On 1/12/2014 I published a post in which I offered to give lectures to students of alternative medicine:
Getting good and experienced lecturers for courses is not easy. Having someone who has done more research than most working in the field and who is internationally known, might therefore be a thrill for students and an image-boosting experience of colleges. In the true Christmas spirit, I am today making the offer of being of assistance to the many struggling educational institutions of alternative medicine .
A few days ago, I tweeted about my willingness to give free lectures to homeopathic colleges (so far without response). Having thought about it a bit, I would now like to extend this offer. I would be happy to give a free lecture to the students of any educational institution of alternative medicine.
I did not think that this would create much interest – and I was right: only the ANGLO-EUROPEAN COLLEGE OF CHIROPRACTIC has so far hoisted me on my own petard and, after some discussion (see comment section of the original post) hosted me for a lecture. Several people seem keen on knowing how this went; so here is a brief report.
I was received, on 14/1/2015, with the utmost kindness by my host David Newell. We has a coffee and a chat and then it was time to start the lecture. The hall was packed with ~150 students and the same number was listening in a second lecture hall to which my talk was being transmitted.
We had agreed on the title CHIROPRACTIC: FALLACIES AND FACTS. So, after telling the audience about my professional background, I elaborated on 7 fallacies:
- Appeal to tradition
- Appeal to authority
- Appeal to popularity
- Subluxation exists
- Spinal manipulation is effective
- Spinal manipulation is safe
- Ad hominem attack
Numbers 3, 5 and 6 were dealt with in more detail than the rest. The organisers had asked me to finish by elaborating on what I perceive as the future challenges of chiropractic; so I did:
- Stop happily promoting bogus treatments
- Denounce obsolete concepts like ‘subluxation’
- Clarify differences between chiros, osteos and physios
- Start a culture of critical thinking
- Take action against charlatans in your ranks
- Stop attacking everyone who voices criticism
I ended by pointing out that the biggest challenge, in my view, was to “demonstrate with rigorous science which chiropractic treatments demonstrably generate more good than harm for which condition”.
We had agreed that my lecture would be followed by half an hour of discussion; this period turned out to be lively and had to be extended to a full hour. Most questions initially came from the tutors rather than the students, and most were polite – I had expected much more aggression.
In his email thanking me for coming to Bournemouth, David Newell wrote about the event: The general feedback from staff and students was one of relief that you possessed only one head, :-). I hope you may have felt the same about us. You came over as someone who had strong views, a fair amount of which we disagreed with, but that presented them in a calm, informative and courteous manner as we did in listening and discussing issues after your talk. I think everyone enjoyed the questions and debate and felt that some of the points you made were indeed fair critique of what the profession may need to do, to secure a more inclusive role in the health care arena.
My own impression of the day is that some of my messages were not really understood, that some of the questions, including some from the tutors, seemed like coming from a different planet, and that people were more out to teach me than to learn from my talk. One overall impression that I took home from that day is that, even in this college which prides itself of being open to scientific evidence and unimpressed by chiropractic fundamentalism, students are strangely different from other health care professionals. The most tangible aspect of this is the openly hostile attitude against drug therapies voiced during the discussion by some students.
The question I always ask myself after having invested a lot of time in preparing and delivering a lecture is: WAS IT WORTH IT? In the case of this lecture, I think the answer is YES. With 300 students present, I am fairly confident that I did manage to stimulate a tiny bit of critical thinking in a tiny percentage of them. The chiropractic profession needs this badly!
Congratulations on exercising patience and respect. The written response from Mr. Newell is a thinly veiled lack of the latter. “We don’t need no stinkin’ evidence” seems to be the mantra. We will listen, but with our hands over our ears, eagerly awaiting question time so we can attempt to “educate” you instead.
I applaud your interest in reaching out and agree that if even one person goes home and questions his or her path, it is worth the effort.
The general attack on drug therapy always amazes me. In my own community it seems that those who cry the loudest about the “eeevilll drugs” are the ones who pour copious amounts (or at least more than the recommended serving size) of alcohol into their bodies on a daily basis.
Grandma wrote: “The general attack on drug therapy always amazes me”
Indeed. I note that within the last few months the Anglo European College of Chiropractic (AECC) has revised its stance on vaccination, and seems, unfortunately, to have chosen to step away from evidence-based public health policy. In July of last year, its website declared:
“we endorse and recommend the NHS vaccination programme”
This is the archived link to the relevant AECC page:
However, the current AECC page appears to be devoid of any mention of its former endorsement and recommendation of the NHS vaccination programme:
That is worrying when you consider that the AECC has a ‘Combined Chiropractic and Midwifery Newborn Clinic’:
Also worrying is the AECC’s omission of the evidence that it’s using to support its treatment of babies (and children – don’t forget it has a Paediatrics Faculty). Perhaps that’s because it wasn’t so long ago (2009) that the Editor of the British Medical Journal, Fiona Godlee, said the following about an article in the journal by Professor Ernst on the British Chiropractic Association’s “plethora of evidence” for the chiropractic treatment of childhood ailments:
“His demolition of the 18 references is, to my mind, complete”.
As far as I know, there has been no robust new data to counter Professor Ernst’s findings from five years ago – something which would suggest that chiropractic students shouldn’t be learning about chiropractic ‘paediatrics’.
Dear Blue Wode,
Here is a rather recent study (2012) which actually suggests that chiropractic treatment for infant colic (unexplained persistant crying in babies) has a rather good outcome.
Note: most of the paediatric treatments do not involve more pressure than the amount one would exert on their own eyeball.
an AECC student
P.s. I’d like to thank Dr Ernst for coming to the AECC and presenting his ideas and visions with a good foundation of evidence. It was really informative and really increased my sympathy for you and all other critical thinkers out there. Also, thank you for answering all the questions we asked to the best of your abilities. Many people like you would not have been able or willing to do so. So, thanks again.
Here’s an analysis of the best evidence for chiropractic for infant colic:
Dear Grandma…unlike the rather generous professor and myself you seem to be somewhat lacking in actual knowledge of the day at hand, insight into the actual questions and discussion and, at the very least, minimal courtesy and respect in the content of your response , and this for 300 people you do not know or have ever met.
I am glad that your statement above will be left in perpetuity as a reminder to all that read it of your entirley absent justification in having commented at all……. yours delightfully devoid of bile and vitriol……Dr Dave Newell
Hi Grandma, just so you are aware, David Newell is not a DC, he holds a Ph D. There are a growing number of DC’s who are very interested in research and are actively seeking a separation in the field for the betterment of our profession. Please attempt to not lump us all together immediately without knowing that we are strongly attempting to evolve.
Now for a world tour! When are you coming to Australia? I would definitely buy a ticket!
Planting seeds and stimulating debate is what you do and direct engagement like at AECC is important. Thankyou!
In reply to Grandma:
I work in a medical centre and the on average 2-3 drug reps who pop in every week would be surprised with what the doctors say. The medico’s are some of the most critical people I know when it comes to drug companies and they are saying the same things as the non medico’s!
You managed to get inside without having to pretend to be a prospective student! Unlike me then… It seems like the nonsense was somewhat muted for your visit, as it was unbearably evident for mine.
EE, your analysis of the safety of spinal manipulation is not shared by the scientific community, nor the professions that choose to use manipulative therapy as part of their approach of dealing with MSK disorders. Your insistence that the harms > risks isn’t supported by any systematic reviews that are outside of your own. There are no Cochrane reviews that share your view, which is the outlier with respect to the harms of spinal manipulation.
You also have fundamental problems with misattribution with the provider of SMT and calling it chiropractic. This can be best illustrated in your recent blog post and tweet that said that for chronic low back pain exercise is better than chiropractic. However, the study was about spinal manipulation performed by physical therapists. Despite numerous tweets to you, you compounded the problem by again tweeting “exercise is better than SMT/chiropractic”.
It appears that when a chiropractor performs spinal manipulation for low back pain, it is alt-med, but when a PT performs spinal manipulation, it is not alt-med.
Regarding the subluxation, the term is indeed very controversial, but it is simply a term that is synonymous with spinal joint dysfunction or a manipulable lesion. In order to provide spinal manipulative therapy, there is/are segments considered to be hypo mobile and painful. Regardless of the provider, the same concept exists if you are an MD, DC, DO, PT, DVM or ND, all of whom who have it within their scope of practice to practice SMT.
Lastly, you do not differentiate between the attitudes and beliefs of subluxation-based chiropractic, which is considered to be fringe in terms of practice traits and the mainstream majority of DCs who are are focused on spinal and MSK disorders. This is problematic because you continuously insinuate that the MSK chiropractors are a minority and that the overwhelming majority are the fundamentalist subluxation-based DCs. This was found to be the case in Canada, which also appears to be congruent with the US and Europe.
“Chiropractors holding unorthodox views may be identified based on response to specific beliefs that appear to align with unorthodox health practices. Despite continued concerns by mainstream medicine, only a minority of the profession has retained a perspective in contrast to current scientific paradigms. Understanding the profession’s factions is important to the anticipation of care delivery when considering interprofessional referral.” http://www.biomedcentral.com/1472-6882/14/51.
While I commend you for providing the salient points to the profession to reflect upon, these criticism you are directing appear to be very specific to a minority group of chiropractors who continue to practice to the principles and tenets as founded by the Palmers. We can both agree that these practitioners merit all the criticism that is directed towards them, both from within and outside the profession. However, when I had asked you directly about the validity of the chiropractic profession for MSK, you suggested that’s what PTs are for. Also, considering that you called evidence-based chiropractic an oxymoron, I hold skepticism that you would approve of the existence of the chiropractic profession for any speciality, even spine care.
they are not a minority!!
crucially, where is the opposition from within chiropractic against the charlatans. its absence is a very bad sign for your profession.
or did you just want to prove my point that chiros lack the ability to think critically???
Marc wrote: “Regarding the subluxation, the term is indeed very controversial, but it is simply a term that is synonymous with spinal joint dysfunction or a manipulable lesion”
IMO, it seems to be whatever chiropractors need it to be in order to appear to be delivering a legitimate intervention:
Subluxation Synonyms and Metaphors
By P. L. Rome
The following 329 terms either relate to, are synonyms for, or have been used or cited in connection with describing a subluxation or aspects of a VSC. The use has been in chiropractic, medical and osteopathic papers. There are in fact 371 terms, including the 42 on the sacroiliac list.
(Ab)normal articular sensory input
Abnormal instantaneous axis of rotation
Abnormal motion or position
Abnormal muscle function
Abnormal nervous system function
Abnormal spinal function
Altered intervertebral mechanics
Altered joint structure and function
Altered nociceptive and proprioceptive input
Altered regional mechanics
(Ab)normal joint mechanics
Abnormal joint motion
Abnormal motion or position
Abnormal muscle function
Abnormalities of range of motion or coupling
Abnormal nervous system function
(Ab)normal regional sympathetic tone
Abnormal restrictive barrier in or around joints
Abnormal spinal function
(Ab)normal structural relationship
Acute joint locking
Adverse mechanical tension of the nervous system
Altered joint motion
Altered nervous system movement
Altered physiological function
Arthron (extremity joint subluxation — see also “vertebron”)
Cervical joint dysfunction
Changes of the dynamic segment
“Changes of thoracic segments”
Compensatory structural subluxations
” … compromise proper function”
Deviation of the bodies
Errors of static or motor mechanics
Facet joint syndrome
Facet synovial impingement
Facilitated spinal system
Chiropractic subluxation complex
” … compromise proper function.”
Degenerative dynamic segment
Derangement of the opposing joint surfaces
Disorder of the disc
Disrelationship of the facets
Disturbance in the mechanico-dynamics
“(vertebrae) … don’t move enough, or they move too much.”
Engagement of the spinal segment in a pathologic reflex chain
Erratic movement of spinal articulations
Excursion (Conley) = (“Wandering from the usual path.” — Taber’s)
Facet joint dysfunction
Fanning of interspinous space
” … force other joints to move too much.”
“(subluxations) … force other joints to move too much.”
Functional and structural changes in the three joint complex
Functional impairments of motion
Functional spinal lesion
Gravitational (im)balance of joints (with) reduced chronic, asymmetrical forces
Harmful dysfunction of the neuromusculoskeletal system
(Im)properly direct(ed) coordinated, (in)harmonious motor programming
Inability of the segment to articulate about its new axis
Incomprehensible pattern of symptoms and clinical findings when compared to with examination of mechanical lesions in the extremities
Instability of the posterior ligament complex
Internal joint derangement
Internal vertebral syndrome
Intervertebral dysfunction of the mobile segment
Intervertebral joint subluxation
Joint movement restriction
“Just short of a dislocation”
Kinetic intersegmental subluxation
Less than a locked dislocation
Locks up and restricts motion
Lose their normal motion or position
Loss of elasticity
Loss of joint movement
Loss of juxtaposition
Loss of segmental mobility
Low back dysfunction
Maladjustment (of a vertebra)
Manipulatable joint lesion
Manipulatable lesion (adjustable subluxation!)
Mechanical irritation of the sympathetic ganglionic chain
Mechanical musculoskeletal dysfunction
Mild pubic diastasis
Misalignment of the fibrocartilaginous joint
Motor unit derangement complex
Multisegmental spinal distortion
Nervous system impairment by the spine
Osteopathic spinal lesion
Osteopathic spinal joint lesion
Pain and debility without recognisable pathology
Painful intervertebral dysfunction (“PID”)
Painful minor intervertebral dysfunction (“PMID”)
Partial or incomplete separation
Pathogenic interaction of spine and nervous system
Pathologically altered bradytrophic tissue
Pathologically altered dynamic segment
Physiologic lock the motion segment
Posterior facet dysfunction
Posterior joint dysfunction (“PJD” — see “three-joint complex”!)
Posterior joint syndrome
Primary fibromyalgic syndrome
Putative segmental instantaneous axis of rotation
“Relative as absolute lack of space within the intervertebral foramen”
Restriction of unisegmental mobility
Reversible with adjustment/manipulation
Sagittal translation (Conley)
Segmental movement restriction
Segmental vertebral hypomobility
Simple joint and muscle dysfunction without tissue damage
Shear strain distribution
Slightly misaligned vertebra
Soft tissue ankylosis
Spinal joint blocking
Spinal joint complex
Spinal joint dysfunction
Spinal joint malfunction
Spinal mechanical dysfunction
Spinal segmental facilitation
Spinal segmental instability
Stable cervical injury of the spine (see also “instability” above)
Static intersegmental subluxation
Structural intersegmental distortion
Subluxation complex myopathy
Three joint complex
Tilting of the vertebral body
Tightened, deep, joint related structures
Unresolved mechanical tension or torsion
Unstable lumbar spine
Vertebral subluxation complex
Vertebral subluxation syndrome
Vertebroligamentous sprain strain
Vertebron (see also “arthron”)
42 Terms for a Sacroiliac Subluxation
Abnormal pelvis biomechanics
Altered sacroiliac mechanics
Changed motor pattern (in muscles)
Change in relation
Disturbed normal relationship
Distorting the normal mechanics
Downslips (see also “upslips”)
” … effect on body mechanics”
Instability of the pelvic joints
” … irritation of the nerves is possible … ”
Joint motion restriction
Limitation of motion
Motions are restricted
Slipping sacroiliac joints
” … stick at the limit of normal motion …”
Strain and laxity
Tilts (anterior, posterior)
Upslips (see also “downslips”)
Vertical slipping of the innominate on the sacrum
59 Synonyms or Metaphors for the “Spinal Adjustment”
Chiropractic manipulative therapy
Corrective spinal care
Diversified-type force application to release the segment at its articulation
Flexion distraction manipulation
Gently relieve the locked subluxation
High velocity facet adjusting
Low force/amplitude manipulation
Manual reflex neurotherapy
Mechanical treatment of the nerve centres.
Neuro-mechanical spinal chiropractic management
Osteopathic manipulative therapy
Osteopathic osteological adjustment
Reduction of dislocation
Release of intraarticular pressure
Restoration of mobility
Slipped into place
Spinal manipulative therapy
Spinal manual therapy
“Springing the spine”
[Ref: Rome PL. Usage of chiropractic terminology in the literature — 296 ways to say “subluxation.” Chiropractic Technique 1996;8:1-12.]
It all sounds very sciencey and absolutely perfect for bamboozling the marks. IOW, how would a chiropractic customer distinguish between an evidence-based chiropractor and a quack one?
Re the McGregor study http://www.biomedcentral.com/1472-6882/14/51 – it doesn’t say what you think it says. It states: “As with any investigation, this study has limitations. First, although the response rate was good at 68%, it remains unclear what practice perspectives and behaviours are associated with non-participants. Also, although the sample was randomly selected and stratified according to the number of licensed practitioners in each province, the sample represented only approximately 12 percent of practitioners from each province. As always, there is the possibility that despite the randomization scheme, a unique sample was selected, and generalizability is a possible concern.”
Certainly, the results do seem somewhat inconsistent with the other available data:
Most significantly, McGregor’s 1st, 3rd, 4th, 5th, and 6th subgroup descriptions don’t seem to exclude the unethical chiropractor element. IOW, 5 of the 6 subgroups could easily indulge in chiroquackery – (1) “Wellness”, (3) “general probs”, (4) “organic-visceral”, and (5/6) “subluxations”.
Also, according to Science Based Medicine author, Jann Bellamy: “The survey was of Canadian chiropractors, most of whom graduated from Canadian Memorial Chiropractic College, which appears to have a more orthodox orientation than, for example, Life or Palmer…the groups not included in the unorthodox category doesn’t mean the others are necessarily free of unorthodox views. While the survey is interesting, I thought it disingenuous for the authors to compare the stratification in chiropractic to that of medicine. That we are talking about vastly different phenomena is illustrated by the two examples they offer from medicine: the original rejection of Jenner’s paper on smallpox, which occurred in 1797, and Duesberg’s claim that HIV is not a cause of AIDS, which has been widely and publicly decried by scientists, and not just in their own journals.”
Have you read that list Blue. It looks like you are calling Dr’s who do spnal and facet blocks and physical therapists subbies! Approximately 50 terms are subluxation variations. You are definitely a listmaster but you should read your lists!
That doesn’t let chiropractors off the hook. The majority promote nonsense and have all those terms at their disposal to dupe unwitting customers.
In reply to Edzard:
“where is the opposition from within chiropractic against the charlatans”
COCA in Australia has around 1200-1500 members.
You are so focused on the minority Edzard, time to support those reformers and critical thinkers. In many previous blogs I have cited researchers, many recent papers both pro and con and reformers etc etc.
“where is the opposition from within chiropractic against the charlatans”
Sam Homola, Stephen, Perle, Dave Newell, Lynton,Giles, Bruce Walker, Simon French, Charlotte LeBoeuf-Yde, Greg Kawchuk, Peter Tuchin, Rod Bonello, Jordan Gliedt, Joel Pikar to name a few!
Some of my friends and associates in Australia:
The Rogue Chiropractor
A critic within the chiropractic profession entails being attacked by the subbies on one side (Which I enjoy) and the external critics on the other side (Which is extremely frustrating). The critics need to distinguist between the subbies and the reformers. Otherwise the reform process is hindered!
Thinking Chiro you said “The critics need to distinguist between the subbies and the reformers. Otherwise the reform process is hindered!”
The point is not to slag off people for the fun of it, people can take it that way if they wish, but i say again that is not the intention.
I believe the intention is to illustrate that if critics with the level of critical thinking skills that visit this site are unable to distinguish between the “subbies and reformers” what chance do the general public have of doing so? along with, why should they have to? surely they should just focus on improving their condition rather than research to separate the wheat from the chaff.
In reply to Neil:
Thanks for the thoughtful reply.
The critics on this site are by and large very well read and already know the difference, yet cherry pick the research, make blanket statements (Eg 15-18% subbies are the majority) and frequently take aim at the reformers. Everyone who comes onto this site is involved in the reform process whether they like it or not. Even evangelical subbies in attempting to defend their beliefs and dogma here are forced to think (I hope). I have never seen critics here as “slagging off for the fun of it”, they are more like pavlov’s dogs and when you ring the chiropractic bell respond in a predictable way. A good example is Edzards blog on paediatric chiropractic, I replied by linking to an excellent article from Sam Homola and the only reply was unrelated to paediatrics and the rest of the usual critics went silent! Or when I cited many articles in regards to current research and where its heading and again silence! I get the feeling that the critics have been conditioned to respond to Ad Hominem, Tu Quoque and Straw Man arguments. Anything different is confusing!
This conditioned response may be the result of the BS and vitriol that flows from the subbies if you are a non-believer, but it does not help the reform process. Chiropractic definitely needs to clean house and the cleaners need your support!
I find it all exceedingly frustrating. A classic example is Stephen Perle who has written 80+ articles critical of the BS within our profession and authored 30 journal papers. (Harriet Hall has cited and complemented one of his articles, high praise indeed!) This has resulted in the subbies sending their lawyers after him and the critics accusing him of being not critical enough. His perseverance and dedication should be lauded! His recent Twitter exchange with Blue Wode is understandable.
We all want to improve the chiropractic condition. Pointing out whats wrong is step 1, pointing out whats right is step 2. The critics need to take step 2. That helps the reform process!
Smart people will know that there are two sides to every story and Edzard Ernst’s side does not give a true reflection of his talk at the AECC, I was there. Valuable points were raised by both him and tutors/students alike. Edzard seems to think that the only skill a chiropractor has is manipulation, selfishly ignoring the excellent skills possessed in patient management and referral, communication with fellow healthcare professionals, exercise rehabilitation and an array of manual therapy techniques amongst many other skills. He conveniently fails to mention here that he was “impressed” by the fact that at least 95% of the students disagreed with chiropractic concepts such as the subluxation model and that chiropractic treatment can be used for asthma, hypertension and other systemic diseases. Edzard, just like everyone else, is entitled to his opinion. My opinion is that Edzard’s research and opinion of the chiropractic profession is out-dated and he’s desperately trying to cling on to his reputation as “the quackbuster”. Maybe instead of looking for old research papers dismissing the chiropractic profession as a whole, he should make another trip to the AECC and speak to any of the hundreds of satisfied patients who are successfully treated by the clinical interns on a daily basis and maybe also perhaps research what a chiropractic treatment actually consists of as it was clear from his attempt at an answer that this is not within his knowledge base.
I would like to thank Edzard for his time and informative talk. I hope he took on board some of the things he learned too, even if he won’t admit it.
GarryD wrote: ” Edzard seems to think that the only skill a chiropractor has is manipulation, selfishly ignoring the excellent skills possessed in patient management and referral, communication with fellow healthcare professionals, exercise rehabilitation and an array of manual therapy techniques amongst many other skills.”
What is it, apart from the subluxation-based quackery, that distinguishes chiropractic from physiotherapy?
With so much of chiropractic both good and bad being adopted by physiotherapists lock, stock and two smoking barrels, What distinguishes physiotherapy from chiropractic? Who holds the physio’s to account? Do they have a adverse event reporting system? Tad biased Blue!
They appear to be far more judicious in their use of spinal manipulation. In particular, see Fig.2:
We’re climbing out of the rabbit hole, while the physio’s are jumping in. There are physio’s now using activators, blocking using SOT protocols, dry needling, HVLA manipulation, physio practice management guru’s promoting how to create lifetime wellness patients etc. Conversely, there are physio’s who I hold in the highest regard. The physio’s are dodging a bullet. A classic example was the recent paper from the American Heart Association and American Stroke association on spinal manipulation and stroke. The critics tore into the chiropractic response yet ignored the identical response from the physio’s!
Hi Blue Wode. Have a look for yourself…
To name a few: 2 more years of education, 2 years of diagnosis/medical training (CV, respiratory, GI and gynae conditions), 2 years of psychology/psychosocial training, ability to take and interpret x-rays, some basic pharmacology training and last but not least we are highly trained and efficient in manipulation (not to remove the evil subluxation but to promote healthy joint movement and optimum MSK health).
That may be so, but when you boil down the evidence for chiropractic spinal manipulation it has short-lived, minimal effects for low back pain, and is no better than cheaper, more convenient, and safer options. Why bother with all the time and money incurred in training to be a chiropractor when you could become a physiotherapist (which has the bonus of not being mired in subluxation-based quackery)?
That’s why chiropractors (like physiotherapists) use a range of treatments not just SMT. However, others, including NICE take a different view on the evidence for manipulation. Once again institutions like the AECC do not teach vitalism and only present subluxations as an historical construct. BW seems desperate for this not to be the case as it shows reform within chiropractic. training as a physio is an option but remember in the UK physio’s are trained to work within the NHS, many are now demotivated, feel de-skilled (as they are often only allowed to give advice) and are finding it very difficult to get decent positions.
Personal preference BW. Also for all the reasons in my previous comment. For me it gives a fuller all round education in MSK health whilst incorporating all aspects of the biopsychosocial model.
Blue Wode: Of course if you want to be knee deep in the mire by all means train to be a physio and then you can expound the virtues of acupuncture to all and sundry. Get real!!!!!!
“ability to take and interpret x-rays”
A radiologist requires a medical degree (MBBS), some years of medical practise, specialist training, and testing at the highest level before they can “interpret x-rays”. Yet, it is only a small part of chiropractic training.
What are they “trained” to look for? It can’t be subluxations since they don’t exist, so what is it that they undergraduate chiropractics are scanning x-rays to detect?
Are you serious? What does the spine have to do with the female reproductive system? This is getting weirder!
What causes the symptom that is low back pain?
Hi Frank C! Of course AECC students are not fully trained radiologists. They receive 2 mandatory years of x-ray training covering the spine and extremities and 2 years of investigative imaging which covers a wide array of conditions. As a final year clinical intern you are required to write and submit an x-ray report each time one of your patients is x-rayed. The report and images are then examined by the on site radiology specialist who makes any necessary changes to the report, makes the final diagnosis and advises on referral if necessary. It’s all part of the learning process for final year interns.
As for the gynae conditions… first of all chiropractors are trained to treat all MSK conditions, not just the spine. Secondly AECC students receive 2 years of mandatory diagnosis training, taught by a medical doctor, which covers some common gynae conditions. Not so we can treat them of course, but to recognise the common signs and symptoms and refer as we see fit. All under the supervision of senior clinical tutors.
P.S – My eyes have now reached their capacity of looking at Ernst’s blog. I’ve been completely honest with everything I’ve written on here but of course someone will always have a problem with what you say. Therefore I wish not to spend any more precious time on here. I hope you find this useful. Cheers!
In reply to Frank Collins:
Radiology is a major part of the chiropractic course and the core text is Yochum and Rowe “Essentials of Skeletal Radiology”. I pick up a minimum of TWO spinal metastatses every year, it is the third most common site in the body. Treating every back is easy, knowing when not to treat and referring on is far more important. This may be of interest:
The bio of Lindsay Rowe:
“What causes the symptom that is low back pain?”
Many things; muscle injuries, infections, cancer but not subluxations or prolapsed discs. Of the latter two, one doesn’t exist while the other won’t normally be found on an X-ray (as told to me by my neurosurgeon who, incidentally, can walk on water). Of the former three, none of them are the in the principal chiro “skillset”, so I don’t see the purpose of chiropractors doing X-rays, or chiropractors generally.
“Of course AECC students are not fully trained radiologists.”
And THAT is the problem.
“I’ve been completely honest with everything I’ve written on here but of course someone will always have a problem with what you say.”
That is an emotive cop-out and reflects poorly. Everyone is subject to scrutiny and I’m not entirely sure you like it.
“I pick up a minimum of TWO spinal metastatses every year”
That sort of problem is one where medical doctors should be primarily involved, not have patients “referred” to them.
In relation to X-rays, do you X-ray most patients/ If so, how many of those X-rays actually show a treatable condition?
Hi Frank –
Are you sure prolapsed discs don’t cause pain? You are right that disc of the spine cannot be seen on X-rays but discs are known to cause pain (see an article on discograms). The problem is that you could perform a MRI on a person without low back pain and find a disc prolapse, so the question then becomes is it worth doing a MRI on people with low back pain. The answer, from my point of view, is that it is not necessary to MRI the vast majority of people with low back pain because you can reach a clinical diagnosis just on the consultation and examination only.
you said “Are you serious? What does the spine have to do with the female reproductive system? This is getting weirder!”
Conditions of the reproductive system (male of female) can cause low back pain. So the spine has nothing to do with the reproductive system (other than nerves supplying those organs come from the spine) but being aware of conditions that cause low back pain is important because you want to make sure that patient is getting the right treatment for the right condition.
Did you have a bad treatment with a chiro? Just asking because you seem to be unhappy with that profession.
All the best 😉
Really? I think it’s quite easy to find chiros advertising they can treat a variety of gynecological conditions.
You’ve just ruined my Friday evening Frank, I just couldn’t stay away 🙂 You seem to do a lot of talking without actually listening to what others say. You said “Are you serious? What does the spine have to do with the female reproductive system? This is getting weirder!”. I’ll thank AN other for answering that one for me!
Thinking_chiro informed you that “I pick up a minimum of TWO spinal metastatses every year” and your reply was “That sort of problem is one where medical doctors should be primarily involved, not have patients “referred” to them”. Come on Frank, think before you speak! Patients don’t come to see chiropractors asking “can you treat my spinal mets?”, they present with back pain and assume it’s an MSK complaint that the chiro can help with. When the chiro examines the patient, and hopefully becomes suspicious, they may then choose to x-ray the patient which then shows they have spinal METS. The chiro then informs the patient that they cannot be treated and are referred to their GP immediately to ensure they get the right care. Now tell me, what’s wrong with that?
And regarding my “emotive cop-out and me not liking being subject to scrutiny”, you’re way off the mark. Maybe you should start directing your negativity at others who are not trying to better themselves and others around them. I simply choose not to spend any more time on here conversing with energy suckers like yourself when I would much rather be doing something I enjoy. Besides, I have lots of medical and radiology study to get back to 🙂 All the best Frank! Over and out
Chiropractors are not primary care providers and have no medical training, so have no legitimate role in referral. I think it unlikely that a school that promotes the subluxation model would have invited a prominent member of the reality-based community, so your comment comes over as sour grapes on that score.
Hi again Guy! Your comment regarding “no medical training” is not correct. 2 mandatory years of diagnosis training focussing on many CV, respiratory, GI and some gynae conditions is within the curriculum. Some basic pharmacology training is also mandatory.
As for patient referrals, legitimate or not, final year interns regularly communicate via letter to GP’s to facilitate further investigation into undiagnosed systemic conditions, need for blood tests, cortisone injections and onward referal for orthopaedic specialist opinion for hip/knee replacement and the like. I know this because I have done it myself.
I have a very difficult time believing that the “training” you are describing can be genuinely categorised as “medical”.
Is it certified as adequate and accurate by a genuine medical authority?
At least it seems to have been completely wasted on the handful of chiropractors I have experienced, most of them US-schooled. This first hand knowledge of mine is both as a patient of one of the more respected ones for some months, listening to them lecturing and from conversations with them. My assessment is that they have certainly been led to fervently believe they know a lot about medicine but the substance, accuracy and practicality of their retained knowledge leaves very much to be wanted.
When chiropractors lecture and advertise that they can improve subfertility, cure gastritis and stimulate the adrenal glands by thumping on the spinal column, one has to seriously question the “medical” quality of their
I must have misspelled an important closing HTML-tag. The last lina was supposed to read: “…the “medical quality of their
[Admin: You did, but I have just fixed it.]
To be honest Bjorn, I’m not sure if it is genuinely classed as medical. Of course we are not in a position to give a confirmed diagnosis nor prescribe meds. What I can tell you is that the training is thorough, taught by a medical doctor and provides us with the knowledge and practical skills to recognize a wide range of medical conditions and refer as necessary within the correct timeframe. Don’t you think this has a valuable place in patient care?
I must reiterate that students at the AECC are not taught and most are in disagreement with claims that our treatment can do the things you previously mentioned. The U.S has a much higher proportion of chiro’s with similar beliefs. All UK schools are being taught the same fundamentals so I firmly believe big changes are in the pipeline, at least here in the UK. I hope these experiences don’t lead you to write off our profession as a whole.
Fascinating stuff. I guess this reflects the straight / mixer split, as seen in Australia in particular. Anything that marginalises the true quacks and helps the sincere to follow the path of righteousness can only be applauded.
In reply to Guy Chapman:
Criticism is a two part process:
1. Point out the BS.
2. Point out whats right and support. Especially the critics and reformers within the profession!
The entrenched critics are very good at step 1 but are struggling with step 2, no matter how much evidence I send their way. I often think they are on autopilot much of the time and getting them to change course even slightly is met with resistance.
Hi Guy! Your last sentence here matches the thoughts of the vast majority of AECC students. AECC education is aimed at providing all the tools to optimize one’s MSK health. The VSC plays no part in the training provided.
I am still alive going strong defying the statistical predictions of my demise, my consulatants no longer expect me to die this summer, I would be very interested in reading a thread on cannabis oil and cancer progression if you have an information on it? Glad you had an interesting visit to AECC, I was hoping to hear you speak and was invited to attend, then Dave told me you did not want chiropractors in practice to attend, I would like to hear you some time. Hi Blue Wode ,I think you raise an interesting point asking whether there is any point to AECC when there are all those physiotherapy courses out there. Some years ago I was interviewing AECC students for a job and none of them could explain the difference between a chiropractor and a physiotherapist that provides spinal manipulation which is available for free on the NHS, what do you think, bearing in mind the chair of the chiropractic regulators the GCC education committee is a physiotherapist
good to hear!!!
I hope you survive cancer as well as I survived Bournemouth. my offer was to lecture to students not chiros – sorry.
Hello Richard, that’s good news that your prognosis has been given a new, positive revision. I had been wondering how you were doing.
You wrote: “Some years ago I was interviewing AECC students for a job and none of them could explain the difference between a chiropractor and a physiotherapist that provides spinal manipulation which is available for free on the NHS, what do you think, bearing in mind the chair of the chiropractic regulators the GCC education committee is a physiotherapist.”
I think it’s indicative that most prospective chiropractic students don”t thoroughly research and think through what they’ll be signing up for. University clearing might have a lot to do with it – i.e. the AECC could be a repository for students who haven’t made the grade for superior, conventional training in healthcare. As for the Chair of the GCC Education Committee being a physiotherapist, perhaps he’s not a critical thinker? However, if he is, then he’ll be really up against it if he tries to influence any sort of regulatory reform:
“Some years ago I was interviewing AECC students for a job and none of them could explain the difference between a chiropractor and a physiotherapist that provides spinal manipulation which is available for free on the NHS, what do you think, bearing in mind the chair of the chiropractic regulators the GCC education committee is a physiotherapist (sic)”
What is the point of the question? You were interviewing AECC students so why would they know what the difference is? From the high self-esteem you have demonstrated from your other posts, I’m sure you thought it was a great question, but I, for one, cannot see the point of it, other than illustrate the paucity of training at the AECC.
Thinking_Chiro wrote on Wednesday 21 January 2015 at 22:44: “The critics on this site are by and large very well read and already know the difference, yet cherry pick the research, make blanket statements (Eg 15-18% subbies are the majority)”
Thinking_Chiro, I’m sure you’ve read this several times…
Why would that not strongly suggest that the majority of chiropractors indulge in unorthodox practices?
In reply to Blue:
Cherry picking the information Blue. If you look at that paper, the 18% subluxation figure correlates closely with other studies in regards to unorthodox views, especially antivaccination.
I disagree, and stand by the reasons given in my link.
As supportive as I am of manual therapies, in principle at least, and as much as I agree that Edzard goes over the top sometimes, often lapsing into weird rants and leaving cool-headedness behind, after twenty-odd years observing MT professions I can only agree: the majority of chiropractors (in particular) display an alarming lack of critical thinking and adherence to outdated ideas. That said, it would serve the cause far better if a more selective, nuanced approach to dealing with MT practitioners were adopted. Simply beating all over them over the head bold type is of limited usefulness in the long run. (I say this as a fairly experienced science communicator.) Unless, that is, of course, if the motivation is to eliminate manual therapies from every clinic on the planet. I commend you, Edzard, for your offer and your conduct at AECC. And I commend AECC for receiving you as they did. I trust you were as open to learning from them as you hoped your audience was from you.
There are so many problems with this post, it is hard to know where to start, so sequentially will have to do;
“As supportive as I am of manual therapies, in principle at least, and as much as I agree that Edzard goes over the top sometimes, often lapsing into weird rants and leaving cool-headedness behind, after twenty-odd years observing MT professions I can only agree: the majority of chiropractors (in particular) display an alarming lack of critical thinking and adherence to outdated ideas.”
– “As supportive as I am of manual therapies, in principle at least,” Which manual therapies or are they all being lumped together? What does the conditional “in principle at least” mean; you support them conditionally, and on what basis?
– “and as much as I agree that Edzard goes over the top sometimes, often lapsing into weird rants and leaving cool-headedness behind” This is contradictory; either EE “goes over the top sometimes”, or he “often lapses into weird rants”. Which is it?
– “after twenty-odd years observing MT professions” If you are the Corey Watts who now works for The Climate Institute, your bio does not reflect any observation of MT professions. This doesn’t mean you haven’t; however, to make any bias evident, which professions and on what basis?
– “the majority of chiropractors (in particular) display an alarming lack of critical thinking and adherence to outdated ideas.” How would you know what the “majority of chiropractors, or any of the other MT professions, display in their thinking? How many chiros in Melbourne have you had enough contact with to establish this as a view?
“That said, it would serve the cause far better if a more selective, nuanced approach to dealing with MT practitioners were adopted.”
What is the “cause” to which you are referring, and just what is that “more selective, nuanced” approach? Such generalised motherhood statements sound very wise but fall apart quickly under even cursory examination.
“Simply beating all over them over the head bold type is of limited usefulness in the long run. (I say this as a fairly experienced science communicator.) ” More “wise” motherhood statements, but of little intrinsic value. The argument from authority does you no favours either. From your bio, “For nearly two decades, Corey Watts has worked as a researcher, advocate, and science communicator at the intersection of rural affairs and sustainability.”, though I don’t see how this necessarily eminently qualifies you as a “communicator” whose personal views are given in a different forum and media than your professional output.
“Unless, that is, of course, if the motivation is to eliminate manual therapies from every clinic on the planet.”
From the articles I’ve read, I haven’t seen that as the intent of EE’s posts. On the contrary, Edzard has said, repeatedly, that he has qualms with any discipline where treatments are based on science and RCTs. I don’t understand how you could suggest this motivation, or what you mean by “clinic”?
“I commend you, Edzard, for your offer and your conduct at AECC. And I commend AECC for receiving you as they did. I trust you were as open to learning from them as you hoped your audience was from you.”
This is dangerously close to the Middle Ground Fallacy, and I am surprised that a science communicator would use this phraseology. What do you think Edzard could learn from a group of chiropractic students? I would dearly love to know what you think he could learn. I would also say that to “commend” Edzard on his “conduct” is damning with faint praise and an insult, as if the suggestion might be an otherwise improper behaviour.
I am suspicious, and I may well be completely wrong, however, I will chance it; your post reads as if you have some emotional stake in this. I suspect you have a close relation or good friend/s who are chiropractors and you have taken these criticisms personally. If this is the case, it would not reflect well on your objectivity as a “science communicator”.
Bill Kusiar wrote on Thursday 22 January 2015 at 17:19: “Blue Wode: Of course if you want to be knee deep in the mire by all means train to be a physio and then you can expound the virtues of acupuncture to all and sundry. Get real!!!!!!”
I understand that the membership of the UK Acupuncture Association of Chartered Physiotherapists is 6,000+ strong. As there are around 49,000 registered physiotherapists in the UK, that would mean that approximately 12 % practice acupuncture (which, of course, is 12% too many). However, according to the latest data on the scope of chiropractic practices in the UK, traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of the respondents, and 63% considered subluxation to be central to chiropractic intervention:
Do you have any better data?
Dear Prof/Blue Wode,
No, I don’t have any ‘better data’, I’m not trying to compete with you. I KNOW a very good many chiropractors spout bullshit! But to imply that only 12% of 49000 UK physio’s are practising quackery is a little hard to swallow! How many also use Reflexology, Craniosacral therapy, Reiki and other dubious remedies. I suggest 12% is just the tip of an iceberg. Sadly it seems to me that ALL physical therapy groups require a massive clean up.
good to see that someone calls “Reflexology, Craniosacral therapy” “dubious”!
why is it that, in alternative medicine, it is always the others who are quacks?
Most chiros think of homeopaths that way and vice versa, many healers believe aroma therapists to be charlatans and vice versa, etc. etc. etc.
Prof Ernst: I’m not convinced that this phenomenon only occurs in ‘alternative medicine’. I’ve spent the best part of 38 years of my working life among medical physicians and orthopaedic surgeons, attending state-of-the-art spinal care conferences and surgical procedures and have heard a considerable amount of name-calling amongst this august group. No profession is immune from it. Some antagonism is more overt, chiropractors and osteopaths have been at each others throats since their inception. But I was staggered to hear one of my pals, an Orthopaedic Surgeon, saying that Neurosurgeons were…shall we say…a lesser variety of specialist!
Ha ha. You think it’s bad amongst your group!! You should get a bunch of Osteopaths together and just watch and laugh at the mud slinging that happens amongst us!!!
I want to point out that there is “an ocean” between European Osteopathic Manipulators including the Commonwealth (Canada – sorry ocean is missing here and Australian Osteopathic Manipulators) and an Osteopathic Physician in the US.
As European physicians the last few years “created” a so called “European Osteoparhic Standard” including craniosacral approach and visceral manipulation an Osteopathic Physician in the US since 1938 became a fully licensed physician in all fields and departments of modern medicine with an additional training in OMM relating to their tradition to be able to treat musculosceletal disorders (neither including visceral manipulation nor craniosacral therapy).
But only 5% seem to use it later on.
Question: Why have M.D. physicians in Europe implemented a standard for OMT including visceral and craniosacral therapy which might be a nice experience but quackery because there is no evidence to this?
The European Osteopathic Manipulators hate it like hell if one points out in public what the difference ist between them and an osteopathic physician in the US. Because of all the billions that the gain with “alternative medicine” what osteopathy in Europe still remains their will be no change and even the M.D physicians now created a stupid standard for such quackery. And such “standards” ate in all the university standards to be awarded a B.Sc. (ost) or M.Sc. (ost) or Dr./ Ph.D (ost) in Europe. But still there is no evidence to such quackery.
Please read the links here to get clear about that