The Royal College of Chiropractors (RCC), a Company Limited by guarantee, was given a royal charter in 2013. It has following objectives:
- to promote the art, science and practice of chiropractic;
- to improve and maintain standards in the practice of chiropractic for the benefit of the public;
- to promote awareness and understanding of chiropractic amongst medical practitioners and other healthcare professionals and the public;
- to educate and train practitioners in the art, science and practice of chiropractic;
- to advance the study of and research in chiropractic.
In a previous post, I pointed out that the RCC may not currently have the expertise and know-how to meet all these aims. To support the RCC in their praiseworthy endeavours, I therefore offered to give one or more evidence-based lectures on these subjects free of charge.
And what was the reaction?
Nothing!
This might be disappointing, but it is not really surprising. Following the loss of almost all chiropractic credibility after the BCA/Simon Singh libel case, the RCC must now be busy focussing on re-inventing the chiropractic profession. A recent article published by RCC seems to confirm this suspicion. It starts by defining chiropractic:
“Chiropractic, as practised in the UK, is not a treatment but a statutorily-regulated healthcare profession.”
Obviously, this definition reflects the wish of this profession to re-invent themselves. D. D. Palmer, who invented chiropractic 120 years ago, would probably not agree with this definition. He wrote in 1897 “CHIROPRACTIC IS A SCIENCE OF HEALING WITHOUT DRUGS”. This is woolly to the extreme, but it makes one thing fairly clear: chiropractic is a therapy and not a profession.
So, why do chiropractors wish to alter this dictum by their founding father? The answer is, I think, clear from the rest of the above RCC-quote: “Chiropractors offer a wide range of interventions including, but not limited to, manual therapy (soft-tissue techniques, mobilisation and spinal manipulation), exercise rehabilitation and self-management advice, and utilise psychologically-informed programmes of care. Chiropractic, like other healthcare professions, is informed by the evidence base and develops accordingly.”
Many chiropractors have finally understood that spinal manipulation, the undisputed hallmark intervention of chiropractors, is not quite what Palmer made it out to be. Thus, they try their utmost to style themselves as back specialists who use all sorts of (mostly physiotherapeutic) therapies in addition to spinal manipulation. This strategy has obvious advantages: as soon as someone points out that spinal manipulations might not do more good than harm, they can claim that manipulations are by no means their only tool. This clever trick renders them immune to such criticism, they hope.
The RCC-document has another section that I find revealing, as it harps back to what we just discussed. It is entitled ‘The evidence base for musculoskeletal care‘. Let me quote it in its entirety:
The evidence base for the care chiropractors provide (Clar et al, 2014) is common to that for physiotherapists and osteopaths in respect of musculoskeletal (MSK) conditions. Thus, like physiotherapists and osteopaths, chiropractors provide care for a wide range of MSK problems, and may advertise that they do so [as determined by the UK Advertising Standards Authority (ASA)].
Chiropractors are most closely associated with management of low back pain, and the NICE Low Back Pain and Sciatica Guideline ‘NG59’ provides clear recommendations for managing low back pain with or without sciatica, which always includes exercise and may include manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) as part of a treatment package, with or without psychological therapy. Note that NG59 does not specify chiropractic care, physiotherapy care nor osteopathy care for the non-invasive management of low back pain, but explains that: ‘mobilisation and soft tissue techniques are performed by a wide variety of practitioners; whereas spinal manipulation is usually performed by chiropractors or osteopaths, and by doctors or physiotherapists who have undergone additional training in manipulation’ (See NICE NG59, p806).
The Manipulative Association of Chartered Physiotherapists (MACP), recently renamed the Musculoskeletal Association of Chartered Physiotherapists, is recognised as the UK’s specialist manipulative therapy group by the International Federation of Orthopaedic Manipulative Physical Therapists, and has approximately 1100 members. The UK statutory Osteopathic Register lists approximately 5300 osteopaths. Thus, collectively, there are approximately twice as many osteopaths and manipulating physiotherapists as there are chiropractors currently practising spinal manipulation in the UK.
END OF QUOTE
To me this sounds almost as though the RCC is saying something like this:
- We are very much like physiotherapists and therefore all the positive evidence for physiotherapy is really also our evidence. So, critics of chiropractic’s lack of sound evidence-base, get lost!
- The new NICE guidelines were a real blow to us, but we now try to spin them such that consumers don’t realise that chiropractic is no longer recommended as a first-line therapy.
- In any case, other professions also occasionally use those questionable spinal manipulations (and they are even more numerous). So, any criticism of spinal manipulation should not be directed at us but at physios and osteopaths.
- We know, of course, that chiropractors treat lots of non-spinal conditions (asthma, bed-wetting, infant colic etc.). Yet we try our very best to hide this fact and pretend that we are all focussed on back pain. This avoids admitting that, for all such conditions, the evidence suggests our manipulations to be worst than useless.
Personally, I find the RCC-strategy very understandable; after all, the RCC has to try to save the bacon for UK chiropractors. Yet, it is nevertheless an attempt at misleading the public about what is really going on. And even, if someone is sufficiently naïve to swallow this spin, one question emerges loud and clear: if chiropractic is just a limited version of physiotherapy, why don’t we simply use physiotherapists for back problems and forget about chiropractors?
(In case the RCC change their mind and want to listen to me elaborating on these themes, my offer for a free lecture still stands!)
84 Responses to THE ROYAL COLLEGE OF CHIROPRACTIC’s pathetic attempt at re-inventing chiropractic
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I have two concerns:
1/ that such nonsense still has access to the vulnerable
2/ that it’s sanctioned by the label “Royal”: a hangover from times when opinions of the over-privileged were more widely valued. It’s undeniable that prominent members of the Windsors have ready access to the country’a (globe’s?) best information and therefore demonstrable that they’re wasting the opportunity by supporting such drivel by association.
Ain’t it ironic that they reciprocally undermine each other’s remaining credibility by sharing marketing like this?
As a modern chiro I agree and disagree with this article. My background in General Sciences and Kinesiology. I deviated from my goal of being a physio in exchange for chiropractic school. Yet as a former personal trainer and college wrestler, I have always been an exercise based practitioner. You will see this in my patient videos: http://www.youtube.com/drparenteau
I support physios being allowed to manipulate as I support chiros going into exercise rehabilitation. Truth is, an evidence based practitioner should employ any and all methods called for in any particular case. I do a lot of active release (soft tissue stripping) and exercise rehab/prescriptions.
At this point I would love to see a physical medicine degree offered through medical schools. A well rounded, evidence based clinician could be well sculpted within that framework. And be able to prescribe meds and injections as needed. It boils down to finding a good chiro or physio or kinesiologist at this point. I DO REJECT the original DD and BJ Palmer model of healthcare. It has been proven false a long time ago. But manipulation is effective in the context of a well rounded program.
Find a good practitioner, try them out. Judge not by the credentials but by the results.
https://www.youtube.com/watch?v=MUQpDdp-lKI
https://www.youtube.com/watch?v=7vGc2xr93hI
oh dear!
intuition-based medicine?
“oh dear!
intuition-based medicine?”
I’m not quite sure what is meant by that statement. I clearly stated “evidence based.” Obviously, in the realm of neuromuscular-skeletal injuries (traumatic and chronic) there is often no direct measurements possible. X-rays and MRIs are often inconclusive for most of the injuries I see. So they are not needed. No blood work would prove or disprove a chronic neck or back injury. But well trained clinicians can parse through the orthopedic testing that all athletic therapists, physios, chiros and MD’s use to offer differential diagnoses for said injuries.
A med school curriculum is currently offered for “rehabilitation specialists.” Unforunately, it only trains them to offer injections and medications as far as treatments. Imagine a well trained MD focusing on the science of exercise, ergo correction and manipulation as well as pharmaceutical options. It would take the modern day physiotherapy programs and enhance the scope and effectiveness IMHO.
@Parenteau
You may find this review of interest
https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/nyas.13551
@ Rich Wiltshire
Re the label ‘Royal’ College of Chiropractors, it looks like Charles Windsor was involved. Apparently much of the early work on the statutory regulation of chiropractors was done at dinner parties attended by him:
http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/2192-the-pursuit-for-chiropractic-legislation.html
And then later, the College of Chiropractors was granted a Royal Charter despite failing to meet the requirements set out by the Privy Council:
http://www.ebm-first.com/chiropractic/uk-chiropractic-issues/2190-jubilation-in-the-chiropractic-world-but-as-usual-all-is-not-what-it-might-seem-at-first.html
While I’m here, the Royal College of Chiropractors’ recent article, entitled ‘the facts’ (see the link in Prof. Ernst’s blog piece above), claims that “NHS England’s National Low Back and Radicular Pain Pathway 2017, as endorsed by NICE…highlights the likely involvement of chiropractors according to local commissioning arrangements”. However, a closer look at that seems to indicate that it’s patient self-referral only:
http://www.noebackpainprogramme.nhs.uk/wp-content/uploads/2015/05/National-Low-Back-and-Radicular-Pain-Pathway-2017_final.pdf
As for the NICE Low Back Pain and Sciatica Guideline (as addressed by Prof. Ernst), it is a real problem for chiropractors and osteopaths. See here:
https://complementaryandalternative.wordpress.com/2016/12/06/nice-guidelines-for-low-back-pain-and-sciatica-a-clarification/
The college also ignores the reality of serious chiropractic adverse events, which, when weighed with the paucity of evidence of benefit, means that chiropractic cannot be recommended – and that’s before you consider the double standards in practice (i.e. subluxationist quackery). It is also wrong of the college to highlight the supposed requirement for “ensuring careful screening for known neck artery stroke risk factors”, when it is known that there are no reliable screening methods available.
I don’t represent the RCC but i suspect the main reason they haven’t invited you to do a lecture is this…
You won’t present any facts that they don’t already know….so your lecture has no value.
D.D.Palmer clearly stated:
“Chiropractic is founded upon different principles than those of medicine.”
If chiropractors no longer follow Palmer’s approach to healthcare they cannot legitimately claim to be chiropractors.
They are charlatans pretending they are party to valuable healthcare insights and knowledge, and may well be frauds.
I ask any chiropractor to explain:
“Why did you train as and qualify as a ‘chiropractor’ and not as a physiotherapist, nurse or doctor?”
Given the medical profession became regulated to protect the public against false claims, charlatans, quacks and healthcare frauds – why did you choose to enter a ‘profession’ unlicensed for medical practice in the UK?”
“What exactly do you ‘profess’?”
“Just what are you up to if not quackery?”
I also ask: “In what way is chiropractic different from physiotherapy or from osteopathy?”
(Answer, if they are honest: “In no way that matters.”)
I also ask the physiotherapy profession (Chartered Society of Physiotherapists) – “Why have you not applied for a Royal Charter as the Royal College of Physiotherapy?”
they might have applied for a royal charter – perhaps you need royal woo protection to get it these days?
The “Chiropractic clown colleges” promulgate the notion that a DC degree is somehow equivalent to a real-college degree in a true scientific or humanities endeavor…which of course it isn’t, or ever was. Their professional envy is palpable.
A DC degree is a means of pretending to be a doctor, to gain a modicum of the “prestige” and societal recognition these frauds think they so richly deserve but with none of the real leg work. You can see it in their Facebook posts suggesting their 4200 hours of college…”is more than an MD”. Lol
They constantly extol the “incredible value” to mankind this “big idea” represents, but at best merely create mundane alterations in symptoms while taking fullest credit for any coincidental pain-attrition and natural healing. IF a condition is self-limiting then it IS a case for a DC…treating real shit ain’t in their bag of tricks.
THIS being the real “big idea”….wealth through obfuscation, fraud and conniving.
The less-reprehensible among them use this non-degree to cloak themselves in the work of real science based clinicians…but always infuse some sort of “subluxation-dogma” into the mix to assure the greatest patient retention income.
And while all of them share the same clown-DC-degree we see a group of nay-sayers in their desperate attempt at an income-stream try the separation-ploy “I’m not like those other quacks….”.
I lived through being married to one for 10 years and am lucky to have escaped with my IQ (and normal penis girth) in tact.
They are a profession of idiots and reprobates or more likely both.
Majority of Chiropractors don’t believe in Plamer’s dogma. The majority treats neuromusculoskeletal issues and they treated effectively. Chiropractic saved my back and helped me go back to work , where the only solution for allopathic medicine is rest and medications which was not helpful.
I’ve been reading your blog for a couple of years , homeopathy is absurd and you are doing a great thing to talk about it.
Spinal manipulation works (the literature you always downplay) and help in neuromusculoskeletal issues and the funny part I know MDs who seek help for their backs.
You need to change the tone of you blog and stop painting all chiropractors with the same brush. if not it will become: Edzard Ernst and his band of grumpy retirees echo chamber…
change the tone so that opinion dominates over evidence, perhaps?
I have no intention to do that, and therefore ask you: where is the evidence that spinal manipulation is effective in neuromusculoskeletal issues? why does NICE no longer recommend it for low back pain? is NIce an organisation of grumpy retirees? do you know that your personal experience does not amount to evidence?
Citizen Kane wrote: “Majority of Chiropractors don’t believe in Plamer’s [sic] dogma.”
Do you have good evidence for that?
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://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922917/
@ DrDale
That study by McGregor et al, which you think, like many chiropractors, shows that only 18% of chiropractors delivered inappropriate treatment…
Ref: https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-14-51
…does not carry the good news that you (and they) evidently hoped for.
Significantly, the study stated:
QUOTE
“As with any investigation, this study has limitations. First, although the response rate was good at 68%, it remains unclear what practice perspectives and behaviours are associated with non-participants. Also, although the sample was randomly selected and stratified according to the number of licensed practitioners in each province, the sample represented only approximately 12 percent of practitioners from each province. As always, there is the possibility that despite the randomization scheme, a unique sample was selected, and generalizability is a possible concern.”
Certainly, the results were somewhat inconsistent with other available data:
https://tinyurl.com/pts2ns5
Indeed, McGregor’s 1st, 3rd, 4th, 5th, and 6th subgroup descriptions don’t seem to exclude the unethical chiropractor element. IOW, 5 of the 6 subgroups could easily indulge in chiroquackery – (1) “Wellness”, (3) “general probs”, (4) “organic-visceral”, and (5/6) “subluxations”.
Also, according to Science Based Medicine author, Jann Bellamy: “The survey was of Canadian chiropractors, most of whom graduated from Canadian Memorial Chiropractic College, which appears to have a more orthodox orientation than, for example, Life or Palmer…the groups not included in the unorthodox category doesn’t mean the others are necessarily free of unorthodox views.”
@BW. Your question was regarding Palmer dogma. The McGregor paper centered around some of the basic and fundamental concepts of Palmer dogma and came up with a set of predictors calculated at 18%. If you have better published survey research that deals with the topic please share it.
From your link re NICE….
“Massage and manipulation by a therapist should only be used alongside exercise because there is not enough evidence to show they are of benefit when used alone.”
Their 2016 guideline…did it change in 2017?
1.2.7 Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy.
https://www.nice.org.uk/guidance/NG59/chapter/Recommendations#non-invasive-treatments-for-low-back-pain-and-sciatica
@ DrDale
The NICE guidelines say that spinal manipulation can no longer be used in isolation for low back pain.
The following has already been linked to in the comments on this post, but here are the salient points:
QUOTE
“The recently published NICE guidelines for low back pain and sciatica are clear and unambiguous. However, they seem to have been misinterpreted by some people. One area where this has happened is the part about manual therapy. Here is what the guideline says: ‘Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy.’
I have seen this misinterpreted as:
• Select just the bits you like
• Manual therapy with exercise or psychological therapy
• Exercise and manual therapy is the choice for low back pain
• Osteopathy or manual therapy continues to be the treatment of choice for low back pain with the proviso that it is provided with exercise
It’s important to understand that the wording from the guideline above makes it clear that exercise is a mandatory part of a treatment package. Manual therapy and psychological therapy are optional add-ons but exercise is compulsory.
That means that the treatment options are: exercise alone, exercise plus manual therapy, exercise plus psychological therapy, exercise plus manual therapy and psychological therapy. Using a treatment package that consists of manual therapy alone, psychological therapy alone or manual therapy plus psychological therapy does not comply with the guidance.
It’s also important to understand that there is no requirement to provide a multimodal treatment package and in some cases exercise alone will be the most appropriate treatment. You certainly can’t ‘select just the bits you like’ as exercise is not an optional component.
Now let’s look at what the NICE guidelines say about exercise: ‘Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica. Take people’s specific needs, preferences and capabilities into account when choosing the type of exercise.’
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. I have already highlighted the fact that osteopathy and chiropractic are no longer first line treatment choices for low back pain and sciatica https://complementaryandalternative.wordpress.com/2016/11/30/osteopathy-and-chiropractic-no-longer-recommended-as-a-first-line-treatment-for-low-back-pain-or-sciatica/
NICE have made it clear in their own press release https://www.nice.org.uk/news/article/nice-publishes-updated-advice-on-treating-low-back-pain that exercise is the ‘first step in managing the condition’. The right person to deliver an exercise programme is of course a physiotherapist.
Ultimately, the purpose behind these guidelines is to bring about improvement in care for patients.
-snip-
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:
1. It doesn’t seem to be in the best interest of their patients
2. They risk being found in breach of their ‘Practice Standards’ which could result in formal complaints to either the GOsC or GCC. ”
[/END OF QUOTE]
Ref: https://complementaryandalternative.wordpress.com/2016/12/06/nice-guidelines-for-low-back-pain-and-sciatica-a-clarification/
And of course the next NICE guidelines might eliminate manipulation completely if the following are anything to go by:
https://edzardernst.com/2015/08/chiropractic-spinal-manipulation-placebo/
https://bodyinmind.org/spinal-manipulative-therapy-a-slow-death-by-data/ (I understand that the academic author of this blog post served on the NICE NG59 Guideline Development Group.)
@ Blue Wode
Group exercise was only recommended on the basis of cost saving as NICE guidelines will be used on the NHS.
Exercise can still be done on individual basis but this has to be down to the patient.
Do NICE specify in their guidelines that a physiotherapist is the right profession to deliver an exercise program?
Also, is there conclusive evidence to show one type of exercise is better than another?
Maybe Prof. Ernst is right when he wrote “My advice to patients (with back pain) is therefore to walk (slowly and cautiously) to the office of their preferred therapist, have a little rest there (say hello to the staff perhaps) and then walk straight back home.”
@BW. What percentage of chiropractors use spinal manipulation in isolation? According to surveys I’ve read, very few, maybe less than 2% of the profession.
Regarding the topic of exercise, yes, the current evidence supports it as a first line approach, I have no issues with this approach. Of course, one also has to look at the barriers to exercise in persons with acute, recurrent and chronic LBP. The reoccurring theme of reported barriers is pain and fear avoidance.
Read the evidence you dope. Take iff your vlunkers. Where is evidence for over 300 drugs that have been recalled in last decade
Where us evidence for over orescriotion surgery ant biotics. Medicine has a long history of hatm from.mirning after tablets to breast implants to advocating smoking. Get off your high horse. Lrica for back pain. Opioids for back pain now 6000p deaths a year in us. Over use if ant deoressants ..a sick care industet
always nice to receive a polite comment!
which evidence are you referring to; could you please provide a link?
drugs are being withdrawn usually because of side-effects; this shows that pharmacovigilance is working. chiros do not even have a vigilance system!
and finally a tip: learn to spell/type.
@ Edzard
NICE do recommend spinal manipulation for low back pain – just not on its own and not as first line treatment
I didn’t asked you to replace evidence with opinion. In matter of fact I’m asking you to use evidence and stop generalizing … Not sure what NICE recommendation you are talking about., but when I went to the a previous article, you put Acupuncture , Osteopathy and Chiropractic in same basket as an example of one brush approach: https://edzardernst.com/2016/03/nice-no-longer-recommends-acupuncture-chiropractic-or-osteopathy-for-low-back-pain/
This talks about Acupuncture mainly https://www.nice.org.uk/news/press-and-media/exercise-not-acupuncture-for-people-with-low-back-pain-says-nice-in-draft-guidance
Quote from the article: “According to musculoskeletal physician and GP Dr Ian Bernstein*, who is on the group developing the guideline: “The diagnosis of back pain includes a variety of patterns of symptoms. This means that one approach to treatment doesn’t fit all. Therefore the draft guidance promotes combinations of treatments such as exercise with manual therapy or combining physical and psychological treatments. The draft guideline also promotes flexibility about the content and duration of treatments, and the choices made should take into account people’s preferences as well as clinical considerations.”
Also you are mixing CLBP with LBP .
I respect your work and I believe you are sincere in defending science but generalizing never helped anyone and especially in science.
really?
you don’t approve of homeopathy – so, my criticism of homeopathy is ok in your view.
you approve of chiropractic – so you dislike my criticism of it.
have you considered that you might be wrong?
Here’s some good examples of DC doing marvelous work : https://www.airrosti.com/home/written-testimonials/
(I guess plenty of anecdotes)
And treated injuries https://www.airrosti.com/injuries-we-treat/
you need to understand what evidence amounts to, I think
https://edzardernst.com/2012/11/what-is-and-what-isnt-clinical-evidence-and-why-is-the-distinction-important/
1. Entrepreneurial theatrics masquerading as health-care for over 100 years.
2. A chiropractor is as a chiropractor does….no matter what that is as long as it sells.
3. Evidence doesn’t exist that pain can be “treated-away” by or at the hands (or mallets) of another.
4. DCs are some of the most tenacious “tuff-protectors” in the whole SCAM world…money is their soul.
5. A $200,000, non-transferable, unrecognized degree allowing no future but that of an independent scam-artist with NO hospital internship…does NOT a doctor make.
6. THAT an occasional MD patronizes a DC or Facebook posters claim amazing-results alters nothing. Many of these folks think a crucified Jew wanders the heavens changing the weather for believers’ picnics. Amen.
A very chiropractic pickle:
(via this link: http://www.abc.net.au/news/2018-07-30/sydney-chiropractor-deregistered-over-cancer-cure-claims/10052272)
A Sydney chiropractor who falsely claimed spinal manipulation treatments could prevent and cure cancer has had his registration to practise cancelled.
Hance Limboro was the first Australian to be prosecuted by the Australian Health Practitioner Regulation Agency last year for misleading advertising relating to a series of articles on a website called Cancer Cure Sydney.
He was convicted of 11 counts of false and misleading advertising and two counts of using testimonials to advertise a regulated health service in February last year and fined $29,500.
Two of the articles were titled: “Chiropractic Treatment as a Cancer Cure” and “Cancer Prevention with Regular Chiropractic Treatment”.
On Monday the NSW Civil and Administrative Tribunal cancelled his registration, describing his actions as “calculated”, “unethical” and “predatory”.
It also prohibited him from providing any health service for two years.
The Cancer Cure Sydney website included claims such as “cancer is 100 per cent preventable” and “by having a regular visit to a chiropractor, people can rest assured that they are prevented from having cancer”.
“A natural cancer cure that most people choose nowadays is chiropractic treatment as it has no significant side effects and guarantees long-term relief,” one advertisement claimed.
Mr Limboro argued that, while he had been found guilty of the offences, he had not claimed to cure cancer himself and was still a suitable person to be a chiropractor.
He told the tribunal hearing he had not written nor read the relevant articles before they were posted online and that he had employed a third party to build content that linked back to the website for his CBD clinic.
He said he had paid a heavy price for “poor delegation and not checking the material because it was made available in the general public”.
Limboro an ‘active participant’, tribunal found
Under cross examination, Mr Limboro said he did not think that using the word “cure” in the website’s name would mislead the public as the word also meant “pickled”.
However, when repeatedly pressed he did eventually concede that at least some people searching for the word “cure” in association with “cancer” may actually have cancer and be seeking a cure.
The NSW Civil and Administrative Tribunal found Mr Limboro was not suitable for registration as a chiropractor and his offences rendered him “unfit in the public interest to practise”.
It found that he took no steps to stay up-to-date with advertising standards and failed to understand why the material on his website may be dangerous or misleading.
“Of far greater concern is the finding that the practitioner was an active participant in a calculated scheme to cast a wide net of false and misleading website names, keywords and content intended to capture the traffic of those searching for health information and assistance concerning cancer, and then divert them to his business,” the judgment said.
“This conduct was extremely unethical and unprofessional; it was from the outset a predatory business venture, not an unintentional failing through oversight or lack of attention to developing standards.”
I reiterate my questions which, if answered honestly, would expose the quackery that is chiropractic:
I ask any chiropractor to explain:
“Why did you train as and qualify as a ‘chiropractor’ and not as a physiotherapist, nurse or doctor?”
Given the medical profession became regulated to protect the public against false claims, charlatans, quacks and healthcare frauds – why did you choose to enter a ‘profession’ unlicensed for medical practice in the UK?”
“What exactly do you ‘profess’?”
“Just what are you up to if not quackery?”
I also ask: “In what way is chiropractic different from physiotherapy or from osteopathy?”
(Answer, if they are honest: “In no way that matters.”)
Chiropractors should retrain in a reputable profession.
Tough.
We cannot always achieve our hearts desire and we have to move on – I never got a chair as a professor.
And chiropractors with integrity should actively advise intending students to avoid the sunk cost fallacy and not to train as ‘chiropractors’ in the first place.
I suspect many know this perfectly well but actually want to be quacks – for the profit motive and the prophet motive (which brings ego satisfaction).
They should not be surprised at the antipathy their activities generate.
AN Other wrote on Tuesday 31 July 2018 at 10:54: “Do NICE specify in their guidelines that a physiotherapist is the right profession to deliver an exercise program?…Also, is there conclusive evidence to show one type of exercise is better than another?
I don’t think so, and I don’t know.
AN Other wrote Tuesday 31 July 2018 at 10:54: “Group exercise was only recommended on the basis of cost saving as NICE guidelines will be used on the NHS….Maybe Prof. Ernst is right when he wrote “My advice to patients (with back pain) is therefore to walk (slowly and cautiously) to the office of their preferred therapist, have a little rest there (say hello to the staff perhaps) and then walk straight back home.” ”
I agree with you. It would save the NHS a small fortune and also prevent many unwitting customers from being ensnared by the chiropractic bait and switch:
https://sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/
Also, with regard to chiropractic, people would avoid wasting their money and risking their lives.
@ Blue wode
So your recommendation of Physiotherapy is not based on NICE guidelines. Why are you happy to recommend something that is not based on the NICE guidelines?
Also, it is still not against the NICE guidelines to offer a patient a one to one exercise class is the patient chooses to.
Bait and switch can happen in all professions. see:
http://www.dcscience.net/2013/06/10/connect-physical-health-sells-quackery-to-nhs/
@ Blue Wode
Still no answer
@ AN Other
It boils down to cost and practitioner integrity. I agree with compandalt’s comment below:
QUOTE
“You are correct that the basis for the recommendation of group exercise rather than individual was cost effectiveness. However, cost effectiveness matters in all contexts not just in the NHS. If the patient is self-funding then unless they are sufficiently wealthy that cost is no object (a small minority of patients) long-term compliance with the exercise program may be impacted if the cost is higher.”
Ref: https://edzardernst.com/2018/07/the-royal-college-of-chiropractics-pathetic-attempt-at-re-inventing-chiropractic/#comment-104642
With regard to the bait and switch of unscientific medicine, scientific medicine might have its flaws, but it’s no excuse for chiropractic not having put its house in order in 123 years. With the British Chiropractic Association not seeming to care http://www.mccoypress.net/i/bca_bennett_letter_december_2016.jpg it’s likely that most chiropractors aren’t bothered about serious reform.
@ blue wode
Can you answer this question:
Why are you happy to recommend something (physiotherapy providing exercise programmes) that is not based on the NICE guidelines?
DrDale wrote on Tuesday 31 July 2018 at 13:38 “@BW. Your question was regarding Palmer dogma. The McGregor paper centered around some of the basic and fundamental concepts of Palmer dogma and came up with a set of predictors calculated at 18%. If you have better published survey research that deals with the topic please share it.”
@DrDale
You are the one who needs to provide better data.
Meanwhile, there are over 1,000 *declared* Palmerists in the UK (that’s c. 30% of all UK chiropractors):
https://twitter.com/Blue_Wode/status/839138108939583488
DrDale wrote on Tuesday 31 July 2018 at 13:48: “@BW. What percentage of chiropractors use spinal manipulation in isolation? According to surveys I’ve read, very few, maybe less than 2% of the profession. Regarding the topic of exercise, yes, the current evidence supports it as a first line approach, I have no issues with this approach. Of course, one also has to look at the barriers to exercise in persons with acute, recurrent and chronic LBP. The reoccurring theme of reported barriers is pain and fear avoidance.”
@ DrDale
None of what you say justifies the use of chiropractic (for reasons already given above).
As long as people actually get better i dont care who they see as a provider.
The chiropractic profession may self implode, or the EB crowd may splinter off, sobeit.
bravo!
let’s all go to the barber surgeon and have some blood-letting!!!
Obviously, i was referring to the three providers which you originally listed…DC, PT, DO.
I am sure some osteos and chiros could be persuaded to start blood-letting too.
Last i saw bloodletting (aka phlebotomy) was still indicated for haemochromatosis, polycythaemia vera and porphyria cutanea tarda.
I’d suggest DCs currently stick to the more common NMSK conditions.
but they don’t!
bed-wetting, asthma, GI problems, otitis, etc.
[btw: haemochromatosis, polycythaemia vera and porphyria are not indications for blood-letting but for haemodilution – quite different]
“Low-risk patients are treated first line with low-dose aspirin and phlebotomy.”
Recommendations for the diagnosis and treatment of patients with polycythaemia vera.
Hatalova A, et al. Eur J Haematol. 2018.
wrong! you have to take out the red cells via a phlebotomy and then fill up the volume with a plasma expander. if not the patient might get hypovolaemic which under certain circumstances can be dangerous. of course, it depends on the volume you take out; small volumes might not need the plasma expander.
“Not only is there compelling evidence that increased blood viscosity due to an elevated red cell mass is the principal basis for the hypercoagulable state in polycythemia vera, there is equally strong evidence that phlebotomy, a venerable practice that was well known in the Hippocratic era, is the most effective remedy.”
Polycythemia vera: myths, mechanisms, and management
Jerry L. Spivak
Blood 2002 100:4272-4290
you are good at copying texts.
but I (by coincidence) did the original research underlying them.
type my name and ‘blood viscosity’ into Medline, and you get exactly 100 papers
https://www.ncbi.nlm.nih.gov/pubmed/?term=ernst+e%2C+blood+viscosity
I’m not on Twitter.
Regardless, if you disagree with the findings of the paper…you have better data…its your responsibility to provide that data, not me.
@AN Other wrote on Tuesday 31 July 2018 at 10:54:
“Group exercise was only recommended on the basis of cost saving as NICE guidelines will be used on the NHS.
Exercise can still be done on individual basis but this has to be down to the patient.”
You are correct that the basis for the recommendation of group exercise rather than individual was cost effectiveness. However, cost effectiveness matters in all contexts not just in the NHS. If the patient is self-funding then unless they are sufficiently wealthy that cost is no object (a small minority of patients) long-term compliance with the exercise program may be impacted if the cost is higher.
@ANOther also wrote:
“Do NICE specify in their guidelines that a physiotherapist is the right profession to deliver an exercise program?
Also, is there conclusive evidence to show one type of exercise is better than another?
Maybe Prof. Ernst is right when he wrote “My advice to patients (with back pain) is therefore to walk (slowly and cautiously) to the office of their preferred therapist, have a little rest there (say hello to the staff perhaps) and then walk straight back home.””
The advice from Edzard Ernst there is not at all unreasonable as the guidelines do not specify a particular exercise type or specific professional to provide it. It wouldn’t be appropriate to push someone to undertake professional exercise advice if they would prefer to just do it of their own accord.
@ compandalt
Why are you happy to recommend something that is not based on the NICE guidelines? (that a physiotherapist is the right profession to deliver an exercise program.) see link below:
https://complementaryandalternative.wordpress.com/2016/12/06/nice-guidelines-for-low-back-pain-and-sciatica-a-clarification/
Also, the cost to a patient can be the same for a group exercise program or an individual exercise program. The cost effectiveness is on the provider of the exercise program.
My rationale for that recommendation is here: https://complementaryandalternative.wordpress.com/2017/01/28/should-osteopaths-provide-an-exercise-program/ and here: https://complementaryandalternative.wordpress.com/2017/02/26/should-osteopaths-provide-an-exercise-program-part-2/
The cost effectiveness recommendation of group exercise ahead of individual exercise comes from NICE. Do feel free to contact them with your views. I’m sure they’d be interested to hear your rationale and detailed health economic assessment that shows “the cost to a patient can be the same for a group exercise program or an individual exercise program”
@ compandalt
But you rationale for recommending physiotherapy is not based on the NICE guidelines. As you said yourself the NICE guidelines do not specify a profession to provide the exercise program..
Therefore do feel free to contact NICE because I am sure they would be interested to hear your rationale on what profession should provide an exercise program
Chiropractic only morphed into its pseudo-respectable position as a “back pain” specialty (equal to NSAIDs at 200xs the cost) because the health-care delusion of subluxation=dis-ease invented by the Palmers had stubbornly refused to manifest as anything but a non-sense money laundering scheme.
It is a profession replete in ignominy, thievery from other professions, bounders and reprobates….but with an occasional apologist trying to explain away the inequity the way a house fly may apologize for having to eat feces.
We all know every argument they can or will ever make….and they all smell bad.
Practitioners who are subluxation based are practicing a pseudo science. But what about someone who has a two degree background (sciences and kinesiology) who goes through chiro school and interns at a medical rehab clinic and practices with non chiros (PT’s, kinesiologists, athletic therapists) and works day in and day out successfully rehabing chronic low back and neck pain? And who follows evidence based guys like Stuart McGill and other cross disciplinarians?
Would you say the fact that they have DC after their name means they are the same as DD Palmerites?
And if so, would it not then be equally fair to place modern physicians in the category of physicians from the 1700’s who blood letted George Washington to death?
did they teach you this in your science course:
“Acupuncture is a complete and holistic system of medicine based on ancient Chinese theories of the flow of Qi, which can loosely be translated as energy within the body. When the body is in balance, Qi flows harmoniously within the channels and nourishes the organs and tissues. Pain and illness arise when the channels becomes blocked and Qi is not able to move freely.”
Nope. I was not in the acupuncture program. I was at the Southern California University of Health Sciences (formerly LACC). Along with the school in Toronto (its sister school) it represents an evidenced based attempt at chiropractic education. We did not learn to practice the DD and BJ model. We learned physio techniques and most of our professors were Medical Doctors. They were from Cuba, Iran and other countries which did not allow them to practice here without a lengthy residency which they could not afford to do and support their families.
@Mr. Pimento: No it wouldn’t be “equally fair”….unless your reasoning is like that of a Chiropractor.
ALL Chiropractic is by definition “subluxation-based”. If not, WTF are you frauds looking for when you accept a patient in-the-name OF your “Chiropractic” practice????? DC=doctor of Chiropractic. Chiropractic=finding and eliminating subluxation.
You need less Stuart McGill and more critical-thinking education.
As I stated, there are a wave of new schools in the chiropractic field that teach a physiotherapy, kinesiology based program, all the while teaching manipulation. But NOT the subluxation theory. I have never used this model. Again, peruse my actual work to get an idea: http://www.youtube.com/drparenteau
When a patient comes in, they may or may not receive manipulation. Active release, ergonomic reviews and exercise prescription are a constant (i.e.: physio/ex. rehab). When they do receive manipulation, they are told that this helps — among other things — to restore full motion. I explain that we do not know the exact mechanism, but that there is a temporary pain relief and increase AROM after joint manipulation. And that to include clean ergonomics, home therapies and exercises will help keep that range.
There are frauds and charlatans in my field. I am painfully aware of this. But please do not paint all of us with the same brush. Thank you.
Someone is suffering from a love of credentials (small penis?) and a sour disposition who has zero actual information about a profession of which he is not a member. So this is how you choose to spend your days? What a royal disappointment you must be to family, friends, and others with your extremely disjointed and disgruntled opinions. Which no one requested. Rating: 1/10
THIS IS GREAT!!!
you just won the award of the most stupid ad hominem ever – congratulations.
I’m not in the obsessive cult of Darwin worship, the cult of Managerialism, a member of the Far Right, a thief, a fence, or a computer hacker. And yet I have researched, studied and published on them all. Does that make my penis small too? I had no idea. Do Chiropractors all have larger then average penisis? Are they thicker than average? Chiropractors I mean.
I can see the bumper stickers now “Chiropractors, are thicker than the average penis”
There’s a market for that. Perhaps it’s the very same market into which chiropractors currently sell themselves.
I wonder what is the ratio of chiropractor commenters on this blog who flaunt the “Dr” honorific vs. real medical doctors (commenting here) who find a need to decorate their identity with such ornaments?
To me, this apparent vanity of chiropractors indicates a subliminal inferiority complex.
To be fair, Björn, and it really hurts to be fair to these harmful quacks, (so sorry) but it might mean they have a PhD (in something that is hopefully from a proper university) as opposed to an honorary title? Maybe everyone deserves the benefit of the doubt, unless they have been proven to be deliberate liars?
@Mike Sutton
I cannot recall having stumbled upon a chiropractor with a PhD. There probably are some.
Those who have a PhD usually prefer to add these letters after their names if needed.
Chiropractors call themsleves “Dr.” as a marketing ploy.
We have to keep our definitions clear in this discussion. ‘Chiropractic’ is the correct term for what DD Palmer invented and promoted on purely imaginary grounds. ‘Chiropractors’ are by definition purveyors of ‘Chiropractic’. If they find a need to distance themselves from DDP’s made up pseudomedicine they not only need to find another name for their trade, they need to demonstrate their credibility as science and evidence based health care providers.
Mr.[sic] Parenteau joins a crowd of Chiropractors who adamantly wish to be taken more seriously and tries to tell us they are different. My message to them is: Go and learn real evidence/science based health care and stop telling the world you are subluxationist charlatans by using a title that says you are subluxationist charlatans.
I can change mine from DrDale to this…it doesnt matter to me.
There are some skeptics that will acknowledge that there are EB chiropractors (but will debate the percentage or their value in healthcare).
Others i think are too invested (either emotionally, mentally or financially) to acknowledge the “split”.
AN Other wrote on Friday 03 August 2018 at 11:32 “@ blue wode Can you answer this question:
Why are you happy to recommend something (physiotherapy providing exercise programmes) that is not based on the NICE guidelines?”
@ AN Other
Because it will be cheaper for most people and will prevent potential chiropractic customers from becoming ensnared by the chiropractic ‘bait and switch’ (see my previous comments above).
Most importantly of all, the recommendation is not NOT based on the NICE guidelines:
Exercise
1.2.2 Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica. Take people’s specific needs, preferences and capabilities into account when choosing the type of exercise.
Ref. https://www.nice.org.uk/guidance/NG59/chapter/Recommendations#non-invasive-treatments-for-low-back-pain-and-sciatica
@ Blue wode
for the sake of clarity (and the double negative), are you recommending physiotherapy providing exercise programs based on NICE guidelines?
or
Recommending physiotherapy providing exercise programs regardless of the NICE guidelines?
@ AN Other
My recommendation is the result of a rational interpretation of the NICE guidelines.
@ Blue wode
Your recommendation is made on your own bias and is not based on the NICE guidelines.
@ AN Other
The NICE guidelines don’t specify a profession to provide the exercise program, however they do advise “Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS…”
How many chiropractors offer a group exercise programme within the NHS?
@ Blue Wode
1. So, you recognise that the NICE guidelines don’t recommend a specific profession to provide an exercise program but you still recommend a particular profession to provide an exercise program. It seems you are biased against the NICE guidelines.
2. It doesn’t matter how many chiropractors (or other professions) offer a group exercise program within the NHS because the NICE guidelines don’t specify a specific profession to provide an exercise program.
@ AN Other
What is it that you don’t understand about “My recommendation is the result of a rational interpretation of the NICE guidelines” ?
Also, you haven’t answered my question which was “How many chiropractors offer a group exercise programme within the NHS?”
@ Blue Wode
You say it is a rational interpretation of the NICE guidelines, I say it is a biased interpretation of the NICE guidelines. You seem to choose when to and when not to apply the NICE guidelines.
I answered your question in my reply above. Maybe you need to find out the answer to that question then you can make your point.
@ AN Other
I’ve made my points. If you’re finding comprehending them challenging, then, sadly, I can’t help you anymore.
@ Blue Wode
So disappointing, resulting to ad hominem. Anyway, all the best 🙂
The movement with EB chiropractors is to open “clinic gym hybrid”. This allows for specific rehab as well as the area to perform group programs. Others are opening clinics in existing gyms for a similiar purpose.
anything really to increase cash-flow!
Do you have valid evidence that those using a clinic/gym hybrid model is to “really to increase cash-flow”?
I should point out that the NICE guidelines are based on an assessment of cost-effectiveness, essential given that the NHS has limited resources.
There are many effective treatments that have not been assessed by NICE at all, though generally this is because it takes time before a new treatment (for instance a targeted cancer drug) can be evaluated.
And there are effective treatments which are rejected by NICE because they are simply too expensive when the NHS has other priorities (again, think how many vaccine doses can be bought for the price of a month’s treatment with a targeted cancer agent, typically about £5,000).
AN Other wrote on Monday 06 August 2018 at 08:19 : “@ Blue Wode So disappointing, resulting to ad hominem.”
@ AN Other
It was not an ad hominem.
You wrote on on Sunday 05 August 2018 at 15:06 “@ Blue Wode 1. So, you recognise that the NICE guidelines don’t recommend a specific profession to provide an exercise program but you still recommend a particular profession to provide an exercise program. It seems you are biased against the NICE guidelines. 2. It doesn’t matter how many chiropractors (or other professions) offer a group exercise program within the NHS because the NICE guidelines don’t specify a specific profession to provide an exercise program.”
But it does matter how many chiropractors offer a group exercise program within the NHS. As the answer is very few (if any), then it follows that physiotherapists are best placed to offer the program. How can that be biased?