MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Imagine a type of therapeutic intervention that has been shown to be useless. Let’s take surgery, for instance. Imagine that research had established with a high degree of certainty that surgical operations are ineffective. Imagine further that surgeons, once they can no longer hide this evidence, argue that good surgeons do much more than just operate: surgeons wash their hands which effectively reduces the risk of infections, they prescribe medications, they recommend rehabilitative and preventative treatments, etc. All of these measures are demonstratively effective in their own right, never mind the actual surgery. Therefore, surgeons could argue that the things surgeons do are demonstrably effective and helpful, even though surgery itself would be useless in this imagined scenario.

I am, of course, not for a minute claiming that surgery is rubbish, but I have used this rather extreme example to expose the flawed argument that is often used in alternative medicine for white-washing bogus treatments. The notion is that, because a particular alternative health care profession employs not just one but multiple forms of treatments, it should not be judged by the effectiveness of its signature-therapy, particularly if it happens to be ineffective.

This type of logic seems nowhere more prevalent than in the realm of chiropractic. Its founding father, D.D. Palmer, dreamt up the bizarre notion that all human disease is caused by ‘subluxations’ which require spinal manipulation for returning the ill person to good health. Consequently, most chiropractors see spinal manipulation as a panacea and use this type of treatment for almost 100% of their patients. In other words, spinal manipulation is as much the hallmark-therapy for chiropractic as surgery is for surgeons.

When someone points out that, for this or that condition, spinal manipulation is not of proven effectiveness or even of proven ineffectiveness, chiropractors have in recent years taken to answering as outlined above; they might say: WE DO ALL SORTS OF OTHER THINGS TOO, YOU KNOW. FOR INSTANCE, WE EMPLOY OTHER MANUAL TECHNIQUES, GIVE LIFE-STYLE ADVICE AND USE NO END OF PHYSIOTHERAPEUTIC INTERVENTIONS. YOU CANNOT SAY THAT THESE APPROACHES ARE BOGUS. THEREFORE CHIROPRACTIC IS FAR FROM USELESS.

To increase the chances of convincing us with this notion, they have, in recent months, produced dozens of ‘systematic reviews’ which allegedly prove their point. Here are some of the conclusions from these articles which usually get published in chiro-journals:

The use of manual techniques on children with respiratory diseases seems to be beneficial.

The majority of the included trials appeared to indicate that the parents of infants receiving manipulative therapies reported fewer hours crying per day than parents whose infants did not, based on contemporaneous crying diaries, and this difference was statistically significant.

A limited amount of research has been published that supports a role for manual therapy in improving postural stability and balance.

…a trial of chiropractic care for sufferers of autism is prudent and warranted.

This study found a level of B or fair evidence for manual manipulative therapy of the shoulder, shoulder girdle, and/or the FKC combined with multimodal or exercise therapy for rotator cuff injuries/disorders, disease, or dysfunction.

Chiropractic care is an alternative approach to the care of the child with colic.

There is a baseline of evidence that suggests chiropractic care improves cervical range of motion (cROM) and pain in the management of whiplash-associated disorders.

Results of the eight retrieved studies indicated that chiropractic care showed improvements [for asthma].

Personally, I find this kind of ‘logic’ irritatingly illogical. If we accept it as valid, the boundaries between sense and nonsense disappear, and our tools of differentiating between quackery and ethical health care become blunt.

The next step could then even be to claim that a homeopathic hospital must be a good thing because some of its clinicians occasionally also prescribe non-homeopathic treatments.

34 Responses to The alchemists of alternative medicine – part 4: you cannot judge me by my signature therapy

  • It not the chiropractors’ fault Edzard if you have a hard time comprehending that for the best part of 100 years chiropractic has involved more than just spinal manipulation. Perhaps this article is an indication that you are finally coming to grips with it

    • are you sure that you have understood my article?

    • The unique differentiating feature of chiropractic is the diagnosis, treatment and prevention of spinal subluxations. These do not exist. Chiropractors accidentally perform physiotherapy while supposedly treating the non-existent condition, that does not make chiropractic a valid modality. It doesn’t matter how well your karma mechanic valets your car, there’s no way realigning its energy fields is a substitute for actual mechanical work.

  • I find this post quite bizare. Surely this is what we should want a profession to do whether they are considered mainstream or CAM. It is called evolution and it is what has happened in all areas of healthcare. In the case of chiropractic in the UK there has for many years been a move away from reliance on one treatment approach, exercise for example along side manual therapy is evidence based and appropriate and is now utilised by most chiropractors.

    If you consider physiotherapy as an example it started as a spin off from massge therapy but now offers a range of treatments and cannot be defined by a single treatment or modality despite in many cases limited evidence.

    • perhaps you find it bizarre because you misunderstood it. I am not against health care professionals doing more than one thing; I am only against any profession saying BECAUSE I DO MORE THAT ONE THERAPY, IT IS IRRELEVANT THAT MY MAIN TREATMENT IS BOGUS

      • However, consider the development of osteopathy in the US. Based on total nonsense, but over time has come so far in from the cold that in another generation, perhaps it will drop its last trappings of woo and be folded in to MD programs. I think there’s at least some chance chiropractic could follow the same arc.
        Then again, I’ve learned (from you, I think) that DOs in UK and AUS are as quacktastic as they ever were.

  • Interesting read. It would appear that chiropractors’ hallmark treatment, *chiropractic* spinal manipulation (adjustments), is crucial to them. See here:
    http://www.zenosblog.com/2010/11/where-the-evidence-leads/

    The link above shows how the UK regulator, the General Chiropractic Council (GCC), made it abundantly clear that a study by Hancock et al [Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial, M.J. Hancock et al, Lancet 2007; 370:1638-43] had nothing whatsoever to do with chiropractic. However, chiropractors’ much touted Bronfort Report, which the GCC commissioned, not only included that study, but was also full of studies in the same vein. It follows that if the Hancock study was removed from the Bronfort Report, then all the other papers that Bronfort cited that were not explicitly to do with chiropractic and chiropractic manipulation would have to be removed too. In other words…

    Quote
    “Chiropractors can’t have it both ways: chiropractors can’t claim to be unique amongst the manual therapists because of their techniques, yet claim any evidence for their particular ‘art’ from the studies that were not about chiropractic manipulations. The GCC has made this perfectly clear. So, the GCC can’t maintain that Hancock is irrelevant because it’s not about chiropractic manipulations, yet allow their prized Bronfort Report off the hook when it cites trials mainly not about chiropractic. Once all those non-chiropractic manipulations have been removed from the Bronfort Report, what’s left? Not a jot .”

    Suffice to say that when chiropractic’s current “package of care” sales pitch is stripped of ‘chiropractic’, what’s left is physiotherapy.

    • I believe that the problem that chiropractors had with the Hancock study was that it was reported in the popular press as “chiropractic does not work” rather than “spinal manipulation is ineffective”. Once again the study which I believe was conducted by physiotherapists was used to “bash” the chiropractic profession. This evidence is relevant to all practitioners who use spinal manipulation.

      Since the NICE guidelines on low back pain were published we have seen an increase in physiotherapists using spinal manipulation and acupuncture so we can argue how close the manual therapy professions are to each other and there is certainly much overlap but that is the situation that we have in the UK.

      • Andy wrote: “I believe that the problem that chiropractors had with the Hancock study was that it was reported in the popular press as “chiropractic does not work” rather than “spinal manipulation is ineffective”. Once again the study which I believe was conducted by physiotherapists was used to “bash” the chiropractic profession. This evidence is relevant to all practitioners who use spinal manipulation.”

        If chiropractors are going to associate themselves with spinal manipulation therapy – and spinal manipulation is chiropractors’ hallmark treatment when compared to those of other manual therapists – then the way in which the Hancock study was reported in the press wasn’t inaccurate. So chiropractors have been caught out.

        Andy wrote: “Since the NICE guidelines on low back pain were published we have seen an increase in physiotherapists using spinal manipulation.”

        Good. Hopefully more patients are turning to them because they are becoming more aware that chiropractors still have this huge problem to overcome…

        Quote
        “Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them (11). And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment.”

        Ref: Spinal manipulation for the early management of persistent non-specific low back pain — a critique of the recent NICE guidelines, Edzard Ernst, Int J Clin Pract (18th August 2009). Reference (11) is Ernst E. Chiropractic: a critical evaluation. J Pain Sympt Man 2008; 35: 544–62. Page 6 of the paper mentions a report that indicates that only 11% of all cervical manipulations are “appropriate” and gives the reference Coulter I, Hurwitz E, Adams A, et al. The appropriateness of manipulation and mobilization of the cervical spine. Santa Monica, CA: RAND, 1996:18e43.

        Andy wrote: “…we can argue how close the manual therapy professions are to each other and there is certainly much overlap..”

        Until chiropractic has been standardised it won’t be very close to other manual therapy professions at all. Currently, its ‘package of care’ line appears to be a window-dressing gambit thrown around in a desperate attempt to maintain an air of legitimacy.

        • BW as I have said before you have twisted tis around to the subluxation argument. The chiropractors I work with do not and have never diagnosed subluxations, they are UK trained and were never taught to diagnose or treat in the way that you describe and do not practice in this way.

          It is interesting that you are so entrenched in your views.

  • Andy wrote: “BW as I have said before you have twisted this around to the subluxation argument.”

    I haven’t twisted it at all. Not only am I pointing out that chiropractors cannot be vitalistic and scientific at the same time, but I am also pointing out that they seem to declare themselves to be on a par with other manual therapists only when it suits them. It is this ambiguity, coupled with shoddy regulation, that renders chiropractic a major public health problem.

    Andy wrote: “The chiropractors I work with do not and have never diagnosed subluxations, they are UK trained and were never taught to diagnose or treat in the way that you describe and do not practice in this way.”

    Anecdotal and irrelevant. I’m looking for data that betters this:
    http://edzardernst.com/2013/03/what-is-next-a-royal-college-of-window-salesmen/#comment-54269

    Do you have any?

  • ´This type of logic seems nowhere more prevalent than in the realm of chiropractic. Its founding father, D.D. Palmer, dreamt up the bizarre notion that all human disease is caused by ‘subluxations’ which require spinal manipulation for returning the ill person to good health. Consequently, most chiropractors see spinal manipulation as a panacea and use this type of treatment for almost 100% of their patients.´

    You have mis quoted and mis understood chiropractic philosophy and hence the rest of you arguement doesn´t stand to reason.
    Chiropractic is not effective for specific conditions rather effective for improved spinal function/structure. That and only that. Obviously that can have various effects on muscular and neural type complaints. We should not be claiming to TREAT any medical type condition.

  • In Reply to Blue Wode:
    I agree with much of what you say Blue , but I think you need to be more selective. In Australia we have chiropractors like John Reggars and Bruce Walker who are asking the critical questions and taking the initiative. They are doing the hard yards and require all our support. Unfortunately, they are also the meat in the sandwich between the critics and the subluxation true believers. The last thing we need is for chiro’s like Bruce and John to throw up their arms in frustration quit. You recently noted that the subluxationists are become more vocal and extreme, I agree with you, they are becoming more entrenched and resistant to change. Would you rather be dealing with chiro’s from AECC or McTimoney?

    Andy made a good comment about the chiropractors he works with and it is the same with me, I associate with chiro’s who read journals, do not treat subluxations, look for best evidence and apply it. Virtually all the chiro’s I associate with have a good referral relationship with doctors and several work closely with doctors in medical centres like myself.

    Positive change is happening in the trenches and at an institutional level here like COCA, Murdock University and Macquarie University. We also have issues with the CAA, Central Queensland University and especially the ASRF. You are very well read and informed and are aware of this, the doctors I work with are also well aware of this and refer accordingly.

    • Thinking_Chiro wrote: “I agree with much of what you say Blue , but I think you need to be more selective. In Australia we have chiropractors like John Reggars and Bruce Walker who are asking the critical questions and taking the initiative. They are doing the hard yards and require all our support.”

      That’s all well and good, but *in the meantime* where are the global directories to which patients can turn to find your chiropractors who read journals, do not treat subluxations, and who look for best evidence and apply it? More to the point, where is the official, readily available information that informs the public that there is currently a huge division in chiropractic which means that a choice must be made between two different types of practitioner? Or do you think that the public should continue to be kept in the dark – i.e. that it should continue to be subjected to the chiropractic ‘bait and switch’?

      Quote

      “Chiropractic is perhaps the most common and egregious example of the bait and switch in medicine. The deception begins with the name itself – “chiropractic” fails the basic test of transparency because it is not unambiguously defined. There are in fact numerous professions doing very different things and employing mutually exclusive philosophies under the banner of “chiropractic.” Therefore someone may go to see a chiropractor and think they will be seeing a medical professional who will treat their musculoskeletal symptoms, but in reality they will see the practitioner of a cult philosophy of energy healing. So-called “straight” chiropractors (who make up an estimated 30% of all chiropractors) still adhere to the original philosophy of chiropractic invented by “magnetic healer” D.D. Palmer, which is based upon the claim that an undetected life energy called “innate intelligence” flows through the spinal cord and nerves and is responsible for health. Such chiropractors will treat any disease or ailment with spinal manipulation.
      Most other so called “mixer” chiropractors reject the notion of innate intelligence either partially or entirely, but still incorporate other pseudosciences into their practice. Chiropractors are the primary practitioners of homeopathy, applied kinesiology, and iridology in the US. The bait – claims that chiropractors are medical practitioners with expertise in the musculoskeletal system. The switch – practitioners of discredited pseudosciences that have nothing to do with the musculoskeletal system.
      A more subtle form of the bait and switch among chiropractors is the treatment of musculoskeletal symptoms with standard physical therapy or sports medicine practices under the name of chiropractic manipulation. Ironically, the more honest and scientific practitioners among chiropractors are most likely to commit this subtle deception. The problem comes not from the treatment itself but the claim that such treatments are “chiropractic.”
      Using techniques like massage, range of motion exercises, strength-building exercises, and mobilization of joints are all legitimate science-based techniques used by physical therapists and physicians with specialties in physiatry, orthopedics, and sports medicine. Some chiropractors also use similar techniques -and with good results. But by doing so and calling it “chiropractic” it legitimizes the pseudoscientific practices that are very common within the profession – like treating non-existent “subluxations” in order to free up the flow of innate intelligence.”

      Ref: http://www.sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/

      How long is it going to take to resolve the ‘bait and switch’ problem? Because let’s get real here, millions of chiropractic patients are currently being duped out of their time and money, and some are being harmed (and not just through injuries caused by manipulation – there’s also psychologic harm related to unnecessary treatment [nocebo effect], psychologic harm caused by exposure to false chiropractic beliefs about ‘subluxations’, and children are being harmed through misinformation given to parents about vaccinations).

      Thinking_Chiro wrote: “Andy made a good comment about the chiropractors he works with and it is the same with me, I associate with chiro’s who read journals, do not treat subluxations, look for best evidence and apply it. Virtually all the chiro’s I associate with have a good referral relationship with doctors and several work closely with doctors in medical centres like myself.”

      As I said to Andy above, that’s anecdotal and irrelevant. I’m looking for data that betters this:
      http://edzardernst.com/2013/03/what-is-next-a-royal-college-of-window-salesmen/#comment-54269

  • In reply to Blue Wode:
    As I said above the doctors are aware of how I practice and refer accordingly. They are aware of the differences as are you when you said above “30% subluxationists”.

    “A more subtle form of the bait and switch among chiropractors is the treatment of musculoskeletal symptoms with standard physical therapy or sports medicine practices under the name of chiropractic manipulation. Ironically, the more honest and scientific practitioners among chiropractors are most likely to commit this subtle deception. The problem comes not from the treatment itself but the claim that such treatments are “chiropractic.”.”
    This is a two way street! Facepalm. Make that three way as the Musculoskeletal physicians I work with are using a lot of chiropractic and physiotherapy teckniques as well.
    I agree with so mush of what you say when highlighting the subluxationists and BS merchants but your blanket approach will not create change within the profession. That is coming from associations like COCA, institutions like Murdock and Macquarie and leaders like Reggars, Walker, Bonello, etc.
    As for Vaccination, 120 out of 4700 in Australia, and they have been delt with by the board, as you already know!
    I am well aware that you have been at this for over a decade (feels like 125 years LOL) and have probably been subject to a lot of personal attach by the BS merchants. However, acknowledging the good work done by those mentioned above among many others will create the momentum for change that you and I both want.

    • Thinking_Chiro wrote: “I agree with so much of what you say when highlighting the subluxationists and BS merchants but your blanket approach will not create change within the profession.”

      My blanket approach has less to do with creating change in the profession as it has to do with the hope that every time I leave a comment on blogs like this that it adds to the small amount of good information on chiropractic that’s available to the public on the internet – i.e. I am hoping to help people to become more aware of the problems with chiropractic, especially if they are thinking of going to one. On that note, I see that you didn’t answer my question about what directories, globally, are available to the public to which they can turn to find chiropractors who read journals, do not treat subluxations, and who look for best evidence and apply it.

  • What exactly is it that chiropractors do, that is so much better than any other profession, that they are needed?

  • Blue Wode wrote:
    “My blanket approach has less to do with creating change in the profession as it has to do with the hope that every time I leave a comment on blogs like this that it adds to the small amount of good information on chiropractic that’s available to the public on the internet”.
    We are on the same page here literally. I am here for the same reason, to provide good information on good chiropractors.
    There are great chiropractors out there working with doctors and making changes individually, collectively and institutionally. Highlighting the BS Blue is fine, but it needs to be balanced by support for the good chiropractors.

    “On that note, I see that you didn’t answer my question about what directories, globally, are available to the public to which they can turn to find chiropractors who read journals, do not treat subluxations, and who look for best evidence and apply it.”
    Recently here in Australia one of the private health insurance companies set up a website called “White Coat” to allow patients to rate and find good doctors’s, specialists, chiro’s, physio’s etc covering everyone. It has hit a rather large snag, as any positive comments and ratings left by patients are testamonials and are therefore banned here. We have been advised by COCA on the issue and it is still to be resolved.
    The whole medical referral sysyem is based on anecdote and patient feedback not a Yellow Pages type directory. If a GP refers to an orthopod and they do a good job, the patient is happy with the GP, if the orthopod stuffs up then they are unhappy with the GP, not the orthopod. The GP will then find a new orthopod. There is no global directory saying this orthopod is great and avoid that one. GP’s don’t refer lightly as they know it comes straight back at them. Being part of a GP’s referral network is a big deal and they watch me like a hawk. Patients also do the same when recommending their doctor, chiro, physio and also warning people off if they have a bad experience. The GP I see and who has immunised my family is fantastic. Unfortunately, I cannot refer anyone else to him as he has closed his books and won’t accept any more new patients. He was recommended to us by one of the other mothers at the early childhood centre.

    Health is the ultimate team sport Blue. There are chiropractors on the other team, but there are also a lot of chiropractors on your team as well. Careful who you tackle as it may be a team mate. Additionally, check the goal before shooting because you do not want an own goal. Providing support to your chiropractic team mates is just as important as applying pressure to the opposition.

    In reply to Preston Long:
    “What exactly is it that chiropractors do, that is so much better than any other profession, that they are needed?”
    No one profession has all the answers or can help everyone and for any one profession to claim that they can is unprofessional. I market myself to my doctors as another approach in the treatment of musculoskeletal conditions. Doctors understand changing the dosage and/or medication to achieve the best result for any given patient and that is how I communicate what I do to them. Interestingly, one GP has sent me nothing but headache patients for the last 15+ years, I have tried to educate him in regards to the full scope of what I do but to no avail. When I first started out in practice I got quite a few anti-referrals from the local doctors with patients I was already seeing. That changed over time to quiet tolerance and finally into referrals. Developing this trust took years.

    • Thinking_Chiro wrote: “We are on the same page here literally. I am here for the same reason, to provide good information on good chiropractors.”

      Then you need to produce the names and practice locations of them, on an international scale, as a matter of urgency. (BTW, I said I was here to help provide good information on chiropractic, not good chiropractors. Apart from yourself – and I don’t know your real name – I don’t know who’s a good practicing chiropractor and who isn’t.)

      Thinking_Chiro wrote: “The whole medical referral system is based on anecdote and patient feedback not a Yellow Pages type directory.”

      MDs are vastly more science-based than chiropractors so the two are not comparable.

      Thinking_Chiro wrote: “Patients also do the same when recommending their doctor, chiro, physio and also warning people off if they have a bad experience.”

      The problem with that is that most chiropractic patients are unlikely to recognise when they’re in the den of a chiroquack – i.e. being ripped off and having their health put at risk. They would therefore be unlikely to warn others off unless they experienced a serious adverse event, or their condition wasn’t regressing to the mean. In other words, most people are unaware of the following common errors of reasoning:
      http://web.archive.org/web/20110723060336/http://www.crhp.net/article1.html

      Thinking_Chiro wrote: “Health is the ultimate team sport Blue.”

      Yes, but unfortunately most chiropractors want to be on the team (mainstream) without playing by the rules. Sadly, those who do become part of the team – who are more akin to physios – have to endure a permanent struggle to distance themselves from the pseudoscience that will be forever associated with chiropractic.

      Thinking_Chiro wrote: “Careful who you tackle as it may be a team mate. Additionally, check the goal before shooting because you do not want an own goal. Providing support to your chiropractic team mates is just as important as applying pressure to the opposition.”

      I acknowledge the good chiropractors (especially Samuel Homola and Preston Long who have been vocal for many years), but to be frank, I fear that current chiropractic reform efforts will prove to be too little too late. That said, I hope I’m proved wrong.

  • In reply to Blue Wode:
    “MDs are vastly more science-based than chiropractors so the two are not comparable.”
    It is when they refer to me and hold me accountable. I have to play by the rules or they would cut me off at the knees instantly. Not long ago I had a similar conversation with specialist about refering to chiropractors and he advises his patients to make sure they are members of COCA.

    “The problem with that is that most chiropractic patients are unlikely to recognise when they’re in the den of a chiroquack – i.e. being ripped off and having their health put at risk. They would therefore be unlikely to warn others off unless they experienced a serious adverse event, or their condition wasn’t regressing to the mean. In other words, most people are unaware of the following common errors of reasoning:”
    Interestingly article and I have read it when referenced by you in the past. Still a good read!
    From my experience (sorry for the anecdote) patients who are medical skeptics tend to seek out doctors, chiro’s, homeopaths etc etc who share their beliefs. When they subsequently come to me I gradually reeducate them. Some have left and thats their decision and I’m fine with that. I have also seen many patients coming in the other direction.

    “Sadly, those who do become part of the team – who are more akin to physios – have to endure a permanent struggle to distance themselves from the pseudoscience that will be forever associated with chiropractic.”
    Interestingly again, I was at a function at a large teaching hospital a coulpe of years ago, sitting at a table full of specialists, and I didn’t have distance myself or apologise once. They were actually very polite, receptive and supportive. They did grill me pretty thoroughly though about what I do, but the more we talked the more pro chiro they became. Maybe they were just curious seeing an animal that they are rarely directly exposed to! LOL! Having said that, I have found that chiropractors communicate poorly with doctors and this is a large part of the problem!

    • chiros communicate poorly FULL STOP! Making false claims and thus misleading their potential clients is a form of poor communication – and there are very few chiros who don’t do this.

    • @ Thinking_Chiro

      I’m not interested in your anecdotes. You know the problems that chiropractic presents for patients and the public. I want to know why there aren’t any global directories to which patients can turn to find your chiropractors who read journals, do not treat subluxations, and who look for best evidence and apply it.

  • In reply to Edzard:
    I would have to disagree with you. The subluxation true believers are all too often very good communicators, the problem is, as you said, with what they are communicating. They are also very loud and aggressive! Billy De Moss is a painful example. When I was at the table of specialists it was interesting that the S word didn’t come up once!

    • @ Thinking_Chiro

      You’re not disagreeing with Prof Ernst. You wrote “I have found that chiropractors communicate poorly with doctors” and Prof Ernst wrote “chiros communicate poorly FULL STOP! Making false claims and thus misleading their potential clients is a form of poor communication – and there are very few chiros who don’t do this.” Therefore the subluxationists DO communicate poorly despite their ‘gift of the gab’.

  • In reply to Blue Wode:
    “I’m not interested in your anecdotes. You know the problems that chiropractic presents for patients and the public. I want to know why there aren’t any global directories to which patients can turn to find your chiropractors who read journals, do not treat subluxations, and who look for best evidence and apply it.”

    There are no global directories for any health profession. The closest there is for any profession is the Professional Association like the RACS and COCA etc which also enforce standards. This is still no guarantee of finding a good surgeon or chiro. Additionally, as you are well aware there are good and bad associations.

    • So, apart the two associations you mention (and we don’t know how many patients are aware that they exist – e.g. I’ve never heard of RACS), the public has no reliable global source available to it to locate chiropractors who read journals, do not treat subluxations, and who look for best evidence and apply it.

      In view of that, how can chiropractic reform be taken seriously when millions of patients continue to be duped and have their lives put at risk on a daily basis by a myriad of unethical chiropractors?

      What’s the solution? It’s not as if this problem has sprung up overnight. It’s been going on for decades. IMO, it would all have been dealt with years ago if it was resolvable.

  • RACS is the Royal Australasian College of Surgeons (Same as RCS(Eng) or RCS(Edin)). Hence the orthopod reference.
    When you move to a new area/city one of the usual difficulties is finding a good local doctor, chiro, coffee and Thai Restaurant that makes Mee Grob! You have not yet established local connections and referral networks. We regularly get new patients ringing to inquire about how I practice, what techniques I use etc. Conversely, I also get patients who are moving asking for a referral to a chiro who practices the same way as I do and who I trust!

    • Thinking_Chiro wrote: “We regularly get new patients ringing to inquire about how I practice, what techniques I use etc. Conversely, I also get patients who are moving asking for a referral to a chiro who practices the same way as I do and who I trust!”

      And what about the millions of chiropractic patients throughout the rest of the world who continue to be duped and have their lives put at risk on a daily basis by a myriad of unethical chiropractors?

  • The subluxationists attract patients who are like minded. Same as for my patients and referring Doctors. Consumers of any product, especially health, should exercise due dilligence. Unfortunately, this is not universal. Conversely, “Dr Google” is driving the doctors who I work with up the wall! Patients taking some responsibility is great, but seeking the advice of an expert doctor or specialist with a great depth of knowledge in their field and then going online and ignoring that advice is the source of many many facepalms/Head desks!

    • Thinking_Chiro wrote: “The subluxationists attract patients who are like minded.”

      Evidence please.

      Thinking_Chiro wrote: “Consumers of any product, especially health, should exercise due dilligence.”

      How can the public be expected to do that with regard to chiropractic when many subluxationists are members of chiropractic regulatory boards? It’s more than likely the reason why regulatory boards don’t make clear to consumers that there are registered EBP chiropractors and registered subluxationist quacks. Regulation is false assurances all the way to ensure the survival of chiropractic. IOW, chiropractors first, patients last.

  • This original post reminds of the Stone Soup folk story. Someone at Wikipedia seems to think it’s acceptable to describe the story as “a lesson in cooperation, especially amid scarcity” but I guess I always thought of it as a scam.

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