I will state my position up front: THERE IS NO CHILDHOOD CONDITION FOR WHICH CHIROPRACTIC SPINAL MANIPULATION GENERATES MORE GOOD THAN HARM. What is more, I have published evidence (published here, here, here, and here, for instance) to support this statement. If you disagree with it, this is the place and time to do so – and please don’t forget to cite the evidence that supports your statements.
Given that there is very little reliable evidence in this area, I find it surprising that so many chiropractors continue to treat kids. Not true! I hear some chiropractors shout, we do not often treat children. Who is correct? Clearly, we need data to answer this question.
The objective of a new paper was to investigate characteristics of clinical chiropractic practice, including the age of pediatric patients, the number of reports of negative side effects (NSEs), the opinions of doctors of chiropractic on treatment options by patient age groups, the conditions seen and the number of treatment sessions delivered by conditions and by patient age.
An Internet cross-sectional survey was conducted in 20 European countries with 4109 chiropractors invited to reply. The 19 national associations belonging to the European Chiropractic Union and the Danish Chiropractic Association were asked to participate. Respondents were asked to self-report characteristics of their practices.
Of the 956 (23.3%) participating chiropractors, 921 reported 19821 pediatric patients per month. Children represented 8.1% of chiropractors’ total patient load over the last year. A total of 557 (534 mild, 23 moderate, and 0 severe) negative (adverse) side effects were reported for an estimated incidence of 0.23%. On the given treatment statements, chiropractors reported varying agreement and disagreement rates based on patient age. The 8309 answers on conditions were grouped into skeletal (57.0%), neurologic (23.7%), gastrointestinal (12.4%), infection (3.5%), genitourinary (1.5%), immune (1.4%), and miscellaneous conditions (0.5%). The number of treatment sessions delivered varied according to the condition and the patient age.
The authors of this survey concluded that this study showed that European chiropractors are active in the care of pediatric patients. Reported conditions were mainly skeletal and neurologic complaints. In this survey, no severe NSEs were reported, and mild NSEs were infrequent.
In my view, a more appropriate conclusion might be that MANY EUROPEAN CHIROPRACTORS ARE ACTIVE IN QUACKERY.
I can’t help but asking the obvious question: are there chiropractors who are NOT active in quackery? Is it even possible for chiropractors to NOT be active in quackery? What type of chiropractic activities would a non-quacking chiropractor have?
I THINK I LET A CHIROPRACTOR ANSWER THIS ONE.
I think that has the potential of being fascinating. The only activity I can see would be retiring from chiropractic and denouncing it as a fraud, but I think it would be wonderful if that turned out to be wrong, and that there are indeed non-quack activities chiropractors could perform that would be of actual benefit to patients.
I would suggest “Chiropractic Abuse: an insider’s lament” by Preston H. Long, DC, PhD. It deals with problems associated with chiropractic practice here in the US from an insider point of view. Unlike osteopaths, chiropractors here in the US are very similar to yours in the UK and europe.
It should come as no big surprise that this book and its author are known to regular readers of Prof. Ernst’s blog: http://edzardernst.com/2013/10/twenty-things-most-chiropractors-wont-tell-you/
Quackery aside, it’s interesting that the authors of the survey say that “European chiropractors are active in the care of pediatric patients. Reported conditions were mainly skeletal and neurologic complaints” – because there certainly isn’t any justification for it :
“Generally, pediatricians classify a child as being under eighteen years of age—before vertebral end plate growth is complete. In a child under the age of eight to ten years, the cartilaginous growth centers are too immature and too vulnerable to injury to be subjected to spinal manipulation. There is some speculation that injury to growth plates might result in spinal deformity (such as scoliosis or Scheuermann’s kyphosis) as growth progresses (O’Neal 2003). Such injury might not be detectable. “The incidence of subtle growth plate fractures following high-velocity [manipulation] techniques in children is surely under-appreciated because of the occult nature of these injuries” (O’Neal 2003)…When the U.S. Department of Health and Human Services published guidelines suggesting that spinal manipulation might be helpful in treating low back pain without radiculopathy (sciatic pain) when used within the first month of symptoms, its recommendations did not apply to children younger than eighteen years of age “since diagnostic and treatment considerations for this group are often different than for adults” (Bigos 1994).
Regarding the figures produced by the survey, I would venture that they are very conservative, given that the response rate was 23.3%. I strongly suspect that it would be only the more ethical chiropractor element who would have bothered to participate. Furthermore, the vitalistic Barcelona and McTimoney chiropractors (who have been barred from joining the European Council on Chiropractic Education), and the vitalistic Scottish Chiropractic Association, seem to indulge in widespread ‘paediatric’ chiropractic quackery so it’s unlikely that they would entertain responding to a survey that was destined to be published in the medical literature. Indeed, according to the Research Director at the Anglo-European Chiropractic College, David Newell, quackery amongst European chiropractors seems set to continue. Newell has declared that he doesn’t…
“…think we are going to be able to pull everybody together in Europe because I know there are factions in Europe that are extreme and take a fundamentalist approach to their beliefs about what they think they are doing and what chiropractic care is.”
One has to wonder, what is the point of regulation if these factions are allowed to flourish unchecked?
Finally, let’s not forget that the President of the European Chiropractors Union, Øystein Ogre (DC) – who is heavily involved in developing chiropractic education throughout Europe – claims that a successful chiropractor “is being that person, the spinal expert in your area, that parents will consult when they are worried about their sick child”. See from 2:30 in here:
With regard to your comments about McTimoney and the ECCE – there is a degree of feeling that this was a stitch-up. For example http://chiropractic.prosepoint.net/106955. I note too that the ECCE is reported to be a self-elected regulatory body.
I had some involvement with McTimoney in the late 80’s / early 90’s, when setting up the GCC was also something of a BCA-led stitch-up which intentionally excluded the vitalist approaches.
I think it’s a case of political and financial power within chiropractic attempting to corral the entire discipline for gain, rather than in any meaningful way to establish effectiveness or safety. The points you make play into their hands by not clearly distinguishing the differing agendas. Your argument is both dishonest and diminished for that, and your other points (which I have not researched) are thereby also questionable.
Vitalism is a concept that is just as irrelevant as the idea that Allah or Yahweh or some other such fairy tale creature is doing everything. Whether or not it is true is totally irrelevant. What is not irrelevant, is whether or not the claims by chiropractors can be substantiated. Since chiropractors are not forthcoming with any – however remote – evidence, and since no one else has been able to come up with any evidence either, the conclusion is unequivocal: chiropractic is nonsense, and those who claim otherwise are either uninformed or quacks.
That conclusion can be changed, however. All you have to do, is come up with credible evidence to the contrary. Conspiracy theories that claim there is a movement within chiropractic that is against vitalism and subluxations are not credible evidence. Even if they are true, they are still irrelevant.
You clearly set out your stall: “THERE IS NO CHILDHOOD CONDITION FOR WHICH CHIROPRACTIC SPINAL MANIPULATION GENERATES MORE GOOD THAN HARM.”
What I think you meant to say was:”Of the single childhood illness (that doesn’t have a spinal cause) I was willing to consider, chiropractic spinal manipulation had no noticeable effect”
3 of your 4 references are behind different paywalls, so it’s not easy for the interested bystander to go check. There aren’t even abstracts in front of the paywall in most cases. It wouldn’t have been hard to pull an extract into the blog post, but given the quality of the one I can get to – the BMJ “Chiropractic for paediatric conditions: substantial evidence?” – I’m suspicious as to why you didn’t.
That article discusses mostly non-spinal manipulation. The comparison of two treatments of unknown effectiveness you correctly discount as there is no control treatment, so that the only trial relevant to your SHOUTY CAPS is the enuresis trial. There is no suggestion of any harm caused, just that the results aren’t statistically significant – i.e. it was no worse than the sham tx.
I’ve just come to your site via the Queen’s Homoeopath thing, with an anti-homeopathy position. But while I’m no fan of quackery I’m also no fan of people who stand on the side of reason and of science and yet debate dishonestly so that not only do they fail to establish the argument, but they undermine the very important general principles of truth-seeking. You shoot yourself in the foot, and diminish the effectiveness of absolutely everybody else who is trying to establish the facts.
no, I did mean what I wrote.
sorry that the refs are not easy to find [but the BMJ, for instance, should be available in many places]. however, I am asking anyone who objects to the statement [backed by evidence or not] to provide evidence that it is incorrect. and for that you need no access to the refs I cited.
Sure, so I’d have to be properly in the business before I was ready to drop ££ on access.
But that’s not even necessary.
I did get the BMJ one and that’s what I was responding to. I do object to your statement, and I think I shot a dirty big hole in your premises based on that one paper.
Given that your premises are false it’s not meaningful to go on to debate the detail of your argument. It’s like you said “Socrates is a Roman”, and expected us to discuss pizza recipes. 🙂
You know, I came to your site expecting to agree with you, to find a serious scientific takedown of quackery. It’s not what I’d expected, or implicitly been led to believe by all the retweets from illustrious peeps.
I am not sure what you are on about
You claimed “THERE IS NO CHILDHOOD CONDITION FOR WHICH CHIROPRACTIC SPINAL MANIPULATION GENERATES MORE GOOD THAN HARM.”
According to one of your cited papers there exists at least one childhood condition (eneuresis) for which spinal manipulation did no more harm than good.
Therefore your original statement that spinal manipulation is harmful in all cases is false.
2 X WRONG AGAIN!
1) there is no good evidence that chiropractic spinal manipulation is effective for enuresis [http://www.ncbi.nlm.nih.gov/pubmed/?term=ERNST+E%2C+enuresis] 2) I don’t know a condition called eneuresis, it does not exist.
PLEASE STOP PRODUCING SO MUCH BS ON MY BLOG
Where did Prof. Ernst say that? I seem to have missed that claim somehow. However, it is actually correct. Since chiropractic is nonsense, it is always harmful, even if and when it does not do any direct physical harm. It does so by encouraging people to believe fairy tales, i.e. it reduces their ability to think critically and makes it easier for them to fall prey to ruthless quacks, some of whom just happen to be chiropractors.
the foam from his mouth might blur has vision a bit, you have to forgive him.
That’s what I thought: he has rabies! The Tao might have some influence as well. In my experience, when people have been trained into “correctly interpreting ancient wisdom”, they become unable to read what is actually written, and consistently read what is not there as though they are under the influence of some mind altering substance. It reminds me of the intellectual giants at Biola who figured out that the Bible is free of errors of any kind. Anyone able to this kind of intellectual souplesse, almost inevitably becomes utterly unable to understand anything written in plain English.
Dude I’m not pushing Taoism. One of your lot looked it up. It’s irrelevant. And I’ve no idea where this Bible/GWB vrap comes from other than Bart B’s Brain – it’s not mine, and verges on Godwin’s Law IMO.
I’ve made not one comment in support of CAM in any of my posts. I’ve attempted to point out issues with the Prof’s content, believing that you have to behave better than the opposition else you lose the high ground.
What happened? Did we debate on merit? No. I’ve come in for attack and derision at almost every point, and 100% from the Prof.
It’s a re-statement of the Prof’s original ALL CAPS statement at the top of the post.
I kind of agree that there is always harm, even if there’s no direct physical harm. However given that the Prof made a VERY STRONG claim, and was referencing specific studies concerned with specific physical outcomes then I’d argue that the psychological aspect wasn’t in scope. In any case believing fairy-tales is IMO of much less significance for the individual, no matter how unfair it seems that the chiropractor makes his money.
I gotta go though, before the Prof sets Simon Singh on me 😉 Thanks for the argues and congrats on your brilliant name.
Re yours from 17:56 (not sure why I’m unable to reply directly):
1) “there is no good evidence that chiropractic spinal manipulation is effective for enuresis” is a true statement, but it’s not the statement you made at the head of the post. You claimed that all spinal tx for childhood conditions do more harm than good. Which is a false statement.
2) You’re just being picky about my mis-spelling of enuresis. That’s a debating style reminiscent of the playground Ernst, and really not a credit to a man of your standing, experience and qualifications.
I’ve kind of had enough. I’m really interested in the science around CAM and I’m generally anti-quack. But today’s experience – which I’ve quite enjoyed btw thanks – shows that you’re not the guy to engage with as you’re only interested only in shouting the loudest. You’ve dismissed, intentionally misunderstood, and responded with ad hom to my comments and in no case have you played a straight bat.
I’ll see if there are any other remaining responses and then I’ll likely be off. Thanks for all the fish.
1) is simply not true
2) thanks for the compliment [ I actually did look up eneurisis, because I wasn’t sure – it sounds like a rare neurological disease]
I am so glad that you now will leave me alone
PS a blog is something different from a scientific paper [in case you did not know]
1) is simply a restatement of your original claim.
A blog *is* different to a scientific paper as you say. But you’re critiquing CAM clinic websites as if they were formal statements of e.g. chiropractic philosophy. I’ve been attempting to address your posts in the same spirit, and you really don’t like it. *Surely* a man of your eminence can do better.
It most definitely is not. It is an interpretation of his original claim, and the interpretation is wrong. The fact that the interpretation is factually true, is not relevant here, since you are accusing the author of saying something he did not say, and that is dishonest.
You mean that he should critique them as if they said something else than what they said? This is usually called a “straw man”. In politician’s terms, we would say that the restatement is perhaps not entirely compatible with the letter of the original. In layman terms, it is called “lying”. Whatever you call it, you cannot reasonably expect an honest scientist to engage in such base behaviour. A blog is not a scientific treatise, but if one is honest, one still wants it to tell the truth and describe reality. I realise that this is difficult concept to grasp for a quack, but you should at least try.
Where did he claim that? Or are you a follower of the biblical Jesus and George W. Bush, two towering intellects who seem to have similar problems understanding elementary logic?
I find it interesting to notice that you repeatedly attack Prof. Ernst on something you claim he claimed, but didn’t, while demanding that he doesn’t hold your mistakes against you.
You are not anti-quack. You *are* a quack.
He claimed it in ALL CAPS at the top of the post.
Here you go:
“THERE IS NO CHILDHOOD CONDITION” => for all childhood conditions
“FOR WHICH CHIROPRACTIC SPINAL MANIPULATION” => chiropractic spinal manipulation
“GENERATES MORE GOOD THAN HARM” => is harmful
The Prof didn’t address the neutral third option where there is no significant effect. We could debate that, but IMO it’s clear his emphasis is on “harm”.
So now it only takes one counter-example where chiropractic spinal manipulation is shown to be not harmful for a childhood condition, and that’s provided by the enuresis (sp?) trial.
Bart B I’m no follower of Jesus or of GWB. Hell I didn’t get a vote either way. It’s a somewhat nasty attack, when I’d assumed from your other posts you were willing to argue on merit. Why the name-calling?
As for the idea that my mis-spelling of a medical term has equivalance to the Prof’s repeated attacks on all and sundry while taking the authority position and using questionable tactics… are you serious?
Do keep your shirt on! You’re provoking bad tempered responses because you’re repeatedly posting comments that miss the point. Here’s what you’re missing in this thread, which seems to have upset you the most.
‘“GENERATES MORE GOOD THAN HARM” => is harmful’
No, no, no! Edzard Ernst is alluding to the eternal problem of considering risk-benefit ratios. Something may be harmless, but if it is also inactive, then it it doesn’t generate more good than harm. Get it now? It’s plain enough English, really.
Wrong again. You are reasoning like the Jesus of the Bible, and such black-and-white reasoning just happens to be the cause of a lot of misery on this planet.
You must learn to read a sentence in its entirety. I realise that this may pose a significant challenge, since the sentence is more than three words long, but your life will tend to be a lot easier and have a lot more nuances if you do. You will also, in the long run, become less likely to fall prey to quacks, priests and other con-artists.
Professor Ernst’s statement says that:
This is correctly interpreted as:
Chiropractic spinal manipulation generates less good than harm or just as much good as harm
Chiropractic spinal manipulation generates at least as much harm as the good it generates.
Harm ≥ Good
Good ≤ Harm
What you are saying is that he claims that
Harm > Good
Good < Harm
Which is not what he is saying.
In other words, you are omitting the possibility that:
Good = Harm
Harm = Good
Professor Ernst is not omitting that possibility.
As I said, knowing English and some elementary logic helps.
Hmm… I seems that I have placed some bolding in two different quotes. That is a mistake. Let’s correct that here:
I hope this mistake is not overly confusing.
Would you leave out the irrelevant and rather unpleasant bible crap please – it’s yours mate, not mine.
We’re now on to discussing the structure of the Prof’s statement, and in particular the interpretation of more/less good/harm.
*I’m* not omitting the “good = harm” case: the Prof himself omitted it. I’ve argued that the strength of the statement, along with the tone/content of his many other posts, suggests that he means “all chiro for childhood conditions has a harmful medical outcome”.
So this is partly just a bit of fun with logic, taking apart an old guy’s rant on the internet. But actually it *is* important because one has to be better behaved than the opposition. Otherwise we lose the high ground and it’s all just yelling in the schoolyard. Nobody learns anything.
I’m saying “Hey Prof, you have a platform here but you’re undermining your own arguments with poor practice”, and you all jump to the conclusion that I’m some religionist or CAM-flunky. That’s irrational, to say the least.
No he did not. You are. It is not Prof. Ernst’s fault that you are limited in your understanding of language. You may not like that, but just because *you* think something is unpleasant does not entitle you to demand that we omit it. You denied yourself such courtesies by talking rubbish.
The Biblical crap is relevant. The only other case I can come up with is George W. Bush, and he got his directly from the New Testament. You are free to give me some pointers, but since you don’t understand the logic involved, it would seem that you are not qualified to do so.
As someone else has written, rather tongue-in-cheek, elsewhere on this blog: you are regressing to the mean. It is a common affliction in quack lovers.
Oh goodness. This just goes on and on (which is why you’re attracting stuff close to ad homs). ‘I’ve argued that the strength of the statement, along with the tone/content of his many other posts, suggests that he means “all chiro for childhood conditions has a harmful medical outcome”.’
If all chiro for childhood conditions is woo, and it occasionally has a harmful medical outcome, then there is no case for chiro for childhood conditions. That is not the same thing at all as your ridiculous overinterpretation that all chiro for childhood conditions is harmful: the point being made is that it’s all potentially harmful, without offering any benefit.
To requote from the original post: “If you disagree with it, this is the place and time to do so – and please don’t forget to cite the evidence that supports your statements.” You’re not even comprehending the simple point, never mind providing evidence.
You’re busily trying to tell Edzard Ernst that he’s spoiling the anti-woo pitch with logical fallacies and erroneous statements. You seem to be blindly oblivious that you’re repeatedly committing both yourself. When I caught you out in a flagrant error yesterday you hand-waved it away. You obviously think you’re very smart, and your last comment about “taking apart an old guy’s blog” confirms this. The wisest thing anyone ever said to me was “When you think you’re good, you’re comparing yourself with the wrong people”. Do try to learn something from the reactions you’re provoking; and read up Dunning and Kruger.
RL is far to smart for this old guy, and this is why he stopped responding to him [his life is too short for that sort of thing].
You didn’t respond so much as insult and dismiss without consideration. Life is indeed too short. I’m out.
you were out of it from the beginning
nice to see you go!