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

During my almost 30 years of research into so-called alternative medicine (SCAM), I have published many papers which must have been severe disappointments to those who advocate SCAM or earn their living through it. Many SCAM proponents thus reacted with open hostility. Others tried to find flaws in those articles which they found most upsetting with a view of discrediting my work. The 2012 article entitled ‘A Replication of the Study ‘Adverse Effects of Spinal Manipulation: A Systematic Review‘ by the Australian chiropractor, Peter Tuchin, seems to be an example of the latter phenomenon (used recently by Jens Behnke in an attempt to defame me).

Here is the abstract of the Tuchin paper:

Objective: To assess the significance of adverse events after spinal manipulation therapy (SMT) by replicating and critically reviewing a paper commonly cited when reviewing adverse events of SMT as reported by Ernst (J Roy Soc Med 100:330-338, 2007).

Method: Replication of a 2007 Ernst paper to compare the details recorded in this paper to the original source material. Specific items that were assessed included the time lapse between treatment and the adverse event, and the recording of other significant risk factors such as diabetes, hyperhomocysteinemia, use of oral contraceptive pill, any history of hypertension, atherosclerosis and migraine.

Results: The review of the 32 papers discussed by Ernst found numerous errors or inconsistencies from the original case reports and case series. These errors included alteration of the age or sex of the patient, and omission or misrepresentation of the long term response of the patient to the adverse event. Other errors included incorrectly assigning spinal manipulation therapy (SMT) as chiropractic treatment when it had been reported in the original paper as delivered by a non-chiropractic provider (e.g. Physician).The original case reports often omitted to record the time lapse between treatment and the adverse event, and other significant clinical or risk factors. The country of origin of the original paper was also overlooked, which is significant as chiropractic is not legislated in many countries. In 21 of the cases reported by Ernst to be chiropractic treatment, 11 were from countries where chiropractic is not legislated.

Conclusion: The number of errors or omissions in the 2007 Ernst paper, reduce the validity of the study and the reported conclusions. The omissions of potential risk factors and the timeline between the adverse event and SMT could be significant confounding factors. Greater care is also needed to distinguish between chiropractors and other health practitioners when reviewing the application of SMT and related adverse effects.

The author of this ‘replication study’ claims to have identified several errors in my 2007 review of adverse effects of spinal manipulation. Here is the abstract of my article:

Objective: To identify adverse effects of spinal manipulation.

Design: Systematic review of papers published since 2001.

Setting: Six electronic databases.

Main outcome measures: Reports of adverse effects published between January 2001 and June 2006. There were no restrictions according to language of publication or research design of the reports.

Results: The searches identified 32 case reports, four case series, two prospective series, three case-control studies and three surveys. In case reports or case series, more than 200 patients were suspected to have been seriously harmed. The most common serious adverse effects were due to vertebral artery dissections. The two prospective reports suggested that relatively mild adverse effects occur in 30% to 61% of all patients. The case-control studies suggested a causal relationship between spinal manipulation and the adverse effect. The survey data indicated that even serious adverse effects are rarely reported in the medical literature.

Conclusions: Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.

In my view, there are several things that are strange here:

  1. Tuchin published his paper 5 years after mine.
  2. He did not publish it in the same journal as my original, but in an obscure chiro journal that hardly any non-chiropractor would ever read.
  3. Tuchin never contacted me and never alerted me to his publication.
  4. The journal that Tuchin chose was not Medline-listed in 2012; consequently, I never got to know about the Tuchin article in a timely fashion. (Therefore, I did never respond to it.)
  5. A ‘replication study’ is a study that repeats the methodology of a previous study.
  6. Tuchin’s paper is therefore NOT a replication study. Firstly, mine was a review and not a study. Secondly, and crucially, Tuchin never repeated my methodology but used an entirely different one.

But arguably, these points are trivial. They should not distract from the fact that I might have made mistakes. So, let’s look at the substance of Tuchin’s claim, namely that I made errors or omissions in my review.

As to ‘omissions’, one could argue that a review such as mine will always have to omit some details in order to generate a concise summary. The only way to not omit any details is to re-publish all the primary papers in one large volume. Yet, this can hardly be the purpose of a systematic review.

As to the ‘errors’, it seems that the ages and sex of three patients were wrong (I have not checked this against the primary publications but, for the moment, I believe Tuchin). This is, of course, lamentable and – even though I have no idea whether the errors happened at the data extraction phase, during the typing, the revising, or the publishing of the paper – it is entirely my responsibility. I also seem to have mistaken a non-chiropractor for a chiropractor. This too is regrettable but, as the review was about spinal manipulation and not about chiropractic, the error is perhaps not so grave.

Be that as it may, these errors are unquestionably not good, and I can only apologise for them. If Tuchin had dealt with them in the usual way – by publishing in a timely fashion a ‘letter to the editor’ of the JRSM – I could have easily corrected them for everyone to see.

But I think there is a more important point to be made here:

Tuchin concludes his paper stating that it is unwise to make conclusions regarding causality from any case study or multiple case studies. The number of errors or omissions in the 2007 Ernst paper significantly limit any reported conclusions. I believe that both sentences are unjustified. The safety of any intervention in routine use has to be examined on the basis of published case studies. This is particularly true for chiropractic where no post-marketing surveillance similar to that for drugs exists.

The conclusions based on such evidence can, of course, never be firm, but they provide valuable signals that can prompt more rigorous investigations in the interest of patient safety. In view of such considerations, my own conclusions in my 2007 paper were, I think, correct and are NOT invalidated by my relatively trivial mistakes: spinal manipulation, particularly when performed on the upper spine, has repeatedly been associated with serious adverse events. Currently the incidence of such events is unknown. Adherence to informed consent, which currently seems less than rigorous, should therefore be mandatory to all therapists using this treatment. Considering that spinal manipulation is used mostly for self-limiting conditions and that its effectiveness is not well established, we should adopt a cautious attitude towards using it in routine health care. 

And my conclusions in the abstract have now, I believe, become established wisdom. They are thus even less in jeopardy through my calamitous lapsus or Tuchin’s ‘replication study’: Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation. 

 

 

31 Responses to A chiropractor’s ‘replication study’ of my review of the risks of spinal manipulation

    • thanks
      I had forgotten most of this

    • @BW
      In your first reference (yet another blog comment) you state:
      “It appears that Tuchin is not a good example of a researcher who is capable of profound critical thinking. For example, in the following letter to an editor he references the dubious chiropractic researchers Cassidy, Goertz, and Hartvigsen in support of his arguments:”
      Cassidy, Goertz and Hartvigsen “dubious”.
      Are you for real Blue?
      Time to stop citing endless blog BS/citing more blogs/citing more blogs………and start citing papers.

      • Critical_Chiro wrote: “Cassidy, Goertz and Hartvigsen ‘dubious’. Are you for real Blue?”

        @ Critical_Chiro

        Yes.

        Here’s an analysis of some of Cassidy’s flawed reasoning (credit – Björn Geir Leifsson, MD, for the first two quotes below):

        QUOTE:
        “Cassidy 2008 and other similar attempts at estimating away the risk of CAD after SMT has been reevaluated in later work and the mistakes analysed. Here is an excerpt from “Case Misclassification in Studies of Spinal Manipulation and Arterial Dissection” Xuemei Cai, MD, Ali Razmara, MD, PhD, Jessica K. Paulus, ScD, Karen Switkowski, MS, MPH, Pari J. Fariborz, Sergey D. Goryachev, MS, Leonard D’Avolio, MS, PhD, Edward Feldmann, MD, David E. Thaler, MD, PhD DOI: http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2014.03.007 :
        ‘The earlier studies omitted the dissection-specific codes (443.xx) in their case definition because they were not in use in Ontario at the time (personal communication, Navin Goocool, April 30, 2013). The population in our study did have these codes available, and therefore, to avoid an overestimation of case misclassification, we included the 3 additional dissection codes in our initial EMR query (‘‘modified Rothwell/Cassidy strategy’’).
        Cassidy et al [2008] suggested that the association between cases and PCP/SMT exposure was because of patients with pre-existing dissections seeking care for neck pain (reverse causation). However, if the ICD-9 code positive predictive value measured in the VA database is generalizable to the Ontario health system data, then the Cassidy study actually found an association between PCP visits and patients with conventional strokes due to atherosclerotic and cardioembolic mechanisms. This association is well known and has been described before. It is because of the frequent clinical visits needed to manage established vascular risk factors.10 Our sensitivity analysis suggests that the ORs for the association between SMT and CAD would be very large with accurately identified cases. Lastly, the misclassification may disproportionately affect ORs for those less than 45 years of age—a group of patients with a lower prevalence of atherosclerosis-related infarcts and a higher prevalence of strokes due to dissections.16 Given the small numbers of true cases, ORs within age strata could not be calculated, but our sensitivity analysis suggests the association between SMT and CAD in younger patients is markedly stronger after adjusting for case misclassification.’
        And what do they mean by “large” ? Among the subgroup of the population less than 45 years of age and applying the above assumptions, those with a chiropractor visit within 30 days of their stroke would have nearly 7 times the odds of CAD (OR 5 6.91, 95% CI 2.59-13.74).That means that the risk is most likely about seven fold and there is 95% chance that the true odds ratio is about between 2,6 to 13.7. That is nothing less than horrendous if correct.”

        Ref: https://edzardernst.com/2017/02/upper-neck-manipulations-by-chiropractors-regularly-cause-serious-harm-why-is-it-still-used/#comment-86782

        and…

        QUOTE:
        “In a hearing before the Connecticut State Board of Chiropractic Examiners Cassidy admitted upon a direct question, that a patient of his suffered stroke after spinal manipulation. He was asked whether he considered the manipulation to have caused the stroke. His reply was to the effect that he did think so at first but after researching the matter he no longer did.
        This fact does cast a different light on the whole matter and should be kept in mind when considering his choice of study subjects, designs and conclusions and when evaluating his results against other researcher’s findings. I certainly find it easier to understand some rather peculiar aspects of his study designs and deductive reasoning.
        I would not blame any therapist or clinician who has faced such a terrible adverse outcome in someone who placed their trust in his hands, if they looked for and tried to find support for the notion that they or their vocation were not to blame.
        David Cassidy has certainly pursued the question with ardour and an admirable academic arsenal, but has the incident, which must have been tormenting, affected his work and his deductive reasoning? I am inclined to suspect it did.”

        Ref: https://edzardernst.com/2017/02/upper-neck-manipulations-by-chiropractors-regularly-cause-serious-harm-why-is-it-still-used/#comment-86862

        I think it’s important to point out the David Cassidy’s integrity really is questionable. For example, he was sued for asking an employee to manipulate the stats in a paper to produce the results he wanted: http://www.chirosmart.net/nfaures.txt

        QUOTE
        “in or about September 1998, and contrary to all normal and appropriate practices and procedures in regards to independent medical research, she [Dr. Emma Bartfay] was instructed by Cassidy to produce certain statistical results that would support the end conclusion desired. Specifically . . . Cassidy instructed her to produce results and graphs that would support the conclusion that an injured person’s time (date) of settlement is a good proxy for the person’s time (date) of recovery” (Statement of Claim, In the Court of Queen’s Bench for Saskatchewan, Judicial Centre of Saskatoon, between Dr. Emma Bartfay, plaintiff, and The University of Saskatchewan and Dr. J. David Cassidy, Defendants. Filed May 21, 1999, Q.B. #1679 of 1999).”

        The insurance company that paid for the study to be performed allegedly attempted to influence the study as well. “Yong-Hing alleged that SGI‚ the province’s only motor vehicle injury insurer, which funded the study‚ wanted its contributions to pay for certain study expenses in a way that “could well be interpreted as an attempt by SGI to disguise the destination of Saskatchewan residents’ money” (Letter from Dr. Ken Yong-Hing, Professor and Head of Orthopedic Surgery, University of Saskatchewan, to Colin Clackson, President, Saskatchewan Trial Lawyers Association (Nov. 3, 1996) (on file with author).”

        Ref: http://scienceblogs.com/insolence/2009/02/04/the-most-ridiculous-kerfuffle-ever/#comment-55817

        I also think it’s important to record here how the Bartfay v. Cassidy case above proceeded:

        QUOTE
        “It was a great day for the advancement of individual rights in Saskatchewan when last Thursday, Justice Irving Goldenberg refused to drop Dr. David Cassidy from Dr. Emma Bartfay’s suit(1). Dr. Cassidy conducted a botched study of no fault insurance in Saskatchewan and Dr. Bartfay quit in the middle of the study saying that Cassidy tried to force her to fudge the data.
        Under no fault insurance injured people cannot sue for pain and suffering. As a result of Justice Goldenberg’s decision, Dr. Cassidy will have to disclose his contracts with the Saskatchewan Government Insurance (SGI) and he will have to answer questions on the circumstances of Dr. Bartfay’s dismissal from the University of Saskatchewan.
        Dr. Cassidy not only manipulated data to support the results SGI wanted, but he showed his copycat approach to researches by basing his results on the previous outdated Quebec study on no fault insurance and on the positive psychology that injured people recover their health faster if they focus on getting better rather than suing for pain and suffering. The Quebec study didn’t conduct any original research, as a matter of fact it was just a compendium of different researches; and the positive psychology movement has been disclaimed by recent researches(2), in fact “little data supports the idea that a positive attitude enhances health(3).”
        In the light of Tort Reform laws which diminish the people’s right to sue for punitive damages(4), I find Justice Goldenberg’s decision a small but significant step towards the betterment of the justice system in supporting individual rights and eventually in reestablishing punitive damages in wrongful dismissals. Punitive damages are not compensatory damages, they are exemplary damages and they tell employers that their callous, malicious, and in Dr. Bartfay’s case socially unacceptable behaviors in dismissing employees are not going to be tolerated. And the importance of punitive damages is becoming more relevant today when our no fault authorities are the perpetrators of such despicable behaviors.”

        References/endnotes:
        http://desantis.hypermart.net/EnsignStories_201-300/Ensign_story204/story204.htm

        and ultimately…

        “…on June 30, 2000, Dr. Barry McLennan, assistant dean of research in the college of medicine at the University of Saskatchewan, was writing in the StarPhoenix that a university committee “concluded there was absolutely no evidence of research misconduct.” Dr. McLennan also absolutely defended Dr. Cassidy’s study when employee Dr. Emma Bartfay, in filing a lawsuit against Dr. Cassidy and the University of Saskatchewan, was stating that she was told to produce statistical results that would prove that whiplash victims recovered faster under the province’s new no-fault system. Some weeks ago we learned that Dr. Bartfay agreed to drop her case against Dr. Cassidy and the University of Saskatchewan and that in return she was going to receive an undisclosed amount of money. This is the way public justice is brokered by the confidentiality of the private contract.
        The Free Market is the new invented socio-economic model where social frauds are legally perpetrated. So we have the much talked no-fault insurance research conducted by Dr. David Cassidy and funded by the Saskatchewan Government Insurance (SGI). I expressed my feeling that this research was a fraud as soon as I read the research’s conclusion that “the elimination of compensation for pain and suffering is associated with a decreased incidence and improved prognosis of whiplash injury”.
        I am not going to rebut the scientific methodology used by Dr. Cassidy in this no-fault study since we have reached today a level of social corruption which can be explained simply with our common sense rather than with the expertise of the Cassidys of this world.
        We must understand that the Free Market has its own shock absorbers so as to make sure that its performance is always protected; and this is why the free marketeers see the world in its static and reductionist way of divide and conquer rather than in its evolving dynamics.
        Yesterday we had the acknowledgment by the University of Saskatchewan that Cassidy’s study didn’t provide the injured participants with their informed consent. However, on June 30, 2000, Dr. Barry McLennan, assistant dean of research in the college of medicine at the University of Saskatchewan, was writing in the StarPhoenix that a university committee “concluded there was absolutely no evidence of research misconduct.” Dr. McLennan also absolutely defended Dr. Cassidy’s study when employee Dr. Emma Bartfay, in filing a lawsuit against Dr. Cassidy and the University of Saskatchewan, was stating that she was told to produce statistical results that would prove that whiplash victims recovered faster under the province’s new no-fault system. Some weeks ago we learned that Dr. Bartfay agreed to drop her case against Dr. Cassidy and the University of Saskatchewan and that in return she was going to receive an undisclosed amount of money. This is the way public justice is brokered by the confidentiality of the private contract.
        Yesterday, we had StarPhoenix journalists who write “Whiplash study remains valid” and that SGI’s no-fault insurance keeps costs down. These StarPhoenix journalists along with the conventional insurance companies are all forgetting that Cassidy’s study is invalid as there is no way injured people recover faster when they cannot sue for pain and suffering. Also, these journalists and insurance companies are forgetting that insurance is a need to be satisfied rather than a cost to be lowered, and they forget that while the no-fault costs may be kept bureaucratically low so the satisfaction of the injured claimants is kept lower.”

        References/endnotes
        Ref: http://desantis.hypermart.net/EnsignStories_801-913/Ensign_story805/story805.htm

        Postcript:
        “The study does not prove what it claims to prove. The exhibited bias and flawed methodology show that under a rigid no-fault scheme that mandates a single treatment regime within an artificial time frame, the duration of open insurance claims is shorter than under a traditional tort system.”

        Ref. https://www.casd.org/index.cfm?pg=No%20Fault%20NEJM

        Also note that Cassidy has reported financial links with the Canadian Chiropractic Protection Association, the Ontario Chiropractic Association, the National Chiropractic Malpractice Insurance Company, and the (subluxation-based) International Chiropractic Association:
        https://www.medpagetoday.com/PainManagement/BackPain/33142

        And here’s some criticism of Christine Goertz, DC:

        “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.” Ref: https://tinyurl.com/yc387mgn (JAMA) Unfortunately for science, Goertz is Vice Chair-person of the Patient-Centered Outcomes Research Institute (PCORI), an independent non-profit organisation, which has allocated $5.7 million to fund “a study of access to holistic therapies for treating low back pain, including massage, acupuncture, osteopathy, chiropractic…”

        Ref: https://www.massagemag.com/holistic-therapies-alternative-opioids-86376/

        As for Jan Hartvigsen, DC, he had a major research role in the recent Lancet Back Pain series of papers which were met with severe criticism:

        Ref: https://tinyurl.com/y7bd6lna
        Ref: https://tinyurl.com/y8e48oq7
        Ref: https://tinyurl.com/yalash5x

        • @ Blue Wode

          Were there any severe criticism from experts on Back Pain (or other musculoskeletal experts)?

          • @ AN Other

            I don’t know the answer to that, but I suspect that there wouldn’t be much, if any, criticism from MSK experts.

            ____________________________________________________________________________

            “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

            ― Upton Sinclair

          • @ Blue Wode

            Just to clarify – that should be – were there any severe criticism from experts on Back Pain (or other musculoskeletal experts), on the Lancet Back Pain Series?

          • @ blue wode

            So, MSK experts like Neil O’Connell and Adam Meakins would not criticise the Lancety Back Pain series because they earn their living from MSK related professions?

        • @BW
          Cite a comment in Edzard’s blog from Feb 2017.
          Cite another comment in Edzard’s blog from Feb 2017.
          Cite yet another comment in a blog from Feb 2017.
          You know that a later paper looking at three ICD codes not used in the study if added wiould have made little difference.

          Then this:
          “I think it’s important to point out the David Cassidy’s integrity really is questionable. For example, he was sued for asking an employee to manipulate the stats in a paper to produce the results he wanted: http://www.chirosmart.net/nfaures.txt
          What an utterly unprofessional BS comment Blue.
          I have discussed this you several times in the past and you know that that David Cassidy came in late to that study, that the doctor leading the research left and that it CAME OUT LATER that the insurance company funding the research threatened not only the researchers but also the subjects involved in the study to get the result they wanted. It was an utter mess that was dropped in David Cassidy’s lap in the 1990’s.
          You know this yet you still cherry pick articles to attack his character.
          Since then David cassidy has had a long and distinguished career at the University of Saskatchewan, Uni of Alberta, Uni of Toronto and the Uni of Southern Denmark for over 25 years collaborating with top researchers from many health disciplines.
          https://www.researchgate.net/profile/J_David_Cassidy
          Do you think that his career would have continued if there was a academic cloud hanging over his head?
          Yet you persist in trying to tear down his research by attacking his character.
          Enough is enough.

          Then you attach Christine Goewrtz citing an blog talking about “A + B v A” study design yet this is discussed in the limitations section of her paper.
          Then you cite a massage magazine.
          Your references are highly “dubious” Blue.

          Then we come to Jan Hartvigsen and you cite blog, blog, blog.
          Dubious echo chambers free from peer review.
          Nice.
          Try this PubMed Tutorial for a start:
          https://www.nlm.nih.gov/bsd/disted/pubmedtutorial/cover.html
          Collating and cross referencing 25 years of blogs and comments to support your bias has dulled your literature search skills.

          • @ Critical_Chiro

            Re my attacking David Cassidy DC’s character, it’s interesting to note another – as you might say – “utter mess that was dropped in David Cassidy’s lap”…

            QUOTE
            “…it was clear to everyone from the get-go that the chiropractors would fight tooth and nail against a rule requiring any disclosure of risk. It was one of those “kumbayah” moments in chiropractic history when a temporary truce is declared in their internecine war and chiropractic organizations of all stripes circle the wagons. This was no better exemplified than by the fact that J. David Cassidy, D.C., Ph.D., Dr.Med.Sc., lead author of the study, “Risk of Vertebrobasilar Stroke and Chiropractic Care,” Spine 33 (2008) S176-S183 [the “Cassidy study”] was required, in order to testify, to appear as a representative of the International Chiropractors Association (ICA), the organization of the super-straight-Daniel-David- Palmer- Innate-Intelligence chiropractors. I’ll bet he doesn’t put that on his C.V.
            -snip-
            Dr. Cassidy should hope and pray that this hearing transcript never, ever gets into the hands of an attorney who is preparing to cross-examine him.
            -snip-
            The Board relied heavily on the Cassidy study in making its decision that “the evidence is sufficient to establish that a stroke or cervical arterial dissection is not a risk or side effect of a joint mobilization, manipulation or adjustment of the cervical spine performed by a chiropractor.” It is worth repeating that the study itself states “[w]e have not ruled out neck manipulation as a potential cause of some VBA strokes.” However, the Board explained this away by noting that “Dr. Cassidy credibly testified ‘this is a study that raises real doubt about the association being a risk …’” In fact, according to Dr. Cassidy’s testimony, he’s become so doubtful he has absolved himself from a previous admission that he caused a patient’s stroke by manipulating her neck.
            -snip-
            … the Cassidy study says that patients with headache and neck pain can be presenting with vertebral artery dissection, and that there is no screening procedure to determine whether patients presenting with headache or neck pain are at risk of VBA stroke…”

            Ref. https://sciencebasedmedicine.org/not-to-worry-chiropractic-board-says-stroke-not-a-risk-of-cervical-manipulation/

            Critical_Chiro wrote: “Do you think that his career would have continued if there was an academic cloud hanging over his head?”

            Yes. See my reference above.

            Critical_Chiro wrote: “Then you attach Christine Goewrtz citing a blog talking about “A + B v A” study design yet this is discussed in the limitations section of her paper.”

            Ergo, her methods seem dubious.

            Critical_Chiro wrote: “Then we come to Jan Hartvigsen and you cite blog, blog, blog.
            Dubious echo chambers free from peer review.”

            I can only conclude that you are unable to defend the arguments made in those blogs.

            ____________________________________________________________________________

            “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

            ― Upton Sinclair

  • “The conclusions based on such evidence can, of course, never be firm…”

    “It can also result in serious complications such as vertebral artery dissection followed by stroke.”

    Seems like you should reword that second sentence.

  • @ Edzard

    Is there an appropriate time to use spinal manipulation?

    Is the infrequent use of spinal manipulation OK?

  • What else can one expect from a chiro who openly advocates the treatment of children for all manner of conditions. From his website; http://wahroongachiro.com.au/uncategorized/paediatric-chiropractic/, this doozy of stupidity;

    “Whilst treatment of children for non-musculoskeletal conditions (eg asthma, otitis media, ADHD, bed wetting, etc), can sometimes improve after chiropractic treatment, the level of scientific evidence for these issues is not yet strong.”

    http://wahroongachiro.com.au/uncategorized/chiropractic-for-headaches/
    This page advocates the the twisting of necks to cure headaches. I wonder how many vertebral arteries have been damaged by Tuchin and that he is totally unaware of how many deaths he may have caused.

  • AN Other wrote on Tuesday 10 March 2020 at 10:36 : “@ blue wode So, MSK experts like Neil O’Connell and Adam Meakins would not criticise the Lancet Back Pain series because they earn their living from MSK related professions?”

    @ AN Other

    Both are respected physiotherapists who have long been unimpressed with manual therapy/spinal manipulation. O’Connell is employed as a Senior Lecturer in Physiotherapy in Brunel University and Meakins is a Specialist Physiotherapist, as well as a qualified Strength & Conditioning Specialist.

    Examples of O’Connell’s views:
    https://bodyinmind.org/spinal-manipulative-therapy-a-slow-death-by-data/
    https://www.ebm-first.com/component/search/?searchword=O%27connell&searchphrase=all&Itemid=101

    Meakins:
    https://www.thesports.physio/2019/03/07/abandoning-manual-therapy/

    • @ blue wode

      You have not answered my question. Both Neil and Adam are MSK Experts but you say MSK Experts would not criticise the Lancet Back Pain series because they make a living from a MSK related profession. For me that is quite a sweeping statement to make.

      Also the only severe criticism you refer to in your post on this blog comes fron NON-MSK experts – why is that? Could it be because MSK experts are in agreement with the Lancet Back Pain series?

      • AN Other wrote: “@ blue wode …you say MSK Experts would not criticise the Lancet Back Pain series…”

        @ AN Other

        You don’t seem to have considered my original reply.

        Here it is again: “I don’t know the answer to that, but I suspect that there wouldn’t be much, if any, criticism from MSK experts.”

        Note the words “I don’t know the answer to that”, “suspect”, and “wouldn’t be much”.

        Readers might be interested to know that Neil O’Connell was part of the Consultation Development Group https://www.nice.org.uk/guidance/NG59/documents/committee-member-list that formulated the latest NICE guidelines for low back pain and sciatica. The guidelines were bad news for chiropractors…
        https://complementaryandalternative.wordpress.com/2016/12/06/nice-guidelines-for-low-back-pain-and-sciatica-a-clarification/

        _______________________________________________________________________________________

        “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” ― Upton Sinclair

        • @ blue wode

          By putting the Upton Sinclair quote after your original replying, you could be implying that MSK experts wouldn’t give much criticism of the Lancet Back Pain series because it affects their own interests.

          Otherwise, why have you put that quote in?

          Wouldn’t it have been better to just write I don’t know!

          • AN Other wrote: “…why have you put that [Upton Sinclair] quote in? Wouldn’t it have been better to just write I don’t know!”

            IMO, no. The Upston Sinclair quote highlights the suspicion that patients’ best interests may not always be at the forefront of MSK therapists’ minds. For example, the following is lifted from one of my references above…

            QUOTE
            “It appears from the emails above that many physios are being chastised, reprimanded, and even threatened with dismal by their peers and managers for not using enough manual therapy on their patients to keep them attending appointments. I find this extremely sad, worrying, and frustrating that some physios seem more focused on patient retention and profit rather than evidenced-based practice and patient outcomes…if physios were financially incentivised for successful achievement of patient outcomes I wonder if there would be as much focus on all the taping, needling, or manual therapy?
            At the moment in this current healthcare system, being a conscientious evidenced-based physio who consistently looks to develop a patient’s self-efficacy, encourage self-management, and strives to achieve a quick and efficient discharge once a patient’s goals have been met is an extremely tough and shitty way to earn a decent living.
            There is no doubt that manual therapy can help reduce pain and improve function for some people, for a short period of time. However, manual therapy is unreliable with variable effects that are only short-lived and minimal in size. In fact, I would argue that a simple hot pack has comparable pain-relieving effects to any manual therapy but is more consistent and reliable in its effect, not to mention a damn sight cheaper, and a lot less time-consuming to apply.
            In my opinion manual therapy is often used to justify the therapist’s existence giving them a feeling of purpose and responsibility, and often used to pander and pamper to patients rather than to genuinely help them…I have talked about how manual therapy is not that skilled or difficult to learn and doesn’t require hours, days, or weeks of expensive training…I have highlighted how there is a large and profitable industry behind manual therapy with many individuals with huge vested interests in it….I still have many therapists attempt to belittle me for not using manual therapy, mostly osteopaths, chiropractors, and even the osteopractors in the US…[they] truly believe that they are more skilled and more effective than me because they think they can feel and correct subluxed ribs, stiff spinal segments, or muscle knots (they can’t, go see my google drive for the research that proves it).”

            Link https://www.thesports.physio/2019/03/07/abandoning-manual-therapy/ (Adam Meakins)
            ______________________________________________________________________________

            “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” ― Upton Sinclair

          • @AN otter: MSK experts, lol. Much like “doctors” of chiropractic….an oxymoron perpetuated by morons. How do “they” validate that the shit they sell “works”? Palpation? Leg checks? Reduced “upslip” of an ilium, muscle “release”?? or some other arcane made up nonsense?
            I’m always curious as how to categorize “self manipulation”? Wouldn’t THAT be the most reliable and “expert” method? Who could know better than the person doing it to themselves? A $150,000 education is unnecessary, no malpractice and you save $50 each time you get 20minutes of “relief”. And if you give yourself a stroke you don’t have to tie up the courts in litigation.

  • @blue wode

    So, are you saying you have a suspicion that Adam (as a MSK therapist) may not always have the patients best interests at the forefront of his mind?

    If not, shouldn’t you say that some MSK therapist may not always have the patients best interests at the forefront of their minds?

    • AN Other wrote: “@blue wode So, are you saying you have a suspicion that Adam (as a MSK therapist) may not always have the patients best interests at the forefront of his mind?”

      With regard to Adam Meakins, it is not a suspicion as he has already admitted that – historically – patient choice got in the way of his professional integrity. However, my current suspicions about MSK therapists are fuelled greatly by his comments here:

      QUOTE
      “…many physios are being chastised, reprimanded, and even threatened with dismal by their peers and managers for not using enough manual therapy on their patients to keep them attending appointments… I was taught to use lots of types of manual therapy on patients, all with various degrees of success and failure…All I find that manual therapy does is wastes time, distracts patients, and doesn’t really help that much in the grand scheme of things…you encounter patients who want, insist, or demand manual therapy due to previous experiences or expectations of getting it…when a patient has had previous positive experience of manual therapy and wants it again. When this occurs, which it does a lot, I find the best way to manage this situation is by asking the patient what they think it does. About 99% of the time they have either been misinformed or believe that it does something which it does not…In the old days I used to bite my tongue and do what they asked, but these days I don’t anymore.”

      AN Other wrote: “shouldn’t you say that some MSK therapists may not always have the patients best interests at the forefront of their minds?”

      I don’t know what the precise numbers are, but “some” doesn’t seem accurate enough when Meakins mentions the dubious practices of “many physios” and “many individuals with huge vested interests in it”.

      Meakins QUOTE
      “In my opinion manual therapy is often used to justify the therapist’s existence giving them a feeling of purpose and responsibility, and often used to pander and pamper to patients rather than to genuinely help them…I have talked about how manual therapy is not that skilled or difficult to learn and doesn’t require hours, days, or weeks of expensive training…I have highlighted how there is a large and profitable industry behind manual therapy with many individuals with huge vested interests in it….I still have many therapists attempt to belittle me for not using manual therapy, mostly osteopaths, chiropractors, and even the osteopractors in the US…[they] truly believe that they are more skilled and more effective than me because they think they can feel and correct subluxed ribs, stiff spinal segments, or muscle knots (they can’t, go see my google drive for the research that proves it https://drive.google.com/drive/folders/1RN_EK3L0YltsjuFbsU1zzp4utYHHrTFj ).”

      Link https://www.thesports.physio/2019/03/07/abandoning-manual-therapy/

      ___________________________________________________________________________________

      “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”
      ― Upton Sinclair

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