“Is Chiropractic Worth the Taxpayer’s Expense?” is the interesting question asked in this article by Ikenna Idika Ogbu from the Department of Neurosurgery, University Hospitals of North Midlands, UK and Chandrasekaran Kaliaperumal from the Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, UK. Here is the abstract:
Chiropractic remains a service provided outside the NHS in the United Kingdom and the argument for inclusion has been ongoing since the 90’s. There are significant patient-reported benefits from chiropractic backed by evidence in specific use-cases as cervicogenic headaches and there are significant potential cost-savings from the inclusion of chiropractic as an NHS service. The evidence, however, does not particularly favour the use case of chiropractic, especially in the context of Low Back Pain (LBP) and the benefits of chiropractic are unclear. Considering the potential cost-savings for the NHS and the society, there should be consideration for its inclusion. However, the evidence will need to be clearer to argue for inclusion of chiropractic in the NHS spectrum of services, especially for spinal services.
So, the authors confirm that, even for back pain, “the benefits of chiropractic are unclear”, and in the next sentence they advocate “consideration for its inclusion.”
Does that make sense?
No!
Let’s be clear: the least expensive way to proceed in the short term is usually to do nothing. No treatment is invariably less expensive than treatment! Yet, this logic obviously does not account for the two most important factors in this equation: risk and benefit.
- Not treating a condition can cause prolonged, needless suffering.
- Not treating a condition can cause significant follow-up costs.
- Treating it can cause adverse effects and additional suffering.
- Adverse effects can cause significant follow-up costs.
- Treating the condition effectively will result in less suffering.
- Treating the condition effectively will result in less follow-up costs.
It follows that we should treat health problems:
- effectively,
- with few risks of side-effects,
- as cheaply as possible.
It also follows that costs are by no means the only factor in this complex equation. Cost-effectiveness without effectiveness is not possible. Moreover, cost-effectiveness withoout an acceptable degree of safety is unlikely.
In the case of chiropractic, we have hardly reliable proof of effectiveness or safety. And this means that, before we can consider chiropractic to be paid for from public money, we first need solid evidence for its safey and efficacy – each for the relevant health problem to be treated. Once we have reliable data about all this – AND ONLY THEN – might we consider including chiropractic into the public healthcare budget.
In other words, the above cited paper is naive and ill-informed to the extreme.
5 Responses to Chiropractic – Is it Worth the Taxpayer’s Expense?
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Queue the usual numpties who will say anything, despite no evidence, chiro is efficacious.
Yes, it’s a very ill-informed article. I might further add that the authors evidently haven’t done their homework when they say that “Chiropractic remains a service provided outside the NHS in the United Kingdom and the argument for inclusion has been ongoing since the 90’s”. I thought that argument had been settled. For example, in a recent British Chiropractic Association survey most UK chiropractors who responded didn’t want to lose their ‘strong private practice identity and be focussed on the NHS system’. See https://tinyurl.com/y5mc9564
Interestingly, one respondent even went as far as saying “Our profession is not respected because of unethical practices and division within the profession.”
The article elaborates with: “Specifically, the argument to introduce chiropractic as an NHS service has been ongoing since at least 1990, when a non-blinded RCT comparing standard outpatient management to chiropractic treatment in 741 patients, showed outstanding benefits in the chiropractic group.” The paper in question was the fatally flawed Meade study which you can more about here:
https://www.ebm-first.com/chiropractic/the-meade-report-criticism.html
The BEAM trial is also mentioned in favour of chiropractic despite its results implying that spinal manipulation was a placebo:
https://www.ebm-first.com/chiropractic/the-meade-report-criticism/1368-the-beam-trial.html
The article also claims that: “In the UK, there are at least 5,099 chiropractors registered with the General Chiropractic Council as at 2020”
Ref: https://www.bemsreports.org/index.php/bems/article/view/151/196
Yet the General Chiropractic Council (GCC), this month, stated: “As of 1 September 2024, there were 3,911 chiropractors registered with the GCC”.
Ref: https://mailchi.mp/gcc-uk/gcc-september-2024-newsletter (scroll to end)
I don’t think the GCC’s Register has ever been as high as 5,000 registrants, or even 4,000 for that matter.
All very sloppy.
good work!
thanks
Blue Wode wrote: “The article also claims that: ‘In the UK, there are at least 5,099 chiropractors registered with the General Chiropractic Council as at 2020’ ”
Whereas the General Chiropractic Council Registration Annual Report 2020 informs us that:
‘At 31 December 2020, there were 3,343 chiropractors on the GCC Register: 3,093 paying the practising fee; 249 the reduced (non-practising) fee.’
https://www.gcc-uk.org/assets/publications/Registration_annual_report_2020.pdf
“the benefits of chiropractic are unclear”, yet it should be considered for inclusion in the NHS.
Dancing naked around a fire at midnight on the full moon would also have unclear benefits so that should be included? At least it would be more fun. (So I’m told.)