Recently, I had a notable comment on one of my posts:
“these treatments are not the best we can offer to LBP-patients.”
Have to agree with you. As a stand alone treatment the research is underwhelming. When used as part of a suite of therapies they have some utility. All therapeutic approaches when studied in isolation are underwhelming (including exercise and rehab). Research needs to reflect how chiro’s/physio’s/osteo’s practice.
The post was about a new RCT suggesting that neither spinal manipulation nor spinal mobilization is effective treatments for chronic low back pain. And the comment came, of course, from an ardent defender of chiropractic. As I have heard this type of argument so often – from virtually all types of providers of so-called alternative medicine (SCAM) – it is perhaps worth considering it in more detail.
What does it mean?
It means that those SCAM-providers who believe in the argument think that, in order for their SCAM to work, it needs to be accompanied by some other therapy. To me, this assumption has always raised doubts.
- My fake 5£ note is worth nothing, unless you add a real fiver to it.
- This mine sweeper will work fine, as long as you use another one in parallel.
- This drink is very strong, but you need a double vodka in order to feel it.
Yes, of course, I am exaggerating. So, let’s use a few more sensible examples from the realm of healthcare:
- This new medication is effective only if you combine it with the standard drug for this disease.
- Ultrasound therapy reduces shoulder pain, as long as you also take a pain-killer.
- This slimming aid works wonders, if you stop eating while you take it.
- Chiropractic manipulations work wonders, but you need to combine them with exercise therapy.
- Crystal healing is very effective, as long as you don’t discontinue your conventional treatments.
A + B is only more than B, if A amounts to more than zero.
If A is zero, A + B = B.
If A is negative, A + B is less than B.
Of course, the argument could also mean that treatment A needs the addition of treatment B, because there is a synergism between the two. Synergism is the interaction of treatments such that the total effect is greater than the sum of the individual effects. It is a phenomenon that occurs with certain medications; it can be studied and must be proven before we can accept it as relevant. Has synergism been studied for any of the SCAMs? No, not as far as I am aware. This means, in SCAM, it is unproven. Until it is proven, we thus should not claim it.
So, what does it mean when SCAM-providers say AS A STAND-ALONE THERAPY MY SCAM IS NO GOOD; IT NEEDS ANOTHER TREATMENT TO WORK?
Call me a cynic, but I think it is an admission that the SCAM in question is ineffective (or perhaps even detrimental).