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

This investigation was aimed at examining the messages utilised by the chiropractic profession around issues of scope and efficacy through website communication with the public. For this purpose, the authors submitted the website content of 11 major Canadian chiropractic associations and colleges, and of 80 commercial clinics to a mixed-methods analysis. Content was reviewed to quantify specific health conditions described as treatable by chiropractic care. A qualitative textual analysis identified the primary messages related to evidence and efficacy utilised by the websites.

The results show that chiropractic was claimed to be capable of addressing a wide range of health issues. Quantitative analysis revealed that association and college websites identified a total of 41 unique conditions treatable by chiropractic, while private clinic websites named 159 distinct conditions. The most commonly cited conditions included back pain, headaches/migraines and neck pain. Qualitative analysis revealed three prominent themes drawn upon in discussions of efficacy and evidence: grounded in science, the conflation of safety and efficacy and “natural” healing.

The authors concluded that the chiropractic profession claims the capacity to treat health conditions that exceed those more traditionally associated with chiropractic. Website content persistently declared that such claims are supported by research and scientific evidence, and at times blurred the lines between safety and efficacy. The chiropractic profession may be struggling to define themselves both within the paradigm of conventional science as well as an alternative paradigm that embraces natural approaches.

These findings strike me as being similar to the ones we published 4 years ago. At this stage, we had conducted a review of 200 chiropractor websites and 9 chiropractic associations’ World Wide Web claims in Australia, Canada, New Zealand, the United Kingdom, and the United States. The outcome measures were claims (either direct or indirect) regarding the eight reviewed conditions, made in the context of chiropractic treatment: asthma, headache/migraine, infant colic, colic, ear infection/earache/otitis media, neck pain, whiplash (not supported by sound evidence), and lower back pain (supported by some evidence).

We found evidence that 190 (95%) chiropractor websites made unsubstantiated claims regarding at least one of the conditions. When colic and infant colic data were collapsed into one heading, there was evidence that 76 (38%) chiropractor websites made unsubstantiated claims about all the conditions not supported by sound evidence. Fifty-six (28%) websites and 4 of the 9 (44%) associations made claims about lower back pain, whereas 179 (90%) websites and all 9 associations made unsubstantiated claims about headache/migraine. Unsubstantiated claims were made about asthma, ear infection/earache/otitis media, neck pain.

At the time, we concluded that the majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.

Comparing the two studies, what should we conclude? Of course, the new investigation was confined to Canada; we therefore cannot generalise its results to other countries. Nevertheless it provides a fascinating insight into the (lack of) development of chiropractic in this part of the world. My conclusion is that, at least in Canada, there is very little evidence that chiropractic is about to become an ethical and evidence-based profession.

36 Responses to The chiropractic profession: “struggling to define themselves”

  • Professor Ernst wrote: “My conclusion is that, at least in Canada, there is very little evidence that chiropractic is about to become an ethical and evidence-based profession.”

    I see that former British Chiropractic Association president, Richard Brown, is moving to Canada where he is to be installed as the new Secretary-General of the World Federation of Chiropractic (WFC) on July 1, 2015. Perhaps he’ll make a difference:

    QUOTE
    “We are most excited to have someone of Dr Brown’s outstanding abilities, character and proven leadership experience to carry the WFC forward during the next decade,” says WFC President Dr Greg Stewart of Canada…Current WFC Secretary-General David Chapman-Smith added his endorsement. “In Richard I see a person with exactly the qualities the WFC now needs and that I hoped my successor would have. He is a man of many talents, a true spirit of service, strong communication skills and a profound understanding of the international profession and the direction it and the WFC should take for future success.”

    Ref: https://www.wfc.org/website/index.php?option=com_content&view=article&id=302%3Awfc-announces-next-secretary-general&catid=56%3Anews–publications&Itemid=27&lang=en

    Hopefully, ‘Dr’ Brown has brushed up his critical thinking skills, and will no longer be focused on window-dressing…
    http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/2086-the-british-chiropractic-association-reflects-on-the-simon-singh-affair.html

    …and the use of defiance as a diversionary tactic
    http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/2085-why-we-sued-simon-singh-the-british-chiropractic-association-speaks.html

    And hopefully there’ll be no more dirty tricks from the WFC with regard to its previous attempt to trash Professor Ernst’s reputation:
    http://edzardernst.com/2012/10/chiropractic-lessons-that-have-not-been-learnt/

    However, with painfully little evidence and tens of thousands of chiropractic livelihoods to protect, I don’t think we should be too optimistic that Dr Brown will be able to establish chiropractic as an ethical and evidence-based profession in Canada, or anywhere else. Indeed, it looks like we should expect lots of ‘jam tomorrow’ false promises.

    • wasn’t Brown responsible for suing Simon Singh for libel when he was head of the BCA? this did lasting damage to chiropractic worldwide. if he continues in this vein in his WFC job, maybe he will rid the world of chiropractic altogether?

  • Some Canadian researchers worth a mention:
    Simon French (One of ours they poached) http://www.ncbi.nlm.nih.gov/pubmed/?term=French+SD
    Simon Degenais http://www.ncbi.nlm.nih.gov/pubmed/?term=Dagenais+S
    Steven Passmore http://www.ncbi.nlm.nih.gov/pubmed/?term=passmore+sr
    Genevieve Newton http://www.researchgate.net/profile/Genevieve_Newton
    The home page of Canadian Memorial Chiropractic College (CMCC) researchers:
    http://www.cmcc.ca/researchers
    Howard Vernon, Brian Budgell and John Triano???
    Research output:
    http://www.cmcc.ca/page.aspx?pid=364

    Reform of the chiropractic profession is a two step process.
    Step 1: Point out the BS.
    Step 2: Support the vital reformers within the profession!
    You are very good at Step 1, now you need to take Step 2. Comments like “maybe he will rid the world of chiropractic altogether?” leeds to the question, Do you support reform? Do you support the critical thinking, evidence based, vocal reformers within the profession? Reform must come from within the profession but externel support is also an important part of the equation!

    • thank you for seeing me as the 1st step. but I should think there should be much more visible initiative from chiros both for taking step 1 and 2

      • Yep, its our mess and we have to clean it up. Helping the cleaners and not making their job more difficult would be appreciated. Stephen Perle is a good example, he has consistenly questioned and critically evaluated what we do over many years and has been attached by the subluxation based chiropractors and threatened legally. Then he gets criticised from without the profession for not being critical enough. His persistence is to be admired!
        I enjoy a good critical, well referenced debate as that ultimately pushes the reform process forward. The process can become extremely frustrating at times!

      • Dr Ernst,

        You are not looking hard enough. Please visit- read- vote- share

        http://www.eicchallenge.weebly.com

    • Thinkingchiro asks Edzard Ernst “Do you support the critical thinking, evidence based, vocal reformers within the profession? Reform must come from within the profession but externel support is also an important part of the equation!”

      Chiropractic began life as a medical pseudoscience, its principles pulled out of the air by D.D. Palmer. You yourself have acknowledged the pure nonsense of the subluxation concept, yet you are happy to belong to a “profession” called chiropractic which attempts to treat medical conditions by manipulating peoples’ spines. The evidence that chiropractic can do more than sometimes provide temporary relief to back pain (as can a competent massage) is equivocal, to give it the most generous assessment. The rational basis for external support of this profession is about the same as that for external support of the faith healing, astrology and flat earth professions.

      You call yourself Thinking Chiro: sorry, but that’s an oxymoron.

    • Why reform ‘the profession’?
      Why not accept that what Palmer and others in his lineage professed does not stand up to critical scrutiny and move on. Just as conventional medicine has done, and continues to do?
      Just what is the problem?
      Is it that ‘chiropractic’ is a faith and not really a healthcare profession at all?

  • I get hate-mail almost on a daily basis – far too much to share all of it with my readers. However, from time to time I receive emails that are just too superb an example of stupidity to not share it with others. Here is one from a chap called James Banville which is a good case in point:
    “You’re big on bigging yourself up, but I suppose you must, no one else will. Qualifications? I don’t believe a damn word you say. I wouldn’t let my pet rat near you.”
    JAMES, THANK YOU FOR INSPIRING ME TO CARRY ON MY FIGHT AGAINST IRRATIONALITY AND MISINFORMATION!!!

  • No hate mail from this end Dr Ernst. Thank you for the article and keep up the fight – there is an ocean of snake oil out there and the tide keeps coming in.

  • Greetings from New Zealand. I have just discovered your site and am already enjoying it. I have regular chiropractic for occupational overuse syndrome and have responded well to it. But if I think about it, at the same time I lost 8kg and started exercising regularly. Now I need to do some thinking!

    • Thank you for so nicely illustrating the point that subjective testimonials are not really evidence!

    • Subjective testimonials are a quite a bit better than evidence. Evidence from a study lets you know that x worked for some people, and maybe it will work for me. Personal experience lets you know that x works for me – woohoo! Much more valuable.
      But, evidence from a controlled study is great if you don’t have access to an experienced practitioner or subjective testimonials. Gotta start somewhere.

        • Exactly – real world experiences, a great counterpoint to the countless examples on this site alone of chiros helping people. If you went by the stories on this site (and from talking to people), you’d think the only negative experiences happened in controlled studies.

      • Subjective testimonials: pshaw!! I bought a product and it broke down within 2 days: therefore the product is no good. I prayed I’d get some money and a month later I received a tax refund for £20, therefore prayer works. When I had a bad cold I stood on one leg every night at 9 p.m. for 10 minutes and I got better, therefore standing on one leg is a valid therapeutic option. I watched a film and I didn’t enjoy it, therefore the film is badly scripted, acted and directed. I heard some strange noises in the small hours that I couldn’t explain, therefore there must be spirits and ghosts.
        What the heck does it take for people to get real in this world?!

        • Franko – that makes as much sense as: Consumer Reports says this product is fantastic. Mine isn’t functioning…but it must be ok. Adverse reactions are reported in only 20% of the users of med-X…so therefore the tendon pain is all in my head. I got a flu vaccine, so this must not be the flu.
          Good question. What DOES it take for people to get real in this world, practice some common sense, and pay attention to what’s going on with themselves?

          • We are best served by objective, blinded, carefully controlled assessments of quality and efficacy of consumer products and medical/surgical procedures alike. None of these things are perfect so we need to know rates of failure and of side effects. But not by extrapolation of individuals’ anecdotal interpretations of their own experiences into generalizations.
            This goes to the nub of medicine and CAM. There are likely to be positive and negative effects associated with both. The problem is to establish cause and effect. You can’t do that by allowing one person to decide that they were cured of something by rubbing goat’s milk on their left elbow every 4 hours and blowing that up into a therapeutic “profession” by dint of their charisma or articulate argument.
            Getting real in this world involves acknowledging the massive fallibility of generalizing from individual subjective experiences.

          • When it comes down to it (getting real), we’re best served by finding out what works for us individually. Objective, blinded, carefully controlled assesments are a great tool. But the reality is that it’s a tool – and the only use for that tool is to find what works for the individual at hand.

  • Thinkin’ Chiro wrote: “Step 2: Support the vital reformers within the profession!” That’s the spirit, TC! How has it been going so far? I am certain that EE and BW will only be to happy to help you out…of your misery.

    Well, Thinkin’ Chiro, looks like Edzard got you now. I told you many times that when the radical anti-chiropractic-hatin’ extremists team of EE and Blue Wode say “reform”, what they mean is “exterminate”. So it looks like they have given you two choices: You can commit suicide yourself (although suicide would be the LAST thing I would do! – Joke) and become a bus driver, postal employee or worse, an underpaid, over-taxed physiotherapist technician that massages sore butts under the direction of an allopath/orthopod. Or you can have them put you out of your misery and exterminate you and the rest of the chiropractic world once and for all, as they have been trying to do on a full-time, family-neglecting basis for years. So it is your choice.

    Thinkin’ Chiro, it seems to me that when EE is not kicking you in the head, he puts down his scone and rubs your belly and you are happy once again! Just sayin’.

  • Thank you for inquiring as to my well-being, Perfesser. Never felt better. No problems. Just had my chiropractic adjustment. Get one every two weeks. Feel great, functioning exceptionally well. Eat healthfully, drink super-antioxidant smoothies and green juices, exercise, some meditation/positive visualization, etc. etc. The same I share with my patients. You know, even if you don’t care to participate, it’s the chiropractic lifestyle. Doesn’t just change lives…saves lives.

    • good to hear

    • I will hazard a guess that there is a bar on SDP’s way home from the chiropractor.
      14:06 seems a bit early though, to already be so insolently intoxicated… and that on a Tuesday! But perhaps SDP lives in an earlier time zone?

      • Ha-ha…Good one, Bjornie! I get it. I wasn’t bjorn yesterday, you know. I commend you on your mastery of juvenile, high-school humor! Hey, I’m no different than anyone else. Yes, I like a good organic beer once in a while. I am sure they have bars over by you in Greenland.

        BTW, I love the little photo of you wearing your Mr. Spock Star Trek tunic. Cool!

  • In reply to ScepDocProf:
    You fail to understand what a critical debate is all about! Both sides put forward their arguments and supporting evidence, both pro and con, and it is discussed on its merits. I am here to put evidence based chiropractic into the public record and to relegate subluxation to the dusty shelves of history!

    • @Thinking_Chiro

      Your mission is like mine. We evidence based practitioners are winning anyway, because there is not real option in modern world to keep up subluxation-theory. You can think how much thing have changed during last 10 years.

      You could think little bit motivation of your fellows like EE. Are they really after evidence based healthcare or their personal funding by medical industry? You never know, but how professionals can do anything full-time without funding. You not tell me because of evidence based healthcare.

      • Ahhhh…here it is again: the notion that I am funded by some dark forces to denounce chiropractic.
        For my whole life, I have lived on my salaries from universities [with rare exceptions when I worked in non-uni hospitals]. since ~2 years I am retired and live from my pension and savings. I receive no funds for this blog or any other activity.
        But this information has long been in the public domain. So, you are either doing these serious allegations because of ignorance [I recommend to inform yourself before making them next time] or because of stupidity, malice etc.

        • I see – you are a bit sesitive about your funding.

          Can you proof you are not funded by pharmacy industry?

          There must be some income from book published about alternative medicine.

          I’m also wondering how such a ‘master pieces’ get published at all? Where this funding for publishing is coming from? Your pension and savings?

          • I am sensitive about the truth – and what you are implying is based on the opposite.

          • Jani Mikkonen said:

            I see – you are a bit sesitive about your funding.

            LOL! Why on earth would you think that?

            Can you proof you are not funded by pharmacy industry?

            LOL again!

            There must be some income from book published about alternative medicine.

            You do seem somewhat fixated by how Prof Ernst pays his bills. Why?

            I’m also wondering how such a ‘master pieces’ get published at all?

            Why would you be wondering that?

            Where this funding for publishing is coming from? Your pension and savings?

            Why do you think that’s any of your business?
            Anyway, do you have any comment on, you know, what this blog post is all about: chiros?

          • I would not worry too much. I get this sort of thing regularly. I posted it merely because I wanted to expose the staggering lunacy of such allegations.

  • In reply to Jani Mikkonen:
    Stick to pushing EBP, that is whats important! Many a time on this blog I have been frustrated and felt like bringing a baseball bat to beat some sense into the entrenched skeptics, but ultimately both sides of the argument need to be aired, so I have taken a few deeeeeeeeeep breaths and continued on in a polite fashion. It is the only way and after a while becomes an enjoyable process!
    Yes we are making headway, the recent result with Barcelona Chiropractic College (BCC) failing to get accreditation from the European Council of Chiropractic Education (ECCE) http://www.cce-europe.com/newsarticle/items/barcelona-college-of-chiropractic-evaluation-result.html is a good result. The subluxationists have been dealt a severe blow. The subbies here that want to do the same in Adelaide using BCC as their model have hopefully been stopped in their tracks!

  • In reply to Jani Mikkonen:
    Do both! We need to clean house and engage with the critics! That is a sign of a mature profession. If you look at Science Based Medicine http://www.sciencebasedmedicine.org/ they write far more articles critical of BS within medicine than BS in CAM. If they were purely anti-CAM I would write them off, but their even handed approach gains my total respect and adds immeasurably to their credibility! We need to do the same!

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