In previous posts, I have been scathing about chiropractors (DCs) treating children; for instance here:
- Despite calling themselves ‘doctors’, they are nothing of the sort.
- DCs are not adequately educated or trained to treat children.
- They nevertheless often do so, presumably because this constitutes a significant part of their income.
- Even if they felt confident to be adequately trained, we need to remember that their therapeutic repertoire is wholly useless for treating sick children effectively and responsibly.
- Therefore, harm to children is almost inevitable.
- To this, we must add the risk of incompetent advice from DCs – just think of immunisations.
Now we have more data on this subject. This new study investigated the effectiveness of adding manipulative therapy to other conservative care for spinal pain in a school-based cohort of Danish children aged 9–15 years.
The design was a two-arm pragmatic randomised controlled trial, nested in a longitudinal open cohort study in Danish public schools. 238 children from 13 public schools were included. A text message system and clinical examinations were used for data collection. Interventions included either (1) advice, exercises and soft-tissue treatment or (2) advice, exercises and soft-tissue treatment plus manipulative therapy. The primary outcome was number of recurrences of spinal pain. Secondary outcomes were duration of spinal pain, change in pain intensity and Global Perceived Effect.
No significant difference was found between groups in the primary outcomes of the control group and intervention group. Children in the group receiving manipulative therapy reported a higher Global Perceived Effect. No adverse events were reported.
The authors – well-known proponents of chiropractic (who declared no conflicts of interest) – concluded that adding manipulative therapy to other conservative care in school children with spinal pain did not result in fewer recurrent episodes. The choice of treatment—if any—for spinal pain in children therefore relies on personal preferences, and could include conservative care with and without manipulative therapy. Participants in this trial may differ from a normal care-seeking population.
The study seems fine, but what a conclusion!!!
After demonstrating that chiropractic manipulation is useless, the authors state that the treatment of kids with back pain could include conservative care with and without manipulative therapy. This is more than a little odd, in my view, and seems to suggest that chiropractors live on a different planet from those of us who can think rationally.
hehehe … It’s conclusions like this one that offer insight into the bottomless bucket of Alternative Medicines filled with faith based pseudomedical stories as told by chiropractors, homeopaths, and acupuncturists, inasmuch as each of their enterprises claim to successfully treat the very same patient complaints… in this case, pain.
The question has always been, on what basis does an Alt-Med advocate choose to go to one AM practitioner over another when opening the phone book to seek care for any given complaint or concern. The conclusion of this study suggests, in fact tells you outright, that the choice is a matter of PERSONAL PREFERENCE only and not what treatment cuts therapeutic mustard. Notably, for the survival of any Alt-Medical Choice in the face of contradictory science, there can BE no argument in matters of taste.
Have you noticed? 🙂
In other words, for the Alternativist practitioner and consumer, results from studies that demonstrate no effect are ignored in favor of personal opinion and psycho-aesthetic preference. That may fine for food, art and music, but not medicine … you’d think. Nonetheless, Alt-Medicine continues to enjoy and profit from an unscientific world in which anything can cause, and anything can treat anything.
Indeed, “participants in this trial may differ from a normal care-seeking population.” But to the extent that a practitioner would practice or a consumer would continue to seek care, no matter, in the face of studies that can’t demonstrate a difference in therapeutic outcomes, that is the extent to which scientific restraint and restrictions do not apply. For example, homeopathy, The Medicineless Medicine and Great Teacher tells us all we need to know about this “phenomenon.” To wit, we know homeopathy can’t work; so, the only remaining question has always been why do adherents believe it does. The conclusion of this study tells us that “can’t work” doesn’t — and never will — matter. It’s only personal preference informed by belief and psycho-aesthetic that does.
Have you noticed? 🙂
Interesting conclusion in the paper. It’s similar to this ridiculous one which was co-authored by a chiropractic academic:
“CLINICAL BOTTOM LINE
The evidence suggests that chiropractic has no benefit over placebo in the treatment of infantile colic. However, there is good evidence that taking a colicky infant to a chiropractor will result in fewer reported hours of colic by the parents.
In this clinical scenario where the family is under significant strain, where the infant may be at risk of harm and possible long term repercussions, where there are limited alternative effective interventions, and where the mother has confidence in a chiropractor from other experiences, the advice is to seek chiropractic treatment.”
Yeah but now the physical therapists are jumping on board Edzard and started calling themselves “Osteopractors” and claiming a high degree of evidence based treatment.
It is very important to note that no harm occurred to any child receiving chiropractic manipulative therapy for the neck or lower back from any of the seven chiropractors involved in this study. As such it can be again stated that the risk of chiropractic treatment is real but rare.
Regarding that the reoccurrence rate was mostly equal between the two groups. Maybe further examination involving standing x-ray imaging may reveal spinal displacements, that if reduced using structural rehabilitation may lead to a better outcome, to either group.
An example I will provide is in the management of cervicogenic dizziness. The MT and Non-Mt tested did equally well at 10 weeks but the group that was identified to have a loss of cervical lordosis and had structural rehabilitation of their cervical lordosis had greater and longer lasting improved function at one year follow up. https://www.ncbi.nlm.nih.gov/pubmed/27575013
I have taken images of numerous children and discovered the presence of cervical kyphosis and spondylothesis which needed structural rehabilitation.
Ya know, Doctor … the Chiropractic Spine does not hold the secrets of health and disease. Nonetheless and importantly, The Chiropractic Assertion that the Chiropractic Spine DOES hold The Answer continues to broadly underpin what chiropractors think, say, and do. To be sure, it’s what uniquely defines “chiropractic” and how chiropractors in the field, like yourself, can be readily identified, selling and serving one or another of the rich panoply of fictitious Subluxation/Adjustment (diagnostic/treatment) pairs that define what chiropractors do in their office.
It occurs to me that you would be doing readers a favor by describing your particular Brandname Chiropractic Technic, which is to say which of the many chirodigms you have chosen to guide your diagnostic and treatment protocols used on all your patients. Extra points for describing how, what you think, say, and do as a chiropractor resonates with what I wrote above. Even more points to say how your management of the dizziness patient you describe differs from what you would do for any other patient complaint.
As a courtesy and aid to know where I stand on the above, I offer the following expanded versions of what I’m saying about The Chiropractic Spectacle HERE:
I’m pretty confident you can locate yourself and your “chiropractic” in most all of my replies to the viewer mail I received after the PBS documentary “A Different Way to Heal?” first aired 🙂
Michael, I’m concerned at your reference to x-rays.
Such investigations are known to carry minimal risk to the customer / patient, so I query what information a chiropractor gives before exposing anyone to this device?
I’m a layman with limited awareness of micromorts / micro-lives as a measure of the risks for all manner of exposures, so please help me understand how exposures are justified as part of the chiropactor’s sales presentation.
By age 58, my dental X-rays have cost me several statistical hours of life: multiplied by the number of her patients, I could infer a total cost to life (justified by the necessity for dental health and producing a demonstrable net gain orders of magnitude greater).
With chiropractors, how many exposures are necessary to recoup the outlay for access to such equipment? What training is put to use? What could I reasonably infer to be the micromort cost to your (or any chiropractor) customers to date.
Though no statistician, I guess that estimates of averages multiples by U.K. chiropractic operators would give a reasonable estimate of the micro-lives (possibly whole lives?) lost to sustain the enterprise?
I see no plausible reasoning to infer customer benefits.
Genuinely, your numerical response would be enlightening, please?
Or should I scribble guesstimates on the back of an envelope?
Nice website by the way.
One X-ray pre day (60 mins of life lost) for 260 working days a year, over two and a half decades suggests a baseline of 9 months of life spent. Multiplied by, say 1,500 long-term chiropractors, that’s over 11,000 years of customer life – how far off am I, and what profit have these people gained?
Of course, the premise of these sums could be in error. I’d welcome whatever evidence you have to correct my conjecture.
ERNST, HOW CAN I HAVE MY PHOTOGRAPH INCLUDED IN THIS BLOG AND ALL FUTURE CORRESPONDENCE?
There’s no need to shout, Epstein.
This blog uses WordPress and that uses the Gravatar system for commenters’ avatars.
What you choose to put on all your future correspondence is entirely up to you.
Interesting that Edzard says the study is fine when it used the A+B design which he oftens declares as poor methodology.
Was it the results that made it fine?
if A+B does not show a benefit over B, the result is far less inconclusive that in the case where it does and the finding is interpreted as a specific effect of A. I think this is common sense, don’t you?
so the answer to my question would be “yes”.
no, the usefulness of a method depends on the question you want to answer.
if your question is ‘does this therapy have a specific effect?’, the design is useless.
if my question is ‘how useless is the addition of A to B?’, it can generate a useful answer.
[I say ‘my question’, because it was not the one the authors had in mind; they aimed at the 1st question and had chosen a useless study design to answer it. but, as things turned out, not all was lost]
Change the question to get the answer you want. Got it.
I doubt it