MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

“There is a ton of chiropractor journals. If you want evidence then read some.”

This was the comment by a defender of chiropractic to a recent post of mine. And it’s true, of course: there are quite a few chiro journals, but are they a reliable source of information?

One way of quantifying the reliability of medical journals is to calculate what percentage of its published articles arrive at negative conclusion. In the extreme instance of a journal publishing nothing but positive results, we cannot assume that it is a credible publication. In this case, it would be not a scientific journal at all, but it would be akin to a promotional rag.

Back in 1997, we published our first analysis of journals of so-called alternative medicine (SCAM). It showed that just 1% of the papers published in SCAM journals reported findings that were not positive. In the years that followed, we confirmed this deplorable state of affairs repeatedly, and on this blog I have shown that the relatively new EBCAM journal is similarly dubious.

But these were not journals focussing specifically on chiropractic. Therefore, the question whether chiro journals are any different from the rest of SCAM is as yet unanswered. Enough reason for me to bite the bullet and test this hypothesis. I thus went on Medline and assessed all the articles published in 2018 in two of the leading chiro journals.

  1. JOURNAL OF CHIROPRACTIC MEDICINE (JCM)
  2. CHIROPRACTIC AND MANUAL THERAPY (CMT)

I evaluated them according to

  1. TYPE OF ARTICLE
  2. DIRECTION OF CONCLUSION

The results of my analysis are as follows:

  1. The JCM published 39 Medline-listed papers in 2018.
  2. The CMT published 50 such papers in 2018.
  3. Together, the 2 journals published:
  • 18 surveys,
  • 17 case reports,
  • 10 reviews,
  • 8 diagnostic papers,
  • 7 pilot studies,
  • 4 protocols,
  • 2 RCTs,
  • 2 non-randomised trials,
  • 2 case-series,
  • the rest are miscellaneous types of articles.

4. None of these papers arrived at a conclusion that is negative or contrary to chiropractors’ current belief in chiropractic care. The percentage of publishing negative findings is thus exactly 0%, a figure that is almost identical to the 1% we found for SCAM journals in 1997.

I conclude: these results suggest that the hypothesis of chiro journals publishing reliable information is not based on sound evidence.

8 Responses to Journals of chiropractic are not a reliable source of information

  • If you have a particular treatment you want evidence for then ask for it. You asked a vague question, so expect a vague answer. If you have no access to chiropractic journals then you can also find similar studies in physiotherapy journals.
    I have asked several times for a specific treatment you want evidence for and you have yet to answer. Is this because you lack the knowledge of what chiropractors actually treat? I can give you a list if that will help. To attack a profession you have no knowledge is the same as anti vaxxers and their attacks on the medical profession. I’ll ask you another question, if someone had listed as their primary injury to be te60., why would you object to them being treated by a chiropractor?

    • bizarre!
      I never asked you anything. are you sure you directed this to the right person; I think you did not even put it on the right post.

      • You asked for evidence of chiropractic treatment in another post, I suggested you either be more specific about which treatment you want information on or try reading their journals. Next day you posted this, hence my response. Are you going to ask a specific question or continue to be vague? That is the way of the anti vaxxers. So either ask about a specific treatment or admit you don’t understand what they do.

  • @EE
    “None of these papers arrived at a conclusion that is negative or contrary to chiropractors’ current belief in chiropractic care. ”
    Really?

    Chiropractors’ views on the use of patient-reported outcome measures in clinical practice: a qualitative study.
    Michelle M. Holmes, Felicity L. Bishop, David Newell, Jonathan Field and George Lewith
    Citation: Chiropractic & Manual Therapies 2018 26:50. Published on: 18 December 2018
    “chiropractors only occasionally use condition-specific PROMs (such as the Oswestry Questionnaire) and generalised PROMs (such as the SF-36) [21]. Bussières et al. [22] suggest that effort should be placed on addressing this knowledge-to-practice gap and improve implementation of PROMs in clinical practice.”

    The interrater reliability of static palpation of the thoracic spine for eliciting tenderness and stiffness to test for a manipulable lesion.
    Amber M. Beynon, Jeffrey J. Hebert & Bruce F. Walker Chiropractic & Manual Therapiesvolume 26, Article number: 49 (2018).
    “In comparing other reliability studies of static palpation, the findings are similar to our own i.e. a low level of reliability with static palpation alone for spinal stiffness. ”

    Current evidence for spinal X-ray use in the chiropractic profession: a narrative review
    Hazel J Jenkins, Aron S Downie, Craig S Moore & Simon D French. Chiropractic & Manual Therapiesvolume 26, Article number: 48 (2018)
    “The use of spinal X-rays in chiropractic has been controversial, with benefits for the use of routine spinal X-rays being proposed by some elements of the profession. However, evidence of these postulated benefits is limited or non-existent. There is strong evidence to demonstrate potential harms associated with spinal X-rays including increased ionising radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased unnecessary costs. Therefore, in the vast majority of cases who present to chiropractors, the potential benefit from spinal X-rays does not outweigh the potential harms. Spinal X-rays should not be performed as a routine part of chiropractic practice, and the decision to perform diagnostic imaging should be informed by evidence based clinical practice guidelines and clinician judgement.”

    O-04 Is effectiveness of Chiropractic Maintenance Care moderated by psychological profile? A secondary analysis of a pragmatic randomized controlled trial.
    Andreas Eklund1, Irene Jensen1, Charlotte Leboeuf-Yde2, Alice Kongsted3, Iben Axén1
    “Patients who, on the other hand, report low pain severity, low interference with everyday life due to pain, low life distress, high activity level and high perception of life control are likely to not benefit from MC and should be recommended care only when they experience a relapse of pain.”

    Comparing the old to the new: A comparison of similarities and differences of the accreditation standards of the chiropractic council on education-international from 2010 to 2016
    Stanley I. Innes, Charlotte Leboeuf-Yde & Bruce F. Walker. Chiropractic & Manual Therapiesvolume 26, Article number: 25 (2018)
    “We found that CCE-International accreditation standards of 2016 have, in general, moved in a positive direction. However, some differences and omissions were not positive. These were not in accord with the evolution of public health frameworks that has seen a move toward engaging a broader range of stakeholders and a move toward the community collective values of transparency, evidence-based effectiveness, and accountability”

    Unravelling functional neurology: a critical review of clinical research articles on the effect or benefit of the functional neurology approach
    Anne-Laure Meyer & Charlotte Leboeuf-Yde. Chiropractic & Manual Therapies volume 26, Article number: 30 (2018)
    “This journal contains no acceptable evidence on the effect or benefit of FN in relation to various conditions and purported indications for intervention.”

    This was just a small sample and took me 10 minutes.
    To quote you again:
    “None of these papers arrived at a conclusion that is negative or contrary to chiropractors’ current belief in chiropractic care” – Edzard Ernst.
    Really.
    You have read the actual articles?
    NONE. Hmmmmmmm

    • As I am off to fly to Sweden for a lecture today, I respond in a great hurry.
      1) Holmes et al: “The results from the study suggested chiropractors use PROMs with their individual patients, but PROMs should be meaningful to patients and chiropractors to improve engagement.”
      2) Beynon et al: “Static palpation was overall moderately reliable…”
      3)Jenkins et al: “The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.”
      4)Eklund et al: cannot find this paper in a hurry
      5) Innes et al: “Some positive changes have taken place, such as having bravely moved towards the musculoskeletal model…”
      6) I did not consider functional neurology to be chiropractic
      I did not consider that these papers were contrary to chiropractors’ current belief in chiropractic care.

      • “I did not consider that these papers were contrary to chiropractors’ current belief in chiropractic care.”
        Charlotte LeBouuf-Yde ripping apart Functional Neurology?
        “I did not consider functional neurology to be chiropractic”.
        Ted Carrick ring any bells?
        I have been told that a FN guru accosted Charlotte at a conference and screamed in her face R.E. this paper.

        Hazel Jenkins paper has provoked a heated response from Deed Harrison.

  • I’m curious to know the proportion of published negative findings in other scientific journals. I have serious criticisms of chiropractic journals, but publication bias is not unique to alternative medicine.

    What I find more troubling is the high proportion of case reports. I have never encountered a case report published in a chiropractic journal that is not a classic case of post hoc ergo propter hoc. Surveys also tend to be quite dubious. I frequently encounter chiropractors falsely marketing breech resolution from Webster’s technique where they cite a survey of chiropractors’ attitudes towards how successful they feel it is. The state of chiropractic education in the sciences is really quite sad.

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