The definitions of a quack as used in healthcare vary somewhat:
- ignorant, misinformed, or dishonest practitioner of medicine
- untrained person who pretends to be a physician and dispenses medical advice and treatment
- people who claim to be skilled in medicine but are not
- person who dishonestly pretends to have medical skills or knowledge
- one who misrepresents ability and experience in diagnosis and treatment of disease or the effects to be achieved by treatment
Richard Lanigan, in his post entitled Skeptics like Edzard Ernst remind me of Humpty Dumpty in their use of words. They make them up as they go along prefers the the definition from the Oxford dictionary: “a person who dishonestly claims to have special knowledge and skill in some field, typically medicine” (actually, the version of the Oxford dictionary I accessed defines a quack not quite like this but as a person who dishonestly claims to have medical knowledge or skills).
More importantly, Richard claims in an oddly incoherent post that not the chiropractors but the critics of chiropractic are are the true quacks:
It would appear “quacks” are people who pretend to have expertise in subjects they know little about, presumably subjects like, chiropractic medicine or acupuncture. I practice chiropractic, I dont diagnose or treat illness or disease, I dont make medical claims. You may not like chiropractic or understand it, however practicing chiropractic would not appear to conform to the definition of “quackery”, however claiming to have “special knowledge” about chiropractic and having only been trained as a medical practitioner may in fact make you a “quack” professor Ernst. All I do is maintain movement in spinal joints that become stiff from sedentary lifestyles, movement effects function of mechano receptors(nerves) in spinal joints. You may not believe that is possible, you may not believe maintaining joint function is important or that it effects wellbeing, you are perfectly entitled to your opinion, however I am not so confident of you depth and breath knowledge in anatomy and physiology. You might start by asking, why joints were immobility post surgery in the 80s and now post surgical treatment is all about maintaining joint motion as chiropractors have been advocating for years.
If I understand this correctly, this means: any non-chiropractor who criticises chiropractic is a quack. Moreover, it means that, as chiropractic is very rarely criticised by a chiropractor, chiropractors cannot be quacks.
I find this fascinating. It amounts to the legitimisation of any healthcare profession, however bizarre, unproven, disproven or dangerous their practice might be:
- crystal therapists cannot be accused of quackery, because only their kind understand their business;
- rebirthing practitioners cannot be accused of quackery, because only their kind understand their business;
- applied kinesiologists cannot be accused of quackery, because only their kind understand their business;
- bioresonance practitioners cannot be accused of quackery, because only their kind understand their business;
- Bach flower therapists therapists cannot be accused of quackery, because only their kind understand their business;
- colour therapists cannot be accused of quackery, because only their kind understand their business;
- colon therapists cannot be accused of quackery, because only their kind understand their business;
- dowsers cannot be accused of quackery, because only their kind understand their business;
- ear candle practitioners cannot be accused of quackery, because only their kind understand their business;
- feng shui practitioners cannot be accused of quackery, because only their kind understand their business;
- faith healers cannot be accused of quackery, because only their kind understand their business;
- gua sha practitioners cannot be accused of quackery, because only their kind understand their business;
- iridologists cannot be accused of quackery, because only their kind understand their business;
- homeopaths cannot be accused of quackery, because only their kind understand their business;
- naprapathy therapists cannot be accused of quackery, because only their kind understand their business;
- neurolinguistic programmers cannot be accused of quackery, because only their kind understand their business;
- osteopaths cannot be accused of quackery, because only their kind understand their business;
- pranic healers cannot be accused of quackery, because only their kind understand their business;
- psychic surgeons cannot be accused of quackery, because only their kind understand their business;
- radionics practitioners cannot be accused of quackery, because only their kind understand their business;
- reflexologists cannot be accused of quackery, because only their kind understand their business;
- Reiki masters cannot be accused of quackery, because only their kind understand their business;
- shiatsu practitioners cannot be accused of quackery, because only their kind understand their business;
- therapeutic touchers cannot be accused of quackery, because only their kind understand their business;
- vaginal steamers cannot be accused of quackery, because only their kind understand their business;
- etc, etc.
I can, of course, easily see why Richard Lanigan would like this concept to be true. Alas, Richard (and all the other SCAM-enthusiasts who make similar arguments), it does not work like this! A quack might be defined as listed above or in many other ways. But, in so-called alternative medicine (SCAM), a quack foremost is a person who habitually misleads the public by making claims that are not supported by sound evidence. And as some wise guy once observed: honest conviction renders a quack only more dangerous. As to the professional background of a quack:
I do not care a hoot!
I have done my best to disclose quackery no matter whether it came from a medic or a SCAM-practitioner, a physio or a nurse, an entrepreneur or a fruitcake, an evangelist or a politician, royalty or commoner. And, believe me, Richard (plus all the other SCAM-enthusiasts who make similar arguments), I will carry on doing so, whether it fits into your little scheme of wishful thinking or not.
83 Responses to To be or not to be … a quack
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I wrote that post about 10 years ago and Am happy to stand by it, even if you feel it’s “incoherent”. Then you also call me a “scammer”, surely it’s for the people who receive my services to say whether they have been scammed rather, than someone who is obviously prejudiced against chiropractic.
If giving “medical” advice without any training in medicine Is a “quackery” surely the same applies to someone giving advice on chiropractic, which I am sure you agree is nothing like medicine, which you are trained in. .
However if you believe cancer treatment is exclusively the domain of medicine, I do accept the title of “quack“, in my efforts trying to advise medical doctors to look into the benefits of cannabis instead of chemotherapy I will wear “The Title “quack” as a badge of honour, as I did in the 80s as one of the pioneers of the fitness boom and making people healthier
please read my post again, Richard:
1) did I call you a scammer?
2) who said that ‘giving “medical” advice without any training in medicine Is a “quackery”’ [I think lots of people have to do that who are not necessarily quacks.
3) I do not believe that believe cancer treatment is exclusively the domain of medicine, and never said so.
I don’t think you have understood what I wrote – but I am sure glad you are well and alive.
First I would say, I wrote that post 8 years ago and that was the definition I found in Oxford dictionary in 2012, it’s not that different from your definition, which defines it as exclusive to medical advice.
Surely the principal is the same, if someone starting advising an architect how to build a High Rise It should be brought into question. I would say “ quackery” is a perfect word to explain what happened at Grenfel.
My 2012 post was in response to comments by Blue Wode on one of your posts.I make it perfectly clear in the post skeptics are entitled to their opinions and to call me names. I stated how I felt the BCA was wrong to sue Simon Singh, I even became friends with Simon during the case and was supportive of his right to write the Guardian article, even though I did not agree with the opinions he expressed.
In the post I Specifically state; “when Ernst thanks fellow “skeptic” Blue Wode for his support in the comments on the blog, by saying; “Thank you BW; this explains very clearly why chiropractors will find it hard or even impossible to free themselves from their long tradition of quackery”
It was in response to that comment and advice you were giving to patients that might seek my help. That chiropractic is is “high risk, with no benefit”.
No doubt their are bad chiropractors as there are bad medical doctors. But I can only refer to my 25 years of experience and what I observed as a fitness consultant for Team Denmark in the 80s, preparing sports people for the Los Angelas and Seoul Olympics.
In the post I put this in the context of David Sacketts model of EBM, which he based on 3 pillars; “best available evidence” ( thousands of case studies), experience and patients beliefs.
Chiropractic is a skill, you don’t get better by doing research, like you don’t get better at golf by reading. I would compare my knowledge of anatomy with anyone. I have said many times you are welcome to visit my practice any time. I have many medical doctors as clients and none of them would question my anatomical knowledge or the benefits of exercise to wellbeing which I have been promoting since 1976 as a PE teacher and in 2004 I did a masters in the subject at Brunel Univetsity
As for the points you raise
1) did I call you a scammer?
The last paragraph states “Richard (and all the other SCAM-enthusiasts who make similar arguments” but as I said in the post, you are perfectly entered to you opinion.
2. who said that ‘giving “medical” advice without any training in medicine Is a “quackery”’ [I think lots of people have to do that who are not necessarily quacks.
As I said above and in the post people are perfectly entitled to criticise. But giving advice on a subject they don’t appear to know a great deal about. I am not an academic have little interest in the research produced by others who may not be as skilled as I am. When the BCA claimed to have a plethora of evidence to support their claims. It was laughable. Every interaction I do is based on experience, and if Covid has thought us anything, the science can mean different things to different people. The only people I care about their opinions, are my family, friends and clients. In fact In my memoir about my cancer journey, I focus more on those relationships that kept me laughing every day as much as the cannabis
3) I do not believe that believe cancer treatment is exclusively the domain of medicine, and never said so.
I don’t think you have understood what I wrote – but I am sure glad you are well and alive
I never said you believed it. I asked “if you believe it” and appreciate your final words. I would like to think our interactions have always been fairly cordial.
It’s ironic what we have one thing in common; the chiropractic establishment hate our guts ??
… and I thought the chiropractic fraternity love me; recently I even dedicated an entire book effort to them!
https://www.amazon.co.uk/Chiropractic-Not-All-That-Cracked/dp/3030531171
Just ordered my copy. I will let you know what I think. Perhaps it might have been titled “ chiropractors not all they are cracked up to be” rather than chiropractic. That the major problem the profession has, “ chiropractors” can’t agree what chiropractic is and how to practice it ?
what happened to the book you were about to publish?
Finished 14 chapters which are a memoir, of my experience of Living with cancer from 2011 to a scan in 2017 which showed I was clear.
Last two chapters are technical stuff around cancer ala “ Emperor of all Maladies” and cannabis the Emperor of all plants. Hoped to finish it during lockdown, but kids around all the time. Now back at school, hopefully I will get it done before Christmas
keep us posted; I for one will buy your book, if you find a publisher.
@chiroquacker/faux-spinal-expert Richy: “I don’t diagnose or treat illness or disease”. Wow, but isn’t ‘joint motion’ just another name for the subluxation? Of course it is. And what about biomechanical experts who seem to suggest much ‘spinal pain’ is from hyper-mobile joints? And do you really believe YOU can accurately feel and apprehend ‘joint motion’? Quite an arrogant statement…but after all hyperbole is the most consistent trait of a quack selling entrepreneurial theatrics masquerading as healthcare. If you didn’t have the ability to become a genuine doctor why didn’t you become a nurse? That’s an honorable profession that truly serves the world without self-aggrandizing rhetoric.
In 1982 I had cruciate ligament reconstruction my knee was immobilised for 3 months, in the 90s medical experts figured out, maintaining joint movement was important. Medics also thought Sacrailliac joints were fused.
We adjust hypo mobile joints which improves function. Hyper mobility is a contraindication to SMT of that particular joint
Richard Lanigan,
I am not aware of any clinical trials which have compared chemotherapy with cannabis. I am sure that if you have any sensible suggestions for how to design and fund such a trial there will be oncologists who would be interested in a collaboration.
What advice, specifically, have you been giving to medical doctors?
Which chemotherapy regimens do you suppose can be replaced by cannabis, and in which role? Primary chemotherapy is often curative on its own so the evidence would need to be pretty strong here. Adjuvant chemotherapy also prevents a lot of tumour recurrences, but trials with long follow-up are required to assess the benefits of any adjuvant treatment, so I am guessing this is not what you are referring to, either. And I doubt that you are recommending cannabis either in the neoadjuvant setting (for instance to render inoperable tumours operable) or as a radiation sensitiser. This covers most chemotherapy use.
So I suppose you must be talking about palliative chemotherapy, where the aim is to relieve the many distressing symptoms that advanced cancer causes, and if possible to prolong survival as well. Depending on the tumour type the response to chemotherapy can be quite variable here, and there is certainly a need for other effective treatments that some patients might find more acceptable (at the moment there is a lot of interest in targeted therapies, which can complement or replace chemotherapy in many situations). But it is important to remember that even in the case of advanced, metastatic cancers that are considered to be incurable, conventional treatment can give years of additional relatively symptom-free life.
I was diagnosed with stage 2 rectal cancer in 2011 and had the usual treatment at the Royal Marsden including 12 cycles of intravenous chemotherapy. Given all clear in 2012. Then at my annual check up in August 2013, was told; cancer was back had metastasised, was incurable, average life expectancy with chemo was 22 months, which was put in writing.
Started chemo but after a couple of cycles was getting same side effects; peripheral neuropathy which meant I had no feeling in my hands and could not practice chiropractic. I chose to work until the cancer made it impossible and would go to Dignitas.
Then I read some studies from 70s on anti tumeral effect of cannabis and decided to give it a go, and followed the advice of Rick Simpson a Canadian engineer who has been promoting the benefits of cannabis for a number of conditions for many years.
I consumed (Orally) 60 grams of concentrated cannabis oil over a three month period. I had my last scan 2 years ago Which was clear. I continue to take a small amount each week for prevention.
I discovered the pharmacy in the Hauge all the kids with epilepsy are now going to and went with Hannah Deacon to ten Downing Street in March 2018? Which ultimately resulted in legalisation for medical use. But let’s face it unless they have been smoking it over the years, you could write what most medical doctors know about cannabis on the back of a stamp
Richard,
I am sorry to hear about your diagnosis, though pleased that you are doing so well.
I think it is a bit unwise to talk about average life expectancy unless you are an actuary advising on how to set insurance premiums. When I hear my colleagues talking to patients in this way, they are usually referring to specific clinical trials where the median survival is given (among other measurements) as a way of comparing one treatment arm with another. However, the subjects recruited into a trial are a selected group and don’t necessarily have the same characteristics (such as age and the presence of other illnesses) as their own patients, so their prospects are never going to be the same. The other important thing to remember is that the median survival is simply the point at which half of the individuals in a group have died. This will certainly include some who never survived long enough even to start treatment, as cancer trials are analysed on an “intent-to-treat” basis, rather than according to treatment received, in order to avoid bias. As there is a very wide range of outcomes, including survival, in any group of cancer patients, it is not surprising that there are a substantial number who live much longer than predicted, often by many years.
While I can’t rule out the possibility that cannabis has been a factor in the behaviour of your disease (since the trials haven’t been done we simply don’t know what it does), I think it is unwise to ignore other possibilities, for instance that you have an intrinsically slow-growing tumour that is less aggressive than most, or indeed that the two cycles of chemotherapy that you had might have been very effective (certainly it seems that the first cycle or two of a course of chemotherapy do a lot more than the final ones).
The classification of cannabis as a Class B drug has certainly impeded its use in medical research. The recent legalisation of CBD oil has led to the widespread sale of many preparations which very enormously in the amount of active ingredient (some contain none at all), and many claims for their therapeutic properties which can’t really be substantiated. At present all we can say is that some people seem to get symptomatic relief from it.
Cancer Research UK has an article about the uses of cannabis in cancer on their Web site:
https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/complementary-alternative-therapies/individual-therapies/cannabis
When I was an undergraduate, my fellow students who smoked cannabis regularly seemed to have a great deal of trouble getting on with anything else. My experience of it is that it alters my perceptions (which is interesting), makes me feel very hungry, sometimes makes things seem funny but more often makes me a bit paranoid, and for about two days afterwards I am very groggy and can’t think straight. I also know people in whom it has triggered serious and long-standing psychosis. I have tended to avoid it over the years, therefore. However, I fail to understand how smoking it over the years could give any insight into its anti-cancer effects. Indeed, NHS UK has this to say about its contribution to the risk of lung cancer:
https://www.nhs.uk/news/heart-and-lungs/cannabis-lung-health-risks-underestimated/
I hope that somebody from the Royal Marsden Hospital is still keeping an eye on you. There have been a number of developments in the treatment of colorectal cancer since 2013 and if your cancer were to relapse in the future it would be nice to know that you were in good hands (I am having my treatment at the same hospital and I have been very impressed by everything there except the food).
To Richard Lanigan:
I note your blog ‘ChiropractLive’ and am confused. Can you explain?
You say: “I practice chiropractic, I don’t diagnose or treat illness or disease, I don’t make medical claims….all I do is maintain movement in spinal joints… movement effects function of mechanoreceptors (nerves) in spinal joints.”
But what is ‘chiropractic’ if it is not a scheme for treating maladies of one sort or another (originally, deafness)?
Why ‘maintain movement of spinal joints’ if the intention is not to release ‘innate’ and thereby treat pathological conditions – as so many chiropractors claim?
Is that not an attempt to practice medicine?
And if all you wanted to do was mobilise joints, why did you not train to be a physiotherapist?
Richard, you go on to say: “You might start by asking, why joints were immobility post-surgery in the 80s and now post-surgical treatment is all about maintaining joint motion as chiropractors have been advocating for years.”
I answer as a surgeon, and one who worked with Professor Robert Salter of Toronto who did much research, and proved, that continuous passive motion (using a device) assisted recovery after orthopaedic and trauma surgery: ‘Medicine’ seeks evidence, and then progresses accordingly – but only when evidence is to hand.
And the evidence that there are subluxations that can be adjusted and innate that can be enhanced by a chiropractor is….?
I must say I applaud the honesty of your bio in ChiropractLive:
“Chiropractors are a strange bunch, at the extremes are those who want to be somebody but don’t have the intellectual resources to achieve much beyond preaching and selling to the converted. On the one side are those not clever enough to get into medschool, they recognise the benefits of chiropractic but rather than devote themselves to the chiropractic profession they devote themselves to gaining acceptance within their first choice career – medicine. The rest accept these people as the representatives of their chosen tribe don’t get involved in politics and provide chiropractic care to their patients and occasionally whingeing when their efforts at building this profession are undermined by the incompetence of the donkeys leading the profession. I thought I could change all that, as I had when student President at the Anglo Europrean College of Chiropractic, however I misjudged the depts the powers that be were prepared to descend to maintain the status quo.”
Interestingly it was the arthritis that developed in my knee and the work of people like “Professor Robert Salter of Toronto who did much research, and proved, that continuous passive motion (using a device) assisted recovery after orthopaedic and trauma surgery” that took me into chiropractic. I was a fitness consultant for team Denmark one of the pioneers of the fitness boom in 80s preparing athletes for LA and Seoul Olympics. Chiropractic is more mainstream in Denmark and observing such instant results of chiropractic appealed to me. And spent 5 years studying chiropractic, had intended going back to Denmark and staying in elite sport but met a woman who did not want to move
Richard:
What was the USP of ‘chiropractic’ which led you to study that discipline and not osteopathy, physiotherapy, nursing, medicine or any other regular health care profession?
Why did you settle on an anachronistic concept devised by non-medically qualified practitioner who entered the health care business as a quack ‘magnetic healer’ trained by Paul Caster (along with A.T. Still who devised osteopathy), and who claimed there was an ‘innate vital force’ that could be released by adjusting ‘subluxations’ of vertebrae – which no regularly qualified anatomist, pathologist, physicist, surgeon or radiologist has ever been able to demonstrate?
Thank you in advance for an explanation.
Should I judge medicine on what they believed and understood in late 19 Century? Should I make generalisations about medicine on Harold Shipman or other bad apples. You if anyone should recognise the damage, joint Immobilisation has on the articulating surfaces and the mechano receptors innervating those joints.
When I was working for Team Denmark in the 80s all National teams had a physio who would do the Post injury treatment and rehab and I would get them ready for performance. It was about 1985 Kirsten Larsen ( All England Badminton Champion 1997) had recurring knee problems. She had been to every expert and was playing in pain.
A chance conversation with a chiropractor who was a member of the gym I owned, asked if they had checked her feet and ankle. Kirsten agreed to allow him to have a look, there was no pronation problem but there was a massive crack when he adjusted the subtaler joint. I shit myself thinkIng he had broken something. Literally from that adjustment, the leg mechanics were changed and she had no more Knee pain and went on to be number 2 in World.
What Ole has done made sense to me, rather than treating the symptom as everyone had done, he figured out what was causing the problem and corrected it. I began to involve Ole more in the programmes I made for the athletes and was amazed at the results I observed.
To be fair there is a more enlightened view to chiropractic in Denmark and had no idea of all the shit I would have to deal with over my choice of profession, but growing up in a very left wing family you get used to personal abuse by the righteous.
Ole was chiropractor to the Danish National team Back then and when I first graduated all the Danish footballers at Chelsea and Fulham were coming to my practice but did not want their physios to know. This made me laugh because, before 1990 most physios at professional football clubs in UK had no proper qualifications. So I have never felt under qualified and I have a masters in Health promotion which I have always believed is being proactive and more important that treating illness; as rises In Type 2 diabetes demonstrates.
Interesting that ee gives 5 dictionary definitions of a quack but then makes up his own definition
“a quack foremost is a person who habitually misleads the public by making claims that are not supported by sound evidence.”
yes, isn’t it?
except I didn’t, did I?
read the sentence again and forget about cherry-picking the bit you fancy:
“in so-called alternative medicine (SCAM), a quack foremost is a person who habitually misleads the public by making claims that are not supported by sound evidence.”
1st caveat: IN SCAM
2nd caveat: foremost
Oh so the quacks in “scam” arent the same as quacks outside of “scam”?
certain characteristics are typical for certain areas – not such a difficult concept, is it?
and ‘foremost’?
in any case, are you trying to distract from the message of my post? why?
I went thru this use and def of a quack a few years back with TEO if I recall. You can read that.
But yah, i might address your “message” later.
But if Richard did not pretend, misrepresent, claim, etc to have knowledge or skill which he does not possess, by dictionary definition, he is not a quack.
you are still not getting the point of my post [hint: it is certainly not about accusing Richard of being a quack]
Well, since the who blog has to do with who is and is not a quack one has to be clear on the definition…not just make one up to fit ones position.
He is trying to distract because that’s what people do when they have nothing else to offer. And I think it is clear to all right-thinking people that DC has nothing else to offer.
I happen to think it is important to use the correct words.
Please would DC (whoever he is – why is he anonymous?) – give us a definition of ‘quack’ with which he is content.
Thank you.
Cambridge…a person who dishonestly pretends to have medical skills or knowledge
Oxford… a person who dishonestly claims to have medical knowledge or skills
Anonymous because i got tired of the threats against my family and myself just because i am a chiropractor. There was even someone from this site who tried to track me down.
Medicine…
Oxford…the study and treatment of diseases and injuries
Cambridge….treatment for illness or injury, or the study of this:
Come on! I have had some terrible abuse From skeptics over the years. Even have offered to meet in public place of their choice, to see if they would repeat the insults to my face. Of course the would not. That was the point of my original post on the definition of quack. It’s just a word, and the profession does itself no favours getting upset by it, they call it moron baiting and it’s entertaining for skeptics to wind you up Sticks & stones ….
@D(umb)C(onfused): suggesting, even tacitly that one can learn (lol) and then possess the ability to externally adjudge joint-motion AND whether THAT which is allegedly felt is in need of the trickery to which a DC sells…that IS the misrepresentation. Again HTF do you quacks KNOW (because clearly your pretense is that you do KNOW and are “experts”) WHERE and HOW to adjust these chimerical joint-dysfunctions? And where have the research studies you have conducted and published PROVEN that “specific Chiroquackery adjustments” vs. random whacking & cracking is superior? Or has ANY long term alteration Or benefit to said ‘dysfunctional motion’…?
“Specificity”, “knowledge of spinal dysfunction” and “validated spinal adjustments” are ALL misrepresentations. And please show me ONE Chiroquacker that doesn’t promulgate them when suckering in patients.
Chiropractors typically use the same methods to determine where to do an adjustment that are used by PTs, DOs and MDs. So if you wish to call all those within the 4 professions who do adjustments quacks that would at least be consistent….you would be wrong but at you would at least be consistent.
I never claimed an adjustment was “specific” so you’d have to ask those who do make such a claim.
DC,
I don’t think physiotherapists “do adjustments”, whatever that means. Spinal surgeons use MRI’s. I can’t speak for osteopaths.
Its usually taught. If they do it depends on several factors.
Of the 116 programs responding to our survey, 87 (75%) currently include joint manipulation in their curriculum or plan to soon include such content in their curriculum. Of the programs currently teaching joint manipulation, 75% taught it as part of a required integrated clinical science course.
https://europepmc.org/article/med/15128186
Seventy-two percent of programs responded to the survey, with 99% of programs teaching TJM and 97% of faculty believing TJM to be an entry-level skill.
https://www.jospt.org/doi/full/10.2519/jospt.2015.5273
DC,
I don’t know what TJM is – … some form of joint manipulation I suppose.
Of course physiotherapists perform joint manipulation. I would imagine that this forms quite a large part of what they do. But “adjustment”? The term implies that the alignment of a joint is somehow changed, which is surely the remit of an orthopaedic surgeon, not a physiotherapist. I suppose a sports physio might occasionally reduce a dislocated shoulder on the playing field, perhaps…
Julian…it’s the term Michael used so i stuck with it.
You know when you open a jam jar and you are not sure whether to turn It right or left, you test it slightly and then go for it.
Giving an adjustment is a bit like that, took me ten years to become skilled at it and I came from a background having good hand eye coordination. Pointing how how unskilled some chiropractors are at it, is like not understanding why a recreational golfer is not as good at putting as a professional golfer
I define a quack as anyone who claims great benefits from treatment without adequate evidence and charges a lot of money…THAT is the definition as the average oncologist, psychiatrist, and most medical doctors. The average patient in the USA is prescribed 13 prescription drugs plus innumerable over-the-counter drugs, and yet, there is no evidence of the safety or efficacy of this polypharmacy (if you have such evidence, please show it). When I think of all the Americans who take NO prescription drugs, this means that many Americans are getting much more than 13 prescriptions.
When Elivs Presley died, they found 11 drugs in his body. His physician claimed that “there were sound and rational medical reasons for each one of them.” THAT proves my point! When a physician can claim to have “sound and rational reasons” for 11 drugs in a person’s body at the same time, you HAVE to question what is meant by “sound and rational” medicine. THIS is quackery!
At least the various “alternative health pracititoners” don’t charge an arm and a leg for their care.
Do you have a source for that claim? Without context, it is impossible to know what it means.
Whoooops…I was wrong. It was not 13 drup prescriptions per year per American, it is 15 filled drug prescriptions per year per American:
https://www.statista.com/statistics/261303/total-number-of-retail-prescriptions-filled-annually-in-the-us/
Where are you getting your figure for the number of drugs?
Nope. I was specifically referring to 2020…and heck, MOJO, math is not one of your super powers. No irony here. Please look somewher else now whie you do sleight of hands and slight of mind. Once again pretending in your arrogant way to be right and others wrong…but math is your stumbling block. So far and yet so far away…
does the figure include repeat prescriptions?
if so, it’s not a lot [in The UK, we usually get prescriptions for 2 months; so, one medication would amount to 6 prescriptions/year]
Dana, where are you getting your figure for the number of drugs?
Sorry, Dana, but your arithmetic is still a bit off. According to your link the (presumably projected) figure for the total number of prescriptions for 2020 is 4.55 billion. The 2020 population of the USA is estimated at about 330 million (I’ve seen figures over 331, but I’m being charitable). Try dividing one number by the other.
But that wasn’t really the point: your link gives the number of prescriptions, not the number of drugs, so it doesn’t support your claim.
Percent of persons using at least one prescription drug in the past 30 days: 48.4% (2013-2016)
Percent of persons using three or more prescription drugs in the past 30 days: 24% (2013-2016)
Percent of persons using five or more prescription drugs in the past 30 days: 12.6% (2013-2016)
https://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm
By the way, you’re only getting 15 because you’re using the projected number of prescriptions for 2025.
Dana,
Oncologists base their treatment (and any claims made for it) on evidence from clinical trials, which are usually multicentre, often multinational and rigorously controlled. Generally they are careful to explain to the patient what treatment involves, and what can and cannot be achieved. I can’t speak for psychiatrists as I don’t really know what might have changed since I was a medical student in the 1980’s.
Where I come from, medical doctors (including psychiatrists and oncologists) are paid a fixed salary by the NHS. Some of them also see private patients (outside their contracted NHS hours), but what they can charge is determined by what the insurance companies will pay, and hasn’t increased since I became a consultant 20 years ago. Most doctors in the UK do not see private patients at all, and indeed many of them work well beyond their contracted hours without additional pay (this is something that has surprised every Government that has thought it could save money by tightening up on doctors’ contracts).
I think you will find that your allegations, if true, don’t actually apply to doctors in most parts of the world. In the US, where success seems to be judged solely on earnings, and where the healthcare system (including alternative medicine) is completely dysfunctional, things may well be different. But extrapolation from a small sample in just one country is always going to be highly misleading.
I think Dana is confusing a quack with one who is promoting/selling pseudoscience. Often an overlap but not always (based on definitions). I will provide definitions of pseudoscience later.
Pseudoscience
any of various methods, theories, or systems, as astrology, psychokinesis, or clairvoyance, considered as having no scientific basis. https://www.dictionary.com/browse/pseudoscience
an idea, theory, method or area of thought that claims to be scientific but has no basis in science. https://www.macmillandictionary.com/us/dictionary/american/pseudoscience
A system of theories, assumptions, and methods erroneously regarded as scientific https://www.merriam-webster.com/dictionary/pseudoscience
a system of thought or a theory that is not formed in a scientific way.
https://dictionary.cambridge.org/us/dictionary/english/pseudo-science
A theory, methodology, or practice that is considered to be without scientific foundation. https://www.thefreedictionary.com/pseudoscience
an activity resembling science but based on fallacious assumptions. https://www.vocabulary.com/dictionary/pseudoscience
A collection of beliefs or practices mistakenly regarded as being based on scientific method. https://www.lexico.com/en/definition/pseudoscience
an activity resembling science but based on fallacious assumptions. Princeton’s WordNet
Any body of knowledge purported to be scientific or supported by science but which fails to comply with the scientific method Wiktionary
“Oncologists base their treatment (and any claims made for it) on evidence from clinical trials, which are usually multicentre, often multinational and rigorously controlled.”
When I was first diagnosed with fractal cancer in 2011, survival rates were 80% after the surgery the cancer had spread to lymph nodes and it was 50%, increased by 13% if I had chemo. In 2013 survival was 0% and in April 2016 I became a cancer survivor from the original prognosis. This research is just a guide that an average person will respond in an average way. It is the ability of the clinician to apply any evidence to the patient that is important not that something has been reported in a peer reviewed journal
Richard,
I think this is more-or-less what I said in another comment to you. Though I’m not sure what you mean by “in 2013 survival was 0%”.
The problem with trying to use median survival for prognosis is firstly, that there is a range (often quite wide) and secondly, that tells you very little about how an individual will fare. Even when you talk about survival rates being 80% after surgery, that is at a specific point in time. One month after surgery they are close to 100% (there are occasional perioperative deaths); 50 years after surgery they are close to zero (there are some people unfortunately enough to get colorectal cancer in their 20’s).
If you meant that you were told in 2013 that the five-year survival with metastatic colorectal cancer was zero, even that only applies to a specific population. When I was a registrar I remember very well looking after a woman who was coming in for chemotherapy every few weeks who had had metastatic colorectal cancer for 15 years.
The figure of 13% improval in survival with adjuvant chemotherapy is more useful, provided that it is explained properly. I used to explain that some people were already cured by their surgery and chemotherapy wouldn’t help them, and others were going to relapse regardless of whether they had chemotherapy (though possibly it might delay recurrence), but for every eight people treated, one of them would survive long-term as a result who would otherwise die. In other words, for that one out of eight people chemotherapy would make a life or death difference. Unfortunately there was no way of predicting in advance which one that would be (this is an area of active research). On that basis most people would generally choose adjuvant chemotherapy and some would prefer to take their chances, but at least they were making an informed choice.
I agree with you. The point I was trying to make is that these percentages are just a guide, no one knows for certain in clinical science. Not as predictive as perhaps physical science.
When I was given the terminal diagnosis in 2013, I read a study on metastasised rectal cancer (2006 I think), which stated no one In medical literature had lived more than 4 years after Such a diagnose and why the 4 years and one became central to the memoir I am writing.
The book that gave me hope was by the consultant; David Servan Schieber “ Anti Cancer”. It’s had a lot of criticism from “Skeptics” as “Woo” treatment for cancer. When in fact the book is basically saying most cancer is caused by lifestyle, smoking over eating and by changing your lifestyle, you increase your chances of being one of the outliers on any cancer survivor bell curve study.
Servan Schreiber lived 20 years after being diagnosed with a brain tumour. I read the book in April 2011 soon after my diagnosis and was inspired. He died in July, I was devastated. So many things can affect a prognosis not just the medical treatment. McMillan tries but it’s not nearly enough
As I have stated here for some time now.
EBM is a system that over-promises and under-delivers true healing to patients.
It appears that this tread is another example of another case in history of this very fact.
I congratulate Mr Lanigan for being able to recognize that the chemotherapy was not the remedy for HIM, and he in fact did find the correct remedy to restore his heath.
This is precisely what more chronic patients need to discover, rather than putting complete trust in one type of medicine that continues to fail many many patients.
“As I have stated here for some time now.”
AND THE MORE OFTEN I STAE SOMETHING, THE MORE TRUE IT BECOMES.
Richard,
The best predictor of survival when starting any sort of palliative cancer treatment is performance status, i.e. how well you are to beging with. This ought to be obvious, but it is surprising how focused people get on the treatment itself.
I’m not sure what you mean by that. Strictly speaking, an outlier in the statistics is exactly what you are, whatever the explanation might be. On the other hand every individual is much more than a statistic, and it is important never to forget that. Medical statistics are a mathematical abstraction and while they might be the only way to understand the behaviour of a disease they do not tell you how to manage a specific patient.
Of course the 22 months was an average and we now know with hindsight that the benefit you gained (In my view mainly due to the chemotherapy) was much more than that, and indeed without going through the full 12 cycles. Unfortunately it is very difficult to know in advance who is going to benefit from treatment and to what degree. Patients don’t like this kind of uncertainty and tend to latch on to figures that they have been given, according them a much greater predictive value than they actually have.
Oncologists don’t like uncertainty, either, and they particularly don’t like it when their treatment, given with the best of intentions, ruins somebody’s quality of life or hastens their demise. There is a lot of research at the moment looking at molecular markers and specific mutations within tumours as ways of predicting behaviour and response, and this has also led to the development of new treatments. The Royal Marsden Hospital are leading the way here.
I am reminded of one of my own patients, who was referred to me by an orthopaedic surgeon after presenting with back pain due to a metastasis in his spine. A CT scan showed a tumour in his kidney which was growing along the renal vein and into the inferior vena cava (as renal cell carcinomas often do), in this case blocking it completely and extending almost into the heart – on the CT this major vein, which normally carries all the blood from the lower half of the body back to the heart, was so stuffed with tumour that it looked like a salami. When I saw the gentleman for the first time he was clearly very unwell and his lower limbs and pelvic region were swollen almost beyond recognition. I explained to him that the prognosis was poor but I wanted to refer him to a surgeon as I still thought he had a chance. Our own renal surgeon was on holiday so I referred him to another centre (the Marsden as it happened) where the surgeon told me afterwards that they had had to transfuse 165 units of blood during the course of the operation to remove the kidney and separate the tumour from his vasculature. In truth there were not many surgeons who could have carried this off. He stayed with the Marsden for the rest of his oncology care, and I received letters from his oncologist periodically telling me that he was doing well. I was rather surprised, therefore, to get a nasty letter from the patient three years later telling me how wrong I was to have been so negative about his prospects at the beginning, and also that I should have considered the benefits of that he could get from surgery myself (I don’t know where he thought the referral to the surgeon had come from if not from me). A few weeks later I had another report to say that he had died from brain metastastases, so perhaps they had affected his thinking at the time of writing to me
I still don’t think I would have managed him any differently with hindsight. I believe it is important to explain the situation to patients as honestly and accurately as possible (including any uncertainties) as it is impossible to collaborate with them constructively in their management decisions if you aren’t both talking about the same thing. Though I do appreciate that there is so much unfamiliar information for them to take in at a time when they are very confused and distressed that this is an uphill struggle.
RG,
On the basis of what Mr Lanigan has said, I think in his case the system under-promised and over-delivered.
Evidence-based medicine doesn’t make any promises. Individual practitioners do, and I think much of the time they have an unrealistic belief in their own powers (I include many doctors here). When somebody returns for follow-up looking much better than before, it is easy to convince yourself that whatever intervention you supplied made all the difference, when many medical problems resolve on their own with time. This is one of the ways in which personal experience can be misleading and why basing management on the evidence is so important.
PRECISELY!
my post tomorrow will try to go into these issues.
@Dr. JMK
You and EE should experiment with some MJ.
It may or may not heal ya, but you might at least come away with a different perspective…. lol
…. and that’al do ya some good.
I have never criticised my doctors. I have no doubt they did their best. But they got the prognosis wrong a number of times. There comes a time when doing the same thing over and over again and expecting a different outcome becomes insanity. I did not stop chemo to try cannabis. I stopped Chemo in 2013 because it hadn’t done what it was supposed to do in 2011 and I was getting sideafects, which did not out weigh the benefits, by preventing the cancer spreading post surgery in 2011.
In February 2014 I did have some radiotherapy as I did in 2011 and it did shrink the tumours. The difference In 2014, was I took cannabis afterwards to prevent metastasis and not chemotherapy.
Of course it could be 3 cycles worked better than 12, that my diet made a difference. The fact I did five day fasts during the three Chemo sessions ( it made the chemo more effective in mince in a study I had read)
Fair to say it would be wrong to claim with any certainty cannabis “cured“ my cancer. But if all the “scientific” I information I was given about the reasons for having Chemotherapy are to be judged retrospectively. It did not apply to my case.
I was scanned after I stopped chemo. Radio was more effective, but it’s the chemo that came last to prevent spread, I was given more Radio In 2014 because I was terminal. I do believe it was the cannabis that worked better than chemotherapy and I believe research out of Israel may eventually confirm my conclusions. Just writing this chapter now.
You guys believe it was the medical treatment that cured me, the point is no one knows for certain what cured me and the medical hasn’t shown any particular interest in finding out because cannabis is not something that sits particular well with their believe system and perhaps how cognitive bias may influence the directions the science should be going in.
Godwin’s Law as outlined in Wiki:
“…if an online discussion (regardless of topic or scope) goes on long enough, sooner or later someone will compare someone or something to Adolf Hitler or his deeds, the point at which effectively the discussion or thread often ends.”
Is this the Elvis version? Shall we call it Ullman’s Law?
Mr. Ullmann
Did you get your MPH in a box of cereals? You are certainly not equipped with the insight, knowledge and understanding of healthcare expected of someone flaunting these letters after their name.
I agree with you. However my services are not cheap. It’s the consumer who decides whether they have value for money or not not the skeptic community. If I was not very good I guess I would have to reduce my prices.
Richard Lanigan.
Didn’t we teach you about survivorship bias, some years ago?
You pontificated about 4 years ago, that 22 months was “only an average” as if I did not know.. The medical view from the Marsden was my cancer was “incurable” and “terminal”, even my consultant admits they were wrong. I guess you are too self righteous to say you were wrong. My case is more than an outlier in the statistics.
You will be glad to know our interaction made it into my memoir “ Cancer Drive me up the Wall” as the only example of medical arrogance that I experienced When I had expected much more on my journey
You obviously didn’t learn anything. I am happy that you are a lucky rare survivor but I deeply deplore the abject tanklessness you show against the scientifically based treatment that saved you.
You just don’t listen. I used work with Icelandic Hanball players and it seems you are well known in Iceland for Tummy Tucks and a celebrity marriage and cancer is not your area of expertise. So let me explain it again to you.
I had all the orthodox treatment in 2011 was given the all clear in 2012. Yes by your definition and mine that was a positive result.
However when a CT scan in August 2013 showed the cancer had returned and was metedtstic, which was defined as incurable.
The treatment offered was another 12 cycles of chemotherapy only to prolong my life to perhaps 22 months after a few cycles I stopped and was told I might only live 6 months.
So is your theory; less is better and in fact it was the3 cycles of chemo that cured me From November 2013 and not the cannabis I took in June 2014 ??
? You need to check your sources better. Celebrity marriage ???
Wrong on all three counts Richard ? Tummy tucks and celebrity marriage ?Can’t wait to tell my wife. ??
Cancer has been a large part of my professional life, including cancer of the colon.
You certainly need to choose your sources with better care.
@Björn
Well, that’s disappointing. I was just about to start namedropping.
? Thanks Dana, for proving me right. This gets my vote for the most naïve comment of the week.
So what I was told about your marriage was incorrect, happy to admit to being wrong.
Yet seem to think you know more about my case never having met or examined me, than my oncologist who is very happy to admit she was wrong. That’s why I trust her and will go to her soon for a checkup. A doctor with your arrogance makes mistakes, I would keep well away, if I was looking for another doctor ??
I quote from “Alternative health practitioner” Richard further down this thread
There is not adequate evidence to support his claims of efficacy. And he charges lots of money.
So this makes him a quack by your definition. And also shows your statement “At least the various “alternative health pracititoners” don’t charge an arm and a leg for their care” to be wrong.
I don’t claim any “effectiveness”, I explain what I do and if people want to try it it’s up to them. I don’t advertise and rely on word if nothing to promote my service like a good carpenter would. I don’t force people to come in or make the sign contracts
@quack Richy: you claimed to have spent 5 years learning Chiroquackery. And that is the question…WTF did you STUDY that IS Chiroquackery? Stroke rehab? Swallow therapy? CP? Therapy for hip and knee replacement? McKenzie and Mulligan PT theories? Why pray tell not become a DPT instead? Chiropractic is a portmanteau and has no inherent definition, criteria Or technical basis. The cherished “diversified” (I believe the most commonly used DC theatric) is a mishmosh of stolen pre-scientific mumbojumbo codified by a deluded Mormon named Janse. There is zero science behind any of the 70 “techniques” you charlatans sell to the gullible unless they were usurped from somewhere else. How are those dental impactors, modified orbital sanders and the “drop” table working for you? Wowza! What sciency advances you can claim!
Chiropractic: “our skill is in getting the public to believe we have a skill…which we don’t”.
“Stroke rehab? Swallow therapy? CP? Therapy for hip and knee replacement? McKenzie and Mulligan PT theories? Why pray tell not become a DPT instead?“
These are topics that would come under standard Subjects in any health and wellbeing curriculum. Anatomy, physiology, or neurology. I guess your objection is not that us “chiroquacks” learn this stuff. It’s we apply it to chiropractic. If you think about it, it’s useful to be able to tell the difference between a spinal process and a rib when I am doing my “show”.
I didnt choose chiropractic over PTI, I was one of the top PTIs in Europe in the 80s. I want to get out of the rat race for a few years and study something that interested me. I also did a Masters in Health Promotion in 2004.
You may not find the subjects I chose to study and no doubt would have preferred I had a PhD in chemistry like my wife, I would have been bored to death.
@Michael Kenny
Listen to this video of Prof Ian Harris from the 1 minute mark.
https://www.youtube.com/watch?v=IzueFu1cq5U
Orthopeadic surgeon, leading researcher and author of the book “Surgery The Ultimate Placebo”.
“There is a very important difference between being cynical and being skeptical. To be skeptical is to be scientific………..to be cynical is to judge the motives of people and not rely on the science”.
Your past posts would indicate that you are a physiotherapist who was once married to a vitalistic chiropractor.
As a physiotherapist your posts are unprofessional, cynical and anecdotal ad hominem’s.
@uncritical: “professional”, is that what you’re calling yourself? It seems to me as a chiroquacker you try pathetically and desperately to set yourself apart from your “less-professional” brethren (those not as brilliant and observant as you regarding the quackery). You resort to name calling and partitioning: “vitalists and subluxationists…” so as to be sure not to be splashed or tarnished by what you apparently think is well deserved criticism. The real problem of course is Chiroquackery (your version) can’t be defined any better than theirs. However UNLESS it’s being defined by them vitalists, Chiroquackery remains a profession in name only, not by any definite criteria. Them vitalists don’t feel the need to cozy up to science and real doctors, which makes them more predictable, principled AND defined ehh? Of course my ex-wife DC was happy to use ultrasound, estim, decompression, Activator, drop-tables etc etc etc (her “philosophy” aside it was ALWAYS about the money and billable services).
You “lofty” DCs seem to be able to tell us what Chiroquackery ISN’T but not what it is. Since most cults decry being pigeon-holed by non-believers your lack of response isn’t unexpected.
I’ve read the mission-statements of many of the colleges and if someone knew nothing at all about Chiroquackery they would still know nothing after reading these. BUT simply reading any one of innumerable DC websites you’d know what Chiroquackery IS: “IT” WORKS! “IT” treats EVERYTHING and amazingly well! “IT” hurts no one…ever! “IT” realigns misaligned spines. “IT” finds & fixes the “cause” of ill health.
“IT IS” entrepreneurial theatrics masquerading as healthcare. Bazinga.
Just go with this one.
WFC
A health profession concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal adjustment and other joint and soft-tissue manipulation.
@Michael Kenny
Nice dodge and weave to avoid discussing your unprofessional comments.
Carpet bombing cynics do not add to the discussion.
Critics both within and without any profession are a valuable resource for reform.
Happy to engage with the critics.
Have a look at the top of this page. “Please remember: if you make a claim in a comment, support it with evidence.”
I have not dodged or weaved when it comes to the problems within my profession. They need addressing and it has to come from within the profession. Do the vitalists need to be partitioned? Definitely.
Read this paper:
Chiropractic, one big unhappy family: better together or apart?
Charlotte Leboeuf-Yde, Stanley I. Innes, Kenneth J. Young, Gregory Neil Kawchuk & Jan Hartvigsen.
https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0221-z
Time for a divorce? Overdue.
BTW I do respond but its not for your benefit.
I respond to engage with all the people reading this who do not post.
They get to see both sides of the argument and “@uncritical: “professional”, “pathetically and desperately”, “Chiroquackery”, “Chiroquackery………” etc coming from a physiotherapist are unprofessional comments and this is just from your above comment. I recommend people reading this post go back through some of your past comments.
Your above unprofessional reply is not unexpected.