Charlotte Leboeuf-Yde, DC,MPH,PhD, is professor in Clinical Biomechanics at the University of Southern Denmark and works at the French-European Institute of Chiropractic in Paris. She is a chiropractor with extensive research experience, for example, she was one of the first chiropractors to have studied adverse reactions of spinal manipulation.
Charlotte certainly knows a thing or two about adverse effects of spinal manipulation, and I have always found her work interesting. Therefore, I was delighted to find a recent blog post where she discussed the Cassidy study of 2008 and two opposed views on the validity of this much-discussed paper.
One team (Paulus &Thaler) argued, Charlotte explained, that the Cassidy case-control study is faulty, because vertebro-basilar stroke in general was not separated from stroke specifically caused by vertebral artery dissections, the presumed culprit in cervical spinal manipulation. According to Paulus & Thaler, this would potentially result in a dilution of ‘real’ manipulative-related strokes among all other causes of stroke that are much more common. They argue that the Cassidy-analyses therefore were polluted by this misclassification, whereas the other team (Murphy et al) vehemently disagrees.
The final word is clearly not yet pronounced on this issue, Charlotte concluded, and both teams agree that research has to address various methodological challenges to obtain a trustable answer. Nevertheless, without an international collaboration involving prospective cases this seems an almost impossible task, particularly in view of the rarity of the condition; problems in capturing all cases (going from the reversible to the permanent injuries); the likely large anatomical and physiological variations between individuals; and the daunting task of obtaining relevant and precise descriptions of treatments from a multitude of practitioners.
In the meantime, Charlotte concluded, “practitioners and patients have to make a decision, similarly to judging risk in other walks of life, such as, should I take the plane or stay at home?”
I have always thought highly of Charlotte’s work, however, her conclusion made me doubt whether my high opinion of her reasoning was justified.
Should I take the plane or stay at home?
This question is not remotely similar to the question “should I have chiropractic upper neck manipulation or not?”
Here are a the two main reasons why:
- Taking the plane of demonstrably effective in transporting you from A to B, while neck manipulation is not demonstrably effective for anything.
- If you want to go from A to B [assuming B is far way], you need to fly. If you have neck pain or other symptoms, you can employ plenty of therapies other than neck manipulations.
Charlotte Leboeuf-Yde, DC,MPH,PhD, may be a professor in Clinical Biomechanics etc., etc., however, logical and critical thinking do not seem to be her forte.
So, how should we deal with the risks of chiropractic neck manipulations? I think, we should deal with them as responsible healthcare professionals deal with any other suspected therapeutic risks: we must ask whether the known risks of the treatment outweigh the known benefits (as they do with spinal manipulation). If that is so, we have an ethical, legal and moral duty not to employ the therapy in question in routine care. At the same time, we must focus or research efforts on producing full clarity about the open questions. It’s called the precautionary principle!
I agree with Dr. Leboeuf-Yde’s thoughts and her conclusions. Apparently, so does organized chiropractic in the USA as disclosure-of-risk forms have been suggested for use by DC’s regarding their patients.
The “precautionary principle” should be followed relative to upper cervical SMT until there is full clarity regarding the treatment, says Edzard. Should “modern medicine” employ the principle to “bungling amateur” bariatric surgeons (quoted from recent post by Geir) to protect the public health? Should it also apply to off-label prescribing?
There is no convicing evidence to date that SMT poses a significant health risk. Should such evidence ultimately evince a significantly deleterious outcome probability, the profession would cease the use of the particular upper-cervical technique found to have been problematic.
“I agree with Dr. Leboeuf-Yde’s thoughts and her conclusions.”
THAT’S BECAUSE YOUR ABILITY TO THINK CRITICALLY ABOUT CHIRO IS CLOSE TO ZERO.
“…disclosure-of-risk forms have been suggested…”
WHY ONLY SUGGESTED?
Yes, the precautionary principle must be applied to all healthcare!
“There is no convicing evidence to date that SMT poses a significant health risk.”
“Why only suggested?” you wrote. Unlike collectivist countries, individual responsibility is still encouraged in the US. If a doctor turns a blind eye to patient disclosure of health risks, he does so at his own financial peril. Lawsuits for amlpractice are all-to-common in the US.
You predictably stated that my critical thinking about chiro is close to zero. You are wrong, as usual. It seems that anyone who shares a different opinion from yours is a dimwit, according to you. As an anti-chiro zealot, your incessant sensationalizing of allegedly significant risks via CAM diminishes your opinion on everything, at least to the open-minded folks who participate in your forum. BTW, if the precautionary principle should apply to all of healthcare, I would expect that you would characterize off-label prescribing as quackery since most applications of it are not supported by hearty RCT’s, only by the flimsiest of “evidence.” Please advise.
” …individual responsibility is still encouraged in the US..”
yes, if you say so – but why was it not ‘suggested years ago and implemented soon after?
I UNDERSTAND THAT YOU HAVE TO CALL ME THIS; it demonstrates perfectly that your ability of critical thinking about chiro is close to zero.
If the precautionary principle should apply to all of healthcare, I would expect that you would characterize off-label prescribing as quackery since most applications of it are not supported by hearty RCT’s, only by the flimsiest of “evidence.” Please advise, Edzard.
I know you are slow on the uptake – let me repeat therefore: my expertise is in alt med.
Off-label prescribing can be evidence-based. Once a medication is registered for a particular use, the manufacturer might not to go through the process and cost of registering it again for another indication, even if there is evidence of efficacy and safety for that indication.
It’s best not to make assertions in an area you are unfamiliar with.
@Logos-Bios on Thursday 20 April 2017 at 17:20
“Unlike collectivist countries, individual responsibility is still encouraged in the US.”
Unlike the US, many other countries have easily managed to incorporate social responsibility along with individual responsibility. They are not mutually exclusive, despite your apparent belief to the contrary.
“If a doctor turns a blind eye to patient disclosure of health risks, he does so at his own financial peril. Lawsuits for amlpractice are all-to-common in the US.”
In many other countries, doctors are concerned about risks because they care about patient wellbeing, not the dollar signs the person represents when you walk in the door. They have compassion, here is a link to help you understand what most other humans feel; https://en.wikipedia.org/wiki/Compassion.
Why do you think Björn Geir, a busy and respected surgeon, contributes to this blog? He isn’t doing for the money, but because he cares for his and other patients, and does not want anyone subjected to dodgy treatments for which there is no or little evidence but risk.
“You predictably stated that my critical thinking about chiro is close to zero.”
I know it is a statement of the obvious but someone had to say it. While you know the term cognitive dissonance, because you have it so strongly, you do not appreciate that you embody it.
“You are wrong, as usual.”
No, that is yet another example of cognitive dissonance.
“It seems that anyone who shares a different opinion from yours is a dimwit, according to you.”
I cannot recall the prof doing as you claim. He has, however, been “guilty” of calling a dimwit a dimwit.
“As an anti-chiro zealot,”
The prof is not “anti-chiro”, but he is zealously anti-“anti-science” which I regard as a badge of honour, to stand for reason and logic when fools still believe in fairies and magic (you, on both).
“your incessant sensationalizing of allegedly significant risks via CAM diminishes your opinion on everything,”
“sensationalizing” the risks of practices when there is not evidence for its benefits is not what a rational person regards as a slur. Congratulations and thank you once again prof for your tireless efforts.
“at least to the open-minded folks who participate in your forum.”
You and all of the other non-meds are far from “open-minded”, given your refusal to accept evidence contrary to your own beliefs.
“BTW, if the precautionary principle should apply to all of healthcare, I would expect that you would characterize off-label prescribing as quackery since most applications of it are not supported by hearty RCT’s, only by the flimsiest of “evidence.”
This has been dealt with before, except for those with cognitive dissonance. Again, why do you, seemingly, readily accept such RCTs but ignore all associated with your back faffing?
Fancy you using the wrong punctuation?
No wonder you are such an embarrassment to your wife and daughter; people of science having to tolerate the rantings of a egotistical loon must be insufferable.
“we must ask whether the known risks of the treatment outweigh the known benefits (as they do with spinal manipulation).”
Good question and how does the risk benefit and cost benefit compare to other interventions?
Recent paper by Cassidy, Cote, Haldeman et al.
Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study.
This recent paper by Neurosurgeons does have a title guaranteed to stir the pot. If chiro’s had said the same imagine the outcry.
Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation
What also has to be taken into account is the view of the critics that chiropractic is a single intervention which is far from how the majority of chiropractors practice.
Having said that do I routinely adjust the upper cervical spine? NO. There has to be a valid clinical reason and mythical subluxations is not one of them. Chiropractors who routinely adjust the upper cervical spine like with “Blair” technique are referred to as “hole-in-one” chiro’s and that is definitely not a complement in chiropractic circles.
Here are the two papers Charlotte refers to for those interested.
isn’t it a bit daft to cite Cassidy in a post that casts doubt about Cassidy?
besides I wrote “we should deal with them as responsible healthcare professionals deal with any other suspected therapeutic risks”
would you say that there is not even a suspicion of risk?
The referenced SR also weighs in on the side of the balance against Cassidy.
Contra Cassidy it found an association between chiropractic and artery dissection.
My bad. Cassidy did find an such an association.
“Chiropractors who routinely adjust the upper cervical spine like with “Blair” technique are referred to as “hole-in-one” chiro’s and that is definitely not a complement in chiropractic circles.”
Leaving aside the issue that people engaged in complementary medicine typically can’t differentiate ‘complement’ and ‘compliment’, this statement confirms my insistence that, by analogy with the ‘no true Scotsman’ fallacy, there is no true chiropractor.
This paper is specifically about Carotid stroke, not Vertebral artery dissections so it is not applicable in a debate about the risks of VAD from HVLA neck-wringing.
Did you read the paper? It says the research scrutinised is of very low quality and they cannot confirm a causal relationship. Move on folks, nothing new to see here!
Do you have evidence for the claim that “the majority” of chiropractors do not stretch the vertebral arteries as part of their theatrical act? Mine did, insisting it was good for me even if I have never felt any problem up there. Preventing problems he claimed.
Here is an interesting article in the context of the paper by a group of neurosurgeons CC referred to. The last author of the paper , Dr. Harbaugh is quoted there. He is rightfully careful to make a judgement and infers from the lack of evidence of causality that cases of young VAD sufferers presenting after neck manipulation most likely had a preexisting intimal lesion or ongoing dissection.
I am inclined to believe he is mistaken. It is likely that for a dissection to occur post manipulation or other trauma, there needs to be a predisposing factor i.e. intimal weakening, whether acquired or hereditary. But that does not change anything in this respect because such predisposition can not be detected and avoided, least of all does this fact justify unnecessary willful manipulation that may exert a trauma to the vertebral arteries. On the contrary it should preclude it altogether.
Whether symptoms that lead someone to consult a chiropractor or other neck wringers stem from an ongoing dissection or not is irrelevant. There are certainly thousands more who get their neck wrung for non-VAD symptoms but have a predisposition for dissection. If the manipulation manages to stretch the VA, the risk is severely aggravated. It may not lead to full dissection in all cases but the risk is unacceptable any which way.
In my mind there is no excuse ever to manipulate someone’s neck in such a way that the VA’s might be stretched.
There is no, or at least not more than infinitesimal benefit from such neck wringing so the risk/benefit ratio is somewhere out in space approaching infinity. The minute possible benefit of neck wringing does not warrant any risk and musculoskeletal or neurological cervical symptoms can be better and more safely managed by other means.
The theory Harbaugh adheres to, that most if not all cases of manipulation-associated VAD’s have a preexisting dissection, is purely speculative. The quality of evidence is low overall and the incidence of the problem is so scarce that studies inevitably lack power to detect a causative effect.
Even if Harbaugh is right, there are still the cases where an intimal weakening or beginning dissection has not started to give symptoms. There are cases of chiropractic associated VAD where no cervical symptoms have been established. Of course it is almost always difficult to reconstruct exactly the pre-morbid situation.
It is likely that cases of spontaneous or non-manipulation-associated dissection do not all progress to full dissection and stroke-causing blockage or embolism. There is overwhelming likelihood that some cases heal again without sequelae… if left alone and not manipulated to death.
Never let anyone manipulate your neck. It is not worth the terrifying, albeit very small risk
“isn’t it a bit daft to cite Cassidy in a post that casts doubt about Cassidy?
besides I wrote “we should deal with them as responsible healthcare professionals deal with any other suspected therapeutic risks”
would you say that there is not even a suspicion of risk?”
Due to the extremely rare incidence Canada with its nationalized health is ideally positioned to do these studies mining their databases. The more recent Cassidy paper looks at the relative risk and the conclusion is applicable.
“The final word is clearly not yet pronounced on this issue”
I agree with Charlotte Leboeuf-Yde on this. Until conclusively proven otherwise there is a suspicion of risk and it is part of my written informed consent. Additionally, I have over the years there have been many times I have refused to manipulate of mobilize or adjust a patients neck due to red flags in the history. I explain why and the patient is appreciative. I also verbally go through the consent 4 -5 times prior to treating the neck on every patient, during the examination, written consent and just prior to treating. I also repeat it on regular reviews and on discharge.
“In my mind there is no excuse ever to manipulate someone’s neck in such a way that the VA’s might be stretched.”
Agreed and I am diligent to not rotate the spine. Everything is P to A and I employ “other means” as standard in a multi-modal approach.
“Do you have evidence for the claim that “the majority” of chiropractors do not stretch the vertebral arteries”
For research into this topic see Walter Herzog:
Quibbling over spelling yet again.
“Of course it is almost always difficult to reconstruct exactly the pre-morbid situation.”
” there is a suspicion of risk and it is part of my written informed consent.”
THIS IS NOT ABOUT YOU; IT’S ABOUT THE CHIRO PROFESSIONS WORLDWIDE
AND THE WAY I PRACTICE IS THE SAME AS THE MAJORITY OF THE PROFESSION WORLDWIDE.
(First time I have ever shouted back with upper case online. That was fun.)
There are many active chiropractic reformers and researchers worldwide and its about time you balanced your criticism with support. Pointing out the BS is necessary as is pointing out reform/reformers/researchers etc who are providing the solution.
It is about me as I am a chiropractor and the BS merchants are MY problem as well and the solution must come from within the profession.
“Charlotte certainly knows a thing or two about adverse effects of spinal manipulation, and I have always found her work interesting.”
So why have you not supported her work over the years? I have cited her many times on this blog and it has been met with silence. Dr Leboeuf-Yde as well as her fellow researchers in Denmark are the solution. Have a look at her ResearchGate profile:
@Critical_Chiro on Monday 24 April 2017 at 07:45
“AND THE WAY I PRACTICE IS THE SAME AS THE MAJORITY OF THE PROFESSION WORLDWIDE.”
How would you know?
@Critical_Chiro on Friday 21 April 2017 at 07:26
Still posting the usual crap I see.
Suggestions; learn to read, as in process the text, not in light of your total emotional and financial investment; learn to spell, hard I know, and; get some treatment for your cognitive dissonance. You and that bonehead, L-B, are sides of the same coin. You have a pretense of rationality, something he lacks entirely, but the thin veneer is transparent.
Still posting the usual carpet bombing I see.
You are as deeply entrenched and resistant to change as the worst Subbie and both of you are a problem when it comes to reform.
“Of course it is almost always difficult to reconstruct exactly the pre-morbid situation.”
I hear that research is well underway in the development of an adverse event reporting form to collect all the relevant information accurately. The researcher is on my watch list.
“I hear that research is well underway in the development of an adverse event reporting form to collect all the relevant information accurately. ”
EVEN IF TRUE, THIS TOO LATE AND FAR TOO SLOW
We tried pushing for it a couple of years ago here and it fizzled due to resistance from the doctors in the hospitals.
It is NEVER TOO LATE and it may prompt the physio’s/GP’s etc to follow suit and adopt it. Why confine it to just chiro’s.
@Critical_Chiro on Monday 24 April 2017 at 04:09
Still posting the usual carpet bombing I see.
You are as deeply entrenched and resistant to change as the worst Subbie and both of you are a problem when it comes to reform.”
While you are engaged in a totally useless pastime, discredited around the world, started by a conman and thief, rooted in the mystical, without any evidence, and which appropriates (that is, steals) from legitimate professions in order to try to legitimise itself.
By-the-way, would you please learn s little about logical fallacies so you may appear less of a moron?
If other causes of sudden force to the cervical spine can cause vertebral artery dissection, why wouldn’t neck manipulation?
When can one be assured that the risk is minimised?
There is no need to specify “chiropractic” manipulation – no provider should manipulate the neck with sudden movement or sheering forces.
Don’t overlook that chiropractic works as do all CAMs – by type I effects of patients being in a constructive therapeutic relationship with an empathic practitioner (TLC, placebo effects, ego massage – often mutual and cumulative) – and, conceivably, type II effects of the actual therapy – the pillule, pricking, preturnatural power, pushing, pumelling, what have you.
It seems some chiros find their abilities to engender helpful type I effects, to care, are enhanced by putting their hands on and manipulating the spine. And the only part of the spine amenable to significant manipulation is the cervical.
I know, I’ve had to use considerable force and bone levers when operating – even on the cervical spine.
DD Palmer gave up his ‘magnetic’ techniques when he found, to his satisfaction, he got better results by hands on techniques.
My point is, that if chiros gave up on manipulation, they would have nothing to sell but counselling.
Commercially – a disadvantage.
Likewise, any who use a palmed ‘clicker’ to create the illusion something has ‘been done’ when manipulating will be chary about being found out and having to desist.
That’s the nature of chiropractic, why it is not part of ‘medicine’ and why it is so hard to carry out meaningful research. Indeed, Palmer intended chiropractic was ‘different from medicine’.
Patients must give fully informed consent to any treatment.
My point, Richard, is that you ignore what differentiates a DC from a PT: DC’s are trained to evaluate and diagnose the whole patient as a portal-of-entry provider. Mainstream DC’s perform the same basic services in their offices as PT’s for NMS disorders but they also have the responsibility to diagnose conditions which require referral or those that might require treatment in their own offices which might not require manipulation. Your implicit characterization of a DC’s skills as being limited to only the technical component(SMT), which you like to criticize, is not representative of reality. A PM&R is not simply a trigger-point injection peddler; he is also a diagnostician.
@Logos-Bios on Friday 21 April 2017 at 23:36
What you don’t seem to understand is that chiros are wholly unnecessary in the the medical process. If someone needs a diagnosis, they can see a doctor who can, not only, diagnose, but treat and/or refer. Chiros are only a speed-hump in the way of proper diagnoses and treatment, and are not qualified for either.
Just think of all the billions who do not ever seek chiropractic manipulation. How do they get by without regular adjustments?? How did they survive after birth without being adjusted?
My back was starting to act up the other day. I did not go to the chiropractor but I was already better the day after. Does that then mean that if I have a lumbago, I should avoid chiropractors?
If the tenets of chiropractic were true, the genus Homo would probably have died out with ‘Homo erectus’
(Due to the terrible onslaught of subluxations as a result of developing an upright posture with a spine developed for horisontal position and a four legged gait)
Chiropractic was invented by DD Palmer as a more lucrative con than waving magnets.
Are you aware of the depth of MSK diagnosis and differential diagnosis taught to chiropractors in the Universities?
Here it is a core subject and is taught to a high standard. Differential diagnosis and when to refer to a doctor is also taught by doctors.
“If the tenets of chiropractic were true, the genus Homo would probably have died out with ‘Homo erectus’” and “How did they survive after birth without being adjusted?”
Love it. When debating the subbies over the years I have used similar words many times.
I also like to equate subluxation to “original sin”. Scare parents and the congregation to come back to their church every week and place a donation on the plate while having subluxation religious beliefs shoved down their throats from the pulpit.
Nice to know we agree on something Björn.
“What you don’t seem to understand is that chiros are wholly unnecessary in the the medical process. If someone needs a diagnosis, they can see a doctor who can, not only, diagnose, but treat and/or refer. Chiros are only a speed-hump in the way of proper diagnoses and treatment, and are not qualified for either.”
So you think the average GP is up to speed when it comes to MSK conditions?
Chronic pain management in medical education: a disastrous omission
Adequacy of education in musculoskeletal medicine.
The inadequacy of musculoskeletal knowledge after foundation training in the United Kingdom.
The inadequacy of musculoskeletal knowledge in graduating medical students in the United Kingdom.
When it comes to chronic back pain medicine has stuffed up.
I am still baffled why you continue to call yourself “Chiropractor”. 😉
@Critical_Chiro on Monday 24 April 2017 at 04:01
“So you think the average GP is up to speed when it comes to MSK conditions?”
I don’t know, however, that is why there are medical specialties and physiotherapists. That does not provide any justification for chiros, less in fact because it elongates the diagnostic process for no patient benefit.
@Björn Geir on Monday 24 April 2017 at 12:35
“I am still baffled why you continue to call yourself “Chiropractor”. ?”
Money and stupidity. It is impossible to claim any moral high ground when no morality is displayed.
Love you too Björn. 😉
GP’s are the first line Tx so applicable when comparing to chiro and physio for that matter.
GP’s dislike seeing chronic backs in their practice and feel that they lack sufficient knowledge to treat. There was a large survey done in the US years ago that asked these questions and this was the response. Will have to dig it up for you.
As for you second response. Up yours! 😉
@Critical_Chiro on Wednesday 26 April 2017 at 08:16
Just because doctors may not like treating low back pain does not mean or infer Chiros provide anything useful, apart from dealing with, predominantly, whingers who want a quick fix when nothing will work that way.
All you do is provide a time buffer to allow for regression to the mean or the progression of a self-limiting condition. You are, in effect, a human homeopathic sugar pill; doing nothing but allowing nature to take its course. You a pill, who would have thought? It is a pity you aren’t smart enough to realise this.
We have long detailed conversations on chiro forums and at seminars in regards to these topics like regression to the mean, etc.
Any treatment be it chiro, osteo, physio or medical if it creates a toxic dependency in the patient AND practitioner then it is unacceptable. The goal of all my care it to help patients become resilient, self reliant and independent. Then I discharge them. I focus on chronic pain and spend a large amount of time de-medicalizing and de-catastrophizing patients. Ones that come in referred by a doctor with a thick wad of CT’s, MRI’s and imaging going back years who have been through the medical mill.
You hear the word chiropractor and think we are all con artists and subscribe to the high church of subluxation. You resistance to accepting chiropractic reform and change just shows your deeply held your beliefs are and how much time you have invested in them.
Medicine has stuffed up when it comes to chronic back pain. Chiro’s and physio’s who follow the evidence and provide best practice are the solution and should be the first line care. I happily work with physio’s, OT’s, psychologists, pain medicine doctors, neurosurgeons and orthopods and they make up 80% of my patient referrals. The majority of chiro’s I know work in a similar way.
“How would you know?”
I read the research. You should try it some time instead of nurturing your cherished beliefs. Just make sure you read the whole paper and not base your views just on the abstract.
@Critical_Chiro on Thursday 27 April 2017 at 05:59
I’ll wait for a response that makes sense and reads as if written by more than a 14 year old. One that doesn’t comprise rationalisations, non sequiturs, logical fallacies, self-justification, and an irrational belief that chiro has any substance apart from it has stolen from medical-based professions, such as physiotherapy. I won’t hold my breath though.
@Frank Collins on Friday 28 April 2017 at 01:10
I have cited research, researchers, best evidence, best practice, practice guidelines etc over the years on this site yet you seem to be blind to the evidence and hold on to you beliefs. Instead you attack the individual. What is that called? You truly are set in you ways and fond of making sweeping statements and generalizations when it comes to the chiropractic profession.
As for “apart from it has stolen from medical-based professions, such as physiotherapy.”
Forgive me for laughing.
You really should start reading the literature.
Are you aware of the largest post-grad course for physio’s in North America? Its Called “Osteopractors”. Do a google search. Also check physio forums and see what they think of James Dunning and this course.
I follow research and evidence and the way I practice is constantly changing. I admire and follow physio researchers like Chris Maher (ranked #3 pain researcher in the world last year), Gwen Jull, Paul Hodges, Mary O Keefe, Lorimer Mosely and Chiro researchers like Jan Hartvigsen (Ranked #1 MSK researcher in the world this year), C Leboeuf-Yde, Grek Kawchuk, Kim Humphries, Joel Pikar, Martin Descarreaux and Andre Brussieres to name a few. Ultimately if chiro’s and physio’s follow the evidence we should be heading down the same path. The resistance to change and reform from dinosaurs in both professions is an issue. Dinosaur critics like yourself who fail to acknowledge reform are also an issue.
You really should start following the evidence and read the research.
On Monday 24 April 2017 at 07:45 Critical_Chiro shouted: “THE WAY I PRACTICE IS THE SAME AS THE MAJORITY OF THE PROFESSION WORLDWIDE.”
Then it follows that you must practice unethically unless you have better data than those provided here:
Critical_Chiro wrote: “the BS merchants are MY problem as well and the solution must come from within the profession”
What is the solution? Why have the regulators been asleep at the wheel for decades?
“Chiropractic is the correct term for the collection of deceptions DD Palmer invented.”
Björn Geir Leifsson, MD
“Then it follows that you must practice unethically unless you have better data than those provided here”
You know how I practice Blue. Nice try. 😉
I have repeatedly cited research from Australia, US, Europe and Canada on this Blue and it consistently shows the BS merchants to make up 15-18% of the profession.
The solution is the BS merchants being forced to reform or being excised.
The regulators are not asleep at the wheel. They are frustratingly slow to act across all professions. Just look at how glacially slow they are at disciplining shonky surgeons. One took 10 years here with him threatening hospital staff, the college etc. He retired before they got him. Surgeons in his specialty were aware of the issues with him, pity the patients were not aware.
The regulators within chiropractic in Australia drew a line in the sand last year and they then had to wait for a moron to cross it. On did recently and he was just prosecuted. Complaints about him were submitted by chiropractors.
How many do the neck-wringers need to destroy before health care authorities wake up?
Assuming the dissection was caused before the visit to the Chiropractor, neck manipulation was the last thing the patient needed. Assuming the manipulation caused the dissection, manipulation was the last thing the patient needed.
Why are chiropractors allowed to do it?
Leboeuf-Yde lacks a firm moral backbone.
That’s it, exactly. If the person presents with pain due to an evolving dissection, the last thing they need is neck manipulation. If the manipulation causes the injury, the last thing they need is neck manipulation. In short, the last thing anyone needs is neck manipulation.
Not everyone seems to agree with you…
“To date, many scientific studies support cervical manipulation for the treatment of head and neck pain of mechanical origin, or for problems that originate in spinal joints, discs, vertebrae, or soft tissues. For instance, a 2007 systematic review of 88 randomized controlled trials in the Journal of Rheumatology3 concluded that exercise combined with manipulation or mobilization demonstrated both pain relief and functional improvement in adults with acute, subacute, or chronic mechanical neck disorders. A study in the medical journal Spine5 concluded that manipulative therapy and exercise can reduce the symptoms of headaches of cervical origin and that the effects are long lasting.”
the current Cochrane review that I have cited often enough arrived at a similar conclusion.
NOW SHOW ME EVIDENCE THAT CHIRO MANIPULATION ALONE IS EFFECTIVE.
EE: NOW SHOW ME EVIDENCE THAT CHIRO MANIPULATION ALONE IS EFFECTIVE.
why? The vast majority of the chiropractic profession does not do spinal manipulation as an alone approach.
the vast majority of surgeons also prescribe drugs; we nevertheless need to know whether their surgery works
Most chiropractors use a multimodal approach.
A few well designed pragmatic studies will inform if or when spinal manipulation may have an additive benefit.
Current evidence suggests spinal manipulation plus exercise may be better than either one alone. An approach many chiropractors utlilize.
Other modalities commoning used havent really been studied for any additive effects.
Even as a sole modality spinal manipulation appears to be as good, or as bad, as other common approaches.
“Even as a sole modality spinal manipulation appears to be as good, or as bad, as other common approaches.”
I’d agree with ‘AS BAD’
BUT MANY OTHER APPROACHES ARE SAFER, AND CHEAPER.
don’t you think?
The correct question is (1) can we do away with neck manipulation? As prof. Ernst points out (along with the majority of us) we need to know if it works, i.e. whether it has an independent efficacy. We also need to know (2) whether it is safe enough to use.
The answers are,when everytihing is taken into account:
(1) Yes we can do away with it because there is no reliable evidence it has a reliable, reproducible and clinically significant efficacy, if any at all.
(2) No it is not safe enough. There has been no pre-marketing research nor is there any post-marketing surveillance. But there are hundreds if not thousands of case reports for many decades of very serious harm directly related to its use and with an obvious mechanism of injury. It is known there are even more cases of arterial damage that are subclinical or give mild symptoms and recover without sequele. The true incidence of any grade of injury is thought to be as high as 1/100.000 manipulations. Drugs have been discontinued for lesser reasons.
If neck manipulation was a drug, it would be long since taken off the market for compelling reasons: a) There are grave concerns about its safety. b) It has very doubtful efficacy. c) There are as good or even better and more reliable therapies available. d) There are no reliable pre-manipulation tests to rule out those at risk. e) The only known risk alleviating measure is to not manipulate. Even HVLA (=chiro-style) manipulation well within the normal range of motion may put untoward strain on the arteries of the neck (research results kindly provided by DC).
The ‘good or as bad’ actually came from you from an interview you did last year. But i dont recall if it was spinal manipulation in general or cervical spinal manipulation. I really dont want to listen to the interview again to find out.
Björn: “If neck manipulation was a drug, it would be long since taken off the market for compelling reasons…”
116.5 million case acute low back and neck pain in USA (1)
NSAID are a common Rx for low back back (2)
900 OTC and Rx drugs contain NSAID (3)
111 million Rx of NSAID per year (1)
30 billion doses NSAID per year is USA (4)
$4.8 billion cost of NSAID per year in USA (1)
71% of those exposed to NSAID for >90 days had visible injury to their small intestine (5)
46 people die per DAY from complications of chronic NSAID use (1)
have you heard of risk/benefit balance?
EE have you heard of risk/benefit balance?
Of course. I have also heard of this…
“Inflammation is a protective response driven in a tissue compartment by a specific set of immune and inflammatory cells with the aim of restoring its structural and functional integrity after exposure to an adverse stimulus.”
J Orthop Translat. 2017 Jul; 10: 52–67
Of course, then we have papers like this to consider for those particular conditions if one wishes to discuss risk vs benefit.
There is little evidence for the specific efficacy beyond sham for invasive procedures in chronic pain. A moderate amount of evidence does not support the use of invasive procedures as compared with sham procedures for patients with chronic back or knee pain. Given their high cost and safety concerns, more rigorous studies are required before invasive procedures are routinely used for patients with chronic pain.
you found a paper by Wayne Jonas!
that’s great, he is totally unbiased and financed by Samueli
and also well done for demonstrating that you do not understand risk/benefit analyses
Yah, the medical approach is doing such a great job for nonspecific spinal issues.
Risk/benefit…read the Lancet series again.
LOL. Your little blog on your addition to the Lancet paper is your evidence?
my little blog also has this:
Yes, a blog where you didn’t address my question.
“It’s best not to make assertions in an area you are unfamiliar with.”
DC wrote: “It’s best not to make assertions in an area you are unfamiliar with.”
Is that aimed at Prof Ernst? If so, I think that you should read his bio at the top of the page:
“I qualified as a physician in Germany in 1978 where I also completed my MD and PhD theses. I received hands-on training in…spinal manipulation. In 1988, I became Professor in Physical Medicine and Rehabilitation (PMR) at Hannover Medical School and in 1990 Head of the PMR Department at the University of Vienna.”
Nah, you must have misunderstood: that was a rare moment of self-criticism
BW Is that aimed at Prof Ernst?
no, sue made that comment somewhere else, it seemed like a fitting reply to her comment.
@D(umb) C(infused): best not re-listen to an erudite, fact based discussion, it could adversely affect your ability to connive the next lame-brain that thinks your “chiropractic-therapy” may really help. The same way Scientology, homeopathy, acupuncture, kinesiotape, energy-balancing, and foot-levelers “help”.
It was, is and will always be just about the money. Not that there’s anything wrong with that. Better to be a fraud and scammer than on the dole I say.
So these recommendations are not evidence based? Or are they OK because they come from PTs (even though many chiropractors do this stuff too?).
@DC on Thursday 13 December 2018 at 19:50
“So these recommendations are not evidence based? Or are they OK because they come from PTs (even though many chiropractors do this stuff too?).”
This raises a few questions, all of which put chiro and you in a bad light. Many of the readers of this blog have seen this before, the old sleight of hand trick and the copycat.
Why do chiros feel the need to steal treatments from physiotherapy if the claimed efficacy of chiro is so high? Chiros stealing from physios seems to have gained momentum in the last few years, with chiros now claiming to be evidence-based (premised on this stealing).
Why can’t chiros do their own research. Gawd knows, there are enough of those shonky colleges handing out bits of toilet paper with the words ‘Doctor of Chiropractic’ printed on them. The answer is, and noted by the prof many times, that chiros do not know how to do research properly, how to set up a plausible mechanism to test for the subject under investigation, and have no idea about statistical analysis. They get carried away when they find a minor statistical glitch which (real) medicine would dismiss as just that.
Why do chiros also feel the need for the sleight of hand trick? Isn’t it bad enough that you steal from another profession, one aligned with (real) medicine and practised in hospitals, without then claiming you must be alright because you stole this from physios?
Palmer was a convicted crook, a conman, liar, fantasist and thief; he stole chiro from Still who invented that other shonky nonsense, osteopathy, dressed it up in a new suit and flogged it to gullible fools 123 years ago. Nothing has changed, except chiros are delusional enough to claim it has.
Here is some news for you; god’s energy (pick your favourite out of the 4,000 odd) does not flow down the spine to the rest of the body.
At this point, however, I must confess that chiro did ‘help’ me 34 years ago. I had mild sciatica which had caused me to limp for 10 months so my GP referred me to a new source for treatment, a chiro. I had not ever heard of such a thing but trusted the doctor. I suspect she didn’t know much about it as they were very rare in Australia then.
After several weeks of that farcical bed thing that makes a lot of noise, very theatrical but useless as a form of treatment, my spine at L5/S1 was so much more damaged that I was in the worst pain I have ever felt and was curled up in a foetal position for six weeks with searing, unrelenting agony from the buttocks to right little toe. I was then sent to a neurosurgeon who performed a laminectomy giving a total and utter relief since then.
So, I have to thank a chiro for damaging my back so much that it forced surgery from a REAL doctor, to whom I am ever grateful for a pain free existence.
It will come as no surprise for me to say I have nothing but contempt for the cult of chiropractic and its moronic followers.
You mentioned chiropractors stealing from PTs. The article I linked mentions some primary approaches…mobilization, manipulation and exercise. This were all used within the chiropractic profession before physical therapists were on the scene, at least in the USA (around 1920-30).
DD Palmer first mentioned the benefit of exercise in 1910. Of course mobilization and manipulation were early treatment approaches in the chiropractic profession.
Palmer, D. D. (1910). Text-book of the science, art, and philosophy of Chiropractic for students and practitioners. Portland, Oregon: Portland Printing House Company.
So, based upon the paper I linked to, I’m not sure what chiropractors have actually stolen from PTs.
“exercise … [was] … used within the chiropractic profession before physical therapists were on the scene, at least in the USA (around 1920-30)
1) I am not convinced that this is correct
2) who cares solely about the US?
This is just my experience, take it for what it is, or leave it, I don’t really care, most of the regulars on this site are very arrogant and I don’t want to spend anymore time in this circle **** of a forum. I have never had a patient in 20 years of practice suffer a stroke, and of the 200 or so chiropractors that I know personally, I do not know of one who has, maybe I’m just lucky right?? I however had two people (who had never been to a Chiropractor before), over the course of my career call up my office looking for help with a headache who subsequently suffered a stroke, but I never got the chance to meet them. They were scheduled to be seen two days after their initial telephone call as I was fully booked at the time. They had never been to a Chiropractor, as we ask that on the first call. Had I seen them, no doubt I would have been blamed for their unfortunate episodes. I also had a patient who I had sent to the emergency for what I thought was a possible Meningitis/viral episode after a trip camping, he had severe neck pain. I hadn’t treated him for several weeks and he never had such neck issues before. The ER in all their unbiased diagnostic supremacy sent him away telling him that I caused it, when I only examined him. He laughed at them, even while suffering severe pain. They sent him away. He came back to me a day later with a bulls eye rash and worsening headaches… lymes. I sent him back to the ER… No one profession has the monopoly on stupidity, and I’ve seen a fair share of it coming from the medical profession, but at least I can admit there are a whole lot of idiots in my profession, apparently nobody here is willing to say that about medicine (god-complex/arrogance?). Regarding Stroke, I am sure that EE has something to say about Cassidy et al’s study that is not very flattering (Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S176-83), but before he does (apparently only his “studies” are valid in his mighty opinion), you should know that in Ontario, from the 80’s up to the mid 2000’s, every time a patient in Ontario visited a medical doctor, chiropractor, hospital, dentist, etc…, that visit was recorded electronically and sent to OHIP. All chiropractors in Ontario were subsidized for care given up to a certain limit of coverage every year, but every visit was recorded and sent to OHIP whether there was reimbursement or not. That means there was a record of every chiropractic/hospital/MD visit over the course of the study period. In addition, not only was the date and time recorded, but the treatment code as well. As you are aware, the study included any stroke caused within 30 days of attending an MD or chiropractor, a very long time period. I won’t say it was a perfect study, but it cannot be said that the basic data set used was biased, or insufficient, as it used several years of data that was held by a governmental organisation that was derived from the reporting of all Ontario hospitals, medical and chiropractic offices. You could argue that maybe the reporting wasn’t quite accurate, but then you would be admitting incompetence in the medical reporting and diagnoses. Luckily there have been studies since to show that the reporting of stroke incidences in Ontario are quite accurate… so…. think what you will. I won’t be posting on this site or visiting it ever again and please don’t contact me via email. Good luck living your unhappy existences… I really don’t know how you all go on living your hate filled lives. You must all feel so empty inside at the end of the day, all alone after turning off your computers, I actually feel sorry for you in a way…
thanks for your sympathy
@DX (or DC) on Thursday 13 December 2018 at 23:35
Regular readers of the prof’s blog have seen this type of response before. It goes like this;
Chiro enters, from stage left with great theatrical flourish, claiming evidence-based chiro is real & cites studies,
(Real) doctors and the rational humans point out the (numerous) problems with the research, not the least of which is that it is nonsense conducted by untrained and unskilled researchers whose premise is to prove the hypothesis, evidence withstanding,
Rebuffed chiro falls back to more more nonsense studies and anecdotes,
Repeat step two and three above several times,
Chiro plays what they think is an ace by claiming chiros use practices from physiotherapy so that opens the gate to legitimisation (ha, got you there, we are ‘medical'(?) too),
Another detailed explanation of why that is nonsense too,
Chiro sulks, writes a slab of meaningless drivel with all of the logical fallacies, faux concern, reference to hate, one or two anecdotes to ‘prove’ they are medical professionals because of something positive they may have done, claims of KNOWING more chiros than is humanly possible (while still being unable to explain why so chiros cannot institute and fund even one research study), insults and uses several ad hominems, refers to hate again, claims all those who aren’t his now best friends (because they don’t think the sun shines out of his/her freckle) are lonely sad people only worthy of his/her sympathy (when, in fact, they are happy, well adjusted people, discerning in their friendships, enjoy life, enjoy humour and comedy, fascinated by the advancements in the human condition given by science, enjoy their close relationships, love their pets, have hobbies, and are critical thinkers), and vows never to return.
Outcome; loss for chiro’s victims who will continue to be fleeced by a charlatan. Sadly for them, that is evolution in practice.
Well DC (or DX), a sendoff for you, and it brings a smile to my face as much as it did 35 years ago when first heard, stick a broomstick up your arse and sweep the floor on the way out. Au revoir, hopefully forever, with your cultist notions.
Frank Collins what a strange account of a chiropractic session: my chiropractor says none of those things – no time while working the magic!! And a constant stream of clients waiting to be helped means being on a long waiting list for some . There is no pretence of being a doctor ( though has that title but not used),no white coat, but will refer to a GP if x rays or medical advice is required.
Interestingly, a local GP refers patients with back pain to a Chiro if they have one. Well, does save our NHS money.
Seriously I don’t go to my Chiro to discuss any of above, there are no theatrics, doesn’t talk anecdotes , doesn’t require to be told ‘ the sun shines out of…’ just to receive a good effective treatment which I am truly grateful is available.
Apologies if posting twice – technology!!!
Your chiropractor has no choice but to refer to a GP for x-rays as only GMC-registered doctors are allowed to request x-rays in the UK.
How does he know when medical advice is required? In my experience chiropractors are not usually aware of the limits of their own expertise, and indeed I have seen a number of patients who have continued to receive manipulation for what subsequently turned out to be spinal tumours.
Do really think misdiagnosis is just a chiropractic problem?
“All patients were transferred to 3–6 hospitals for extended periods due to misdiagnosis with conditions such as ankylosing spondylitis, chronic arthritis, lumbar disc disease, osteoporosis and somatoform disorder.”
“In only 12 percent of the cases was the diagnosis confirmed.
In 21 percent of the cases, the diagnosis was completely changed…”
Findings from Mayo clinic.
Journal of Evaluation in Clinical Practice.
DX wrote: “Regarding Stroke, I am sure that EE has something to say about Cassidy et al’s study that is not very flattering (Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S176-83)…I won’t say it was a perfect study…I won’t be posting on this site or visiting it ever again”
It’s unfortunate that DX won’t be back as he’s correct in saying that the Cassidy study wasn’t perfect. Here’s an analysis of some of Cassidy’s flawed reasoning (credit – Björn Geir Leifsson, MD, for the first two quotes below):
“Cassidy 2008 and other similar attempts at estimating away the risk of CAD after SMT has been reevaluated in later work and the mistakes analysed. Here is an excerpt from “Case Misclassification in Studies of Spinal Manipulation and Arterial Dissection” Xuemei Cai, MD, Ali Razmara, MD, PhD, Jessica K. Paulus, ScD, Karen Switkowski, MS, MPH, Pari J. Fariborz, Sergey D. Goryachev, MS, Leonard D’Avolio, MS, PhD, Edward Feldmann, MD, David E. Thaler, MD, PhD DOI: http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2014.03.007 :
‘The earlier studies omitted the dissection-specific codes (443.xx) in their case definition because they were not in use in Ontario at the time (personal communication, Navin Goocool, April 30, 2013). The population in our study did have these codes available, and therefore, to avoid an overestimation of case misclassification, we included the 3 additional dissection codes in our initial EMR query (‘‘modified Rothwell/Cassidy strategy’’).
Cassidy et al  suggested that the association between cases and PCP/SMT exposure was because of patients with pre-existing dissections seeking care for neck pain (reverse causation). However, if the ICD-9 code positive predictive value measured in the VA database is generalizable to the Ontario health system data, then the Cassidy study actually found an association between PCP visits and patients with conventional strokes due to atherosclerotic and cardioembolic mechanisms. This association is well known and has been described before. It is because of the frequent clinical visits needed to manage established vascular risk factors.10 Our sensitivity analysis suggests that the ORs for the association between SMT and CAD would be very large with accurately identified cases. Lastly, the misclassification may disproportionately affect ORs for those less than 45 years of age—a group of patients with a lower prevalence of atherosclerosis-related infarcts and a higher prevalence of strokes due to dissections.16 Given the small numbers of true cases, ORs within age strata could not be calculated, but our sensitivity analysis suggests the association between SMT and CAD in younger patients is markedly stronger after adjusting for case misclassification.’
And what do they mean by “large” ? Among the subgroup of the population less than 45 years of age and applying the above assumptions, those with a chiropractor visit within 30 days of their stroke would have nearly 7 times the odds of CAD (OR 5 6.91, 95% CI 2.59-13.74).That means that the risk is most likely about seven fold and there is 95% chance that the true odds ratio is about between 2,6 to 13.7. That is nothing less than horrendous if correct.”
“In a hearing before the Connecticut State Board of Chiropractic Examiners Cassidy admitted upon a direct question, that a patient of his suffered stroke after spinal manipulation. He was asked whether he considered the manipulation to have caused the stroke. His reply was to the effect that he did think so at first but after researching the matter he no longer did.
This fact does cast a different light on the whole matter and should be kept in mind when considering his choice of study subjects, designs and conclusions and when evaluating his results against other researcher’s findings. I certainly find it easier to understand some rather peculiar aspects of his study designs and deductive reasoning.
I would not blame any therapist or clinician who has faced such a terrible adverse outcome in someone who placed their trust in his hands, if they looked for and tried to find support for the notion that they or their vocation were not to blame.
David Cassidy has certainly pursued the question with ardour and an admirable academic arsenal, but has the incident, which must have been tormenting, affected his work and his deductive reasoning? I am inclined to suspect it did.”
I think it’s important to point out the David Cassidy’s integrity really is questionable. For example, he was sued for asking an employee to manipulate the stats in a paper to produce the results he wanted: http://www.chirosmart.net/nfaures.txt
“in or about September 1998, and contrary to all normal and appropriate practices and procedures in regards to independent medical research, she [Dr. Emma Bartfay] was instructed by Cassidy to produce certain statistical results that would support the end conclusion desired. Specifically . . . Cassidy instructed her to produce results and graphs that would support the conclusion that an injured person’s time (date) of settlement is a good proxy for the person’s time (date) of recovery” (Statement of Claim, In the Court of Queen’s Bench for Saskatchewan, Judicial Centre of Saskatoon, between Dr. Emma Bartfay, plaintiff, and The University of Saskatchewan and Dr. J. David Cassidy, Defendants. Filed May 21, 1999, Q.B. #1679 of 1999).”
The insurance company that paid for the study to be performed allegedly attempted to influence the study as well. “Yong-Hing alleged that SGI‚ the province’s only motor vehicle injury insurer, which funded the study‚ wanted its contributions to pay for certain study expenses in a way that “could well be interpreted as an attempt by SGI to disguise the destination of Saskatchewan residents’ money” (Letter from Dr. Ken Yong-Hing, Professor and Head of Orthopedic Surgery, University of Saskatchewan, to Colin Clackson, President, Saskatchewan Trial Lawyers Association (Nov. 3, 1996) (on file with author).”
I also think it’s important to record here how the Bartfay v. Cassidy case above proceeded:
“It was a great day for the advancement of individual rights in Saskatchewan when last Thursday, Justice Irving Goldenberg refused to drop Dr. David Cassidy from Dr. Emma Bartfay’s suit(1). Dr. Cassidy conducted a botched study of no fault insurance in Saskatchewan and Dr. Bartfay quit in the middle of the study saying that Cassidy tried to force her to fudge the data.
Under no fault insurance injured people cannot sue for pain and suffering. As a result of Justice Goldenberg’s decision, Dr. Cassidy will have to disclose his contracts with the Saskatchewan Government Insurance (SGI) and he will have to answer questions on the circumstances of Dr. Bartfay’s dismissal from the University of Saskatchewan.
Dr. Cassidy not only manipulated data to support the results SGI wanted, but he showed his copycat approach to researches by basing his results on the previous outdated Quebec study on no fault insurance and on the positive psychology that injured people recover their health faster if they focus on getting better rather than suing for pain and suffering. The Quebec study didn’t conduct any original research, as a matter of fact it was just a compendium of different researches; and the positive psychology movement has been disclaimed by recent researches(2), in fact “little data supports the idea that a positive attitude enhances health(3).”
In the light of Tort Reform laws which diminish the people’s right to sue for punitive damages(4), I find Justice Goldenberg’s decision a small but significant step towards the betterment of the justice system in supporting individual rights and eventually in reestablishing punitive damages in wrongful dismissals. Punitive damages are not compensatory damages, they are exemplary damages and they tell employers that their callous, malicious, and in Dr. Bartfay’s case socially unacceptable behaviors in dismissing employees are not going to be tolerated. And the importance of punitive damages is becoming more relevant today when our no fault authorities are the perpetrators of such despicable behaviors.”
“…on June 30, 2000, Dr. Barry McLennan, assistant dean of research in the college of medicine at the University of Saskatchewan, was writing in the StarPhoenix that a university committee “concluded there was absolutely no evidence of research misconduct.” Dr. McLennan also absolutely defended Dr. Cassidy’s study when employee Dr. Emma Bartfay, in filing a lawsuit against Dr. Cassidy and the University of Saskatchewan, was stating that she was told to produce statistical results that would prove that whiplash victims recovered faster under the province’s new no-fault system. Some weeks ago we learned that Dr. Bartfay agreed to drop her case against Dr. Cassidy and the University of Saskatchewan and that in return she was going to receive an undisclosed amount of money. This is the way public justice is brokered by the confidentiality of the private contract.
The Free Market is the new invented socio-economic model where social frauds are legally perpetrated. So we have the much talked no-fault insurance research conducted by Dr. David Cassidy and funded by the Saskatchewan Government Insurance (SGI). I expressed my feeling that this research was a fraud as soon as I read the research’s conclusion that “the elimination of compensation for pain and suffering is associated with a decreased incidence and improved prognosis of whiplash injury”.
I am not going to rebut the scientific methodology used by Dr. Cassidy in this no-fault study since we have reached today a level of social corruption which can be explained simply with our common sense rather than with the expertise of the Cassidys of this world.
We must understand that the Free Market has its own shock absorbers so as to make sure that its performance is always protected; and this is why the free marketeers see the world in its static and reductionist way of divide and conquer rather than in its evolving dynamics.
Yesterday we had the acknowledgment by the University of Saskatchewan that Cassidy’s study didn’t provide the injured participants with their informed consent. However, on June 30, 2000, Dr. Barry McLennan, assistant dean of research in the college of medicine at the University of Saskatchewan, was writing in the StarPhoenix that a university committee “concluded there was absolutely no evidence of research misconduct.” Dr. McLennan also absolutely defended Dr. Cassidy’s study when employee Dr. Emma Bartfay, in filing a lawsuit against Dr. Cassidy and the University of Saskatchewan, was stating that she was told to produce statistical results that would prove that whiplash victims recovered faster under the province’s new no-fault system. Some weeks ago we learned that Dr. Bartfay agreed to drop her case against Dr. Cassidy and the University of Saskatchewan and that in return she was going to receive an undisclosed amount of money. This is the way public justice is brokered by the confidentiality of the private contract.
Yesterday, we had StarPhoenix journalists who write “Whiplash study remains valid” and that SGI’s no-fault insurance keeps costs down. These StarPhoenix journalists along with the conventional insurance companies are all forgetting that Cassidy’s study is invalid as there is no way injured people recover faster when they cannot sue for pain and suffering. Also, these journalists and insurance companies are forgetting that insurance is a need to be satisfied rather than a cost to be lowered, and they forget that while the no-fault costs may be kept bureaucratically low so the satisfaction of the injured claimants is kept lower.”
“The study does not prove what it claims to prove. The exhibited bias and flawed methodology show that under a rigid no-fault scheme that mandates a single treatment regime within an artificial time frame, the duration of open insurance claims is shorter than under a traditional tort system.”
Also note that Cassidy has reported financial links with the Canadian Chiropractic Protection Association, the Ontario Chiropractic Association, the National Chiropractic Malpractice Insurance Company, and the (subluxation-based) International Chiropractic Association:
I don’t understand why the osteopathic manipulative practitioners who apply manual osteopathic treatment are not mentioned together with chiropractors.
They have the same training of high velocity low amplitude techniques for the spinal areas and they are applying such techniques with the same effort and frequency like the chiropractors do. The only difference is that they don’t call the problems “subluxation” but “osteopathic dysfunction” but the techniques applied are the same with the same risks. So to make an exception in monitoring incidents by spinal manipulations for osteopaths will put patients to a high risk because they might think that osteopaths are less dangerous to them than chiropractors.
But the critique should be based upon the procedures, not the profession.
However, the results of the critique may impact professions differently.