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

My new book has just been published. Allow me to try and whet your appetite by showing you the book’s introduction:

“There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking.” These words of Fontanarosa and Lundberg were published 22 years ago.[1] Today, they are as relevant as ever, particularly to the type of healthcare I often call ‘so-called alternative medicine’ (SCAM)[2], and they certainly are relevant to chiropractic.

Invented more than 120 years ago by the magnetic healer DD Palmer, chiropractic has had a colourful history. It has now grown into one of the most popular of all SCAMs. Its general acceptance might give the impression that chiropractic, the art of adjusting by hand all subluxations of the three hundred articulations of the human skeletal frame[3], is solidly based on evidence. It is therefore easy to forget that a plethora of fundamental questions about chiropractic remain unanswered.

I wrote this book because I feel that the amount of misinformation on chiropractic is scandalous and demands a critical evaluation of the evidence. The book deals with many questions that consumers often ask:

  • How well-established is chiropractic?
  • What treatments do chiropractors use?
  • What conditions do they treat?
  • What claims do they make?
  • Are their assumptions reasonable?
  • Are chiropractic spinal manipulations effective?
  • Are these manipulations safe?
  • Do chiropractors behave professionally and ethically?

Am I up to this task, and can you trust my assessments? These are justified questions; let me try to answer them by giving you a brief summary of my professional background.

I grew up in Germany where SCAM is hugely popular. I studied medicine and, as a young doctor, was enthusiastic about SCAM. After several years in basic research, I returned to clinical medicine, became professor of rehabilitation medicine first in Hanover, Germany, and then in Vienna, Austria. In 1993, I was appointed as Chair in Complementary Medicine at the University of Exeter. In this capacity, I built up a multidisciplinary team of scientists conducting research into all sorts of SCAM with one focus on chiropractic. I retired in 2012 and am now an emeritus professor. I have published many peer-reviewed articles on the subject, and I have no conflicts of interest. If my long career has taught me anything, it is this: in the best interest of consumers and patients, we must insist on sound evidence; not opinion, not wishful thinking; evidence.

In critically assessing the issues related to chiropractic, I am guided by the most reliable and up-to-date scientific evidence. The conclusions I reach often suggest that chiropractic is not what it is often cracked up to be. Hundreds of books have been published that disagree. If you are in doubt who to trust, the promoter or the critic of chiropractic, I suggest you ask yourself a simple question: who is more likely to provide impartial information, the chiropractor who makes a living by his trade, or the academic who has researched the subject for the last 30 years?

This book offers an easy to understand, concise and dependable evaluation of chiropractic. It enables you to make up your own mind. I want you to take therapeutic decisions that are reasonable and based on solid evidence. My book should empower you to do just that.

[1] https://pubmed.ncbi.nlm.nih.gov/9820267

[2] https://www.amazon.co.uk/SCAM-So-Called-Alternative-Medicine-Societas/dp/1845409701/ref=pd_rhf_dp_p_img_2?_encoding=UTF8&psc=1&refRID=449PJJDXNTY60Y418S5J

[3] https://www.amazon.co.uk/Text-Book-Philosophy-Chiropractic-Chiropractors-Adjuster/dp/1635617243/ref=sr_1_1?keywords=DD+Palmer&qid=1581002156&sr=8-1

113 Responses to Chiropractic: Not All That It’s Cracked Up to Be

  • Just ordered it.
    Looking forward to the audio-book version (read by you hopefully) 🙂

  • The graphic design for the cover is great!

    • thanks
      I hope the rest of the book lives up to it.

      • I know that it will, because I own and have read: Trick or Treatment; Homeopathy the Undiluted Facts; More Harm Than Good; Alternative Medicine A Critical Assessment of 150 Modalities, and SCAM So-Called Alternative Medicine.

        • thanks again
          [in my view, A SCIENTIST IN WONDERLAND was my best book; certainly the one I found the most difficult to write]

        • I was musing, in a grammatical kind of way, about the inclusion of “that” in the title. It could have read “not all it’s cracked up to be” and still made sense. “That” is a funny old multi-function word in English.

          It struck me that the inclusion of “that”, gives the subtitle the exact metre of the first line of a limerick.
          Thereupon, the muse came on me, and I proffer, blushing, shuffling feet, and looking up from eyes modestly downcast, the following:

          Not all that it’s cracked up to be,
          Chiropractic is kidology
          He wrestled my spine;
          I almost felt fine
          Until he demanded his fee.

  • “Some” humans lack fundamental reasoning, once they believe in something they will die with their belief. I believe folks who see a chiropractor will never read your book, just like a christian will never read the Koran or vice versa with muslims and Bible, for example only. Those of us who will read your book do it for fascination and enjoyment.
    .

    • I am well aware of this phenomenon; therefore, I write my books not for believers, I write them mostly for those who have not made up their minds.

  • The questions I always ask chiropractors (and all other camists) is:

    “What induced you to study, train in, and practice as a chiropractor (or other SCAM), and not as a doctor (MD), osteopath (DO), physical therapist, nurse – or any other profession?
    What, for you, was the USP of ‘chiropractic’ (or other SCAM)?”

    I have never had a reply.
    Could be:

    “I couldn’t get into any other school – I wasn’t up to it;
    The chiropractic school suggested I would earn more;
    I determined I would make more by taking advantage of gullible and vulnerable patients;
    I did study the claims of other health care professions, but came to believe that there are subluxations and that patients’ lives can be improved by adjusting them (and I did not want to be bothered by studying medicine first and then doing chiropractic as a post-grad specialism);
    I am basically a fraud and charlatan and not a genuine healthcare professional at all…”

    Who knows?

    We should be told.
    Meanwhile, Edzard’s book is the best answer we have.
    (Other than my own!)

    No chiropractor has ever fessed up.

    • Richard….Actually i answered that question a few years back.

      Summary…

      I looked at osteopathy, i wasn’t impressed with their manual therapy training.

      I consider medical school, i decided i didn’t want to treat all those diseases but rather focus on conservative care of MSK.

      I considered veterinarian school, but decided I’d rather work on humans.

      I considered PT but at the time there wasn’t a DPT program. The kids that come thru my clinic and inquire about being a chiropractor, i strongly encourage them to compare DPT and DC.

      Thus, i picked what i thought was the most science focused chiropractic college at the time (visited most campuses in the USA).

      I was in my 40s when i went to chiro school. In retrospect i wish i would have started medical college in my 20s and became an orthopedic surgeon.

      Suffice?

      • @DC
        Thank you for this enlightening insight, it makes it very much easier to appreciate your sometimes bewildering contributions to this forum. I understand (and respect of course) how you ended up in chiro-college. But can you elaborate on why you now wish to have trained as an orthopedic surgeon?

        • Bjorn. Several reasons but mainly due to my interactions with orthosurgeons over the years in particular with my daughter’s issues. We were fortunate to have some of the best pediatric surgeons in the USA for her conditions but i was very impressed with their knowledge and approach and the conditions they could address and how it literally changed kids lives.

          They have a ways to go regarding a more wholistic approach within MSK but they are slowly getting there.

      • DC (whoever you are):
        Many thanks.
        I am sure you’d have made a good surgeon.
        I am sure you’ve been a good chiropractor – it’s just that chiropractic doesn’t cut the mustard.

        Has no one told you? There aren’t any subluxations, and adjustments have no substantial effects (except for a recent case in the UK when a patient died after cervical drop technique).

        DPT? Is that ‘Doctor of Physical Therapy’?
        Why did you want to be a doctor? And if you did, why not a MD?
        Doctors treat patients, not diseases.
        We have to learn about as many as we can, full-range, before we specialise.
        How can we be sure we want to specialise in MSK until we’ve had a little experience of other specialisms?
        I always wanted to be a surgeon, but I checked out the others first – even psychiatry!

        Science and medical practice is tough.

        Tough.

        Best wishes and may the Wu be with you.
        Richard

        • Subluxations? Basically it is sprain/strain. A little unique due to it’s location with the body (involuntary control and such) and relationship with the ANS.

          Manipulation seems to help speed up the recover process with some folks. We aren’t really sure why or how. Its just a tool in the clinical bag.

      • “I looked at osteopathy, i wasn’t impressed with their manual therapy training”

        Could you elaborate more on this. My understanding is that part of chiropractic training in manual therapy is performed on ‘course colleagues’ because chiropractors have no access to real patients.

        What was ‘good’ about manual training for chiropractic?

        • There is student clinic in mid tris (students) and then outpatient clinic in later tris (public).

          • How are their outpatients? In UK NHS does not refer to chiropractic and all the teaching hospitals are NHS. So how do you get enough patients from the public who have issues that need a chiropractor?

            For MSK therapists such as physios the public go through the NHS so the trainees are exposed to real patients?

          • Burdle

            At any given time around 50% of the public have back or joint pain. Yes, often it will self resolve. Sometimes its recurrent and can lead to, or is, chronic pain.

            It’s not hard to find people who need proper education and intervention.

          • “At any given time around 50% of the public have back or joint pain.”
            I doubt it
            any evidence?

          • I should have worded it better.

            “One in two Americans have a musculoskeletal condition

            New report outlines the prevalence, scope, cost and projected growth of musculoskeletal disorders in the U.S.

            Date:
            March 1, 2016

            Source:
            American Academy of Orthopaedic Surgeons
            Summary:

            An estimated 126.6 million Americans (one in two adults) are affected by a musculoskeletal condition — comparable to the total percentage of Americans living with a chronic lung or heart condition — costing an estimated $213 billion in annual treatment, care and lost wages, according to a new report.”

          • “I should have worded it better.”
            no, the way you phrased it, the statement was simply wrong!

          • I suppose i could go thru and look at daily prevalence of back, neck, knee, foot, hand, shoulder, wrist, etc pain…tease out multimobidity, come up with a percentage. Account for if it’s daily or most days, age, gender, etc. But you’re not worth the time.

            Back around 11%
            Neck around 20%
            Knee around 20%
            Foot around 20%
            Hand around 14%
            Etc

            But if feel you need a “gotcha” moment…

    • I’m on page 222 of Real Secrets of Alternative Medicine.

    • @RR
      12 years rugby union playing in the forwards. Got injured (severe LPB with radicular pain) and my father who is a surgeon referred me to a chiropractor.
      Set my feet on the path to being a chiro.
      Considered physiotherapy but surgeon/doctors attitudes to physio 30+ years ago meant I discounted it.
      Brother is also a surgeon so thought about it. It was interesting seeing a group of chiro students (during our B.Sc 3rd year majoring in anatomy and physiology) in the anatomy museum grilling him on anatomy and physiology etc for his surgery part 1 exams.
      What is surprising my oldest son who is currently in final year engineering considered medicine.
      All 4 surgeons in the family advised against it. “I wouldn’t go into medicine now days”.
      The two GP’s who I work with said don’t go into medicine now.
      The negativity of all the doctors who he asked for advice was surprising. Not one positive.

  • It would be interesting if you got into the various divisions within the profession, with percentages, and which factions tend to be guilty of any issues.

    Or did you just tend to lump the profession together?

    • some of the content:
      THE HISTORY OF CHIROPRACTIC
      CURRENT POPULARITY AND ACCEPTANCE
      THE MAIN AXIOMS OF CHIROPRACTIC: SUBLUXATION AND SPINAL MANIPULATION
      OTHER MODALITIES USED BY CHIROPRACTORS
      OTHER MANUAL THERAPIES
      THERAPEUTIC CLAIMS BY CHIROPRACTORS
      EFFECTIVENESS OF SPINAL MANIPULATION
      SAFETY OF SPINAL MANIPULATION
      EDUCATION AND PROFESSIONALISM OF CHIROPRACTORS
      ETHICAL AND LEGAL ISSUES
      [not much ‘lumping together, I think]

  • I HAVE NOT READ THE BOOK AND I HOPE TO BE SURPRISED… BUT READING YOUR POSTS OVER THE PAST YEAR YOU ARE FAR FROM BEING A SCIENTIFIC CRITIC

    Looking only at the evidence that suit your crusade…

    dismissing everything that does not suit your political agenda…

    judging according to impossible standards one health profession (that you don’t care for) while ignoring others…

    does that sound familiar???

    I wish you luck with your new book but there is a long way before anyone will be able to take your “criticism” seriously.

    • thank you very much indeed!
      what a compliment
      if a chiro calls anything ‘far from scientific’, it must be highly scientific.

      • G. Almog said to Prof Ernst: “I wish you luck with your new book but there is a long way before anyone will be able to take your ‘criticism’ seriously.”

        @ G. Almog

        What nonsense. Critical assessment is a huge part of Prof. Ernst’s and he is already the recipient of 17 scientific awards: https://edzardernst.com/about/

        In particular, he received this one for standing up for science:
        https://senseaboutscience.org/activities/2015-john-maddox-prize/

      • While i agree with many of the issues you raise your critic is far from balanced and thus far less effective.

        Take it as a friendly comment or ignore it all together… Its all up to you.

        • @Dr. Guy Almog

          Far from balanced? It’s lopsided for a reason! There is just little, if anything, for the other side to present.

          It’s like when journalists are criticized for not presenting a balanced view of the vaccine manufactroversy. There is no balanced view. Vaccines work. Get over it. Chiropractic is a sham. Get over it.

    • I prefer to take a condition and look at the evidence from various approaches across health professions. IMO that has more value.

      Example…one could focus just on surgery (example) but what about other alternatives…how do they hold up?

      https://journals.lww.com/pain/Fulltext/2020/09001/Surgery_for_chronic_musculoskeletal_pain__the.10.aspx

      “Based on the observation that when such studies have been performed, only 14% (on average) showed a statistically significant and clinically important benefit to surgery…”

    • Completely in agreement with you, Ernst exhibits a profound ignorance of the topics to be discussed, systematic contradictions in his editorials, reviews and books, and an express lack of knowledge in philosophy of Science, in addition to obvious cherry picking.

      • @Lolly

        On the scale of one to whack job, you are clearly at the whack job end of the scale.

        Here is a little advice if you are going to be a troll (because you couldn’t possibly believe half the crap you write)

        Don’t go so far overboard. For example, to suggest the Professor “exhibits a profound ignorance of the topics to be discussed” is just too much. Given his almost unparalleled expertise (please see https://edzardernst.com/about/), you just sound wacky when you write things like that.

        Maybe just say his grandma wears army boots or he is known to wear socks and sandals, that sort of thing. That way, you won’t sound half as crazy as you do now and the under-, mis- and ill-informed are more likely (!) to take you seriously.

        Also, change your name, That is just dumb.

        • @Ron Jette

          I have very little sympathy for Lollypop’s views, but calling someone a “whack job” and telling them their handle is “just dumb” is more or less the same as saying your “grandma wears army boots.”

  • Not all that it’s cracked up to be?
    Who says? I’m quite sure it’s not me!
    I crack spines for a living;
    It’s my way of giving
    Good health to our society.

    Not all that it’s cracked up to be!
    Subluxations just don’t impress me.
    To suppose that your spine’s
    All that makes your health fine’s
    An outrageous delusion, you see.

    For what it’s worth – absolutely nothing – I think the second one is probably the only limerick with the word ‘subluxations’……

    • I’m really sorry; I don’t quite know what’s come over me:

      Not all that it’s cracked up to be,
      But think of the fact that if we
      Act nicely enough
      While doing our stuff
      Placebo suits all to a tee.

      • I feel a book coming on: ‘The chiro from Limerick’

        There was an old chiro from Limerick
        He knew almost every single trick
        With one single stroke
        He regularly broke
        The neck of neck of his patients and made them sick

      • “Not all that it’s cracked up to be”
        Said the chiro examining me;
        “Your spine’s a disgrace –
        And so is your face
        Please remove them from my misery”

        • Not all that it’s cracked up to be?
          Chortled wily bone-wrangler McPhee
          “Why, the back is a goldmine –
          Buys me the best old wine.
          So begone with your dour repartee!”

          • “Not all that it’s cracked up to be”,
            Quoth the Duchess, a-quiver with glee:
            “I chased and pursued
            And successfully sued!
            (But this is between you and me)”.

          • Just when you thought it was safe…..

            Not all that it’s cracked up to be:
            This vertebra’s quite all at sea!
            With spinal adjustment
            A powerful thrust meant
            The spinal cord severed – teehee!

          • And now, this makes ten – count them, ten – Chiropractic Limericks. And one by the Prof.

            Not all that it’s cracked up to be,
            “As the twig is bent so grows the tree”.
            The concept applied
            To the column inside
            By the Palmers, D.D and J.B.

          • Not all that it’s cracked up to be
            Says the book of researcher Prof E
            Surgeon Rawlins’s claim
            Is exactly the same
            So avoid chiropractic, prithee.

  • Ordered and paid for!

    Thank you for continuing to make my life more interesting, dear professor Ernst.

  • Congratulations, Professor!

    I see that Dr. G. Almog accused you of “dismissing everything that does not suit your political agenda.” Are you running for something? I sure hope so!

  • “Charlotte Leboeuf-Yde, DC,MPH,PhD, is professor in Clinical Biomechanics at the University of Southern Denmark and works at the French-European Institute of Chiropractic in Paris. She is a chiropractor with extensive research experience, for example, she was one of the first chiropractors to have studied adverse reactions of spinal manipulation.” – Edzard Ernst.

    “Charlotte certainly knows a thing or two about adverse effects of spinal manipulation, and I have always found her work interesting.” – Edzard Ernst

    “I have always thought highly of Charlotte’s work, however, her conclusion made me doubt whether my high opinion of her reasoning was justified.” – Edzard Ernst

    Edzard you have read her work over many years and think highly of it, then you ignored it until you could take issue with two lines in a blog then wrote this blog (quoted above):
    https://edzardernst.com/2017/04/we-have-an-ethical-legal-and-moral-duty-to-discourage-chiropractic-neck-manipulations/
    Some critics just look for what feeds their bias and find it. Selection bias is common here.
    You on the other hand read the research then ignore it.
    This is more than just cherry picking.

    I have asked several highly published and highly regarded physiotherapy and chiropractic researchers over the years “why don’t you go on Edzard’s blog and answer the criticism?”
    The response from them “Why bother he will never change”.

  • It seems not to be available through the US Amazon site. Will it come there as well soon?

  • “THE MAIN AXIOMS OF CHIROPRACTIC: SUBLUXATION AND SPINAL MANIPULATION”
    Bugger never drank that cool aid or went to that church and spinal manipulation makes up 25% or less of any patient encounter.
    Is the book like the Chiropractic Wikipedia page where a core of critics put a negative spin on everything and block any editing, updates or latest research that questions their beliefs?

    • You could read the book and find out.
      I’ve just started reading it, and I think it takes a very fair and scholarly approach, starting with the history of chiropractic (i was charmed to learn that the founder claimed to have received instruction from a spirit medium), and looking at how subsequent chiros have tried to resolve the claims originally made for subluxation with the actual evidence.

      Is this negative spin? I don’t think so, on the contrary, I think it’s scientific and scholarly.
      I wish i’d had this book to read 10 years ago before i went to a chiro, and after the X-ray it was straight onto the treatment table to have my neck jerked.

      • According to his son BJ, his dad later recanted the claim re the “spirit medium”. He may have used that as a response of the AMA coming down hard on practices like osteopathy and chiropractic, claiming they were practicing medicine without a license.

      • @zebra
        The “neck jerk response” is fairly standard on this blog. (Couldn’t resist). 😉

    • That’s interesting about the 25%. Are you speaking for chiropractors in general, or referring specifically to your own practice?

      What are you including as a “patient encounter”? Do you mean treatments administered, or time spent?

      For example, suppose that each patient appointment lasts, say, thirty minutes. For each patient, 22 1/2 minutes is given to taking a case history and examining. Then each patient gets 7 1/2 minutes of spinal manipulation. With those figures, every patient gets spinal manipulation, but you can say “spinal manipulation makes up 25% or less of any patient encounter”.

      If you mean only a quarter of patients get spinal manipulation, what do the other three-quarters get?

      • @David B
        Contrary to what many of the cynics here think chiropractic is not a technique.
        25% treatment applied for chronic MSK pain is manip/adjust.
        Rest is soft tissue work, advice, exercises/review, strength and conditioning/review, rehab/review, pain science, behavior/ADL’s review/modification, explaining pain, how to manage flares, build independence and resilience, wean patients off passive care, build up active care etc.
        Multimodal approach is used by the vast majority of chiro’s.

        • Ah right, thank you. So , all patients get some manipulation/adjustment – is that right?

          • Critical_Chiro wrote “Contrary to what many of the cynics here think chiropractic is not a technique.”

            @ Critical_Chiro

            Chiropractic is whatever chiropractors want it to be, IMO. There is no standardisation in the industry.

          • “Chiropractic is the art of adjusting by hand all subluxations of the three hundred articulations of the human skeletal frame, more especially the 52 articulations of the spinal column, for the purpose of freeing impinged nerves, as they emanate thru the intervertebral foramina, causing abnormal function, in excess or not, named disease.” (DD Palmer, BJ Palmer 1906)

        • ‘build independence ‘ .Chiros do the opposite. Latest pain science findings do not suggest finding something ‘ wrong ‘ – however this is exactly what chiro does.Then patient has to keep coming back to keep on top of pain. The whole process is self fulfilling for the chiro.

  • i mentioned your writings about chiropractic to someone and he mentioned this: This is someone who has deep issues when you dedicate your whole life to destroy a profession that helped millions of people in MSK field…
    my advice is to take a deep hard look inside yourself.

    • “i mentioned your writings about chiropractic to someone”
      and I mentioned the moon to someone and he said: “entirely made of Cheddar cheese, you know.”

    • anecdotes – pure anecdotes.
      chiros are always saying they helps “millions” of people……..where’s the evidence and what about the placebo effect?
      what about the millions it didn’t work for?
      how about the millions with side effects – those with broken necks and vertebro-basilar strokes?
      since no chiros or their so-called regulatory bodies keep any kind of records of adverse events of any kind there is no register of these totally unlike the register of adverse events kept for drugs.

      from imaginary subluxations to unnecessary X-rays chiros have a lot to answer for. “Adjustments” in infants and “regular” adjustments in healthy adults along with claims for treating systemic complaints by adjusting the spine are just some of the scams perpetrated on an unsuspecting public.
      What about the monstrosity of cranio-sacral therapy which imagines the impossibility of manipulating the fused cranial bones in an adult and thereby moving the CSF around its flow? Magical thinking anyone – or just bilking the public?

      Given the additional fact that so many chiros are anti-vaccine and anti-science in general there is an argument for having the “profession” thrown out altogether as being good for nothing it is difficult to see that they have a leg left to stand on

      • “Always”
        “Millions”
        My kids used to use those words when arguing as well.

        For the rest:
        “millions with side effects”
        Research for both physio’s and chiro’s has temporary soreness as the most common side effect in 50% of patients.

        “broken necks and vertebro-basilar strokes”
        Please read this article by neurosurgeons (research not anecdote):
        Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation.
        (Imagine the stink and outcry if chiro’s had written this).
        https://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation
        Neurosurgeons wrote:
        “In fact, this idea seems to enjoy the status of medical dogma.”
        They also discuss the poor quality of the research. That’s Medical reporting of possible chiropractic adverse events.
        As for research on serious edverse events I recommend you check the retrospective studies done in Canada by Cote, Cassidy and Haldeman. Here is the most recent paper:
        Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study.
        https://pubmed.ncbi.nlm.nih.gov/27884458/
        They have done several more studies if you are interested using large data sets from Canada.

        Several years ago there was a report of a baby having a broken neck after seeing a chiropractor.
        Chiro treated the baby with gentle procures, baby had a reaction, chiro referred the baby straight away to the children’s hospital. They did xrays and the report showed possibility of fracture in the upper cervical spine. Subsequent ct and MRI said no fracture. Doctors went public with the xray report and it was trial by media. (Ignoring the CT and MRI reports).
        Follow up MRI 6 months later at the childrens hospital said no fracture.
        Private MRI 9 months later said possibility of healing in upper cervical spine which may indicate a healing fracture. 9 months later???
        Review of all the evidence by the hospital radiologist 1 year after the event said no fracture.
        Guess which 2 reports the critics locked onto and guess which they ignored?
        The Chiropractic Board of Australia also sent all the evidence to a world leading medical pediatric radiologist when reviewing the case and he reported no fracture and the diagnosis of a burst fracture is a common misdiagnosis.
        Doctors still cite the case to this day as an example of a chiro fracturing a baby’s neck.
        BTW the chiro did not go near the upper cervical spine and used gentle techniques also employed by physio’s.
        Food for thought.

        Now adverse event reporting.
        There are robust adverse event reporting for drugs (as you have noted) and systems in place in hospitals but what about GP’s in private practice.
        Zip, nada, none.
        Physio’s have none.
        Years ago we trialed a standardized AE reporting system in a Melbourne hospital ER for all professions where data was collected free from medical assumptions, bias and dogma that was then sent to the relevant board for investigation. Chiropractors backed it, the physio’s were unaware of it and many doctors supported it.
        Guess what happened?
        It was killed off by doctors who “snivelled” (doctors who was involved said this) about the additional paper work.
        The chiropractor’s in the UK have an AE reporting system in place but this should be done by the regulatory boards who advocate for the patient, not an association who advocates for the profession. Right idea wrong people doing it.
        Read at my post about then check the work of Chalotte Leboeuf-Yde. Edzard harps on about this topic, reads her work which he highly regards then ignores it.

        “cranio-sacral therapy” as DC has said is not used by chiro’s. That’s SOT and if you look at them here in Australia there are about 100 of them. That’s out of 5500 chiro’s or 1.8%.
        Food for thought.

        Finally “anti-vaccine and anti-science”.
        I recommend you read this paper from 170 chiro PhD’s and climbing (more are adding their names):
        A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity.
        https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-00312-x

        “Please remember: if you make a claim in a comment, support it with evidence.”

        • @ Critical_Chiro

          Re: ‘Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation’. For the umpteenth time, see https://sciencebasedmedicine.org/chiropractic-and-stroke-no-evidence-for-causation-but-still-reason-for-concern/

          Re: ‘Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study’. For the umpteenth time, see https://edzardernst.com/2020/03/a-chiropractors-replication-study-of-my-review-of-the-risks-of-spinal-manipulation/#comment-121303

          Re: ‘food for thought’ about a baby having a broken neck after seeing a chiropractor. See https://www.ebm-first.com/component/search/?searchword=baby%20broken%20neck%20chiro&searchphrase=all&Itemid=101

          Re: Adverse event reporting: Here are medicine’s answers to its critics:

          Part 1
          http://www.sciencebasedmedicine.org/answering-our-critics-part-1-of-2/

          Part 2
          http://www.sciencebasedmedicine.org/answering-our-critics-part-2-of-2-whats-the-harm/

          And here’s a snippet from Death by Medicine:

          QUOTE
          “Doctor-bashers use their numbers to argue that alternative medicine is safer. Maybe it is. I suppose not treating at all would be safer still. It depends on how you define ‘safe’. To my mind, a treatment is not very ‘safe’ if it causes no side effects but lets you die. Most of us don’t just want ‘safe’: we want ‘effective’. What we really want to know is the risk/benefit ratio of any treatment.
          The ironic thing is that all the statistics these doctor-bashers have accumulated come from the medical literature that those bashed doctors have written themselves. Scientific medicine constantly criticizes itself and publishes the critiques for all to see. There is NOTHING comparable in the world of alternative medicine.”

          Ref: http://www.sciencebasedmedicine.org/death-by-medicine/

          Re: Chiropractors in the UK having an AE reporting system in place. That is true, but it’s worse than useless. See: https://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1888-british-chiropractic-association-members-attitudes-towards-the-chiropractic-reporting-and-learning-system-a-qualitative-study.html

          Indeed, the UK chiropractic regulator, the General Chiropractic Council, has ignored my concerns about it for over six months now: https://twitter.com/Blue_Wode/status/1297821408177852418?s=20

          Re “cranio-sacral therapy” which you indicate is not used by chiropractors. FYI, the UK General Chiropractic Council says that “craniosacral therapy (and applied kinesiology) fall within its definition of evidence-based chiropractic care. See https://jdc325.files.wordpress.com/2009/06/gcc-ak.pdf

          Re: anti-vaccine and anti-science. It’s worth remembering that just eight years ago anti-vaccination attitudes still abounded within the chiropractic profession.

          QUOTE
          “…*many* chiropractors do not believe in vaccination, will not recommend it to their patients, and place emphasis on risk rather than benefit. This is positioned within a context privileging individual autonomy, which by many is seen as core ethical value. But this puts the chiropractic profession outside the greater healthcare…”

          Ref: http://www.tihcij.com/Articles/Anti-Vaccination-Attitudes-within-the-Chiropractic-Profession-Implications-for-Public-Health-Ethics.aspx?id=0000377

          @ Critical_Chiro do you have any robust evidence that things have changed significantly?

          • I do admire your patience – personally, I have long given up to get some sense into some people

          • Re the Hall write up, she states…

            “They say they found no evidence of causation; I agree.”

            Seems pretty clear.

          • DC, is that truly how you interpret the overall tenor, and the viewpoint represented, by Dr Hall’s article? Really?

            “I certainly agree that there is no definitive evidence for causation, but I think there is evidence to support a strong enough probability of causation to constitute a good reason to avoid neck manipulation”.

            Is Dr Hall for, against, or undecided, regarding neck manipulation? Does she think patients should have it, or should avoid it?

          • David…she states she agrees “found no evidence of causation”.

            Do you agree with Hall or not?

          • DC, she writes “I think there is evidence to support a strong enough probability of causation to constitute a good reason to avoid neck manipulation”.

            Does she want patients to have neck manipulation, or to avoid it?

          • Harriet Hall’s blog not once refers to the authors as neurosurgeons. All the way through it is “they”.
            Priceless and puts a different spin on the Church (2016) paper. The paper discusses the poor quality of the reports (that’s medical reports on chiropractic).
            I recommend you all reread Harriet’s blog noting the “they” are neurosurgeons.

            She even references Edzard’s blog on phrenic nerve injury from chiropractic neck manipulation.
            That blog cites a paper where the patient clearly described to the doctor what treatment was performed by the chiro. It was a bog standard levator scapulae stretch used by just about every profession (chiro/physio,osteo/massage/etc) then called it a “chiropractic neck manipulation”. Very poor science. What is even worse Radiopedia also cites the paper ascribing phrenic nerve injury to chiropractic. Sent them a letter but still up and still being cited by people who could not be bothered to read research of of so just the abstract.

            “Re: ‘Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study’. For the umpteenth time, see https://edzardernst.com/2020/03/a-chiropractors-replication-study-of-my-review-of-the-risks-of-spinal-manipulation/#comment-121303
            For the umpteenth time Blue Wode they did a follow up study that showed the three IDC codes not included would have not made a difference.
            Then you go after David Cassidy’s integrity (in the blog comment of yours that you cite) when you know full well the research done years ago that was dropped on him had an motor vehicle insurer who financed the research threatening not only the researchers but also the participants in the research. He has then gone on to have a long distinguished research career at several universities. Do you think this would be possible if there was a academic cloud hanging over him?
            So stop with the character assassination.
            I recommend you watch this video by Ian Harris, author of the book “Surgery: The Ultimate Placebo”
            Listen from 1 minute. He describes the difference between a critic and a cynic.
            https://www.youtube.com/watch?v=IzueFu1cq5U
            The majority of people on this blog fall into the later category.

            R.E. Craniosacral/AK etc chiro’s are like GP’s in that the definition of what they can do is broad.
            This is definitely an issue and the Canadian Chiropractic Guideline Initiative set up by Andre Bussiers and Co is a step in the right direction. I have heard that similar guidelines are in the pipeline her in Australia. We need a clear definition of our scope. Regulate out the BS or at least make it impossible for them to get PI Insurance unless their guideline compliant.
            Conversely I have now seen physio’s here adopt the activator and call it PIM (Physio Instrument Manipulation) where hey claim we are “evidence based” then swipe what little chiro research there is on activator and claim it as their own. Also recently an Upper Cervical physio technique for headaches (C1,2 and 3).

            “@ Critical_Chiro do you have any robust evidence that things have changed significantly?”
            How is 140 chiro PhD’s (and more adding their names as we chat. Up to 170 now) calling out the minority of BS merchants:
            “A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity”.
            https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-00312-x

            Finally please read the top of this page;
            “Please remember: if you make a claim in a comment, support it with evidence.”
            Blogs are not evidence and the plural of anecdote does not equal evidence no matter how much it fits your bias.

        • @Critical_Chiro , Thanks for posting this. To be honest I appreciated this blog when it focused on critiquing research…
          Now, This forum is an echo chamber for Edzard and his boys club. I’ve been following this blog for years and all they have is: Let’s unearth what DD Palmer said 100 of years ago, or let’s find someone on the fringe whose saying wacky thing and project his statement on the whole profession. Basically this blog is Fox new style that keep regurgitating the same thing. Like someone who has a blog that talks about how MDs didn’t wash their hands 100 years ago.
          As Alan Watts said, you need the evil so you can justify that you’re good and E.E. decided that Chiropractic is evil, hence you have the statements of millions are suffering side effects and dying right and left.

  • Craniosacral was from an osteopath in the 70s a revision of Sutherland from the 30s. But i suppose there a some chiropractors out there doing it…seems more common among massage therapists.

  • DC wrote on Friday 28 August 2020 at 20:29: “Re the Hall write up, she states… ‘They say they found no evidence of causation; I agree’. Seems pretty clear.”

    @ DC

    It’s ‘clear’ until you read the rest of what Dr Hall says:

    QUOTE
    “I certainly agree that there is no definitive evidence for causation, but I think there is evidence to support a strong enough *probability* of causation to constitute a good reason to avoid neck manipulation.

    – snip –

    Flaws in the study’s Discussion section

    Here’s where it really becomes problematic. They report that they found a small association between chiropractic care and cervical artery dissection, but then they discount their own finding and try to rationalize it away. They say the evidence is low quality; I agree. They say they found no evidence of causation; I agree. But then they try to say there is no convincing evidence of even the *association* that they themselves found.

    They found no evidence for causation. On the other hand, they found no evidence *against * it.

    They say they are concerned that a false belief in a causal connection ‘may have significant adverse effects such as numerous episodes of litigation’. On the other hand, a lack of belief might prevent justified litigation where patients were harmed or killed.

    They say neck pain and headache are confounders. They say patients with headache and neck pain more frequently visit chiropractors, and patients with cervical artery dissection more frequently have neck pain and headache, so the appearance of more cervical artery dissections after visits to chiropractors is spurious. They say the Cassidy study showed that visits to a primary care provider or a chiropractor were likely to be due to pain from an existing dissection. It did not. There is absolutely no evidence to support that speculation.

    In fact, there are numerous ‘smoking gun’ cases where patients consulted a chiropractor not for neck pain or headache, but for pain in parts of the body below the neck, such as shoulder pain or tailbone pain, and developed stroke symptoms on the chiropractor’s table at the time of neck manipulation. Sandra Nette had no pain at all; she felt fine and let the chiropractor manipulate her neck only because she falsely believed that regular maintenance adjustments were an effective means of keeping her healthy.

    They fail to even mention the smoking gun cases or the evidence that the incidence of stroke rises with the proximity to the time of manipulation.

    They make a big deal of Hill’s criteria for assigning causation to association. With a rare condition like VBA dissection, and with the characteristics of this condition, it would be very difficult to fulfil all of Hill’s criteria. We may never see that kind of proof, so we must rely on lesser quality evidence.

    They cite cadaver studies to claim that SMT doesn’t place significant strain on the vertebral artery. And yet we know that very small strains can cause strokes in susceptible live patients. ‘Shampoo strokes’ have been reported after hyperextension of the neck at beauty parlors.

    Other considerations

    The indications for neck manipulation are questionable. Upper cervical (NUCCA) chiropractors do neck manipulations on every patient, no matter what the complaint. Some chiropractors do neck manipulations for somatovisceral conditions rather than just for musculoskeletal conditions. Whatever the indications, chiropractors certainly have no business doing neck manipulations on a patient with an existing dissection, and they have not shown that they can reliably diagnose a stroke in progress. There are no tests to reliably identify patients at risk of dissection.

    Underreporting is a problem. If a dissection is temporarily sealed by a clot that breaks loose several hours or days later, the connection with manipulation may be missed. Patients may never return to the chiropractor. I heard of at least one case where a patient developed stroke symptoms immediately following manipulation, was hospitalized for a disastrous stroke, and never let the chiropractor know what had happened.

    Edzard Ernst weighs in

    Edzard Ernst reported on a case of a man who had a stroke following chiropractic manipulation for chronic neck pain. *Chronic*, not a new symptom suggesting a stroke in progress. He also reported on a case of phrenic nerve injury from neck manipulation.

    Ernst commented:
     There is no effective monitoring scheme to adequately record serious side-effects of chiropractic care.
     Therefore the incidence figures of such catastrophic events are currently still anyone’s guess.
     Publications by chiropractic interest groups seemingly denying this point are all fatally flawed.
     It is not far-fetched to fear that under-reporting of serious complications is huge.
     The reliable evidence fails to demonstrate that neck manipulations generate more good than harm.
     Until sound evidence is available, the precautionary principle leads most critical thinkers to conclude that neck manipulations have no place in routine health care.

    The American Heart Association and American Stroke Association agree. They were concerned enough about the apparent association to have issued a joint scientific statement warning about it and recommending that patients be informed of the possible risk prior to manipulation.

    Bottom line: A double standard

    Edzard Ernst has said:
    ‘Imagine a conventional therapy about which the current Cochrane review says that it has no proven effect for the condition in question. Imagine further that this therapy causes mild to moderate adverse effects in about 50% of all patients in addition to very dramatic complications which are probably rare but, as no monitoring system exists, of unknown frequency…’

    Now I ask you to imagine that there is a pharmaceutical drug that fits this description. Imagine that there are the same numbers of studies showing an association of that drug with a deadly side effect like stroke or death. The FDA would pull it off the market; they wouldn’t wait for definite evidence of causation that fulfilled all of Hill’s criteria. And I think the people who are making excuses for neck manipulation would want them to take that drug off the market. I don’t think they would want to take such a drug.

    I wouldn’t risk taking a drug like that, and I wouldn’t risk neck manipulation.”

    Ref: https://sciencebasedmedicine.org/chiropractic-and-stroke-no-evidence-for-causation-but-still-reason-for-concern/

    @ DC, as David B. posted above, “Is Dr Hall for, against, or undecided, regarding neck manipulation? Does she think patients should have it, or should avoid it?” …

    • In Puentedura et al review of 134 cases they concluded that 44.8% of AE could have been avoided if the practioneer had properly ruled out contraindications and red flags (probably higher since some reports didnt provide enough information to determine this)

      They also suggested that in 19.4% of cases the SMT was not properly performed.

      Thus, if one is considering “probability” one needs to seperate procedure from practioneer error.

      One paper actually suggested that a VAD can occur up to one year after, and possibly due to, a MVA. How many case reports looked at risk factors for the prior year?

      But we have been thru this all before. I have stated that more research needs to be done. I think there are potential risk factors that need examined (estrogen for example). But the “probability” of a serious AE , when cSMT is properly applied and known contraindications are followed, with the current evidence, doesn’t currently lean towards pulling cSMT off the market.

      • @ DC I don’t think many people, armed with the data, would agree with you there. Once again…

        “Bottom line: A double standard

        Edzard Ernst has said:
        ‘Imagine a conventional therapy about which the current Cochrane review says that it has no proven effect for the condition in question. Imagine further that this therapy causes mild to moderate adverse effects in about 50% of all patients in addition to very dramatic complications which are probably rare but, as no monitoring system exists, of unknown frequency…’

        Now I ask you to imagine that there is a pharmaceutical drug that fits this description. Imagine that there are the same numbers of studies showing an association of that drug with a deadly side effect like stroke or death. The FDA would pull it off the market; they wouldn’t wait for definite evidence of causation that fulfilled all of Hill’s criteria. And I think the people who are making excuses for neck manipulation would want them to take that drug off the market. I don’t think they would want to take such a drug.

        I wouldn’t risk taking a drug like that, and I wouldn’t risk neck manipulation.”

        Ref: https://sciencebasedmedicine.org/chiropractic-and-stroke-no-evidence-for-causation-but-still-reason-for-concern/

        • I think I shared this before, but start with non chiropractors, get them to ban cSMT on their patients. It appears they are the ones putting patients at greatest risk. (Oh, and one doesn’t prove an effect, one has evidence for or against).

          So, some “data”, again…

          around one third of published case reports on serious adverse events after cervical spinal manipulation are attributed to non chiropractors, and considering non chiropractic licensed professionals only perform around 10% of all spinal manipulations, plus at least 40% of those serious AE cases indicate a failure to do a proper history and exam (which are often centered around identifying contraindications of cSMT), one should question letting a under qualified MD, DO, PT, and especially a layperson, from performing spinal manipulation.

          • Re effects, latest Cochrane that I am aware of. Yes, we need better evidence, but this is the current evidence…

            “Cervical manipulation for acute/subacute neck pain was more effective than varied combinations of analgesics, muscle relaxants and non-steroidal anti-inflammatory drugs for improving pain and function at up to long-term follow-up. For chronic cervicogenic headache, cervical manipulation provided greater benefit than light massage in improving pain and function at short-term and intermediate-term follow-up. For chronic CGH, cervical manipulation may be superior to transcutaneous electrical nerve stimulation (TENS) in improving pain at short-term follow-up. For acute neck pain, cervical manipulation may be more effective than thoracic manipulation in improving pain and function up to intermediate-term follow-up.”

            Published: 23 September 2015

          • I am worried that, one day you might suffocate on all the cherries that you are picking:
            https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004249.pub4/full?highlightAbstract=neck%7Cpain

            Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed.

            Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate‐term follow‐up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long‐term follow‐up. Since the risk of rare but serious adverse events for manipulation exists, further high‐quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.

          • It appears there may be some evidence of benefit to cSMT.

            Unless of course one wants to cherry pick.

    • I think a MD posted this in here awhile back. Seems to be alot a similarities.

      “Minor side-effects from vaccines tend to affect a great many more than 1% of the people vaccinated, but they are self-limiting. Major side-effects are much, much rarer. Most people find it difficult to accept that when bad things happen we often don’t know why, so they look for anything that seems plausible to them as a cause. If a health problem presents or is diagnosed following a vaccination then it is a common reaction to blame the vaccination. However, when two things happen one after another it is usually coincidence, not cause and effect. If a serious adverse event (defined as something happening during or after treatment, not necessarily caused by it) occurs at the same rate in vaccinated and unvaccinated populations then that tells us quite clearly that vaccination does not cause it.”

      Of course there are contraindications for some vaccines. If ignored or missed, it increases the probablity of a AE being caused by the vaccine.

      But we don’t blame the vaccine, we could however blame the person administering the vaccine.

    • As far as AE reporting, I’ve mentioned the issues before (doesnt establish causation, unaware of occurrence, etc). But take a look at how good it’s working in the medical field…

      Examples…

      Most of the physicians (n = 137/77.8%) stated that they report ADR, which they have observed to the competent authority rarely (n = 59/33.5%), very rarely (n = 59/33.5%) or never (n = 19/10.8%); the majority (n = 123/69.9%) had not reported any ADR in 2014. https://www.sciencedirect.com/science/article/abs/pii/S0924933817326482

      This systematic review provides evidence of significant and widespread under-reporting of ADRs to spontaneous reporting systems including serious or severe ADRs. https://pubmed.ncbi.nlm.nih.gov/16689555/

      FDA believes hospitals throughout the United States are under-reporting such events, according to Shuren. He wrote, “We believe that these hospitals are not unique in that there is limited to no reporting to FDA or to the manufacturers.” https://www.advisory.com/daily-briefing/2016/10/31/hospitals-are-under-reporting-adverse-events

      I support AE reporting within chiropractic but if the medical field, with all their resources, have this kind of track record, would one within chiropractic even provide any valuable information? Maybe to the pseudoskeptics, eh?

      • it is unsatisfactory when you have a decent system; it is unacceptable when you have no system for reporting AEs

        • It’s a waste of time and money if you have a system that provides no valuable information.

        • Except of course there are AE reporting systems for chiropractic (unlike private sector osteopathy or physio therapy) https://www.chiropractic-ecu.org/education-and-cpd/european-academy/cpirls/

          I can only conclude that EE is not up to date or prefers to misinform. Either way it brings his expertise into question.

          • i think your conclusion might be erroneous; we have discussed this system repeatedly here on this blog; it is useless and cannot be accessed by the public:
            In order to submit, view and comment on incident reports, view a list pf the types of incidents to report and to read safer practice notices, you must have a username and password.

            For UK chiropractors, these can be obtained from the secure membership area of your association’s website or from the Royal College of Chiropractors website (if you are a member) – please click the relevant link below:

            British Chiropractic Association
            The Royal College of Chiropractors
            McTimoney Chiropractic Association
            Scottish Chiropractic Association
            United Chiropractic Association

        • @EE
          “it is unsatisfactory when you have a decent system; it is unacceptable when you have no system for reporting AEs”.
          There is no such system for chiro’s or physio’s or GP’s in private practice so stop making it out that is is purely chiropractic issue. We trialed one here in a Melbourne ER years ago. Chiro’s supported it, physio’s knew nothing of it and the doctors “snivelled” (doctor involved word who supported the trial) about the extra paperwork and killed it off.

          @DC
          Hospitals have in house reporting and their own lawyers to bury their mistakes.
          A surgeon once said to me “in medicine we bury our mistakes”. I asked “Which meaning are you talking about?” to which he replied “both”.

          • doctors are duty bound to report AEs no matter where they work; not sure about physios [and don’t care all that much, because I am researching SCAM]

          • Critical_Chiro wrote on Monday 31 August 2020 at 07:08: “There is no such [AE reporting] system for chiros or physios or GPs in private practice so stop making it out that is purely chiropractic issue.”

            @ Critical_Chiro

            In the UK, the Medicines and Healthcare Regulatory Agency’s ‘Yellow Card’ scheme allows anybody to report suspected problems and/or incidents with medicines, devices, diagnostic tests, etc: https://yellowcard.mhra.gov.uk/

            There’s also the NHS’ National Patient Safety system: https://improvement.nhs.uk/resources/learning-from-patient-safety-incidents/

          • EE…
            doctors are duty bound to report AEs no matter where they work

            Duty bound vs actually doing it.

            “Providers documented adverse drug events in charts to support continuity of care but never reported them to external agencies.”

            https://publichealth.jmir.org/2018/1/e21/

          • yes, reporting is not optimal. but it’s better than nothing [like what chiros offer]

          • ee…yes, reporting is not optimal. but it’s better than nothing [like what chiros offer]

            Seems many disciplines are in need of a system, and have barriers.

            But I suppose it’s easy to be a bench seat critic.

          • where have you learnt to employ all those fallacies so well? is that a subject in chiro school? is it part of the brainwash you go through?

          • I have yet to see you blog any viable solutions to the barriers.

            Perhaps because it just takes a little knowledge to point out a problem. But it takes wisdom to find a workable solution.

            But please, share what you think are the three biggest barriers for chiropractors to have a AE reporting system, one that provides valuable information, and the viable solutions to those barriers.

  • I am pleased to feature your new book in October’s “The Freethought News” in the Tampa Bay Skeptics column. http://tampabaycor.net/newsletters.htm

  • Andy wrote on Saturday 29 August 2020 at 23:27 “Except of course there are AE reporting systems for chiropractic”

    @ Andy

    I think readers will be interested to know how robust – or otherwise – they are:

    Globally, the main place for reporting adverse consequences arising from chiropractic in the UK appears to be the ‘Chiropractic Patient Incident Reporting and Learning System’ (CPiRLS): https://cpirls.org/ – and even then, it’s wholly unreliable

    According to the Royal College of Chiropractors https://rcc-uk.org/cpirls/ it is “a secure website which allows chiropractors to view, submit and comment on patient safety incidents” and is “currently open to all UK-based chiropractors, all ECU (European Chiropractors Union) members and members of the Chiropractic and Osteopathic College of Australasia”.

    However, it does not appear to be open to the public – unlike the UK Medicines and Healthcare Regulatory Agency’s ‘Yellow Card’ scheme which allows patients and the public to report suspected problems and/or incidents: https://yellowcard.mhra.gov.uk/
    And there’s also the NHS’ National Patient Safety system:
    https://improvement.nhs.uk/resources/learning-from-patient-safety-incidents/

    The CPiRLS evolved from the British Chiropractic Association’s paper system called CRLS in February 2005 (it later merged with another small paper system, PIRLS, in 2009). Scroll down this link: https://tinyurl.com/yxgbjssa

    The Royal College of Chiropractors now administers it “on behalf of the pan-professional team that developed it”:
    http://www.slideshare.net/ecupresident/contact-magazine-september

    It has a trigger list which apparently is for chiropractors eyes only:
    https://cpirls.org/what-are-incidents/
    https://cpirls.org/trigger-list/

    However, I managed to find a copy of it here:
    https://rcc-uk.org/wp-content/uploads/2014/04/CPiRLS-Trigger-List.pdf

    Interestingly, in the General Chiropractic Council’s [GCC] 2nd March 2006 meeting, item C-020306-7, summarising a Report on European Summit on Patient Safety, it says in para 3:

    “*IF* chiropractors are to provide a safe clinical experience for patients then a reporting procedure needs to be put in place, within the clinics and within the profession as a whole, which allows for adverse events and near misses to be shared on an anonymised basis so that we can all learn from them.” Ref: https://tinyurl.com/y5wsdp27

    However, by 2008, it appears that the CPiRLS was being underutilised:

    “Reasons identified for under-reporting included fear of retribution, being too busy and insufficient clarity on what to report…until there is greater clarity of the purpose and role of the CRLS, the system will probably remain under-utilised.”

    Ref: British Chiropractic Association members’ attitudes towards the Chiropractic Reporting and Learning System: A qualitative study, Clinical Chiropractic, Volume 11, Issue 2, Pages 63-69 (June 2008)
    https://www.sciencedirect.com/science/article/pii/S1479235408000321

    FYI, this is an interesting critique of the CPiRLS in 2009: https://www.zenosblog.com/2009/05/to-protect-the-public-apparently/ )

    Indeed, by 2010, it was reported that the system would suffer problems of reporting bias and sample section as only some chiropractors reported incidents. See pp40-41 of the original document in this link:
    https://tinyurl.com/yxo2j49m

    In the Autumn of 2010, the subheading in this article, revealed that the submission rates to the system were ‘low’
    https://www.slideshare.net/ecupresident/contact-magazine-september

    And by 2011, not much seemed to have changed:

    “A comprehensive strategy for national implementation must be in place including, but not limited to, presentations at national meetings, the provision of written information to all practitioners and the running of workshops, so that all stakeholders fully understand the purposes of adverse event reporting. Unless this is achieved, any system runs the risk of failure, or at the very least, limited usefulness.”

    Ref conclusions here: Creating European guidelines for Chiropractic Incident Reporting and Learning Systems (CIRLS): relevance and structure
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079683/

    It is not known if the British Chiropractic Association’s 2012 reports of rib fracture injuries (and more) in patients were reported to the CPiRLS. See 5.7 to 5.10 here: https://tinyurl.com/ybsooum8

    Also, 5.11 and 5.12 of the link above indicate that the McTimoney Chiropractic Association seems to receive complaints out with the CPiRLS, and 5.13 indicates that harms notified to the United Chiropractic Association and the Scottish Chiropractic Association are unknown.

    In September 2012, the Royal College of Chiropractors ran a ‘Patient Safety Week’ in which is promotional letter to the trade implied that it had no mandatory Safety Incident Management Policy:
    https://us1.campaign-archive.com/?u=74bc029fbb860d713b48c4577&id=b26c57ab4d

    Then in 2013, the European Chiropractors’ Union mentioned that it was going to adopt the CPiRLS as a risk management system, although it wouldn’t be compulsory: https://tinyurl.com/y3hlenmc

    In 2016, this paper noted that “The safety culture around SMT is characterized by substantial disagreement about its actual rather than putative risks. Competing intra- and inter-professional narratives further cloud the safety picture. Participants felt that safety talk is sometimes conflated with competition for business in the context of fee-for-service healthcare delivery by several professions with overlapping scopes of practice. Both professional leaders and frontline practitioners perceived multiple barriers to the implementation of an incident reporting system for SMT.”

    Ref: https://www.ncbi.nlm.nih.gov/pubmed/27251398

    As far as I know, by summer 2018, there had been 230+ reports to the CPiRLSt (including some from Europe). See p.12 of this Royal College of Chiropractors’ publication: https://online.flowpaper.com/785c0759/ArticulateIssue19/#page=12

    It is also not known if the GCC reports any notifications of injuries to the CPiRLS even although in its April 2019 newsletter, on p.3., it said:

    “We have just published our annual report on fitness to practice for 2018. This includes a breakdown of the types of complaints that we receive about chiropractors. The most common complaints relate to substandard treatment, most notably concerns about inappropriate or excessive treatment. Other allegations we receive regularly include rough treatment causing injury, concerns about techniques and failures to follow up or review the patient. Often a single complaint contains allegations about both clinical care and communication or consent issues.”

    Ref: https://www.gcc-uk.org/assets/publications/Newsletter_-_April_2019.pdf

    Bearing in mind that one of the GCC’s main duties is to protect the public, I recall in 2017 that a UK chiropractor called Akhlaque Hussain Rahman was scheduled for a GCC hearing for an issue that included causing a ‘cupping’ burn injury to a patient, but I don’t know where that has been recorded, if at all. I did ask the GCC via Twitter if it shared injury complaints it received with the CPiRLS, but didn’t receive a response.

    With regard to the rest of the world, there are no chiropractic adverse event reporting systems. There isn’t one in the U.S. due to a loophole https://www.ebm-first.com/chiropractic/risks/1842-letter-from-britt-harwe-president-chiropractic-stroke-awareness-group-csag.html

    The only other one is in Canada – SAFETYNET10 – and it isn’t up and running properly yet:
    https://www.ncbi.nlm.nih.gov/pubmed/30662067

    All the above hardly paints a reassuring picture.

  • Critical_Chiro wrote on Monday 31 August 2020 at 07:33: “How is 140 chiro PhD’s (and more adding their names as we chat. Up to 170 now) calling out the minority of BS merchants?”

    @ Critical_Chiro

    That is not robust evidence that things have changed significantly for the public.

    Critical_Chiro wrote: “We need a clear definition of our scope”

    And there’s your problem.

    Meanwhile…

    QUOTE
    “…the danger of sending patients to chiropractor: the wide range of useless pseudo-medicines that are often incorporated into the chiropractic practice along with a propensity for anti-vaccine rhetoric…chiropractic manipulation has no foundation in basic science, its placebo effects are minimal and transient at best, it is dangerous, costly and time consuming for the patient”

    Ref: https://sciencebasedmedicine.org/spinal-manipulation-for-back-and-neck-pain-does-it-work-annotated/

  • Edzard quoted on Monday 31 August 2020 at 10:31 “Chiropractic is the art of adjusting by hand all subluxations of the three hundred articulations of the human skeletal frame, more especially the 52 articulations of the spinal column, for the purpose of freeing impinged nerves, as they emanate thru the intervertebral foramina, causing abnormal function, in excess or not, named disease.” (DD Palmer, BJ Palmer 1906)

    Readers might also be interested in this:
    https://edzardernst.com/2017/01/educating-chiros/#comment-85340

    • So? Johnsons medical dictionary in the 1700s defined….

      Lunatic: mad, having the imagination influenced by the moon.

      But maybe Ernst was just giving a history lesson?

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories