hands on homeopathy".

    by Michael Kenny - Monday 11 December 2017 15:04
    Interesting as usual, though not quite as enticing as the dead-vagina. The “critical-chiro” frequenting the blog tends to suggest the thorough disengagement of the “big idea” from Chiropractic represents its best reformation. The Problem with that is, as has been pointed out innumerable times; WHAT would such a profession look like other than a wannabe PT? Or a lower-tier PT who spent $200K on a non-transferable degree built from the dregs of pre-scientific dogmas? Even Chiropractic apologists routinely point out “subluxation” is the WHY of Chiropractic...without it, all uniqueness disappears and it’s USP (unique selling proposition) is lost. A “reformed” Chiropractor is just superfluous. This is especially true in the US where the number of DCs hovers (plateaus) near 60K with PTs (and PTassistants) nearing 200K and growing. Chiropractors can’t agree what Chiropractic actually IS. IF that definition includes or is exclusive to the: ‘adept and effective addressing of NMS complaints via any sort of manual “whacking” ‘then indeed another vocation is in order.

by Andy Murray - Wednesday 13 December 2017 10:11
I think we all UNDERSTAND homeopathy very well. That's why everyone can see just how silly it all is.

by Richard Rawlins - Wednesday 13 December 2017 07:47
The leaflet is headed 'My Voice'. Clearly, the voice of desperation.

by Alan Henness - Tuesday 12 December 2017 17:38
That's a very good question. However, it's not clear it would fall within the ASA's remit as it's not intended directly for public consumption. If a homeopath was to use it as advertising, then it probably would - and I suspect it would be in breach. I also suspect they will not do so now and may even withdraw it just in case one of their members does publish it.

by Lenny - Tuesday 12 December 2017 16:02
You make these statements only because you do not UNDERSTAND homeopathy, Barrie. It is not like your allopathic systems. If you understood, you would not ask these foolish questions. (Just saving the idiots the job of posting this tedious, oft-repeated and fascile response in case any fancy turning up to the party)

by UK Homeopathy Regulation - Tuesday 12 December 2017 14:06
I wonder what the Advertising Standards Authority (ASA) would make of some of these claims? As the Society of Homeopaths' campaign exists to promote the businesses of its members, it could strong be argued that it is in fact marketing/promotion and thus would fall under the remit of the ASA.

by Barrie Lee 'Wellness' Thorpe - Tuesday 12 December 2017 13:02
If homeopathy is indeed tried on healthy humans, as is claimed, how can it therefore not 'work'? I could put a bandage round my leg, but if it were not injured in the first place, should I then attribute its continuing health to homeopathy? This campaign reminds me of a booklet once sent to the journalist Simon Hoggart by a friend in America. It was published by some American religious set-up, and was along the lines of ' How to answer the most frequently asked questions critical of religion'. Basically, it said ' After recent disasters such as tsunamis, floods, earthquakes, the Twin Towers, etc, even the existence of dinosaurs alongside humans,there is no doubt that religion is coming under attack. Here is how to answer any criticisms and questions'. I don't remember the details, except that the whole thing was dismaying ly comic, , but Hoggart finished his article by saying 'Proof, were it needed, that these people need not be taken seriously for one more minute'.

by Frank van der Kooy - Tuesday 12 December 2017 11:57
Out of curiosity. Do you get homeopaths that are critical of 'classical' homeopathy? For example; in chiropractic you get chiropractors that's against sublaxations, so it stands to reason that there might be some homeopaths that will call remedies such as Berlin Wall, 'excrementum caninum' etc. absolute rubbish. But for some reason I don't think so.

by Steve Tonkin - Tuesday 12 December 2017 10:39
HOMEOPATHY IS USED BY 450 MILLION PEOPLE WORLDWIDE = More than 94% of people worldwide do not use homeopathy.

by Critical_Chiro - Tuesday 12 December 2017 22:29
@MK " that EVERY real doctor sitting in that “meeting” wouldn’t know…and likely far better than you?" " pt mangt that wouldn’t be amply and adeptly available via these other professionals?? Anything you offer would inevitably have come from their respective research institutions NOT yours." Wish I could bring you to our regular meetings Michael. You would find them educational and challenge your cherished beliefs about what is chiropractic. What you would find is a group of professionals where no one has all the answers, no one approach is best, no one professiopn has all the answers and a multidiciplinary approach that benefits the patient and where we all contribute. Chronic pain management is frustrating and the research is still in its infancy and seriously underfunded. "That you see the fraud of the profession is admirable but denying that your adoption of science-based physical medicine approaches is NOT Chiropractic (and will never be) is specious." There are crooks in chiropractic who overtreat patients and foster a toxic dependency in patient and practitioner and it is up to the profession to clean them up with the assistance of external critics. Friends of Science in Medicine here have become more and more supportive of the chiropractic critics and reformers and we get along well. In countries like Australia, UK, Canada and the Scandinavian countries this is achievable. In the US with competing state registration boards and wildly varying scope of practice between states I am pessimistic. I actually enjoy interacting with the external critics like yourself and look on you as drivers of reform. You are tools. For reform that is. 🙂 I realize that some are unlikely to change but I am also here to put both sides of the argument into the public record.

by ChiroBabe - Tuesday 12 December 2017 21:24
Ooooh ooooh, do my rebuttals next! This one got over 35k reads: https://medium.com/@chirobabe/the-science-babe-is-neither-scientist-nor-babe-shes-bullshit-89eba206cd9 And this one is at 10k. Enjoy! https://medium.com/@chirobabe/a-chiropractor-does-research-haters-gon-hate-be87bed59c88

by Lighthorse - Tuesday 12 December 2017 09:24
Maca root "Used for centuries in Asian countries". Right. Since when were Peru and Bolivia Asian countries?

by Alan Henness - Sunday 10 December 2017 10:14
I decided not to go here... 🙂

by James - Saturday 09 December 2017 22:32
Would I not be justified in thinking... They probably invented the theatrical as a hoax, and named the points accordingly to warn sufficiently rational bystanders as an undercover gentlemen's agreement...

by Frank Odds - Monday 11 December 2017 10:24
@Yasmin Your obvious enthusiasm for 'nutrigenomics' and its relevance just might be exceeding the real expectations. IOW, I get the impression you're putting the cart a very long way ahead of the horse. (And the horse itself is probably just a foal at this stage.) From the article you linked to in your first post (by the way, it's a weak, unscholarly review that doesn't even cite references properly) the bulk of the nutrigenomic field so far consists of measuring genomic changes that result from exposure of cells in vitro to 'nutrients' — predominantly vitamins. But in which of the ~200 cell types in the human body are the changes investigated? I guess we're looking at tissue cultures. Your 'perspective' article mentions experiments in mice, but provides no reference to a peer-reviewed article containing details. (You can stand up and say anything you like at a conference.) All this is a very long way from any medical treatment, yet you're asking about the relevance of this work to medicine. Short answer, it's got a helluva way to go to acquire any meaningful relevance. The other face of nutrigenomics is apparently concerned with associations between gene sequence changes (SNPs) and diet. This is a branch of epidemiology (your linked article says "...integration of genomic science with nutrition and, when possible, other lifestyle variables such as cigarette smoking and alcohol consumption") and you must make yourself aware of the huge minefield into which this pokes a scientific toe. Epidemiological work requires very long-term studies that take account of as many lifestyle variables as possible. And even then, they tend to fall into the classical trap of 'correlation does not imply causation'. Take a look at this website, which is a bit of an eye-opener about correlations. You ask "Does Nutrigenomics mean that herbal-based medicine is a possibility?" Herbal medicine is a reality! Many herbs have been found to have medicinal properties, and analysis has usually succeeded in identifying the molecule that causes the medicinal effect. The active molecule may then be modified to improve one or other of its properties, but it's always better to treat diseases with a known molecule(s) than with a herb, where the specific type of herb, the part of the herb used and the method of preparation can all differ. The main reason herbal medicine (as currently practised by its fans) is deprecated on this blog is because so very few herbal remedies have been adequately tested to prove their efficacy in robustly scientific clinical trials. Re-read the final para graph of James's excellent response to you and try to understand and apply its points to your own thinking. Maybe you'll let us know (in outline) exactly what your PhD project entails, and you might attract some useful or at least interesting responses on this blog. But please try to suppress your eager enthusiasm for the grandiose, theoretical long-term implications of nutrigenomics for medical science and stay within the bounds of reason.

by Yasmin - Monday 11 December 2017 02:24
Hello, I appreciate the effort in the explanation. I think the issue with this mainline of conversation is bias. If each experiment is meant to be proven, disprove, and/or support an already well-known theory then isn't the following act of the process to take in new information as it applies as long as evidence proves supportive. Most of these clinical trials listed are, of course, unlikely to be proven true but that isn't what I'm asking in relation to Nutrigenomics. I'll try to clarify because I don't want to derail the conversation. Nutrigenomics is based on the idea that certain genes are constantly changing and are changed by the ingestion of foods that produce amino acids and other nutrients our body can use to do its work. The question is: Does Nutrigenomics mean that herbal-based medicine is a possibility? Is it possible that we simply haven't found the right mixtures or the right people to react to the medicine effectively? I only question this because we know how telomeres work in cellular aging and we know that the sudden appearances or losses of allergies are the byproducts of the natural changes our biochemistry goes through as we age. I'm using theories and basic biochemistry as a reference so I don't find this anything but critical. If you would like to be critical of this idea based on factual evidence or supporting evidence that contradicts the existence of Nutrigenomics then by all means do so. I'm interested.

by Leigh Jackson - Sunday 10 December 2017 02:52
Yasmine, you are failing to communicate. You are talking to yourself. Is that all you wish to do?

by James - Saturday 09 December 2017 23:27
Quoting Wikipedia: By determining the mechanism of the effects of nutrients or the effects of a nutritional regime, nutrigenomics tries to define the causality or relationship between these specific nutrients and specific nutrient regimes (diets) on human health. Nutrigenomics has been associated with the idea of personalized nutrition based on genotype. While there is hope that nutrigenomics will ultimately enable such personalised dietary advice, it is a science still in its infancy and its contribution to public health over the next decade is thought to be major. The trouble with alternative medicine is that it usually lays claims on highly implausible mechanisms, at times highjacks seemingly relevant, but ultimately irrelevant, mechanisms, and boldly and persistently, but all-too-often stagnantly, stands on correlation, without providing any high-quality evidence of causation. Establishing a causal link with the help of robust evidence usually upgrades alternative medicine to plain medicine. The first thing you will necessarily have to forfeit is wishful thinking, which is the hardest part. From then on, things are straightforward. If you get increasingly confident evidence for a specific effect of a nutrient on some locus and this is accompanied by a clinically relevant manifestation (i.e. not a "silent mutation" type of thing etc.), you can check for clinical effects of whatever contains this nutrient. You might get an apparent association there. By piling evidence, a causal link may unfold and, with time, you may be approaching the next generation of blood type diets, for example. But you need mechanisms, so you must dive to the molecular level. And because these are bold claims to begin with, you must pile extraordinary and robust evidence. Because alternative medicine researchers are not usually equipped with a strong line of defense against wishful thinking (though there are bright exceptions, such as the host of this blog you're reading right now, and which is the primary reason you are in the right place), to answer your question about how nutrigenomics will affect the understanding of alternative medicine, I believe it will primarily provide far more ground for spurious and flimsy conclusions, a new era of highly implausible claims and profound amounts of misrepresentation to promote whatever is the next generation of dietary supplements...among other "unfortunacies". On the other hand, a small number of herbal preparations may be found to have specific effects, or, even better, some subtle dietary details may help organize and tailor a diet for diabetes patients of varying genotypic manifestations, or for sensitive dietary cholesterol responders. Try to be critical with whatever you view as evidence and don't jump to conclusions. And try to spare the majestic sentimental appeals, science is about reason. If you are using your question to lay out your type of thinking, then it is not an honest question, and you are probably already equipped with your desired answer. If you dropped by to reinforce some belief of yours, you are in the wrong place.

by Leigh Jackson - Sunday 10 December 2017 13:58
Richard, you assume, "one" doesn't. Can you address Edzard's criticisms of the report? If not, ipso facto, your tuppence worth ain't worth a ha'penny.

by James - Sunday 10 December 2017 12:09
Nope. The authors are biased, the methodology is flawed, the result is highly unreliable. It's that simple!

by Edzard - Sunday 10 December 2017 07:39
"...one assumes..." assume as much as you want!

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