On this blog, I have discussed the adverse events (AEs) of spinal manipulative therapy (SMT) with some regularity, and we have seen that ~ 50% of patients who receive SMT from a chiropractor experience some kind of AE. In addition there are many serious complications. In my book, I discuss, apart from the better-known vascular accidents followed by a stroke or death, the following:
- atlantoaxial dislocation,
- cauda equina syndrome,
- cervical radiculopathy,
- diaphragmatic paralysis,
- disrupted fracture healing,
- dural sleeve injury,
- haematoma,
- haematothorax,
- haemorrhagic cysts,
- muscle abscess,
- muscle abscess,
- myelopathy,
- neurologic compromise,
- oesophageal rupture
- pneumothorax,
- pseudoaneurysm,
- soft tissue trauma,
- spinal cord injury,
- vertebral disc herniation,
- vertebral fracture,
- central retinal artery occlusion,
- nystagmus,
- Wallenberg syndrome,
- ptosis,
- loss of vision,
- ophthalmoplegia,
- diplopia,
- Horner’s syndrome.
Considering this long list, we currently have far too little reliable information. A recent publication offers further information on this important topic.
The aim of this study was to identify beliefs, perceptions and practices of chiropractors and patients regarding benign AEs post-SMT and potential strategies to mitigate them. Clinicians and patients from two chiropractic teaching clinics were invited to respond to an 11-question survey exploring their beliefs, perceptions and practices regarding benign AEs post-SMT and strategies to mitigate them.
A total of 39 clinicians (67% response rate) and 203 patients (82.9% response rate) completed the survey. The results show that:
- 97% of the chiropractors believed benign AEs occur.
- 82% reported their own patients have experienced an AE.
- 55% of the patients reported experiencing benign AEs post-SMT, with the most common symptoms being pain/soreness, headache and stiffness.
- 61.5% of the chiropractors reported trying a mitigation strategy with their patients.
- Yet only 21.2% of patients perceived their clinicians had tried any mitigation strategy.
- Chiropractors perceived that patient education is most likely to mitigate benign AEs, followed by soft tissue therapy and/or icing after SMT.
- Patients perceived stretching was most likely to mitigate benign AEs, followed by education and/or massage
The authors concluded that this is the first study comparing beliefs, perceptions and practices from clinicians and patients regarding benign AEs post-SMT and strategies to mitigate them. This study provides an important step towards identifying the best strategies to improve patient safety and improve quality of care.
The question that I have often asked before, and I am bound to ask again after seeing such results, is this:
If there were a drug that causes temporary pain/soreness, headache and stiffness in 55% of all patients (plus an unknown frequency of a long list of serious complications), while being of uncertain benefit, do you think it would still be on the market?
90 Responses to Beliefs, perceptions and practices of chiropractors and patients about adverse events after spinal manipulation
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Not all that it’s cracked up to be;
Adverse E’s beset much therapee
So forsake the Chiro –
Why walk that high-wire-o?
Get treatment by homeopathee……
Would it?
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0494-1/figures/1
“We found that some of the medications have relatively low effect sizes with only 11 out of 17 of them showing a minimal clinically important difference.”
instead of asking a daft question and linking irrelevant evidence you could answer this:
which drug that causes temporary pain/soreness, headache and stiffness in 55% of all patients or other side-effects with that regularity (plus an unknown frequency of a long list of serious complications), while being of uncertain benefit, is still on the market?
You brought up topic of drugs as a comparison. Apparently you did not think it through.
on purpose or not thought through?
or perhaps you just can’t answer it!?
Something else to consider…new vs pre-existing (as well as many other factors such as doctor error, procedural error, etc). If only it was black and white like some wish it to be.
“A correlation between a history of pre-existing pain and adverse effects was found.”
https://www.mskscienceandpractice.com/article/S2468-7812(17)30038-3/abstract
answer my question, please.
Your question is based on the premise of “uncertain benefit”.
The question is vague and poorly presented…probably on purpose.
In my opinion the question is neither vague now poorly presented. But even if it were, would you not attempt an answer?
“Uncertain benefit”?
Reads like a layperson asked the question.
Conclusions and Relevance Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms.
JAMA. 2017;317(14):1451-1460. doi:10.1001/jama.2017.3086
thank you, just as I said: UNCERTAIN
“Uncertain benefit”?
“There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe. Multimodal programs may be a promising option.”
The Spine Journal, VOLUME 18, ISSUE 5, P866-879, MAY 01, 2018
thank you, just as I said: UNCERTAIN
“Uncertain benefit”?
“Studies published since January 2000 provide low-moderate quality evidence that
various types of manipulation and/or mobilization will reduce pain and improve function for chronic
nonspecific neck pain compared to other interventions.”
Pain Physician 2019; 22:E55-E70
thank you, just as I said: UNCERTAIN
So, the criteria for uncertain benefit is low to moderate quality evidence of mild to moderate improvement? So the comparison is to any drug that has that level of evidence? If so, then the answer to your question is…yes.
good try!
the question was:
which drug that causes temporary pain/soreness, headache and stiffness in 55% of all patients or other side-effects with that regularity (plus an unknown frequency of a long list of serious complications), while being of uncertain benefit, is still on the market?
your answer is: YES
???????????????????????
No, you queried…”If there were a drug…” not “which drug…”.
read the thread again and you will find the exact question I asked YOU
because I only copied it the 2nd time.
I answered the question.
in your dreams?
Your question was…
“…do you think it would still be on the market?”
My answer…yes.
Where us your evidance for 55% AE?
When you point out a list of complications can you present the numbers?
How many SMT procedures are done in a year and how many complications were reported… That is of course if you want to present the facts.
read it again; it’s all there:
the 55% are the findings of the survey I report on.
about the other complications I explained that “we currently have far too little reliable information”.
you insinuation that I do not want to present the facts is just stupid!
Other prospective studies never came close to 55%.
To present a list of complications without even descriptive stats is not serious.
At the same time i congretulate the authors for presenting a paper that is all to do with AE and complications. This is rare in ALL professions.
you need to inform yourself a little better, I am afraid.
The aim of this systematic review was to summarize the evidence about the risks of spinal manipulation. Articles were located through searching three electronic databases (MEDLINE, EMBASE, Cochrane Library), contacting experts (n =9), scanning reference lists of relevant articles, and searching departmental files. Reports in any language containing data relating to risks associated with spinal manipulation were included, irrespective of the profession of the therapist. Where available, systematic reviews were used as the basis of this article. All papers were evaluated independently by the authors. Data from prospective studies suggest that minor, transient adverse events occur in approximately half of all patients receiving spinal manipulation. The most common serious adverse events are vertebrobasilar accidents, disk herniation, and cauda equina syndrome. Estimates of the incidence of serious complications range from 1 per 2 million manipulations to 1 per 400,000. Given the popularity of spinal manipulation, its safety requires rigorous investigation.
https://pubmed.ncbi.nlm.nih.gov/12015249/
and please take off your blinkers
We cannot ignore the fact that some of those serious complications, while rare, are conditions that existed prior to SMT being performed with the practitioner missing it upon initial examination. Which then leads to SMT exacerbating an existing injury, thus getting getting the blame for it. For example, that woman a few years ago who suffered a stroke following a couple of visits to her chiropractor.. After falling and experiencing blunt for trauma directly to the neck before seeking care. That sounds more like the fall creating the initial issue, which was not caught by the hospital or the chiro on examination, resulting in death.
yes, the evidence is far from complete.
why?
because chiros refuse to have a reporting system of AEs!
An AE reporting system doesn’t establish causation.
Bob…
“From a clinical perspective, a thorough examination to rule out all contraindications and red flags may have the potential to prevent nearly half of all AEs related to CSM. Additionally, 19.4% of CSMs reviewed were performed for inappropriate conditions,”
J Man Manip Ther. 2012 May; 20(2): 66–74.
Were these patients asked if this soreness occurs in the visits following their first treatment? While it does happen on the 2nd, 3rd, etc visits in some people, that is the minority. I personally get a bit sore after each treatment, but it is nothing unexpected. Soreness actually makes physiological sense if you think about the mechanisms that lead someone into seeking a chiropractor. You have X amount of days/months/years of compensatory motion in a region due to a variety of issues, usually postural or from an injury. While compensation is necessary in many instances, prolonged compensation can lead to abnormal mechanics and reduce imbibition into soft tissues, joints, etc. Not to mention the fascial changes that occur and further restrict motion. At the very root of it, we are trying to restore as optimal of spinal mechanics as the area will allow. With the reintroduction of mechanically sound motion, there can be soreness initially as the soft tissues of the region are not functioning as they should. This soreness is not unlike working out an area for the first time in a long time.. Or the soreness one would reasonably expect from physical therapy. I advise all my patients that their first visit may result in soreness. You are right in regards to soreness, those percentages, off the top of my head, seem appropriate for what people see after visit one. Usually, it does not happen again in the average 5-10 visit treatment plan. At 8 years in practice, seeing 30-50 people a day, I have yet to see any of those more serious side effects. Issues like those usually occur after a practitioner did not do a proper examination. This sort of thing happens in all disciplines in the medical world. People miss stuff sometimes. I am not making an excuse for it, just pointing out reality. Chiropractic, like physical therapy, spinal surgery, statins, etc etc is not for everyone. Everyone is different, and patient A may need something completely different than patient B, even if all demographics are equal. I am very critical of my profession, and admit a large number of chiropractors should not be in practice. Research in chiropractic is lacking terribly. I will say it is also very difficult to make a blanket statement that “it does not work” when there are so many ineffective treatments considered “chiropractic” on top of the fact that some chiropractors are significantly better than most at finding, properly diagnosing, and then implementing the proper care. It does not help that we also have chiros running around saying they can prevent Covid contraction, cure cancer, etc etc. I can tell you I spent a lot of time learning what works and what does not. A lot does not work. But if nothing about this profession worked, I would not be doing what I do. I spent time learning how to properly manipulation with minimal rotation to provide more effective and comfortable care. A lot of chiros have not. I would not have a waiting list of patients if what I did was ineffective. I do 0 marketing, my business is 100% word of mouth. I would not be successful if it did not work. No gimmicks, no up selling, no long term plan BS. Just addressing bio-mechanics to restore function. I have no hard “evidence” to offer you other than what I see day in and day out. I am not sure if you have even been to a chiropractor for an issue… A good, no BS chiro. If not, it is hard to stand on a pedestal and say something does not work without having experienced it first hand.
“my business is 100% word of mouth. I would not be successful if it did not work”
I knew a drug dealer who said this to a judge before getting sent down.
And here lies a perfect example on why we wont be able to have an objective conversation about this. That is actually a shame. But, ill play.. The drug dealer was probably providing a service that worked for his clientele. We can insert all sorts of legit and illicit “professions” in that sentence and it still works. It actually does nothing to diminish what I have said.
an objective conversation with a chiro who calls himself Dr Bob? pull the other one!
Correct. I chose not to use my real name publicly on here as I have said somethings about my profession some people might be hurt by (likely rightfully so), but I would be happy to share it privately if you are really that interested. You continue to throw some passive aggressive “insults” that really do nothing for your credibility in this conversation. But hey, you are apparently too closed minded to have a reasonable conversation. I guess I will ask a couple of questions. Do you feel it is reasonable to objectively assess the dangers of a profession based on the cost to insure that discipline of practice against malpractice lawsuits? We all know insurance companies are not in the business of losing money, so I feel it might be a good 3rd part analysis of risk. Thoughts?
1) Do you feel it is reasonable to objectively assess the dangers of a profession based on the cost to insure that discipline of practice against malpractice lawsuits?
no
Why not? Surely there is risk assessment and premiums are based upon the expected payouts due to damages. For example, an OBGYN pays significantly more than a dentist for malpractice insurance because of significantly more risk.
I am sure you find the answer yourself, if you think a bit
Title of the article:
“Beliefs, perceptions and practices of chiropractors and patients about mitigation strategies for benign adverse events after spinal manipulation therapy”.
Edzards blog title:
“Beliefs, perceptions and practices of chiropractors and patients about adverse events after spinal manipulation”.
Edzard old boy what happened to “BENIGN”.
Was this intentional or unintentional?
This paper matches physio research on BENIGN adverse events post treatment R.E. temporary soreness/stiffness which we have discussed in the past yet you conveniently ignore.
Then you pull out the BS about adverse event reporting which we have discussed on many occasions.
The BCA have one though it should be done by regulatory boards who advocate for the patient not an association that advocates for the profession. Right idea wrong people. Ignored
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154058/
There are NO adverse events reporting for physio’s, GP’s, Osteo’s.
A system was trialed here in Melbourne around 2014 in a hospital Emergency where information of a possible AE (regardless of profession) was harvested free from medical bias and assumptions that was then sent to the appropriate board for investigation. Chiropractors supported it, physio’s were unaware of it and doctors “snivelled” (word used by a medical doctors involved in the trial) about the extra paperwork and killed it off. This was discussed in the comments of an article on it int the Medical Journal of Australia at the time.
We have discussed this in the past.
Which makes your statement here:
“yes, the evidence is far from complete.
why?
because chiros refuse to have a reporting system of AEs!”.
Is Incorrect.
Interestingly a recent physio paper from the Netherlands put the percentage of physio’s who use high velocity, low amplitude (HVLA) manipulation on the cervical spine at 30%. I do not know what the training is for physio’s overseas but here it is a handful of PA thrust manip’s for the thoracic spine. So a large percentage of physio’s are jumping on the HVLA bandwagon with little if any training. There are four times as many physio’s as chiro’s here so that would indicate a large number of neck HVLA’s being performed by physio’s. Where are their adverse events?
This article may give an indication;
https://www.abc.net.au/news/2019-08-05/concerns-over-the-rise-of-resistant-superbugs/11377930
“Mr Fox had developed a clot on his brain following a neck manipulation by a physiotherapist” is the only mention then it is ignored and they discuss the MRSA. Imagine how the article would have read if it was a chiro?
Physio AE’s do not get reported and are most likely overlooked by doctors in an emergency department.
Why do physio’s not have an AE reporting system?
Why have you never written an article on the lack of a physio AE reporting system Edzard?
I do admire your skills of observation!
yes, I do focus on chiros and not on physios or doctors or nurses (who also do a lot of nonsense, no doubt).
why do you think that is?
could it have something to do with the fact that my blog is about SCAM?
… and please, if you have a minute, look up the ‘tu quoque’ fallacy.
CAM is CAM regardless of ones professional title.
“The stock introduction to scientific reviews of virtually all treatments is “there is insufficient evidence to draw conclusions.” This does not apply only to the stuff in left field: we’re talking about the bread and butter treatments of mainstream physical therapy — interventions that consumers and insurers spend billions on every year — as well as stranger and newfangled stuff.”
https://www.painscience.com/articles/pseudo-quackery.php
so…?
perhaps
then tell me:
what is the hallmark therapy of physios?
and
what is the hallmark therapy of chiros?
it has nothing to do with “hallmark” it has to do with what they use…examples:
“There was little evidence that active therapeutic ultrasound is more effective than placebo ultrasound for treating people with pain or a range of musculoskeletal injuries or for promoting soft tissue healing.” Physical Therapy, Volume 81, Issue 7, 1 July 2001, Pages 1339–1350
“There is insufficient evidence to guide the use of TENS for acute LBP.”
Scandinavian Journal of Pain | Volume 19: Issue 2
“A total of 506 papers were identified in the electronic database search, with only one study showing moderate evidence of early physical therapy promoting a more rapid return of short-term improvement in function and pain.” Shoulder and Elbow, November 25, 2018
“A rigorous review of literature showed insufficient evidence to support or refute the effectiveness of many of the current physical therapy interventions for chronic LET.” Physical Therapy Reviews
Volume 25, 2020
“There was moderate evidence of no effect for other commonly prescribed interventions, such as laser therapy, extracorporeal shockwave therapy, pulsed electromagnetic energy, and ultrasound.” Journal of Orthopaedic & Sports Physical Therapy, February 29, 2020 Volume 50 Issue 3 Pages 131-141.
etc, etc, etc
But modalities can certainly increase income, eh?
There is no such thing as CAM. If something works it is called medicine.
@EE
Neck manipulation is done by many professions.
We have physio’s using activators, calling it PIM (Physio Instrument Manipulation who claim “we are evidence based unlike the chiro’s” then swipe Arlan’s research to support that claim. Priceless), upper cervical neck manipulation for headaches (Watson Headache Approach) etc.
As DC has stated “CAM is CAM regardless of ones professional title”.
Unfortunately, in the past you have taken physio research papers, written a blog then in your “posted in” list tagged chiropractic and not physiotherapists. Nice to see you have tagged the physio’s in this blog.
That trial in a Melbourne emergency was for ALL professions not just chiropractic and was a great initiative.
You harp on and on about chiropractics lack of an AE reporting system then ignore initiatives to create one.
You harp on and on about chiropractors burying their heads in the sand in regards to serious adverse events then willfully ignore research from Charlotte LeBoeuf-Yde whose AE research you highly regard and ignore until you could take issue with two lines in a blog then did a hatchet blog here:
https://edzardernst.com/2017/04/we-have-an-ethical-legal-and-moral-duty-to-discourage-chiropractic-neck-manipulations/
Many critics here look for the BS within chiropractic and find it. Selection bias is to be expected.
You are across the research yet cherry pick it to feed your blogs/bias.
I like Science Based Medicine because they spend more time highlighting the BS within medicine than in other professions. Do they get it wrong? Yes.
They wrote a blog on chiropractic utilizing forces in a cervical adjustment that is equivalent to those developed in a hanging. I read the full article and the contact points were for a lumbar technique. Pointed it out the error to the author of the blog and crickets to this day.
Above in your list of serious AE you include “diaphragmatic paralysis”.
You did a blog on this topic a while ago and cited 4 papers. I read all 4 papers and only ONE clearly described the treatment technique employed by the chiropractor which was a bog standard levator scapulae stretch used by physio’s/osteo’s/massage therapists etc which is then called a “chiropractic manipulation”.
I pointed this out to you yet you still cite it.
What is really annoying is that this same paper is cited by Radiopedia here:
https://radiopaedia.org/articles/phrenic-nerve-palsy?lang=us
Wonder if they even bothered reading the paper?
Its open access so no excuse for just reading the abstract.
Unfortunately this Radiopedia post has now been cited by others in regards to chiropractic manipulation and phrenic nerve trauma. Poor science now cited by more poor science becoming medical dogma.
Even neurosurgeons have noted the poor quality of medical papers on chiropractic adverse events in the Church 2016 paper in Cureus here;
https://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation
Imagine if a chiropractor wrote this:
“this idea seems to enjoy the status of medical dogma”.
Now Blue Wode will probably pop onto this blog and cite another blog in Evidence Based Medicine criticizing the Cureus paper as proof the paper is ‘flawed”. What is interesting is SBM not once in that blog refers to the authors as being neurosurgeons. Instead it is “they” throughout the entire blog. The blog also discusses the poor quality of the evidence yet not once notes that the poor quality papers are by medical doctors writing case reports full of assumptions and bias.
It comes across as the chiropractic profession burying its head in the sand.
Classic.
I am happy to discuss the problems within my profession and the external critics arguments usually match similar discussions within the profession. Both are essential to drive reform.
What I do not have time for is carpet bombing critics who are make sweeping statements and look of chiropractic researchers and reformers as acceptable collateral damage.
These cynics damage reform within chiropractic and are just as resistant to changing their cherished beliefs as the most dyed in the wool subluxation based chiropractor.
Both employ the same arguments as well which is ironic. “If it’s not subluxation it’s not chiropractic” and my favorite “medipractor/pseudophysio”.
Critical_ Chiro wrote: “Now Blue Wode will probably pop onto this blog…I am happy to discuss the problems within my profession and the external critics arguments usually match similar discussions within the profession. Both are essential to drive reform.”
@ Critical_Chiro
Yes, here I am, and here are your seemingly unresolvable problems:
“Chiropractic reform has failed…profession now more diverse than it’s ever been…chiropractors now practice in a range of different settings, using a wide range of interventions, and practicing from varying philosophical standpoints… [the focus is now on] commonality based on high standards of care and protecting patient welfare”
Ref: https://www.wfc.org/website/images/wfc/qwr/2018/QWR_2018JUL.pdf (President’s Message)
This recently from McTimoney chiropractors (NB. they are regulated by the UK General Chiropractic Council who don’t specify scope of practice):
“Is ‘subluxation’ a historical concept? Whilst the answer might play a role in your clinical, personal or practical philosophy, the McTimoney Chiropractors Association will support you and have your back no matter your view. In our opinion we are all Chiropractors and are all deserving of #ChiropracticTolerance.”
Ref: https://www.facebook.com/mctimoneychiropracticassociation/photos/a.145823282157071.35903.145726228833443/1980951451977569/?type=3&theater
And chiropractic reform in Europe not going to happen, apparently:
https://www.chiropractic-ecu.org/wp-content/uploads/2017/03/01-32-Backspace-Mar17-to-print.pdf (President’s Message)
More reasons why chiropractic reform is unlikely:
Ref: https://pubmed.ncbi.nlm.nih.gov/27920616/
Reform is a fib, apparently:
“One of the strengths of the chiropractic profession remains its diversity”
Ref: https://www.wfc.org/website/images/wfc/qwr/QWR_2016B.pdf (President’s Message)
Then the British Chiropractic Association admitted in 2016 that “unity need not mean uniformity”: Ref: http://www.mccoypress.net/i/bca_bennett_letter_december_2016.jpg
That is a stance that is wholly reconcilable with a recent comment made by Michael Copland-Griffiths [DC, FRCC, FBCA, FEAC – former Chair of the Chiropractic Registration Steering Group (1994-1997), former President of the British Chiropractic Association (1985-1987) and former Chair of the General Chiropractic Council (2002-2006)] on the Chiropractors’ Act 1994:
“the diverse Chiropractic profession had to continue to speak with one voice…disunity would kill the commencement of the Act”
Ref: https://www.gcc-uk.org/UserFiles/Docs/Newsletters/The%20Chiropractors%20Act%20and%20opening%20of%20the%20GCC%20register%20MCG.pdf (link now dead)
Indeed, that fits in very neatly with his article in the European Journal of Oriental Medicine, Vol.2 No.6, 2004, in which he wrote:
“In spite of strong mutual suspicion and distrust, the profession united under a group formed specifically to pursue regulation and secured the Chiropractors Act (1994)…..Regulation for a new profession will literally ‘legitimise it’, establishing its members within the community, making them feel more valued. In turn, this brings greater opportunity for more clients and a healthier bank balance.”
Ref: https://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1437-statutory-regulation-the-chiropractic-experience.html
Then there’s this: Global and European chiropractic reform unlikely says senior chiropractic academic:
Ref: https://tinyurl.com/y4vl9ath
The academic seems to be correct, not least because the European Chiropractors’ Union admitted two years ago that it had not yet covered serious areas such as “the subluxation complex, vaccination, the use of drugs and patient management, where we know there is a significant difference in opinion between the two groups [mechanists/vitalists].”
Ref: https://www.chiropractic-ecu.org/wp-content/uploads/2017/03/01-32-Backspace-Mar17-to-print.pdf
At this point it’s worth noting that six years after inventing chiropractic, DD Palmer discarded it https://www.facebook.com/204610332906631/photos/a.349152545119075/2047167945317518/?type=3&theater – only for it to be resurrected by his (ruthless) businessman son, BJ Palmer.
Meanwhile, the current President of the World Federation of Chiropractic, Vivian Kil DC (who dreams of uniting the profession and wrote in 2015 that: “If we miss the boat, the nightmare has set in, and our profession may no longer have a reason to exist” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685193/ ) – said in May of last year that:
“We need, at least to the outside, to act as one profession…”
Ref: http://chiropractic.prosepoint.net/164440
@ Critical_Chiro
ChiroprACTORS, yes? I certainly think so. And to me, it looks like Kil’s ‘nightmare’ has set in already.
@Crackpot_Chiro,
How is it possible to reform a cult which has no basis or reason for existence?
Chiros can’t even, legally, lance a boil (you are too young to understand this thus adding to your long list of ignorances), simply because they are not competent to do anything meaningful in healthcare.
Faffing about with the worried-well only demonstrates one thing; chiro is a sham and chiros are charlatans.
@Blue Wode
“Unity with Diversity” has been tried by the WFC and it has failed. Greg Kawchuk, Jan Hartvigsen and another researcher called out subluxation BS at the WFC/ECU conference in Berlin 2019. Gerry Clum and the vitalists were pissed off (they even tried to sneak in during lunch breaks and hand out Rubicon Group propaganda).
If Matthew McCoy is complaining about “subluxation deniers” within the WFC and the ACA then the profession is moving in the right direction.
“Unity with Diversity” is just a plea from the subbies to tolerate their BS for the sake of harmony and to keep the noise down. Not happening anymore.
For every reform there is going to be push back from the subbies.
Looks like this is occurring this week at the WFC though we are still waiting for details.
Will the subbies ever change. Highly unlikely. That’s why shoving reform down their throats like in Denmark where scope of practice is legislated is needed. The Canadian Chiropractic Guideline initiative is also a step in the right direction. Make it impossible to practice outside guidelines and best evidence based practice.
Unresolvable problems? Possibly, so maybe it’s time for the divorce:
https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0221-z
Reform is ongoing and vested interests will always fight it.
@Frank Collins
Carpet bombing generalizations and name calling.
Ring the chiropractic bell Frank and you respond in a predictable way.
You need to keep up with the research otherwise your carpet bombing is predictable and your ignorance apparent.
Highly recommend as a starting point the recent September supplement in Pain. The Biennial review of Pain. See here:
https://journals.lww.com/pain/toc/2020/09001
Several very important papers including an update of the Lancet LBP series by Buchbinder, Hartvigsen, Underwood and Maher.
Surgery for Musculoskeletal pain: the question of evidence from Ian Harris.
As for relative levels of evidence I once assumed like many on this blog that chiropractic had little while other professions did have evidence until I read the 2008 supplement in The Spine Journal where 25 different approaches for the treatment of LBP were compared here:
https://www.sciencedirect.com/journal/the-spine-journal/vol/8/issue/1
Then I realized that these assumptions were wrong.
Chiropractic is not a technique.
Chiropractic is not subluxation and only the dinosaur chiro’s and critics cling to it.
BTW I don’t faff around with the “worried well” ( We use that term as well. OMG don’t tell me we have something in common). I work in a medical centre with doctors and have an extensive referral network of GP’s, pain specialists, physio’s, neruo’s, ortho’s, exercise physiologists etc.
Maybe I’m just brilliant at marketing and I have conned all of them.
Maybe since they work with a chiro their all charlatans as well.
Critical_Chiro wrote: “@Blue Wode ‘Unity with Diversity’ is just a plea from the subbies to tolerate their BS for the sake of harmony and to keep the noise down. Not happening anymore.”
@ Critical_Chiro
Yes, it *is* happening. You cannot escape the fact that in the World Federation of Chiropractic’s [WFC] Strategic Plan 2019-2022, under its ‘Values’, it states: “We respect diversity in the range of approaches that chiropractors take.”
Ref: https://www.wfc.org/website/images/wfc/docs/Strategic_Plan_2019-2022/WFC_STRATEGIC_PLAN_2019-2022.pdf (see p.7)
Indeed, WFC Secretary-General, Richard Brown, is of this view:
QUOTE
“The WFC has unity as one of its core pillars. While it would seem very simple to cut adrift a section of the chiropractic community with whom we disagree, the reality is that this is neither possible nor desirable…The richness of the chiropractic profession lies in its diversity of approaches…Education is delivered differently. The philosophy of chiropractic care takes many forms, some aligned with other health professions, others quite distinct…The WFC values evidence-informed care and promotes research as a means of developing the chiropractic profession.”
Ref: https://www.wfc.org/website/images/wfc/qwr/QWR_2017JUL.pdf (pp 5-6)
In support of the above, in March 2019, the WFC partnered with the European Chiropractors Union (ECU – an autonomous organisation established by chiropractors and with no statutory powers) for an ‘EPIC’ event https://tinyurl.com/yyz7423m and in doing so would have known that the ECU’s education arm accredits the subluxation-based McTimoney and Barcelona chiropractic colleges:
http://www.cce-europe.org/accredited-institutions.html
There was a damning, skeptical write up of the event beforehand:
https://complementaryandalternative.wordpress.com/2019/03/18/world-federation-of-chiropractic-biennial-congress-epic2019-evidence-based-or-not/
…and another one after it:
https://edzardernst.com/2019/05/chiros-at-war/
Note in the last link above (chiros at war) that Vivian Kil DC, current President of the WFC, states that part of her vision is:
QUOTE
“1. That we will (the chiropractic profession) set aside our differences within the profession, unite as a profession, and agree that becoming the source of nonsurgical, nonpharmacological, primary, spine care expertise and management should be a primary common goal.
2. That for us to do the necessary work to fulfill this role and do it with the entire profession, every chiropractor will be involved and not just a small active group of leaders.”
Critical_Chiro wrote: “Unresolvable problems? Possibly, so maybe it’s time for the divorce: https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0221-z ”
A successful divorce would require an enormous public relations campaign that would likely further damage the reputation of chiropractors in general. Meanwhile (and notwithstanding that evidence-based ‘chiropractic’ is an oxymoron), the bottom line is that there continue to be no well-publicised directories available to the public and healthcare professionals to which they can turn in order to find chiropractors who do not treat mythical subluxations, who read good, scientific journals, and who look consistently for best evidence and apply it.
Ergo, IMO, it looks like the marriage will continue – in the form of an arranged one based on pecuniary interests – similar to what Michael C. Copland-Griffiths, former Chairman of the UK General Chiropractic Council, described some years ago:
QUOTE
“In spite of strong mutual suspicion and distrust, the profession united under a group formed specifically to pursue regulation and secured the Chiropractors Act (1994)…..Regulation for a new profession will literally ‘legitimise it’, establishing its members within the community, making them feel more valued. In turn, this brings greater opportunity for more clients and a healthier bank balance.”
Ref: https://www.ebm-first.com/chiropractic/uk-chiropractic-issues/1437-statutory-regulation-the-chiropractic-experience.html
“and notwithstanding that evidence-based ‘chiropractic’ is an oxymoron”
It seems we all need to do better.
“Less than 20% of patients with LBP received evidence-based information and advice from their family practitioner.”
PAIN: April 2020 – Volume 161 – Issue 4 – p 694-702
“This survey showed that analgesic polypharmacy is common, though guidelines on the use of medications for LBP highlight the small benefit from these therapies.”
Expert Opinion on Pharmacotherapy Volume 21, 2020 – Issue 8
“More high quality trials are needed to determine an evidence-based management protocol for the treatment of acute low back pain in the ED, specifically focusing on non-pharmacological management and the first line management of patients presenting with LBP with sciatica.”
Physiotherapy. Volume 109, December 2020, Pages 13-32
“NSAIDs seemed slightly more effective than placebo for short‐term pain reduction (moderate certainty), disability (high certainty), and global improvement (low certainty), but the magnitude of the effects is small and probably not clinically relevant.”
Cochrane Systematic Review – Intervention Version published: 16 April 2020
Etc, etc.
But yes, a chiropractic divorce is not a feasible option at this time. There are other options, some of which have been discussed on this blog. But i don’t see any of the so called skeptics that share regularly here as part of a viable solution.
@ DC
Re your citations, I was addressing the top-down enormous tolerance for quackery within the chiropractic industry, not the evidence for low back pain.
DC wrote: “i don’t see any of the so called skeptics that share regularly here as part of a viable solution [re reform].”
@ DC
At the end of the day, it’s not our problem.
I agree.
I have often made constructive suggestions; they either were ignored or led to fierce opposition.
Now I focus on disclosing chiro-BS, lies, errors, ethical violations, etc.
As they have continually rejected help, I leave it to them to sort themselves out.
BW… I quoted your comment that I was responding to.
Edzard…perhaps it’s because your suggestions weren’t feasible or they were just plain silly.
there you are!
thank for confirming what I wrote
That your suggestions may have been silly to those who are better informed? I can see that.
@Edzard Ernst
A few years ago we had issues with vitalistic chiropractors staging a conference and inviting US guru’s who have no place here.
We contacted medical lobby group “Friends of Science in Medicine” (FSM) for their help in stopping the conference and the email chain that came back going through their executive was enlightening. All the emails boiled down to “not our job to reform chiropractic but happy to support the reformers within the profession”.
They were a big help.
Last year another chiro tried to stage a conference with an American guru and again FSM helped. We lobbied their venue and the conference centre pulled out.
I have said this many times in the past on this blog:
Step 1. Point out the BS and demand reform.
Step 2. Support the academics, reform and reformers within the profession.
You are good at Step 1.
You are across the research and know the researchers and reformers so it’s way past time to support them. Failure to take Step 2 would make you part of the problem and not the solution.
@Blue Wode
Vivian Kil stepped in after Laurie Tassell (who is a vitalist and a “unity with diversity” proponent) resigned.
She is very much evidence based so wait and see how it pans out. WFC is moving in the right direction
@DC
“But i don’t see any of the so called skeptics that share regularly here as part of a viable solution.”
True after so many public statements pushing their beliefs change is unlikely no matter how much research you cite.
Human nature once they making a public statement their hard wired to defend it no matter what evidence is presented.
I post here primarily to engage with all those lurking and reading these comments to put both sides of the argument into the public record.
Otherwise it’s just an echo chamber.
DC wrote: “BW… I quoted your comment that I was responding to.”
@ DC
Then perhaps you’d like to respond to this point I was making… “the bottom line is that there continue to be no well-publicised directories available to the public and healthcare professionals to which they can turn in order to find chiropractors who do not treat mythical subluxations, who read good, scientific journals, and who look consistently for best evidence and apply it”.
The foundation has been laid and they are building upon it.
https://www.forwardthinkingchiro.com/member-map-1#!map
DC wrote: “The foundation has been laid and they are building upon it. https://www.forwardthinkingchiro.com/member-map-1#!map ”
@ DC
Well, it looks like you’re off to a bad start. I’ve had a quick look at all the entries for the UK:
Back Clinics appears to have an out-of-date reference to the NICE guidelines for low back pain
https://backclinics.co.uk/what-we-do/
Newcastle Chiropractic Clinic treats infants and children
https://chiropractorinstoke.co.uk/new-patient-forms
and removes ‘nerve interference’
https://chiropractorinstoke.co.uk/how-does-it-work
Beckham & Sevenoaks clinic sees ‘patients of all ages’ and claims that ‘You are never too young or too old for Chiropractic care’
http://www.sevenoakschiropractic.com/
The Llandaff Chiropractic Clinic is wholly misleading about the evidence for chiropractic
http://www.cardiffchiropractor.com/chiropractic/ (scroll down)
YMYB Chiropractic only lists common side effects of treatment and not the life-threatening ones
https://www.ymyb.co.uk/andover-chiropractic/what-is-chiropractic
Davies Chiropractic Care uses a dubious device called an ‘Activator’
https://davieschiropracticcare.co.uk/chiropractic-treatment/
Back In Action clinic asks ‘who can benefit from chiropractic treatments?’ and goes on to say ‘The early, formative years are those of learning new skills. Along the way children may lose their balance; they trip, they slip, they tumble, and they fall. Chiropractic care can be useful for more prolonged “little knocks”.’
https://back-in-action.net/chiropractic/
@ DC
The Forward Thinking Chiropractic Alliance, who run the directory, need to take an urgent and serious look at their quality control. Please notify them.
The initial goal was to help steer the public away from vitalistic chiropractors towards those who are more evidence based.
But sure, with 9000 members, some may slip in that don’t meet their standards or need to clean up their webpage.
Regardless, as i stated, it’s a foundation to build upon.
“some may slip in that don’t meet their standards…”
SOME???
Yes some. Do you need a dictionary definition again?
Some: an unspecified amount or number of.
I took a browse thru the pages. I didn’t see anything that would make them guilty of practicing quackery. Sure, some things could be worded better, be updated, etc.
As I stated, the purpose is to help steer people away from the true quacks in this profession.
“I didn’t see anything that would make them guilty of practicing quackery.”
could this be because you are a quack?
EE: could this be because you are a quack?
Not by definition. But if you see quackery on one of those web pages feel free to point it out.
@Blue Wode
Caveat emptor applies to all professions.
There are neurosurgeons, orthopods, physio’s, exercise physiologists, pain specialists, intervention anesthetists who are superb and I refer to regularly. There are also members of those professions who I would not touch with a 40 foot barge pole.
Same for chiropractic. That is why referral networks are so important as they have inbuilt checks and balances. The doctors who refer to me hold me to account.
That is one of chiropractics greatest failings. Practitioners who live in silo’s and do not communicate well with other professions.
The vitalists have an us and them mentality which is not in the patients best interests. It’s only in the interest of their “foolosophy” – Keith Charlton (DC, PhD).
@uncritical quack: “there are neurosurgeon, orthopods, physios, exercise physiologists, Pain specialists, intervention anesthesiologists…I refer to”, well this begs a question doesn’t it: WTF are YOU offering and doing to your gullible marks that WOULD’NT be done better by one of those real professionals FROM THE GET GO? You’re just interfering with and delaying their arriving at an office of someone having spent the time and effort and dedication to get educated and licensed in a real, a viable, a vetted and a trusted profession. Oh wait, you can offer to “thrust” on whatever hurts…and then the other real professionals can say: “ok well that never works, let’s try something that might”. Unless you are telling us you treat outside your scope of practice?
“At the end of the day, it’s not our problem.”
I never said it was. But one doesn’t have to be part of the problem to be part of the solution. But I don’t see anyone here that can be part of a viable solution. Too much animosity against the profession. Moving on.
DC wrote: “The initial goal was to help steer the public away from vitalistic chiropractors towards those who are more evidence based. But sure, with 9000 members, some may slip in that don’t meet their standards or need to clean up their webpage. Regardless, as i stated, it’s a foundation to build upon.”
Here’s a huge problem:
“Values of The Forward Thinking Chiropractic Alliance
Tenets our members stand for:
1. SCIENCE
We are evidence informed chiropractors… ”
Ref. https://www.forwardthinkingchiro.com/values
…but the public are being deceived by the Alliance’s declaration that they are evidenced *based*…
https://www.forwardthinkingchiro.com/member-map-1#!map
@ DC
As you have stated previously (above) that you “don’t see anyone here that can be part of a viable solution” to chiropractic’s problems, are you going to notify the Forward Thinking Chiropractic Alliance of its errors which have I have pointed out in this post and my previous one?
Ref. https://edzardernst.com/2020/09/beliefs-perceptions-and-practices-of-chiropractors-and-patients-about-adverse-events-after-spinal-manipulation/#comment-126309
Evidence based isn’t black and white.
@ DC
As Prof. Ernst has said in the past, ‘evidence informed practice’ is a weasel word for those who do not want to implement the best available evidence.
If chiropractors twist that to mean patient preference, then they have to factor in not misleading patients in the first place.
On the subject of misleading patients, have you notified the ‘Forward Thinking Chiropractic Alliance’ of the misleading UK websites highlighted here https://edzardernst.com/2020/09/beliefs-perceptions-and-practices-of-chiropractors-and-patients-about-adverse-events-after-spinal-manipulation/#comment-126309 ??
No, i have been busy with patients all day and i haven’t had time to look at those web sites.
If i see an issue i will follow up on it.
DC wrote: “No, i have been busy with patients all day and i haven’t had time to look at those web sites. If i see an issue i will follow up on it.”
@ DC
“If” you see an issue? I’ve already uncovered a few issues to start on…
https://edzardernst.com/2020/09/beliefs-perceptions-and-practices-of-chiropractors-and-patients-about-adverse-events-after-spinal-manipulation/#comment-126309
If it’s alright with you i prefer to look at the webpage first, see what, if any, changes need to be made, contact the chiropractor with any suggestions, allow them the opportunity to make said changes.
Sometimes chiropractors work as an employee and do not have much or any control over webpage content.
I have done this in the past for chiropractors…not my first go around.
Critical_Chiro wrote on Wednesday 16 September 2020 at 03:09: “I have said this many times in the past on this blog: Step 1. Point out the BS and demand reform. Step 2. Support the academics, reform and reformers within the profession. You are good at Step 1. You are across the research…”
@ Critical_Chiro
The problem is that, even with reform, the research isn’t convincing.
Critical_Chiro wrote: “Vivian Kil…is very much evidence based so wait and see how it pans out. WFC is moving in the right direction.”
It doesn’t look like she’s evidence based if her vision is anything to go by…
“That we will (the chiropractic profession) set aside our differences within the profession, unite as a profession, and agree that becoming the source of nonsurgical, nonpharmacological, primary, spine care expertise and management should be a primary common goal.”
Ref. https://edzardernst.com/2019/05/chiros-at-war/
Further, as already pointed out, her vision appears to be shared by the World Federation of Chiropractic Secretary-General, Richard Brown:
QUOTE
“The WFC has unity as one of its core pillars. While it would seem very simple to cut adrift a section of the chiropractic community with whom we disagree, the reality is that this is neither possible nor desirable…The richness of the chiropractic profession lies in its diversity of approaches…Education is delivered differently. The philosophy of chiropractic care takes many forms, some aligned with other health professions, others quite distinct…The WFC values evidence-informed care and promotes research as a means of developing the chiropractic profession.”
Ref. https://www.wfc.org/website/images/wfc/qwr/QWR_2017JUL.pdf (pp 5-6)
It’s also worth mentioning here that the World Federation of Chiropractic has just lost several of its Research Committee members…
http://chiropractic.prosepoint.net/172624
…as well as 17 international sponsors:
http://chiropractic.prosepoint.net/172621
Looks to me like Vivian Kil is the captain of a sinking ship.
“Looks to me like Vivian Kil is the captain of a sinking ship.”
Breaking news: Christine Goertz has just been named as WFC Research Committee Interim Chair:
https://www.facebook.com/notes/world-federation-of-chiropractic-wfc/leading-academic-named-as-wfc-research-committee-interim-chair/3623226174396861/?__tn__=-R
Learn more about her here: https://edzardernst.com/2019/03/disaster-service-by-chiropractors-yes-its-quite-a-disaster/#comment-110779
Confirmation that the WFC is definitely holed below the waterline?
DC wrote on Wednesday 16 September 2020 at 12:27: “If it’s alright with you i prefer to look at the webpage first, see what, if any, changes need to be made, contact the chiropractor with any suggestions, allow them the opportunity to make said changes.”
@ DC
A couple of questions:
1. Are you going to do that for all 9,000 members?
2. Don’t you think that the Forward Thinking Chiropractic Alliance should be proactively monitoring their evidence based/informed chiropractor members? Otherwise it’s a pretty unreliable resource for the general public.
DC wrote: “Sometimes chiropractors work as an employee and do not have much or any control over webpage content.”
That’s a red flag if ever there was one – i.e. that such chiropractors are happy to associate themselves with colleagues who do not embrace their standards.
Happy? Hardly. I hear the stories.
No, I am not an official officier in the FTCA so i will not be looking at 9000 chiropractors webpages.
My understanding is it’s all volunteer work. They vet as they can. They could easily be 20,000 members with looser criteria.
You asked for a source for the public. I gave one. Sorry if it’s not perfect and to your standards.
But hey, you now have something else to complain about.
DC wrote: “Happy? Hardly. I hear the stories.”
@ DC
Then surely if those chiropractors weren’t happy associating with colleagues who do not embrace their standards they’d do something about it?
DC wrote: “My understanding is it’s all volunteer work. They vet as they can. They could easily be 20,000 members with looser criteria. You asked for a source for the public. I gave one. Sorry if it’s not perfect and to your standards. But hey, you now have something else to complain about.”
I was hoping for a reliable source for the public.
Re “some may slip in that don’t meet their standards or need to clean up their webpage”
DC wrote on Wednesday 16 September 2020 at 12:53 : “Yes some. Do you need a dictionary definition again? Some: an unspecified amount or number of.”
It’s nearly 100% for the chiropractors listed for the UK:
https://edzardernst.com/2020/09/beliefs-perceptions-and-practices-of-chiropractors-and-patients-about-adverse-events-after-spinal-manipulation/#comment-126309
That is not ‘some’.
an amount or number of something that is not stated or not known; a part of something: Cambridge
You use some to refer to a quantity of something or to a number of people or things, when you are not stating the quantity or number precisely. Collins
Etc, etc, etc.
Buy a dictionary.
DC wrote [re ‘some’]: “an amount or number of something that is not stated or not known; a part of something: Cambridge You use some to refer to a quantity of something or to a number of people or things, when you are not stating the quantity or number precisely. Collins Etc, etc, etc. Buy a dictionary.”
@ DC
What is it that you don’t understand about chiropractors who don’t meet the Forward Thinking Chiropractic Alliance’s standards (or need to clean up their webpage) being nearly 100% for the chiropractors listed for the UK?
Ref. https://edzardernst.com/2020/09/beliefs-perceptions-and-practices-of-chiropractors-and-patients-about-adverse-events-after-spinal-manipulation/#comment-126309
All that effort by the Alliance and they end up with a useless resource.
That’s your “nearly 100%”
Since i have not gone thru it i used “some”…i dont have a number to report.
“Some” isn’t that hard to understand.
@ DC
You’re evading the issue. The source is of no use to anyone in the UK seeking an evidence based chiropractor – ergo it doesn’t auger well for any of the other countries.
Actually no i am not evading.
I just understand that being evidence based isn’t so black and white. There is a degree of flexibility.
Sometimes the best evidence doesnt work or is not always the best for a particular patient.
DC wrote: “Sometimes the best evidence doesn’t work or is not always the best for a particular patient.”
Given the quackery contained in nearly all of the UK chiropractic websites listed on the Forward Thinking Chiropractic Alliance’s ‘evidence based’ resource, I’d like to know how chiropractors ensure that their own beliefs and values don’t prejudice a patient’s care.
I will see if the websites contain actual quackery.
medical methods that do not work and are only intended to make money. Cambridge
the methods or behaviour of somebody who pretends to have medical knowledge. Oxford.