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

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).

16 Responses to My SCAM is effective – but only if we combine it with another therapy! A reasonable argument or not?

  • “No good” is not what the original commentator wrote. He or she wrote “underwhelming”.

    • yes!
      but my post is not about merely the the original commentator.

      • I am unaware of a valid sham for exercise.

        Until then we have to research what is feasible.

        SMT without exercise
        SMT with exercise
        SMT sham with exercise

        That is assuming one is limiting to just two approaches.

        Of course many chiropractors also add in ergonomics, lifestyle modifications, mobilization, etc. That is what the original comment stated.

        Do these have an additive or synergistic effect? Maybe in some populations and for some conditions.

        It’s not so black and white like some wish it to be.

  • This seems to be the pith of the matter, especially regarding the alleged “reputable” scammers like DCs. And more than just the added-components it is the psychology and intense manipulative “education” they dish out as well….focusing the gullible marks that, among other things: “these treatments take a lot of time, your problem didn’t occur overnight I can’t fix it in one treatment“, “you may feel worse before you get better”, “even if the pain remains the reduction in spinal pressure from the adjustments are doing you immense good”, “it may appear expensive, but compare it to surgery…and what is REAL health worth to you?” And of course the more mechanoreceptors, and skin & muscle receptors they monkey with the more potential for temporary pain-gating…and thus more room to concoct a story regarding the “benefits” of ongoing “treatment”. My experience with DCs is they downplay “therapies” and up-play the “adjustments”. Don’t want the gullible to get the idea their pain relief may be in their own control and not require a quack thrusting on them.

  • SCAM always tries to piggy back on the coat-tails of conventional medicine medicine.
    This is the main thrust behind so-called “integrative medicine.”
    Without “conventional medicine” then “integrative medicine” would have zero effect beyond placebo.

    Plus of course IM gets to benefit from being placed in all the great centres such as the Cleveland Clinic and what have you
    where it gets the added kudos of a “centre of excellence” that it would not otherwise acquire.
    It is unfortunate that such centres and most conventional MDs either are unaware of the SCAM or are the admins running these centres blinded by the additional lucre available from adding these SCAMS (which are often popular among the public) – and allow them in without realizing the inherent dangers.

    Accordingly many do not realize the consequent damage done by allowing real medicine + “harmless SCAM” given to their patients. After all where is the harm?

    Well the harm is:
    – added cost either to the patient or the health system as a whole for ineffective therapy.
    – confusion for the patient and the public and other health professionals about the “benefit” of SCAMs
    – potential direct harms of SCAMs – of which there are many
    – potential indirect harms of SCAMs where patients are tempted to try SCAMs instead of conventional therapy in which case they are totally useless.
    – egregious waste of funding on useless research and training and education on patently absurd SCAM modalities which could be much more usefully be applied to scientific applications
    – contributing to the anti-scientific bent of the public at large especially in such areas as anti-vaccine etc

  • We’re back to square one.

    We all know that ‘care’; ‘therapy’; ‘TLC’; and of course, ‘love’, makes folks feel better.
    Those pesky neurotransmitters – especially the couple of dopes stuck on the end of an amine molecule.

    The issue before us is whether the specific modalities of camistry and their underlying philosophies make any difference at all to pathological processes afflicting human beings.
    And evidence to date in respect of SCAMS, suggests, they do not.

    Tough. Face up to it. Move on. Train in another disclipine.
    Reflect why it was you chose chiropractic, osteopathy, homeopathy, reiki, crystals, fairy wrangling etc. in the first place and not physiotherapy, nursing or medicine.

    And now reflect on why so many folks regard scamists as, well, SCAM artists.
    Sorry my friends – you’ve been found out, and found wanting, so let us all move on.
    Thank you.

    • Placebo effect is generally temporary, lasting while taking the placebo, and limited to a few conditions with a large psychological component, like pain.

      Homeopathy has 200+ years of well documented long-term cures of chronic and serious acute diseases alone, unmixed with other treatments. Frequently patients come to homeopathy after everything else has failed. And in addition many studies of homeopathy showing better results than placebo. Of course these are ignored by skeptical scientists who always consider the sample size to be too small, to be worthy of their consideration.

      • “Homeopathy has 200+ years of well documented long-term cures of chronic and serious acute diseases alone, unmixed with other treatments.”
        NOT TRUE

    • Join medicine?

      “Our findings show that there have been very few studies comparing common surgical procedures for chronic musculoskeletal pain to not performing the procedure, comprising less than 1% of published RCTs on these procedures. When such studies have been performed, they are mostly not in favour of surgery.”

      “We suggest that the relatively low rate of comparative trials in surgery is due, in part, to the lack of any incentive to perform them…”

      https://journals.lww.com/pain/Fulltext/2020/09001/Surgery_for_chronic_musculoskeletal_pain__the.10.aspx?fbclid=IwAR2iG87HMUHT-et2w2tFUAlXG4xc–mL8cHuwnXIq3GoEUIUX61y5upAkyQ

    • Join physiotherapy?

      “Many physical therapists seem not to follow evidence-based guidelines when managing musculoskeletal conditions.”

      https://bmjopen.bmj.com/content/9/10/e032329

    • “It’s the biggest secret in medicine. For the vast majority of the drugs out there, the chance that you, as an individual, are going to see a benefit is quite small.” F. Perry Wilson, Yale University School of Medicine.

    • Here again, for general delectation, are my 13 Chiropractic Limericks (based on the subtitle of Professor Ernst’s new book), with apologies (and a mention of Dr. Rawlins in No 11):

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

      TWO
      Not all that it’s cracked up to be?
      It’s still Chiropractic for me!
      They pull and they prod
      Until I feel odd,
      And oh dear, now I no longer be.

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

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

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

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

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

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

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

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

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

      TWELVE
      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 treated with homeopathee……

      THIRTEEN
      Not all that it’s cracked up to be:
      Respected researcher Prof E
      Says to thrust your poor back
      Until vertebrae crack
      Won’t cure you of your maladee.

  • Hahnemann had two ‘laws’ of homeopathy: He revived the ancient Babylonian concept of ‘Similars’ and then came up with ‘Infinetesimals’.
    To which we can add a third: ‘Repetitive placebics’.

    Provide desperate folks (“after everything else has failed”) with placebos ad infinitum.
    Nice little earner.

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