Monthly Archives: March 2016
Whenever I write something critical about an alternative therapy, chances are that I get hate mail, sometimes lots of it (and much of it is hilarious). It usually centres around themes such as:
- Ernst is bought by ‘Big Pharma’.
- Ernst is incompetent.
- Ernst is a lousy scientist.
- Ernst is a liar.
- Ernst has an axe to grind.
However, one theme that comes up more often than any other is, I think, the allegation of my ‘lack of qualifications’. Here is an example posted as a comment to my recent article on acupuncture in THE SPECTATOR:
“Ernst’s appointment as a professor at the University of the Penisula, his apparent ‘qualifications’ in Complementary Medicine (including homeopathy as well as what he says here about acupuncture) are controversial to say the least and he lacks qualifications in evidence-based medicine too.”[This particular quote is quite funny; the author not only was wrong about my qualifications but also re-named the University of Exeter ‘The University of the Penisula’ – begging the penetrating questions, who is Ula? And what has his penis to do with my professorship?]
If I have the time and the patience, I do like to respond even to the weirdest of attacks.
Because my attackers often claim that a non-response amounts to an ‘admission of guilt’ on my part. Yet, all too often, this strategy turns out to be a mistake, and the whole thing quickly degrades even further.
In the above-mentioned instance, I replied: “I never said that I had formal qualifications in acupuncture or homeopathy. I learnt these things as doctors learn most other techniques: initially by studying them and subsequently applying them, first with supervision and later independently. I once wrote as a footnote to a critical article on homeopathy: ‘CONFLICTS OF INTEREST: I AM A TRAINED HOMEOPATH’. Only a moron could miss that this was tongue in cheek. Moreover, it was correct: I was trained during several months working in a homeopathic hospital. It seems that this is the origin of all these false allegations against me. To accuse me of having no qualifications in these areas is, I think, akin to me accusing you of having no degree in particle physics.”
Rather than carefully considering what I had written, my attacker answered by bringing up a new lie: “You are not and were not a registered medical doctor in the UK at the time but were a professor of Complementary Medicine. (fact or ad hominem attack?) If this is so you deserve to be congratulated on a superb interview to get the job with your only ‘qualification’ being picking up a bit of knowledge here and there on CAM as a doctor.”[One has to excuse the confusing language of the commentator who seems far too overwhelmed with emotion and excitement to express things clearly. What was meant, I think (mostly from previous, similar attacks), was the allegation that I was not even a GMC-registered physician when I took up the Exeter job.]
I have only little hope that it will deter future attacks of this nature but, for the sake of honesty, integrity and transparency, I will (yet again) try to clarify the situation regarding my ‘lack of qualifications’.
- There is nothing controversial about my qualifications.
- I have never claimed to hold qualifications that I did not earn.
- I have no formal ones in alternative medicine, and I have never said otherwise.
- I am not even sure that such qualifications existed when I was in my ‘qualifying years’ (late 1970s).
- As for any degrees in EBM, they certainly all came in after that time (even the term ‘EBM’ was invented only later).
- If you are qualified as a doctor, you do not need to have any extra qualifications to practice alternative medicine.
- Neither does one need them to research alternative medicine.
- As I stated many times before, I have received training in several forms of alternative medicine.
- I consider myself competent to research most areas of alternative medicine.
- I have been registered with the GMC since the late 1970s.
- When it became clear that this registration was no longer needed to conduct the research I did at Exeter, I cancelled it to save the considerable annual expense.
- I have also published a full memoir entitled ‘A SCIENTIST IN WONDERLAND’ where the background to many of these issues is discussed in more detail.
All that I need to say now to future ad hominem attackers: PLEASE FIND A DIFFERENT LINE OF ATTACK; THIS ONE IS GETTING BORING AND MERELY DISPLAYS YOUR IGNORANCE.
You have to admit, quacks had a difficult time recently:
- homeopathy has been disclosed as humbug,
- chiropractic is not much better,
- ‘acupuncture awareness week’ left acupuncturists bruised…
Need I go on?
One has to pity these guys; their income is dwindling; they have no pensions, no unions to protect them etc., they know nothing other than quackery…what can they do? They are clearly fighting for survival.
I suggest we all focus, use our imagination and come up with come constructive ideas to help them.
Alright, I start: HOLISTIC DOPING
The fate of the poor (not in a monetary sense, of course) tennis star Sharapova gave me that brainwave.
Our elite athletes are in a pickle: they feel the need to enhance their performance but more and more ways of achieving this with cleverly administered drugs are becoming illegal. Their livelihood is at stake almost as much as that of our dear quacks.
What if the two groups jointed forces?
What if they decided to help solve each others’ problems?
This could be a classical win/win situation!
I am sure homeopaths, chiropractors, acupuncturists etc. could design holistic program for improving athletic performance. It would be highly individualised and embrace body, mind, spirit, sole and anything else they can think of. It could include the newest concepts in quantum healing, energy field, qi, vital force, etc. The advantages are obvious, I think:
- none of these interventions will ever be found on a list of forbidden drugs,
- the program will work perfectly well because it will generate large placebo responses,
- performance will therefore increase (as always in alternative medicine, anecdotal ‘evidence’ will suffice) ,
- and so will the quacks’ cash flow.
Is there a downside? Not really…oh, hold on…yes there is!
My idea is not that original; others have had it already. In fact, there are quite a few quacks offering alternatives to good old-fashioned doping.
THAT’S THE AWFUL THING ABOUT QUACKERY: ALL THE GOOD IDEAS TURN OUT TO BE ALREADY TAKEN!
As if to celebrate the end of ‘Acupuncture Awareness Week’, I am off today to give a few lectures in Oslo. One title is most fitting: ACUPUNCTURE: FACTS AND FALLACIES. Here are some of the fallacies I intend to discuss:
- Appeal to popularity
- Appeal to tradition
- Science can explain how it works
- Acupuncture is a ‘cure-all’
- It worked for me, my aunt, etc.
- Acupuncture even works for animals
- Even if it’s just a placebo, it helps patients.
- It defies scientific testing.
- Acupuncture research is productive
- Acupuncture is by definition rubbish
- Acupuncture is risk-free
- Its benefits outweigh its risks
None of these themes need much by way of explanation for the readers of this blog, I think.
So, why do I mention them at all?
The answer is simple: I was hoping to get a few inspirations and tips from you for further subjects that I might include.
WHAT DO YOU THINK ARE THE MAIN FALLACIES IN THE REALM OF ACUPUNCTURE?
The current ‘Acupuncture Awareness Week’ is perhaps a good occasion to look beyond acupuncture for humans. The ‘Chi Institute’ is an organisation that teaches TCM for animals. There you can specialise in all sorts of intriguing things that a critical mind would have never thought about. Take acupuncture for horses, for instance; on their website, the Institute informs us that:
The Equine Acupuncture Program…certifies students in veterinary acupuncture with an emphasis on horses. The program begins with an overview of fundamental aspects of Chinese Medicine, including Ying-Yang and Five Elements theory, which serve as a foundation for case diagnosis and treatment presented later in the class. A variety of acupuncture techniques are taught, including electro-acupuncture and moxibustion, in addition to conventional “dry” needling. Students of the program learn acupuncture points on large animals only, and horses are used for practice in the wet labs.
The program is presented in five sessions (two online and three on-site) over a period of six months. Online sessions are composed of lectures that students can stream at their own convenience. Afternoon wet-labs of on-site sessions give students the opportunity to learn acupuncture points on live animals in small lab groups of five to six students per instructor. A spring class and a fall class are held each year. Equine Acupuncture is offered to licensed veterinarians and veterinary school junior/senior students only.
- Traditional Chinese Veterinary Medicine (TCVM) Principles: Five Elements, Yin-Yang, Eight Principles, Zang-Fu Physiology and Pathology, Meridians and Channels
- Scientific Basis of Acupuncture
- 200 Transpositional Equine Acupuncture Points (hands-on, wet-lab demos)
- 70 Classical Equine Acupuncture Points (hands-on, wet-lab demos)
- How to needle acupuncture points in horses
- TCVM Diagnostic Systems, including Tongue and Pulse Diagnosis
- How to integrate acupuncture into your practice
- How to use veterinary acupuncture to diagnose and treat:
- Musculoskeletal conditions, lameness and neurological disorders
- Cardiovascular diseases and respiratory disorders
- Gastrointestinal disorders and behavioral problems
- Dermatological problems and immune-mediated diseases
- Renal & urinary disorders and reproductive disorders
- Dry needle (conventional needling)
- Aqua-acupuncture (point injection)
But is there not something missing, I asked myself when I read this. What about the evidence? What about the question whether there is any proof that any of this works?
As it happens, some time ago, we looked into this by conducting a systematic review. Here is our abstract ( I should mention that the first author of this paper was a vet who was very fond of acupuncture):
Acupuncture is a popular complementary treatment option in human medicine. Increasingly, owners also seek acupuncture for their animals. The aim of the systematic review reported here was to summarize and assess the clinical evidence for or against the effectiveness of acupuncture in veterinary medicine. Systematic searches were conducted on Medline, Embase, Amed, Cinahl, Japana Centra Revuo Medicina and Chikusan Bunken Kensaku. Hand-searches included conference proceedings, bibliographies, and contact with experts and veterinary acupuncture associations. There were no restrictions regarding the language of publication. All controlled clinical trials testing acupuncture in any condition of domestic animals were included. Studies using laboratory animals were excluded. Titles and abstracts of identified articles were read, and hard copies were obtained. Inclusion and exclusion of studies, data extraction, and validation were performed independently by two reviewers. Methodologic quality was evaluated by means of the Jadad score. Fourteen randomized controlled trials and 17 nonrandomized controlled trials met our criteria and were, therefore, included. The methodologic quality of these trials was variable but, on average, was low. For cutaneous pain and diarrhea, encouraging evidence exists that warrants further investigation in rigorous trials. Single studies reported some positive intergroup differences for spinal cord injury, Cushing’s syndrome, lung function, hepatitis, and rumen acidosis. These trials require independent replication. On the basis of the findings of this systematic review, there is no compelling evidence to recommend or reject acupuncture for any condition in domestic animals. Some encouraging data do exist that warrant further investigation in independent rigorous trials.
What a pity that the pupils of the above course are not being told that THERE IS NO COMPELLING EVIDENCE that any of the tings they are about to learn has any value…but that would be bad for business, wouldn’t it? And we cannot have a bit of evidence jeopardize a nice little earner, can we?
Yes, we discussed this study on a previous blog post. But, as it is ‘ACUPUNCTURE AWARENESS WEEK’ in the UK, and because of another reason (which will become clear in a minute) I decided to revisit the trial.
In case you have forgotten, here is its abstract once again:
Background: Hot flashes (HFs) affect up to 75% of menopausal women and pose a considerable health and financial burden. Evidence of acupuncture efficacy as an HF treatment is conflicting.
Objective: To assess the efficacy of Chinese medicine acupuncture against sham acupuncture for menopausal HFs.
Design: Stratified, blind (participants, outcome assessors, and investigators, but not treating acupuncturists), parallel, randomized, sham-controlled trial with equal allocation. (Australia New Zealand Clinical Trials Registry: ACTRN12611000393954)
Setting: Community in Australia.
Participants: Women older than 40 years in the late menopausal transition or postmenopause with at least 7 moderate HFs daily, meeting criteria for Chinese medicine diagnosis of kidney yin deficiency.
Interventions: 10 treatments over 8 weeks of either standardized Chinese medicine needle acupuncture designed to treat kidney yin deficiency or noninsertive sham acupuncture.
Measurements: The primary outcome was HF score at the end of treatment. Secondary outcomes included quality of life, anxiety, depression, and adverse events. Participants were assessed at 4 weeks, the end of treatment, and then 3 and 6 months after the end of treatment. Intention-to-treat analysis was conducted with linear mixed-effects models.
Results: 327 women were randomly assigned to acupuncture (n = 163) or sham acupuncture (n = 164). At the end of treatment, 16% of participants in the acupuncture group and 13% in the sham group were lost to follow-up. Mean HF scores at the end of treatment were 15.36 in the acupuncture group and 15.04 in the sham group (mean difference, 0.33 [95% CI, −1.87 to 2.52]; P = 0.77). No serious adverse events were reported.
Limitation: Participants were predominantly Caucasian and did not have breast cancer or surgical menopause.
Conclusion: Chinese medicine acupuncture was not superior to noninsertive sham acupuncture for women with moderately severe menopausal HFs.
When I first discussed this trial, I commented that the trial has several strengths: it includes a large sample size and the patients were adequately blinded to eliminate the effects of expectations. It was published in a top journal, and we can therefore assume that it was properly peer-reviewed. Combined with the evidence from our previous systematic review, this indicates that acupuncture has no effect beyond placebo.
The reason for bringing it up again is that a comment about the study has recently appeared, not just any old comment but one from the British Medical Acupuncture Society. It is, in my view, gratifying and interesting. It was published on ‘facebook’ and is therefore in danger of getting forgotten. I hope to preserve it by citing it in full.
Here it is:
A large rigorous trial published in a prestigious general medical journal, and the usual mantra rings out – acupuncture is no better than sham. In this case there was not a fraction of difference from a non-penetrating sham in a two-armed trial with over 300 women. Ok,…so we have known for some time that we really need 400 in each arm to demonstrate the usual difference over sham seen in meta-analysis in pain conditions, but there really was not even a sniff of a difference here. So is that it for acupuncture in hot flushes? Well, we have a 40% symptom reduction in both groups, and a strong conviction from some practitioners that it really seems to work. Is 40% enough for a strong conviction? I have heard some dramatic stories from medical acupuncturist colleagues that really would be hard to dismiss as non-specific effects, and from others I have heard relative ambivalence about the effects in hot flushes.
Personally I always try to consider mechanisms, and I wish researchers in the field would do the same before embarking on their trials. That is not intended as a criticism of this trial, but some consideration of mechanisms might allow us to explain all our data, including the contribution of this trial.
Acupuncture has recognised effects that are local to the needle, in the spinal cord (mainly in the segments stimulated) and in the brain (as well as humoral effects in CSF and blood). The latter are probably the mildest of the three categories, and require the best group of patient responders for them to be observable in clinical practice.
Menopausal hot flushes are explained by the effects of reduced oestrogens on the thermoregulatory centre in the anterior hypothalamus. It is certainly plausible that the neuro-inhibitory effects of endogenous opioids such as beta-endorphin, which we know can be released by acupuncture stimulation in experimental settings, could stablise neurones in the anterior hypothalamus that have become irritable due to a sudden drop in oestrogens.
So are endogenous opioids always released by acupuncture? Well, they and their effects seem to be measurable in experiments that use what I call proper acupuncture. That is, strong stimulation to deep somatic tissue. In the laboratory, and indeed in my clinic, this is only usually achieved in a palatable manner by electroacupuncture to muscle, although repeated manual stimulation every few minutes may have similar effects.
Ee et al used a relatively gentle acupuncture protocol, so they may have only generated measurable effects, based on mechanistic speculation, in the most responsive patients, perhaps less than 10%.
What does all this tell us? Well this trial clearly demonstrates that gentle acupuncture protocols generate effects in women with hot flushes via context rather than penetrating needling. In conditions that rely on central effects, I think we still need to consider stronger stimulation protocols and enriched enrollment in trials, ie preselecting responders before randomisation.
In my original comment I also predicted: “One does not need to be a clairvoyant to predict that acupuncturists will now find what they perceive as a flaw in the new study and claim that its results were false-negative.”
I am so glad Mike Cummings and the BMAS rushed to prove me right.
It’s so nice to know one can rely on someone in these uncertain times!
As it is ‘ACUPUNCTURE AWARENESS WEEK’, I thought I make a constructive contribution to this field by assessing what is currently being published on the subject. For this purpose, I looked at the first 100 Medline-listed articles of 2016. This has the advantage, of course, that all the numbers thus generated can be seen as absolute and as percentage figures at the same time. I categorised the articles according to where they were published and what their subject was.
My results show that, of the first 100 articles,
- 33 were published in CAM journals,
- 67 were published in mainstream medical journals,
- 6 were RCTs,
- 6 were other clinical studies,
- 30 were pre-clinical investigations,
- 27 were systematic reviews,
- 8 were surveys,
- 23 were other types of papers.
I have to admit, these results are not as bad as I had feared. What seems impressive is foremost the notion that acupuncture research has entered the mainstream journals. But there are issues that might be of concern; in my view these results suggest that:
- Too little research is focussed on the two big questions: efficacy and safety.
- In relation to the meagre output in RCTs, there are too many systematic reviews.
- As long as we cannot be sure that acupuncture is more than a placebo, all these pre-clinical studies seem a bit out of place.
- The vast majority of the articles were in low or very low impact journals.
- There was only one paper that I would consider outstanding (my next post will discuss it).
So, what conclusions can one draw from these data?
Not many, I fear.
My little exploration does not lend itself to grand, generalizable or far-reaching conclusions. Acupuncture fans might proudly say: LOOK HOW FAR WE HAVE COME! Less enthusiastic experts, however, might think: LOOK HOW FAR YOU HAVE TO GO!
It’s acupuncture awareness week in the UK, and therefore, I will focus on this treatment for a few days.
Yesterday, the ‘HALE CLINIC’, London happened to be in the papers for making unsubstantiated claims. It seems to be THE place where the super-rich take their money when they feel a little off colour.
This institution has for many years been a great promoter of acupuncture. On their website, which seems to have changed significantly since the press report about bogus claims made there, they even advertise acupuncture for children and little babies:
Acupuncture has been a normal part of the healthcare system in China for thousands of years, ever since ancient times, being used on babies and children as well as adults. Paediatric acupuncture is a specialist branch of traditional acupuncture, fundamentally the traditional theory is no different, the difference comes with how we assess the children and the way we use the needles. A child’s vital energy or Qi is abundant and much easier to access as it is young. This often means results can be very dramatic and sustained in a positive way, enabling the child to grow into adulthood without conditions that may have stayed throughout their lives.
Acupuncture involves using very short, fine sterile needles which are inserted using a very gentle needle technique specifically for babies. The needles do not stay in so the consultation is relatively quick and the child feels very little. Moxa is often used which is a herb called mugwart that has been rolled into a cigar shape. This is lit and then it smoulders producing a gentle heat which is held over the skin of the child creating a delightful warming sensation. This therapy is very popular with the children as it is very relaxing.
Acupuncture is an extremely effective therapy for babies and children and they are very receptive to it. Once their initial natural anxieties have been overcome, children often find the whole experience enjoyable and look forward to coming for their appointments.
In the interest of promoting awareness of the truth about acupuncture, I think, one ought to point out a few things here:
- The history of acupuncture was not at all as simple as implied above. Acupuncture was even banned in China. Mao re-introduced it, not because he thought it was effective but because he needed to offer some sort of healthcare to the masses.
- The concept of vital energy is a pre-scientific myth which has no basis in reality.
- To claim that children can grow into adulthood without conditions that may have stayed throughout their lives, implies that acupuncture effectively prevents certain diseases. I am not aware of any good evidence for this claim and would therefore classify it as bogus.
- The claim that acupuncture is an extremely effective therapy for babies and children is not supported by good evidence.
What does that tell us about the honesty of the claims made for acupuncture?
You are not surprised?
Considering that the HALE CLINIC now had many hours to ‘clean up’ their website after the allegations in the press, I have to admit that I am a little shocked. They seem to make unsubstantiated claims in order to take parents’ money for sticking useless and potentially harmful needles into their tiny infants.
I am shocked that such misleading information seems to be deemed to be inoffensive.
I am shocked to think that some parents might be sufficiently gullible to do this sort of thing to their infants.
And I am shocked that some people seem to earn their living doing such things.
THE LOCAL, SPAIN’S NEWS IN ENGLISH just reported that a master’s degree in homeopathic medicine at one of Spain’s top universities has been scrapped, because of its “lack of scientific basis”. A university spokesman confirmed the course was being scrapped and gave three main reasons:
- “Firstly, the university’s Faculty of Medicine recommended scrapping the master’s because of the doubt that exists in the scientific community.
- Secondly, a lot of people within the university – professors and students across different faculties – had shown their opposition to the course.
- Thirdly, the postgraduate degree in homeopathic medicine is no longer approved by Spain’s Health Ministry.”
“All of these reasons taken together convinced the university to stop the course,” he added. The news has been praised by doctors and scientists throughout Spain, not least by Adrián Gómez, a chemistry student at the university, who five months ago launched a petition on the website change.org calling for the homeopathy master’s to be scrapped.
The university had started its Homeopathic Medicine Masters in 2004. Since then opposition to the course seems to have grown. Even Spain’s own Health Ministry stated in a 2011 report that “homeopathy has not proved its effectiveness in any specific clinical situation”.
The current student intake (n=20), which is due to finish the course in October 2016 will continue to the end, but there will be no new courses in homeopathy. THE LOCAL also reported that the homeopathic industry in Spain is worth around €60 million annually.
Vis a vis the now overwhelming evidence that homeopathy is a placebo therapy, more closures of homeopathy courses can be expected worldwide. Indeed, one has to ask why this particular course was started in 2004 when the evidence had been quite clear for some time. In my view, it is unethical of universities to set youngsters on a path of quackery and thus contribute to an obstacle to evidence-based health care.
Sometimes it is helpful when journalists tackle complex medical issues – and sometimes it is not.
The recent article in THE SPECTATOR entitled “The war on homeopathy isn’t working. We need to call a truce” is a good example for the latter scenario. Here are a few crucial excerpts from it [my comments are in square brackets and bold letters]:
No matter how many trials and meta-analyses are carried out, despite multiple experts opining [if what they say is based on good evidence, it is misleading to call it ‘opinion’] that, to borrow scientific language, ‘it’s all a bunch of fluff’, and despite arousing the ire of the entire medical establishment en masse, homeopathy refuses to die [he obviously has not seen the statistics on homeopathy usage on the NHS]. It remains the treatment of choice for millions of patients, sales of homeopathic remedies appear to be increasing [do they really?] and thousands of practitioners are registered in the UK alone, not to mention the fact that it is available on our very own NHS [see my previous comment].
Prominent supporters include HRH the Prince of Wales, and the Honourable Member for South West Surrey, the Secretary of State for Health. Homeopathy stimulates great emotion on both sides. Supporters all have their stories of miracles, of chronic diseases cured or relieved when allopathic medicine failed [as you say, they are stories and not evidence], and are usually dismissed out of hand as though they were simpletons [no, they are corrected in that stories are no evidence], something that only drives patients further towards the homeopaths [that is what you think; here you could have used the term OPINION correctly].
Opponents can be especially nasty [really], as I discovered when I mistakenly suggested we keep an open mind on the subject, and was rewarded with sustained online abuse [and that’s your evidence for this very far reaching statement? All you demonstrate here is that you have an axe to grind, in my view]. The vitriol of the attack could not have been more appropriate had I suggested we start drowning little children (and kittens) at the bedside of cancer patients, whilst smearing honey on our faces and howling at the moon, instead of using chemotherapy [this overblown analogy loses you the last bit of credibility as an objective science journalist, I think]…
Given that homeopathy costs the NHS between £4 million and £12 million a year, the issue really has to be put to bed once and for all. I would suggest that prominent members of the British Homeopathic Society and relevant specialists in the medical/surgical fields call a truce, come together, and agree to settle the question definitively, to the satisfaction of all concerned [I can probably name more than 100 occasions where this has happened already and generated a negative result for homeopathy. The still largest research program in homeopathy was done by the Nazis in the 1930s. The entire homeopathic elite was involved and later made the results disappear].
How? Simply subject homeopathy to several, high-quality, randomised trials as this one, with the study design carried out by homeopaths, thus rendering the argument that the trial was biased against homeopathy from the beginning obsolete, and supervised by those with training and experience in the administration of clinical trials, thus rendering the argument that the trials were methodologically weak inapplicable. Funding for these trials will not be out of the public purse but can be provided in a transparent fashion by private donors, with the results being completely accessible in the public domain in the same way the full statin trial results aren’t [see my previous comment].
If positive results are obtained, well and good. If not, instead of arrogantly dismissing homeopathy [really? this is what you think of experts who have sound evidence from ~400 clinical trials and ~1000 pre-clinical papers which, in total, generate a negative result for the validity of homeopathy?] and by extension the millions of patients who have benefited from it, even as a placebo, medics can simply declare the debate over — and the real debate as to whether it should be accessible on the NHS can begin [this debate has long begun and, in the face of overwhelming evidence is about to end].
As I stated above, sometimes it is unhelpful when journalists tackle complex medical issues – particularly, if they are ill-informed.
Recently, I came across this website. I think it is worth having a good look because it is just too funny for words. Amongst other things, it offers 5 tips for finding a ‘wellness chiropractor’. I could not resist the temptation of reproducing these 5 tips here – and for good measure, I added some footnotes of my own; they appear in the otherwise unaltered text as numbers in square brackets referring to short comments at the bottom:
- Does the practice focus on vertebral subluxation  and wellness? Physical, biochemical, and psychological stress may result in spinal subluxations  that disrupt nerve function  and compromise your health . If you’re looking for a wellness chiropractor, it’s essential that this be the focus. Some chiropractors confine their practice to the mechanical treatment of back and neck pain, and this is something you need to be aware of beforehand.
- Does the doctor “walk the talk”? If he or she is overweight, looks unhealthy, or does not live a healthy lifestyle, this speaks volumes regarding their commitment to wellness .
- Do the two of you “click”? Do you like each other? Do you communicate well? Avoid a doctor  who seems rushed, talks down to you, or seems disinterested in listening to your concerns .
- Does the doctor use objective assessments of nerve function? Since your care is not based just on addressing pain, your chiropractor should be using some form of objective assessment of your nerve function, as spinal subluxations  can sometimes be asymptomatic . Non-invasive instruments that measure the electrical activity in your muscles, and/or a thermal scanner  that evaluates the function of your autonomic nervous system can be used, for example.
- What treatment techniques are used? Chiropractic techniques include low-force adjustments by hand, and more forceful adjustments using instruments . Ask which technique would be used on you , and if you have a preference, make sure the doctor  is willing to use it.
- ‘Spinal subluxation’, as used in chiro-lingo, is a non-entity that has no place in reality; it is merely a tool for making money.
- I am not aware of any evidence to suggest that this is true .
- As subluxations do not exist, it is safe to say that this is pure fantasy.
- The assumption seems to be that only a healthy chiro is a good chiro!?!?
- Chiros were just promoted to doctors – obviously much better for generating a health income.
- There are qualities that are required from everyone – your waiter, bus-conductor, butcher etc. – even from your chiro.
- Non-existent entities are always asymptomatic.
- Test with lousy reliability.
- Very misleading statement; manual ‘adjustments’ can also be forceful and are often more forceful than those using instruments.
- This statement makes it very clear that informed consent is not what patients can regularly count on with chiros. This leads me to suspect that chiros frequently breach one of the most important ethical rules in clinical practice.
Yes, I do think the chiro fraternity often is completely hilarious – unwittingly perhaps but surely hilarious [if we would not laugh at them, we would need to get angry with them which is to be avoided at all cost, as they tend to sue for libel]. Without the chiros regularly making themselves ridiculous, my life would certainly be far less droll.
Elsewhere on this intriguing post, the author informs us that where I think chiropractic shines is that we address the cause of the problem. Personally, I think, where chiropractic shines brightest is in amusing us with their continuous flow of humorous bovine excrement.
WE SHOULD BE THANKFUL!