The literature on malpractice in medicine is huge: more than 33 000 articles listed in Medline. By contrast, the literature on malpractice in alternative medicine hardly exists. An exception is this recent article. I therefore thought I share it with you and provide a few comments:
START OF QUOTE
According to the (US) National Practitioner Data Bank, between September 1, 1990 and January 29, 2012, a total of 5,796 chiropractic medical malpractice reports were filed. Lawsuits with the highest payouts in any medical field are related to misdiagnosis, failure to diagnose and delayed diagnosis of a severe medical condition.
Common reasons for chiropractic malpractice lawsuits:
Chiropractor causes stroke: Numerous cases have been documented in which a patient suffers a stroke after getting his or her neck manipulated, or adjusted. Especially forceful rotation of the neck from side to side can overextend an artery that runs along the spine, which can result in a blockage of blood flow to the brain. Strokes are among the most serious medical conditions caused by chiropractic treatment, and can result in temporary or permanent paralysis, and even death.
Herniated disc following adjustment: Although many patients seek the medical attention of a chiropractor after they have experienced a herniated disc, chiropractors can actually be the cause of the problem. Usually a herniated disc is caused by wear and tear, but a sudden heavy strain, increased pressure to the lower back or twisting motions can cause a sudden herniated disc. The stress that chiropractors exercise in their adjustments have been known to be the root cause of some herniated discs.
Sexual misconduct: The American Chiropractic Association has assembled a code of ethics “based upon the acknowledgement that the social contract dictates the profession’s responsibilities to the patient, the public and the profession.” Sexual misconduct is among the top ten reasons that patients file lawsuits against chiropractors. Often, chiropractic practices are unfamiliar to many new patients and can be misinterpreted as inappropriate even though they are absolutely normal, so it is important that patients familiarize themselves with common chiropractic methods of healing.
END OF QUOTE
In this context, a study of chiropractic from Canada might be interesting. It highlights the conclusions from Canadian courts: informed consent is an ongoing process that cannot be entirely delegated to office personnel… A further study showed that valid consent procedures are either poorly understood or selectively implemented by chiropractors. Arguably, not obtaining informed consent amounts to malpractice.
In our book, this is what we conclude about informed consent by alternative therapists in general: Genuine informed consent is unattainable for most CAM modalities. This presents a serious and intractable ethical problem for CAM practitioners. Attempts to square this circle by watering down or redefining the criteria for informed consent are ethically indefensible. The concept of informed consent and its centrality in medical ethics therefore renders most CAM practice unacceptable. Conventional healthcare subscribes to the ethical principle ‘no consent, no treatment’: we are not aware of the existence of any good reasons to excuse CAM from this dictum.
I fear that, if we were to count the lack of informed consent by chiropractors (and other alternative practitioners) as malpractice, the numbers would be astronomical. Or, to put it differently, the often-cited relatively low malpractice rate in chiropractic is due to the omission of the vast majority of malpractice cases.
134 Responses to Malpractice of chiropractors – just the tip of an iceberg?
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I take issue with the heading, “Malpractice of chiropractors” in that it streams some of their activities; all ‘practice’ by chiropractors is ‘mal’.
Actually chiropractic has some evidence of helping with lower back pain. Granted it is on a level with massage and physical therapy but with a less favorable risk benefit ratio. It seem that any vigorous manipulation of the muscles will cause some relaxation for 3-4 hours. Still I doubt that informed consent would be adequate.
“some evidence” ????
almost anything has some evidence.
the question is whether the totality of the reliable evidence shows that it generates more good than harm –
AND I DOUBT IT!
You doubt it? Solid evidence.
Exactly!. The heading of this article is blatantly and obviously biased.
Medical practitioners mal practice Insurance is thousands of dollars more..furthermore, when you bring suit against them, they arm up with multiple defense attorneys.. Chiropractors have the same education as a medical internist. We do not dispense medication to treat the symptoms of disease ..we look to the origin. It is not within our scope of practice to diagnose disease. Most chiropractors that branch out into functional medicine and nutrition can likely see the underlying problems..by which we REFER back to their PCP.
I will say the amount of patient negligence, misdiagnosing and excessive drug administering Ive seen coming from the medical field amazes me..Yet they still reign supreme .. Most people are so ill or non informed about their own health and they look to the MDs to save them..yet when they get the wrong treatment or pills..they don’t scream lawsuit..they simply take another pill or treatment ..in hopes that it will work????!!
Bashing chiropractic used to anger me..now I just shake my head..especially at articles like this one.
“Medical practitioners mal practice Insurance is thousands of dollars more.”
because patients do not complain about non-informed consent?
Most of that evidence is on spinal manipulation. Chiropractic is a profession not a modality.
Informed-consent in an even cursory-ideal situation would entail the DC describing in rigorous detail the underwhelming benefits “chiropractic” (and ALL it’s farcical theatrics) has to offer including that its entire basis is built on religious, pre-scientific entrepreneurial shtick with no discernible positivist research in 120 validating it’s underlying premise.
Yeah, that’s a consultation we’d all like to hear. It would start and finish virtually every chiroquaker practice on day one.
@MK
“entire basis”??
“underlying premise”??
You and the vitalist chiropractors use similar arguments and are both resistant to change Michael.
Wow!
Except academic physical therapy has largely moved away from hands on crackycracky to straight evidence based interventions.
I’d even suggest that academic PT now is almost a behavioral discipline. In a good way.
“…to straight evidence based interventions” … such as?
CBT. Exercise. Administration of validated scales to determine catastrophising, self efficacy, self management etc before, during and after interventions.
That kind of thing. Now that is not to say all PTs do this yet, but this does seem to be a syrong trajectory within the discipline.
@Lipid
Excellent resource from Jonathan Field (Chiropractor) in the UK.
“Care Response” which generates and collects Patient Reported Outcome Measures (PROM) with automatic follow up PROM’s. Also compares your outcomes to all practitioners. I have been using it for years and 800+ chiro’s now use it.
You should set up a free account as it makes PROM’s and PREM’s easy to generate and collect.
https://support.care-response.com/
Chiropractic a medical field? Surely we grant credibility with letting such a claim go unchallenged?
Chiropractic patients? Really? At a push, I might one day concede they’re clients, but it’s more accurate to say customers – or victims?
@EE
Informed consent has been a common law requirement in Australia for ALL health care providers since 2000. It is checked every year by the regulators and the professional indemnity insurance providers.
See this 2004 article that I have cited here many times.
Risk Management for Chiropractors and Osteopaths. Informed consent
A Common Law Requirement.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2051308/
My Informed consent form is on its 6th edition and has been standard in my practice with every patient since 1995.
good for you Australians; sadly, it is not done elsewhere
That’s a foolish assumption as I was trained and provided appropriate forms and procedures in my schooling and private practice both in California and Utah. This forum is full of bias and false assumptions. I’m sorry for those of you who have negative opinions of a practice thats existed for decades born out of public demand and clinical results. The research body and organization of chiropractic has always been small as compared to allopathic medicine and yet it has a place and will continue to thrive.
IF YOU SAY SO.
That is also the case for recreational drug use, bullying and swindling, among many other things. Your point?
Critical Chiro, Thank you for your comment. I’m a chiropractor in Utah and am disappointed by the negativity of this forum. Would you mind sending me a copy or link of your most recent informed consent document? I’d like to update mine and check it against one like yours.
Thank you so much
Stop. Think about it. 5,796 claims filed. Over two decades of time and UNDER 6,000 claims across the ENTIRE United States. The average for ALL medical malpractice claims for the US is approximately 85,000 PER YEAR. Not all chiropractors are the same or have the same level of education and expertise. Don’t jump to conclusions.
why don’t you re-read the last paragraphs of my post?
I think you are all ignorant. You shouldnt speak of things you know nothing about. I have treated tens of thousands of patients in the past twenty years. Very successful practice due to great results. Patients that couldnt get relief from any other field. There are terrible practioners in every field. The worse ones i have seen are medical doctors and orthopedic surgeons. God complexes. They dont care about their patients. They get paid to perform unnecessary surgeries that have a track record of 65% getting worse afterwards. Most chiropractors have their physiotherapeutic licenses as well, state mandated so they not only address the osseous component but also the muscle. Btw, i could have chosen to study any field in the medical arena. I chose to be a chiropractor. Check out our curriculum and compare it to that of a md. You will see almost identical courses. It is not only a legitimate profession it deserves the utmost respect for its place in the medical society. Also, my malpractice insurance has never exceeded $2000.00 per year. The insurance companies set the rates based on the past claims. If my job was so dangerous my rates would be that of lets say an mds.
Yes, Ms. Julie, but you are not a doctor. Neither a PhD nor an MD. You are at best an alternative health practitioner. Defensive, full of whataboutism and unsubstantiated anecdotes. These behaviours are all entirely consistent with the conduct of an alternative health practitioner.
Actually, the Dept of Ed in the USA states we are doctors of chiropractic.
There are also doctors of divinity. The difference is that while their opinions are equally meaningless, doctors of divinity tend to be better read.
Regardless, in America and several other countries we are called doctors of chiropractic. Thus Lipid was in error.
That is true, and it is disconcerting. The title “dr” should be reserved for people with genuine qualifications not a randomly chosen collection of people that includes quacks. The fact that this is not the case, incited me to question the qualifications of an ophthalmologist, because I also live in a city were even quacks are allowed to call themselves doctors, so I have had to learn to ask what someone’s title actually means. Caveat emptor.
Fortunately, there are still countries with enough insight (or merely tradition) that do not allow the quacks to don titles they shouldn’t be allowed to have. Lipid may well be living in such a country.
In a big country far far away a narcissistic idiot gets to call himself president, that does not make him competent to be president.
It seems quackery does not protect against pretentions or delusions of grandeur.
Dr.Julie.
Bravo!
Sincerely, Dr.Ava
Its too bad most naysayers believe our profession is cookie cutter.
My thousands of patients in the last 25 yrs believe in me and chiropractic.
yes, I always suspected that chiropractic was a religion.
I don’t think so. Most naysayers, and indeed most people with a few remaining functional neurons, are well aware that cookie cutters have at least some sharpness to them.
There are also people who believe in the prophet Muhammad, Jesus Christ or Charles Manson, among a lot of other crackpots.
Rigorous evidence based discussion this is not. Just a bunch of dumbasses spouting an “expert” opinion. And then acting like one person’s opinion is somehow more stupid than your own.
Thanks for the input. I feel informed.
… and your contribution to it might be the dimmest of them all.
Wow this is a lot of BS by pretentious low self esteemo folks that didn’t even quote the articles from their own journal endorsing chiropractic as the opioid epidemic they started kills hundreds of thousands.
Just because there is the odd positive article doesn’t mean chiropractic has any objective worth. Only rigorous tests can determine that, and those do not seem to favour chiropractic.
‘They’ didn’t start the opioid epidemic. The users did and do that. It isn’t an epidemic either. Measles can cause an epidemic, medicines do not. The opioid crisis is in no essential way different from the alcoholic drink crisis or the tobacco crisis except for one simple fact: opioids are manufactured for genuine medical reasons, while the other two are not. In that sense, the opioid crisis is no different from the glue-sniffing crisis: these products have genuine reasons to exist, and the crises are caused by misuse of otherwise very useful products.
Shut up.
Medicines dont kill people.
Who started the opioid epidemic?
Take a seat..shut up.
Thank you kindly.
a very good argument indeed!
Are you working for the Office of Alternative Truths? You should be. Such stellar argument I have rarely seen.
The AMA has been successfully sued by chiropractic.
The AMA along with big Pharma are the 3rd leading cause of death and injury
In the nation and the biggest drug pushers in kindergarten.
States counties and cities are suing them for the heroin and opioid crisis killing 100 of thousands.
But this article and others seek to divert your attention.
Chiropractic nutrition massage acupuncture to name a few use a commonsense approach of above all do no harm.
There are folks that don’t belong in patient care in all professions like Edward.
and you cannot even spell my name correctly
That’s about as brilliant as suing automobile manufacturers for the deaths caused by incompetent drivers.
As I understand chiropractors won the case against the AMA based on an economic monopoly argument.
The case predated evidence based medicine.And the case certainly had little to do with the the alleged health benefits of chiopractic.
Indeed legal aggresiveness and aggressive marketing seem to have be the foundations of chiropractic since the AMA case.
Chiropractic is above all an aggressive corporate practice. It is not science. And it is not primarily concerned with clinical outcomes.
Chiropractic spawned as a made-up religion, not science. As with most religious cults invented in historical times, it was developed into a potentially lucrative business dependent on marketing and customer attraction
Yep the medics prescribed them also even smoking in the office and testifying for big tobacco.
It is all a wall street game of never wanting folks to consume less and chiropractic does that.
@Dope Tim: why don’t you, in your erudite, articulate stylings so consistent with the DC “degree” tell us once and for all WTF IS “chiropractic”? Which of the 100 disparate techniques and myriad stolen PT modalities constitute the profession of Chiroquackery? I’ll opine: ANYTHING a DC does in the name of innate, DD, BJ or financial remuneration constitutes chiropractic. It has no core, no substance and no logic to which any non-religious, non-sympathetic, thinking person can grasp and investigate. Is it Activator, random manipulation, specific manipulation, upper-cervical, Logan, toggle, spinal Decompression…..all of these or none of these? And how do YOU know what it is vs Professor Ernst or the 60% of the population which ignore it? How does it compare with Scientology and anthroposophical medicine or non-touch therapies or acupuncture…..all of which have dedicated apologists willing to make fools of themselves demonstrating arrogance and egotism befitting any religious zealot.
Chiropractic is the accurate term for a set of made-up medical pantomime invented by DD Palmer.
Take some time and look at the surveys of what chiropractors actually do in practice. Job Analysis put out by NCMIC is a good start.
Exercise, rehab, ergonomic, etc based. Heck, the stuff Lancet just recommended for nonspecific back pain…the condition that the vast majority go to chiropractors.
Do we have our share of quacks…sure. Just dont lump us all together.
@Wannabe-Doctor Dale said:
Don’t blame someone else for what the chiropractic community does without outside help.
If Chiropractors were genuinely interested in gaining respect and going down the road of science based health care, they would start by dropping all connection to the set of parlour tricks devised by chiropractor #1 with its made-up theoretical basis of a “vertebral subluxation complex” and “innate intelligence” along with later imbecile add-ons e.g. “applied kinesiology”.
The silly toys (“nervoscope”, “activator”, etc. ) need to be scrapped and the former chiropractors, now physiotherapists/health-promoters under some other nice name, would need to start actively promoting real public health issues like vaccinations and obesity prevention.
Let’s not forget they have to stop selling overrated food derivatives (i.e. food supplements) and snake-oil.
Then, maybe then, we who work hard to provide real health care can start trying to show this cultish congregation of wannabe doctors some respect as providers of honest health care.
Ah, the activator. One of my favourites! It requires such a gigantic amount of imagination to receive any benefit from this thing, it easily tops the list of science-fiction healthcare!
And, as I was completely ignorant about until this very moment, this thing costs quite a lot. Impossible…
Dear Mr Dale, if you are providing a physical therapy service, then do a physical therapy degree. And you will get the respect that physical therapists are afforded within the mainstream.
But if you insist on calling yourself a chiropractor, and keep continuing to serve physical therapy in a quackery cocktail, then you will continue to be an alternative health practitioner. And will continue to laughed at and derided in forums such as this one.
Simple, really. Your choice.
Lipid, physical therapy professionals can’t provide all the diagnostic services chiropractors can offer. It would be a demotion in degree status.
true! Physios do not diagnose fictitious SUBLUXATIONS!
Yet when allowed physical therapists will do spinal manipulation. Go figure.
“Don’t forget that the M.D.’s sprain is the Chiropractor’s subluxation.” BJ Palmer, 1920.
Is a sprain fictitious?
if you really believe that, why not call it SPRAIN?
I do, as well as other evidence based chiropractors.
Since there is no evidence for subluxations, those chiropractors are evidently not evidence-based, despite their claim they are.
Bart, i agree if they are clinging to traditional chiropractic definitions.
The Association of Chiropractic Colleges (ACC) hereby adopts the following guideline for the Doctor of Chiropractic (“Doctor”) programs at member institutions.
http://www.chirocolleges.org/resources/informed-consent-guideline/
Apart from the travesty of the meaningless word salad in this document pretending to be an official proposal for informed consent, as one that has devoted my life to healthcare I detest the arrogant use of the ‘doctor’ honorific, which they even capitalise to indulge their grandiose delusions. Real doctors don’t need to flaunt it.
I know these are harsh and hurtful exclamations to those who do not know better than their six years or so of chiro-school gave them a the right to call themselves doctors.
I simply have to be honest and truthful to my (low) opinion of people who, albeit unwillingly, play doctor with a fake toolset.
Well, your beef, at least in the USA, is with the Dept of Ed as they set the educational requirements for use of the title doctor in such fields as dentistry, optometry, chiropractic and more recently physical therapy.
We are required by law to inform the public in advertising and marketing that we are doctors of chiropractic.
The medical field doesn’t own the title.
Chiropractic without the subluxation (or whatever neuvo chic definitional-shift you quakes are on about these days) = Christianity without the resurrection.
Idiotic with…idiotic, and pointless without.
Bjorn.
Those chiropractors are out there. I’m a member of two groups, one with 7000 members (mainly chiropractors) and another with 6000 members (all chiropractors) who hold basically the same positions and views that you mentioned (and more).
We desire to further distance ourselves from the old time chiropractic thinkers, embrace science and research and value an evidence based approach. We dont speak of innate intelligence or subluxation…at least in the Palmerian sense. We acknowledge those concepts as a part of our history but not as concepts for us to use today.
We have discussed a creditial program to help other providers and the public to easily recognize EB chiropractors, the possibility of buying of a college in the future to have a strict EB program and also creating a nonprofit watchdog organization to go after false, deceptive and misleading advertisers.
So yes, dont lump us all together.
@Ding-dong-dale: perhaps a quick read of Bogduk et al: “in order to diagnosis a sprain/strain the tissue and the extent of injury must be ascertained with valid and reliable tests…in contemporary practice this is not possible”. “Subluxation has no criteria of which to base a diagnosis”.
Or McGill: “Chiropractors attempt to identify segments which are “blocked” or demonstrate less motion….however by definition stiff joints are more stable and would require large perturbations to make them unstable….more motion means less stability and a greater requirement from muscular sources. There may be a peril in over-manipulation compromising stability”.
Whether DC or PT searching for spinal vertebral-“mis-givings” is a religious pursuit not scientific…and like all religious pursuits finds its essence in power, finance and egoism. When you post you embarrass yourself….simply trying to defend an indefensible position with illogic and nonsense statements….further proving your clinical pursuits are unscientific and implausible.
If however you could prove the “typical” success rate of DCs (advertised as +80% generally) is generated after the 1st treatment THEN I’d say you had something.
Problem is that won’t buy your accustomed lifestyle (and it ISN’T nor has EVER been the case)….and as soon as you get up to 6, 8 or 12 treatments you’re just staring natural healing and attrition square in the face. Of course that’s a class they don’t offer at clown college.
Same old Kenny…alot of ranting and rambling but he doesnt really say anything relevant to the discussion.
@ding-dong-dale: Lol, like a chiropractor can understand the difference between ranting, rambling and relevant. And I understand how a quack would find Bogduk, McGill et al irrelevant….they ain’t no BJ Palmer.
Perhaps you could be relevant and explain what a non-subluxation-hunting quack does between 9 and 5 three days a week?
Me: EB chiros dont speak of subluxation (sic)
Kenny: let’s discuss subluxation and treatment duration.
Me: another Kenny rant and ramble
What he actually said is:
It is a very interesting and relevant question. If chiropractors are not chasing subluxations, that is to their credit. But if they are not, what are they actually doing? As far as I can see only the fondling of customers remains. That would mean chiropractic is just another name for or perhaps an offshoot of prostitution.
Mr Kenny is a pseudoskeptic. Even his request revealed this by classifying them as a quack even before the start of a discussion.
He must take anything presented to confirm his strong bias. He has become what he hates. A waste of my time…a blackhole.
Michael Kenny does not live in a vacuum and does not miraculously become a blank page whenever a new discussion is started. Nor is that even relevant. His question is a valid one and of (potential) interest to anyone who – based on available evidence – has concluded that chiropraxy is merely one of numberless forms of quackery. Chiropractors can make it very easy for skeptics and ignoramuses alike by presenting the strongest evidence available that they are making a relevant and non-negligible contribution to medicine.
The peculiar thing is that they hardly ever present evidence, and never present strong evidence. There are two possible explanations for this: they are unwilling to do this or they are unable to do this. Given how much the case of chiropractic would be helped along by presenting strong evidence, it seems rather logical to tentatively conclude that this evidence does not exist. If there is no evidence, there are no reasons to believe chiropractic claims.
Not having any reason to believe something is a jolly good reason not to believe that something.
The conlusion is simple: chiropractors are quacks. If they are not, they are doing a pretty good job of fooling people into thinking that they are and they should therefore not be surprised and play the wounded targ when people see them as such.
Bart, first one has to understand what most chiropractors actually do on a daily basis.
Perhaps, but it seems that chiropractors don’t know that themselves. As you said:
That is a scary proposition to me, even more so because chiropractors claim to have an education. What is the worth of this education that doesn’t even seem to teach them what the job entails?
@Ding-dong-dale: a blackhole is better than your type of hole.
What is a pseudo-skeptic? Isn’t that you? I bet you don’t ‘believe’ in Scientology, fortune telling or homeopathy…? but the DD & BJ gypsy show you get your pecuniary reward from appeals to you just fine. You are the pseudo-brain.
And yes using the word quack does show my bias…fraud is clearly the most accurate word to describe chiropractic…today, yesterday and tomorrow.
I was married to one of you frauds for 10 years, I took in all manner of seminars, conventions and events. I saw many typical daily “practices”. I got to see first hand the Ted Korans and Arlan Fuhrs, Foot Levelers, AK, Contact Reflex Analysis, Activator, Neuromechanical innovations, class III & class IV “lasers”, spinal Decompression, neck-curve restorers, flexion-distraction, a dozen “drop-table” techniques, allergy testing, muscle-challenges for “proper” foot orthotics and pillow prescription, a 100 “Chiropractic-specific” vitamin peddlers, upper-cervical gobbledegook, pediatric-subluxation treatment methods, anti-VAX campaigns and a 1001 posters, brochures, videos and management-strategies to use in your conniving, alarmist, intimidation, hyperbole and pseudoscience rankings to get patients “into the care they desperately need to improve their immune function and vitalistic health”. Better stated: entrepreneurial-theatrics masquerading as healthcare. Whatever a chiropractor does to defraud an insurance company or to get cash from the uninformed, misguided and gullible IS chiropractic. Not one of you A-holes has ever defined or delineated it so a skeptic or a reasonable-person could actually evaluate it. All we can do is see it as it manifests in society. And it ain’t pretty….
Yeah I’d say anyone but a quack would be biased against all of it.
I see. I recall a survey from about 10 years ago where they found that around 65% of MDs and DOs recommend their patients consult with a chiropractor (most likely for low back and neck pain). Perhaps the bias isn’t so strong in the trenches.
There was a time when I suggested chiropractic to people for LBP. I even tried it myself. The only omprovement was in the bloke’s bank account. Then I studied what chiropractic really is and what research (not surveys) tells us. Now I recommend exercise and sensible use of medication.
The best way to know what “chiropractic is” is to look at surveys as to what chiropractors do. The vast majority do or promote exercise, rehab, ergonomics, healthy lifestyle, etc.
We have our share of quacks. But we also have our share of chiropractors who strive to be evidence based.
For example…. https://www.google.com/amp/s/www.researchgate.net/profile/Christine_Goertz/amp
@ DrDale
Oh dear, that’s far from an impressive example. Christine Goertz was the lead author of this recent paper:
https://edzardernst.com/2018/05/new-back-pain-study-support-for-the-inclusion-of-chiropractic-care-as-a-component-of-multidisciplinary-health-care-for-low-back-pain/
Blue Wode, Yes i know. The authors acknowledged some of the limitations.
Regardless, the point…there is a section of chiropractors trying to advance this profession apart from the antiquated views some still hold onto.
@Blue Wode. For clarification. The JAMA study was set up by the DOD. It was the first of a three part study. (The second part failed to enrol enough subjects, the third part is still underway).
The DOD set it up as a chiropractic add on because that’s how they use chiropractors in the military. They wanted a pragmatic design. One can’t fault the chiropractic authors for the study design.
DrDale wrote on Wednesday 11 July 2018 at 12:27: “@Blue Wode. For clarification. The JAMA study was set up by the DOD [U.S. Department of Defense]…The DOD set it up as a chiropractic add on because that’s how they use chiropractors in the military. They wanted a pragmatic design. One can’t fault the chiropractic authors for the study design.
@ DrDale
Bearing in mind this, which is lifted from Prof. Ernst’s critique of the paper:
QUOTE
“Regular readers will have spotted it straight away: This trial follows the infamous ‘A+B versus B’ design. It will almost always generate a positive result – so much so that it is a waste of time to run the study because we know its findings before it has started. And if this is so, the trial is arguably even unethical. The reason is, of course, that the study design does not control for placebo effects. And this means that even an utterly useless treatment will produce a (false-positive) result as long as it generates a placebo effect. Some of the authors of the present study are experienced researchers and clearly know all this.”
Ref. https://edzardernst.com/2018/05/new-back-pain-study-support-for-the-inclusion-of-chiropractic-care-as-a-component-of-multidisciplinary-health-care-for-low-back-pain/
Shouldn’t the authors have had the integrity to take an ethical stance? That is, shouldn’t they have refused to conduct the study?
Meanwhile, it’s alarming to see the American Chiropractic Association’s John Falardeau, Senior Vice President, Public Policy & Advocacy, deem the paper a ‘game changer’:
https://twitter.com/ACAontheHill/status/997507424927076353
@Bart: Bravo, and exactly! ?
I forgot to add the (perhaps) 1, primary common-quack-denominator: motion-palpation. That most specious gypsy trick where by the graduates of clown college can Devine with fingers and prevarication the where-abouts of the deadly subluxation/mal-alignment/restricted/aberration-of-intervertebral “motion”.
Then jettisoning them back into proper-order signaling innate to stifle all dis-ease and dis-order of every system in the “patients’’” body! Of course it is a lifetime process since the Doctor-of-clownery will need a 30 year vocation.
I hope ding-dong-dale, GibletGiblet, ineffectiveChiro and the others will read and digest Dr. Ernsts’ post today…pertinent, pithy and devastating.
But they won’t. Digesting facts & logic is way too uncomfortable.
Sigh. EB chiros acknowledge that the specificity of the identification and the specificity of manipulation is not supported by research…that we dont realign bones…that if any type O changes can occur the mechanism is unknown and unpredictable.
Mr Kenny…there is a division within chiropractic…has been for over 100 years. If you dont want to acknowledge it, sobeit.
@Ding-dong-dale: Sigh…oh the unmitigated arrogance and self-edification to so blithely dismiss the vast majority of your fellows to the junk-pile of the errors-of-the past. Poor DD & BJ, all their hard work disposed of with facile disregard by the likes of you, “Dr”ding-dong-dale.
The litany of theatrics I supplied in my previous post (and there are many, many more) simply don’t fit-in with you and your “new and improved EB chiropractic”?? And you base YOUR particular theatrics on WHAT? Perhaps Deed Harrison? Goertz? Roy Sweat? Chris Colloca? but NOT Arlan Fuhr, Ted Koran or Vern Pierce, Pettibon or Thompson?? Do you assume they all branded themselves in private conversations as “frauds, quacks and bounders”? Or is that just your immutable insight?
Pray tell WHAT adjudication protocol (other than your ego) do you use to seperate the wheat from the chaff???? Prayer? Seance? The testimony of “critical_Chiro”?
Let me give a quote from a lofty German philosopher: “if one religion is true then they must all be true, conversely if one religion is false then they must all be false….since all are based on the same thing; belief, testimony and mis-interpretation of natural events”.
I think arrogance and self-righteousness nicely explains how you daily tolerate your vocation. You tell yourself those “others” are all quacks, frauds and blockheads….”I however am “different”….AND better!”.
As an attorney for 30 years I know that stunt well…but at the end of the day there is actually something to “the law”. No matter how you re-design and re-name it Chiropractic is and will always be made-up bullshit. OR perhaps in your office: simply “physical therapy”. But you “reformers” have already told us how ineffective that is.
You can always become an RN and actually deliver “health care”.
Simple…its called clinical guidelines within an evidence based model.
But you play the “damned if you do, damned if you don’t” game.
Good bye.
@ DrDale
Re guidelines, chiropractors and osteopaths in the UK are faced with the following re manipulative treatment of low back pain [their hallmark intervention] and sciatica:
QUOTE
One important point from this guidance is that NICE recommends a “group exercise programme”. This presents something of a problem for pure manual therapists such as osteopaths and chiropractors as they don’t normally have access to a group exercise programme for their patients…The new NICE guidelines are something of a problem for osteopaths and chiropractors as their treatments are no longer first line choices and they are not well placed to offer a suitable exercise programme. Some of them may opt to continue treating patients the way the always have and not take the NICE guidelines into account. However, that is a potentially risky strategy for two reasons:
It doesn’t seem to be in the best interest of their patients
They risk being found in breach of their “Practice Standards” which could result in formal complaints to either the GOsC or GCC.
Ref: https://complementaryandalternative.wordpress.com/2016/12/06/nice-guidelines-for-low-back-pain-and-sciatica-a-clarification/
@ Blue Wode
I read on your twitter feed that Sam Homola is an “evidence based chiropractor”.
Please can you explain what makes him an evidence based chiropractor?
I would have thought that this term describes a chiro who is critical of all the non-evidence-based stuff other chiros engage in on a daily basis.
@ Edzard
So, what treatment would an evidence based chiropractor do?
this is a question that you better put to a chiro.
That’s a good question and it is one I am desperately trying to get a reasonably accurate answer to. I don’t seem to get anywhere.
For some reason, chiropractors are rather frugal with the provision of information, even the ones who claim they are evidence-based. One would almost feel tempted to think that they don’t want people to know what they do.
My best guess (yes, it is a guess) so far is that their activities amount to what is commonly known as fondling, in other words, a form of prostitution.
Again, this is a guess, based in part on the apparent lack of ability and/or downright unwillingness of chiropractors to clearly say what they do. If you have more precise and/or more comprehensive information substantiated by some form of credible evidence, I’d be happy to adjust or even radically change my guess.
Thanks for the reply Bart
Maybe you should ask either Blue Wode or Samuel Homola what treatment would an evidence based chiropractor do?
I think prof. Ernst got it right when he said:
After all, they are the ones doing it. I think/guess that what they do is a form of prostitution, but I don’t know that for certain and would certainly not presume to know.
To me, an evidence-based chiropractor seems a remarkable animal indeed. It would be somewhat like chemists continuing to work as they did in the past, while rejecting phlogiston theory. That would make no sense. As far as I know, subluxation theory is fundamental to chiropractic. Take that away, and one gets treatments for no reason, i.e. a form of entertainment, sometimes risky entertainment.
Yes, group exercise improves adherence. I actually brought this up earlier today within a group. So yes, an EB chiropractor should incorporate this into their practice if at all feasible.
There is also evidence that texting patients reminders to exercise increases adherence. Also that patients prefer group exercises at work with their co-workers.
Also in the guidelines…
B. Manual therapy should be considered for short term relief of pain for patients with chronic low
back pain.
B. Manual therapy, in combination with exercise, should be considered for the treatment of patients with chronic neck pain.
@Another(?): Let me quote an eminent Doctor-of-quackery; Dr. DDDale:
“EB chiros acknowledge that the specificity of the identification and the specificity of manipulation is not supported by research…that we dont realign bones…that if any type O changes can occur the mechanism is unknown and unpredictable”. Voila’
So EB chiroquakers have WTF at their collective disposal??? Certainly it ISN’T (according to this spokesman) the actual 123 year old BASIS on which the entire profession perpetuates: palpation of the spine to find mis-alignments….then jettison them back to “proper” align. Nope it ain’t that. It ain’t PT. It ain’t osteopathy. And it ain’t a religion built on innate-intelligence.
Is it Ultrasound? Estim? Hot lasers? Decompression? Logan basic? NUCCA? Pettibon? CBP? Thompson? Vibrators? Magnachairs? Activators???????
So EB chiroquakers…..like nonEB chiroquakers simply do whatever the f_ _ _ they want or need to to build a practice and manitain a revenue stream. There’s your evidence.
Thanks for the reply Michael.
I understand you are a physio – what do you think an evidence based physio would do treatment wise with musculoskeletal complaints?
@AN Other
The rational answer to your question (I know it’s intended for Michael Kenny, but it reveals the gross medical inadequacy of so many comments on this blog) is “It depends entirely on the precise clinical and pathological details of the musculoskeletal complaint.”
The problem with chiropractic, acupuncture and so many of the branches of pseudo-medicine we read about here is that they offer a one-size-fits-all approach to therapy — they are typically even so immodest as to suggest that the approach can cure any or all forms of disease.
Elsewhere in this thread you asked “What stupid question?”. The question you posed above is a fine example.
Almost 19% (18.8% – 95% CI: 15.5 – 22.7) of chiropractors surveyed associated themselves with the predefined unorthodox perspective of “Chiropractic Subluxation as an Obstruction to Human Health”, while 81% (81.2% – CI: 77.3 – 84.5) were associated with a strata of a more orthodox view, identifying themselves with biomechanical disorders or musculoskeletal joint dysfunction.
https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-14-51
@ Frank Odds
In fact a simple answer to my question would be exercise, which I would say is an example of a one size fits all therapy.
That is easy enough to answer: he would do what he was taught during his studies. If he wouldn’t, it would be malpractice.
The same answer could be given for chiropractors, but there is a not-so-minor catch: since chiropractic is subluxation-based, chiropractors rejecting that would effectively be malpracticing, yes?
@AN Other
Fine. So you consider exercise is an appropriate treatment for osteomalacia, tendonitis, muscular dystrophy and myasthenia gravis? For any of the six hundred and fifty-seven rare diseases all listed here under the heading of ‘Musculoskeletal Diseases’? Thank you for demonstrating the sheer ignorance of those who practise pseudo-medicine.
@ Edzard
So, as someone who has written numerous articles and reviews on chiropractic and its main treatment (manipulation), you don’t know what an evidence based chiropractor can do?
Also you have written articles on this blog about clinical guidelines for the most common condition treated by chiropractors (low back pain) and made recommendations regarding treatments but you still can’t answer what treatments an evidence based chiropractor can do?
hmmmmmmmm…
Maybe Blue Wode could answer the questions I have stated so far (considering he can identify an evidence based chiropractor)
“you don’t know what an evidence based chiropractor can do?”
You are fantasising – I did not say that!!!
That would seem to be quite tough, given that those who claim to be evidence-based chiropractors are seemingly unable and/or unwilling to disclose what they do. The rather obvious answer would be: nothing of interest. Whether that is correct, I don’t know. My own tentative conclusion is that they are practising a form of prostitution, perhaps something in the BDSM field.
@ Bart
Trying contacting Samuel Homola (he writes on the Science based medicine website). He is a retired chiropractor, who could give you an answer
Perhaps, but that would be – almost certainly – an invalid answer, since Samuel Homola is considered a heretic by (almost?) the entire profession. I’d like to have an answer from actual practitioners. Why are they seemingly unable or – heaven forbid – unwilling to disclose such rather important information?
@ Bart
Sam Homola is the perfect one to ask – he calls himself a chiropractor, he practiced as a chiropractor and has been given the seal of approval by skeptics. Ideal chiropractor to ask about evidence based treatments
I have a problem with that assessment. I am not looking for someone who is preaching to the choir, I want to hear from people in the profession, just as I do not want to hear from an atheist or an apostate what a religionist believes. Unfortunately, chiropractors appear to be as diverse as religionists and seem to be equally unable or unwilling to clearly state what they are about.
@ Edzard
Well. if you can’t answer the simple question I asked you (what treatment would an evidence based chiropractor do?), you are either avoiding answering the question or you don’t know!
I do admire your sharp intellect!!!
yes, I avoid answering the question.
I am not obliged to answer every stupid trick question people think of.
@ Edzard
Ad hominem attacks are signs of victories of reason over unreason – Edzard Ernst
Explain how my question (what treatment would an evidence based chiropractor do?) is a stupid trick question – other people have been able to answer that question without the ad hominem attack.
@AN Other on Saturday 07 July 2018 at 17:52
Hey Annie,
When are you disclose what skin you have in the alt-non-med game, or will continue asking stupid questions?
Just because you are the receptionist at a chiro office doesn’t mean you need to defend the indefensible.
@ Frank
What stupid question?
Well Bart, asking ‘what treatment would a EB chiropractor do?’ is dependant on the condition, doctors experience, patient values and current practical research.
I gave the overall approach…but again…
For basic MSK conditions an approach may include…
joint manipulation and mobilization
soft tissue manipulation and massage
exercise and physical rehabilitation prescription
home care and activity modification advice
I appreciate that you try, but something rather fundamental is missing, in my opinion. Before treatment, there is diagnosis. Take away subluxation theory, which is, as far as I know, used for most all diagnoses, and what remains is treatment for no discernible reason, which is precisely why I see chiropractic as a version of prostitution: the only/main remaining reason I can see is patient and/or practitioner enjoyment.
My lack of imagination is only important to me, not to anyone else. There may well be other reasons I am not aware of. I have been told that 5 to 10% of those attempting to climb Mount Everest come back in a bag or a box or not at all, usually after enthusiastically polluting its fragile environment. That’s not counting those who come back with some type of injury/injuries, however mild or severe. I suppose these people have reasons/justifications for their behaviour, but I’m not aware of them. Something similar may well be true for chiropractic.
In short, my question remains. What does an evidence-based chiropractor do? How does a chiropractor make a connection between diagnosis and treatment if subluxation is thrown out, assuming he/she is even able to diagnose anything to begin with?
For example, how does a chiropractor diagnose “basic MSK conditions”? How does that chiropractor decide what treatment is appropriate for such diagnosis? How does a chiropractor objectively decide treatment was successful or not?
DrDale wrote on Sunday 08 July 2018 at 18:14: “Almost 19% (18.8% – 95% CI: 15.5 – 22.7) of chiropractors surveyed associated themselves with the predefined unorthodox perspective of “Chiropractic Subluxation as an Obstruction to Human Health”, while 81% (81.2% – CI: 77.3 – 84.5) were associated with a strata of a more orthodox view, identifying themselves with biomechanical disorders or musculoskeletal joint dysfunction.
https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-14-51 ”
@ DrDale
That study by McGregor et al doesn’t say what you think it does. See
https://edzardernst.com/2016/10/top-model-died-as-a-result-of-visiting-a-chiropractor/#comment-83306
@ Blue Wode
I read on your twitter feed that Sam Homola is an “evidence based chiropractor”.
Please can you explain what makes him an evidence based chiropractor?
AN Other wrote on Sunday 08 July 2018 20:47: “@ Blue Wode I read on your twitter feed that Sam Homola is an ‘evidence based chiropractor’. Please can you explain what makes him an evidence based chiropractor?”
@ AN Other
IMO, Samuel Homola is an evidence based chiropractor because he adheres to best scientific evidence and promotes incorporating sound risk/benefit assessments into clinical decision-making in the best interests of patients.
Further, not only does he follow that model, but he has also dedicated himself to continuously defining the proper limits on chiropractic as the evidence comes in and to educating consumers and professionals about the field.
For example, on the jacket of his book, ‘Inside Chiropractic’ (published in 1999), the problem with chiropractic is laid bare – i.e. “until chiropractic is properly specialized and regulated, consumers will have to learn how to make an informed choice in finding a good practitioner”.
In the Preface he says: “Although progress has been made, the profession still has one foot lightly planted in science and thot her firmly rooted in cultism.”
On page 169 he says: “The profession as a whole has done almost nothing to confront its rampant quackery. Although a few methods have been debunked by studies published in chiropractic journals, these studies appear to have little or no influence on what chiropractors do.”
And on page 172 he offers this very perceptive summation: “Will chiropractic colleges, licensing boards, or prominent organizations ever declare war on the gimmicks, shoddy examination procedures, unreasonable treatments, or promotion of false hopes that are documented throughout this book? Will chiropractor leaders ever admit that chiropractic ‘aberrations’ are not the exception but the rule? Can chiropractic’s absurd procedures disappear without abandonment of metaphysical ‘subluxation’ concepts? Will chiropractic ever define its appropriate scope? Will research ever pinpoint what chiropractors do that is helpful? Is there reason to believe that chiropractic can be reformed? I, myself, am not optimistic. Unless and until major improvements take place, if you decide to see a chiropractor, choose carefully!”
Suffice to say that it’s a sad indictment on the chiropractic industry that Samuel Homola’s book is as relevant today as it was when it was written nearly 20 years ago.
Sam is not in active practice any more, as far as I know.
I believe Sam is retired from practice.
The issue I’ve seen raised from the EB crowd isn’t so much his positions but where he chooses to submit that information.
@ Blue Wode
I have read many comments on this blog that explain that an evidence based chiropractor is an oxymoron. A chiropractor practicing as you describe would be called a physio with a limited scope of practice by many on this blog. Also, many would suggest he should have retrained to become a physio.
So, if all chiropractors practiced like Sam Homola, would the profession called chiropractic be OK to carry on existing?
Also, what treatments would an evidence based chiro like Sam Homola be able to do?
AN Other wrote on 09 July 2018, 15:59:42: “@ Blue Wode…if all chiropractors practiced like Sam Homola, would the profession called chiropractic be OK to carry on existing? Also, what treatments would an evidence based chiro like Sam Homola be able to do?”
@ AN Other
In such a scenario I don’t think that it would be wise for chiropractic to carry on existing as there’s too much quack baggage associated with it. However, that situation will probably never arise as chiropractic looks set to survive for the foreseeable future due to a lack of enthusiasm for reform. For example, David Newell, a senior chiropractic academic in the UK, has this to say:
QUOTE
“My dream would be to see the unification of as many chiropractors as possible under a common description of a model of chiropractic care. One that is patient centred, ethical, evidenced and uses scientific language to describe the use of different modalities and skills that chiropractors are trained to deliver competently and safely in the management of MSK problems….I would love to see the profession pulling together underneath such a model but I don’t think we are going to manage that globally. I don’t even think we are going to be able to pull everybody together in Europe because I know there are factions in Europe that are extreme and take a fundamentalist approach to their beliefs about what they think they are doing and what chiropractic care is. And as much as I want it, I don’t think there is enough, if any, common ground to be found between some of these factions.”
Ref: https://tinyurl.com/y8fvw8nu
Then there’s this letter from the (former) president of the British Chiropractic Association, which was written 18 months ago, in which he pleads for ‘unity’ although not necessarily ‘uniformity’:
http://www.mccoypress.net/i/bca_bennett_letter_december_2016.jpg
Perhaps most astonishing of all, is this month’s message from the president of the World Federation of Chiropractic, Laurie Tassell:
QUOTE
“For thirty years the WFC has attempted to facilitate unity in the global chiropractic community. When it was realized that unity was unattainable the WFC sought unity with diversity. Neither objective has yet been achieved.
At its recent meeting in Lima, WFC Council made the bold decision to shift away from endeavoring to promote unity. Instead, it was agreed that the priority of the WFC should be focused on the creation of trust, legitimacy and promoting the best available care. It was agreed that commonality based on high standards of care and protecting patient welfare are the profession’s strengths and should be at the core of our focus.”
Ref. https://www.facebook.com/WorldFederationofChiropractic/photos/a.728364260619159.1073741834.391186181003637/1626185534170356/?type=3&theater
My interpretation of that is that Mr Tassell is all for double standards.
With regard to your second question, an evidence based chiropractor, in my opinion, would employ joint mobilisation techniques, muscle stretching, massage and soft tissue techniques, and instruction on self-care, exercises, and coping tactics. I would expect manipulation to be used very, very sparingly.
Looking to the future, I think Samuel Homola offers excellent advice to anyone thinking of becoming a chiropractor:
QUOTE
“Persons interested in studying manipulative therapy should consider going for a Doctor of Physical Therapy (DPT) degree that would allow interaction with the scientific community in researching and performing manual therapy without the stigma associated with chiropractic.”
Ref. https://sciencebasedmedicine.org/inside-chiropractic-yesteryear-and-today/
“My interpretation of that is that Mr Tassell is all for double standards.”
The thinking is…unite those who strive for an EB model of chiropractic care.
@ Blue Wode
Thanks for the considered reply – much better than Prof Ernst.
I agree with your selection of treatments that an evidence based chiropractor would do – in fact this is what all evidence based therapist, who treat common musculoskeletal disorders should do.
I think you are right that chiropractic will always have “quack baggage” but from my experience there is a reasonable amount of quack baggage associated with physiotherapy and osteopathy (but obviously not as much as chiro).
My hope would be to educate the public about what treatments they should expect from an evidence based therapist and therefore would choose a therapist on this basis.
BW.
“Samuel Homola is an evidence based chiropractor because he adheres to best scientific evidence and promotes incorporating sound risk/benefit assessments into clinical decision-making in the best interests of patients.”
Thank you. Thats all i asked was to acknowledge that a chiropractor can be EB.
Of course what percentage of the profession is EB could be debated.
If a basic bell curve i would say about 20% are EB or committed to that goal.
Indeed @Blue Wode.
Perhaps chiropractors can retrain as PT assistants? They can then provide exercise, assist with CBT and be engaged in evidence based practice across the health system in a safe, well supervised environment. Sounds like a strategic plan Mr Dale. Sounds like a plan.
“QUOTE
“Physical therapy, by 2020, will be provided by physical therapists who are doctors of physical therapy and who may be board-certified specialists. Consumers will have direct access to physical therapists in all environments for patient/client management, prevention, and wellness services. Physical therapists will be practitioners of choice in patients’/clients’ health networks and will hold all privileges of autonomous practice…There can be cooperation between chiropractors and other practitioners of manual therapy if everyone works under the common denominator of science and if treatment methods are standardized. Subluxation-based chiropractors whose goal is to improve health by removing nerve interference may use any one of a variety of esoteric techniques, making cooperation difficult or impossible. Until the chiropractic profession as a whole is properly defined and specialized and its practitioners uniformly limited in use of acceptable treatment methods, across-the-board cooperation between evidence-based manual therapists and chiropractors is not feasible.”
Ref: http://jmmtonline.com/documents/HomolaV14N2E.pdf“
From one of your posts, McDonald paper…
“…and 2 in 10 thought they explain all of illness (so-called straight chiros).”
DrDale wrote on Sunday 08 July 2018 20:50: “From one of your posts, McDonald paper… “…and 2 in 10 thought they explain all of illness (so-called straight chiros).”
@ DrDale
I think you refer to this post:
https://edzardernst.com/2013/03/what-is-next-a-royal-college-of-window-salesmen/#comment-54269
It’s worth reposting it here in case any chiropractor has better data and wants to correct me:
[STARTS]
A large survey of (and by) chiropractors which was carried out in 2003 (McDonald W, Durkin K, Iseman S, et al, ‘How Chiropractors Think and Practice’, Seminars in Integrative Medicine, 2004 V.2 No.3 92-98, Institute for Social Research, Ohio University) revealed that 89.8% of chiropractors in the USA (where well over 50% of chiropractors practice) felt that spinal manipulation should not be limited to musculoskeletal conditions – a figure which appears to be supported by this 2004 survey of chiropractors in Portland, Oregon…
http://www.chirobase.org/02Research/laidler.html
…which found a 100% incidence of beliefs and practices that were unsubstantiated or clashed with established scientific knowledge. Interestingly, the McDonald et al survey also revealed that 9 in 10 chiropractors believed in (fictitious) subluxations, 4 in 5 thought they were involved in visceral illness, and 2 in 10 thought they explain all of illness (so-called straight chiros).
A further indication that the majority of chiropractors are using spinal manipulation as a panacea can be found in research which the World Federation of Chiropractic (WFC – an association of chiropractic organisations in 85 countries) gathered during its 2004-2005 consultation on ‘The Identity of the Chiropractic Profession’. It gives valuable insight into the chiropractic profession’s perceptions of itself on an international scale. For example, not only did the consultation result in the participating chiropractors’ unanimous agreement that the most appropriate public identity for the profession within health care was “The spinal health care experts in the health care system” – a definition which clearly allows pseudoscientific chiropractic practices to continue to flourish – it also produced a document entitled “Abstracts of Previous Relevant Research” which cited 2003 McDonald et al study, and specifically mentioned the following in section E, #6:
Quote:
“Approximately 9 in 10 [USA chiropractors] confirmed that the profession should retain the term “vertebral subluxation complex” (88.1%) and that the adjustment should not be limited to musculoskeletal conditions (89.8%). Subluxation is rated as a significant contributing factor in 62.1% of visceral ailments.”
In addition to that, the results of the WFC consultation produced a chart called “Perceptions of How the General Public Perceives the Chiropractic Profession”. It illustrates the percentage of chiropractors who said that the following phrases described the profession “perfectly” (7 on a scale of 1 to 7) or almost perfectly (6):
Quote:
“Management of vertebral subluxation an its impact on general health”
– 65% of chiropractors said that the general public should perceive chiropractic that way
“Management of vertebral subluxation”
– 57% of chiropractors said that the public should perceive chiropractic that way
Those figures are supported by a 2007 survey of UK chiropractors which revealed that traditional chiropractic beliefs (chiropractic philosophy) were deemed important by 76% of respondents, with 63% considering the subluxation to be central to chiropractic intervention:
http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1188-the-scope-of-chiropractic-practice-a-survey-of-chiropractors-in-the-uk.html
Indeed, in 2010, the vitalistic Alliance of UK Chiropractors (which claims to be the largest of the four UK chiropractic associations), pressured the UK regulator, the General Chiropractic Council (GCC), into changing its former stance about there being no evidence to link imaginary chiropractic subluxations to “health concerns”. Shockingly, when the GCC caved in it apparently provided no evidence to support its U-turn. See:
http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1827-alliance-of-uk-chiropractors-october-2010-newsletter.html
[ENDS]
From the McDonald paper
There was a statistically significant relationship between
the self-rated scope of practice findings and each of the 10
dependent variables used in the bivariate analyses. This
means that the 9-point scope of practice scale and the accom-
panying definitions (broad scope, middle scope, and focused
scope), taken together, constitute a powerful scope of prac-
tice index.
Such Tom Follery suggesting there is “evidence” to the spurious notion that one person can treat-away another persons pain. And that “education” needs to cost $150,000 and 6 years.what idiocy!
It’s Santa Clause science. These bounders can’t make a living following anything remotely EB since that would preclude an elongated, pointless series-of-treatments while waiting on natural resolution.
Watching all these losers scramble to validate themselves is simply embarrassing to all of us.
If that’s how you choose to make a living it’s best to keep your light under a very big basket.
I don’t have an ethical issue with the study.