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

One of my recent posts prompted the following comment from a chiropractor: “… please don’t let me stop you…while we actually treat patients“. It was given in the context of a debate about the evidence for or against chiropractic spinal manipulations as a treatment of whiplash injuries. My position was that there is no convincing evidence, while the chiropractor argued that he has been using manipulations for this indication with good results. Here I do not want to re-visit the pros and cons of that particular debate. Since similar objections have been put to me so many times, I want rather to raise several more principal points.

Before I do this, I need to quickly get the personal stuff out of the way: the comment implies that I  don’t really know what I am talking about because I don’t see patients and thus don’t understand their needs. The truth is that I started my professional life as a clinician, then I went into basic science, then I went back into clinical medicine (while also doing research), and eventually, I became a full-time clinical researcher. I have thus seen plenty of patients, certainly enough to empathize with both the needs of patients and the reasoning of clinicians. In fact, these provided the motives for my clinical research during the last decades of my professional career (more details here).

Now about the real issue that is at stake here. When offered by a clinician to a scientist, the comment “… please don’t let me stop you…while we actually treat patients” is an expression of an arrogant feeling of superiority that clinicians often harbor vis a vis professionals who are not at the ‘coal face’ of healthcare. Stripped down to its core, the argument implies that science is fairly useless because the only knowledge worth having stems from dealing with patients. In other words, it is about the tension that so often exists between clinical experience and scientific evidence.

Many clinicians feel that experience is the best guide to correct decision-making.

Many scientists feel that experience is fraught with errors, and only science can lead us towards optimal decisions.

Such arguments emerge regularly on this blog and are constant company to almost any type of healthcare. The question is, who is right and who is wrong?

As I indicated, I can empathize with both positions. I can see that, in the context of making therapeutic decisions in a busy clinic, for instance, the clinician’s argument weighs heavily and can make sense, particularly in areas where the evidence is mixed, weak, or uncertain.

However, in the context of this blog and other discussions focused on critical evaluation of the science, I am strongly on the side of the scientist. In fact, in this context, the argument “… please don’t let me stop you…while we actually treat patients” seems ridiculous and resembles an embarrassing admission of having no rational argument left for defending one’s own position.

To put my view of this in a nutshell: it is not a question of either or; for optimal healthcare, we obviously need both clinical experience AND scientific evidence (an insight that is not in the slightest original, since it is even part of Sackett’s definition of EBM).

33 Responses to Don’t let me stop you…while we actually treat patients.

  • Thank you Doctor Ernst!
    Always getting to the core of the issue.
    No rabbit trails here.
    Be well!

  • The chiropractic management for car accident whiplash disorders incorporates more than just spinal manipulation. Whilst manipulation is usually perceived as just manual, instrument-based manipulation using electro-mechanical percussive devices is used pervasively in the chiropractic profession and with whiplash disorders, is considered as a treatment of choice. What I need to point out is that in addition to manipulation, cervical spine rehabilitation that improves the cervical sagittal configuration is strongly suggested for spinal pain syndromes. I include a recent chiropractic-designed RCT manuscript that discusses this complaint and its expansive clinical effect far from the cervical spine.
    https://www.mdpi.com/2077-0383/11/19/5768

  • Judging from this exchange, it would appear that Chiropractors often deflect and quickly scatter off topic running in all directions, when faced with those darn pesky scientific facts.

  • Well, you give way too much credit in your “in a nutshell” when referencing the role chiropractors’ “clinical experience” plays in adding anything more to the scientific pot than they’ve already provided in more than 100 years of chiropractic Dalmatians. Like other alt-meds … eg. acupuncture, homeopathy … the chiropractic fiction was pretty much in place at its inception in 1895, remaining intact in concept and practice today. Any changes that might be construed by the alt-med advocate as discovery or development amount to little more than a self-referential touching of their own pseudo-medical nose. Take a look.

    This is the point where you’re supposed to challenge chiropractors here with the question, “Can you name five things that chiropractors think say, and/or do that have changed since its inception as a result of STUDIES that demonstrate that what was previously thought, said, and done was found to be wrong and therefore, no longer thought, said and/or done.” It’s a tough question for the alt-med advocate to answer inasmuch as they will have difficulty providing even one example.

    That said, here’s an example of chiropractors touching their own pseudo-medical nose. There is no bottom and no place to gain purchase enough to make anything resembling progress or advancement despite the claims and testimonials made by those advocates featured in the video.

    STRESSED – A DOCUMENTARY FILM

    ~TEO.

    • DD Palmer: “95% of all diseases are caused by displaced vertebrae, the remainder by luxations of other joints”

      Palmer DD. The Science of Chiropractic: Its Principles and Adjustments. Davenport: the Palmer School of Chiropractic, 1906

      Most, if not all, have abandoned this thinking.

      • … and reduced the figure to 94% ???

        • Probably closer to 0%.

          • you mean to say that close to 0% now deviate from DD’s gospel, of course.

          • Probably closer to 0%.

            Do you have evidence for this?

            Except it is the core theme of DC curriculum, and new grads are being brain washed with it. See earlier discussion: https://edzardernst.com/2022/09/a-2-6m-insurance-fraud-by-chiropractors-and-doctors/#comment-141127

            https://www.palmer.edu/wp-content/uploads/2021/12/palmer-catalog.pdf

            Health is a state of optimal physical, emotional and social well-being. Central to the philosophy of chiropractic is the principle that life is intelligent. This innate intelligence strives to maintain a state of health through adaptation mechanisms. The nervous system is recognized as an avenue for these self-regulating processes. Interference with neurological function can impede these mechanisms, disrupt homeostatic balance and adversely impact health. Chiropractic posits that subluxation of the spinal column and other articulations can affect nervous system function and the expression of health, which may result in symptoms, infirmity and disease. The understanding of the subluxation complex continues to progress from D.D. Palmer’s early writings about misalignment of vertebrae and other articulating structures to include additional anatomical, physiological, biomechanical, chemical and biopsychosocial factors.

          • EE: you mean to say that close to 0% now deviate from DD’s gospel, of course.

            that’s not what I wrote and it is not the topic.

            JB: “Can you name five things that chiropractors think say, and/or do that have changed since its inception as a result of STUDIES that demonstrate that what was previously thought, said, and done was found to be wrong and therefore, no longer thought, said and/or done.”

            Thus the question is: what percentage of chiropractors still think that 95% of disease is caused by a displaced vertebrae?

            Around 20% of chiropractors are “subluxation based” and within that group there may be a group that still holds to that original belief. The group that is most likely to hold onto this belief this is Maximized Living.

            ML claims to have around 190 clinics. I don’t know how many chiropractors that employs, but at 190 clinics and 100,000 chiropractors worldwide, that’s about 0.0019% of the profession.

            But even ML encourages nutrition and exercise so it’s unlikely they even hold strongly, if at all, to the 95%.

            So yah, I’d say it’s close to 0%.

          • I gotta give it you for presenting back-of-the-napkin math as evidence.

            Is Maximized Living the only group in the entire world that holds this belief?

            What is the difference between “subluxation based” belief and original belief? Isn’t “displaced vertebrae” a kind of subluxation?

          • RD: Do you have evidence for this?

            I am not aware of any survey’s that specifically asked this question. But having been around chiropractors for 50 years and having discussions with thousands of them, I have yet to come across even one that would make the claim that 95% of ***ALL*** disease are due to vertebral displacements/subluxations.

            There may be a few out there thus making it close to 0%.

          • Thus the question is: what percentage of chiropractors still think that 95% of disease is caused by a displaced vertebrae?

            Around 20% of chiropractors are “subluxation based” and within that group there may be a group that still holds to that original belief. The group that is most likely to hold onto this belief this is Maximized Living.
            ML claims to have around 190 clinics. I don’t know how many chiropractors that employs, but at 190 clinics and 100,000 chiropractors worldwide, that’s about 0.0019% of the profession.
            But even ML encourages nutrition and exercise so it’s unlikely they even hold strongly, if at all, to the 95%.
            So yah, I’d say it’s close to 0%.

            Is Maximized Living the only group in the entire world that holds this belief?

            I am not aware of any survey’s that specifically asked this question. But having been around chiropractors for 50 years and having discussions with thousands of them, I have yet to come across even one that would make the claim that 95% of ***ALL*** disease are due to vertebral displacements/subluxations.

            I understand that you are referring to belief in “95% of ALL diseases due to subluxations” as “original belief”. What is “subluxation based” belief that 20% of chiropractors subscribe to?

          • RD: Is Maximized Living the only group in the entire world that holds this belief?

            Do you have a reading comprehension problem? I wrote most likely to believe.

          • No, I don’t have reading comprehension. Just confirming that your calculations are not worth the scrap paper they are written on. Moreover, your anecdotes such as the one below is worth nothing because you choose to stay anonymous. There is no way for anyone here to verify whether you have 50 years of experience and have talked to thousands of chiros.

            But having been around chiropractors for 50 years and having discussions with thousands of them, I have yet to come across even one that would make the claim that 95% of ***ALL*** disease are due to vertebral displacements/subluxations.

            For all it matters you could be a lowly intern at one of the Chiropractic associations trying to promote a chiro-friendly narrative.

    • Is there still a subgroup, yes.

      “Palmer’s notion of innate intelligence (see the subsection on “Magnetic Healing” under “Chiropractic’s Origin”) was in dispute from the beginning. Many of his first disciples, destined themselves to be influential teachers of chiropractic, never adopted it. The list of those who reject the innate as “religious baggage” reads like an honor roll of chiropractic’s history.24 Willard Carver (1866-1940), who founded a core group of chiropractic teaching institutions, thought a physiological theory of nerves was sufficient.25 John A. Howard (1876-1953), who came to chiropractic from a conventional medical background and, in 1906, founded what became the National College of Chiropractic, was thinking of innate intelligence when he warned students not to “dwindle or dwarf chiropractic by making a religion out of a technic.”26(p17) The first chair of what became the Council for Chiropractic Accreditation, Claude O. Watkins (1909-1977), called for scientific research and the abandonment of all cultist and vitalist principles, starting with that of the innate.27”

      Arch Intern Med. 1998;158(20):2215-2224

  • LOL…perhaps it’s time for the Chiropractors to just put the shovel down and stop digging.
    They are in way over their heads on this Blog.

    Once again, it’s overwhelmingly evident, that when grasping for straws in any failing exchange, (and failing to back up silly claims with little or no real supporting evidence), these Chiros continually don’t even appear to identify what their own “schools” are promoting and their own current teaching literature exposes!

    The bells are ringing, the gates are down, lights are flashing… but the train she isn’t coming.
    Smells like BS to me.

    • what schools may or may not teach or have on their web page isn’t necessarily representative of what practicing chiropractors may or may not believe.

      • Well, that’s rich.
        So what pray tell then is the point in getting accredited at a Chiropractic School, if at the end of the day it is the student who gets to cherry-pick and choose what to believe as accurate or factual scientific based teachings? Can you imagine an Internal Medical Doctor applying the same logic?

        Hence, your own words betray your position on this topic and confirm the fallacies that propagate Chiropractic current teachings.

        The more I delve into trying to understand Chiropractic, the more I understand what happened to my wife.
        If it wasn’t so catastrophic and tragic it would make for a good horror story.

      • DC says:

        what schools may or may not teach or have on their web page isn’t necessarily representative of what practicing chiropractors may or may not believe.

        DC, Thanks for confirming that the entire field of chiropractic is nothing by smoke and mirrors.

      • @DC
        So if I may summarize: consulting a chiropractor is a complete gamble, with the practitioner’s medical competence ranging from zero to perhaps on par with physiotherapists in the best case. And there is no way to tell from their actual education or any one of a bewildering list of credentials, because it’s up to each chiro’s own discretion and beliefs what they do and how they do it. There is no science-based standard of care, there is no quality control, and there certainly is no disciplinary body to intervene in the more egregious cases of medical incompetence and physical harm.

        I think the best advice for anyone is to steer clear of you guys, and just stick with physiotherapy if the need arises …

        • Richard: I completely agree with your summation.

          Best avoid and don’t gamble unnecessarily. I want only those who are qualified to be on my health protocol routines.

          It comes down often to risk versus benefit. And for me the risks of injury or catastrphic loss while puttings ones trust in Chiropractic are far too great.

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