BCA
In a recent post, I mentioned a new report which allegedly claimed that “employing chiropractors in the [English] health service could save £1.5 billion“. Thanks to ‘Blue Wode’, we can now read the original report, and I had a critical look at it. Here are some quotes of crucial passages from the report:
The objective of this analysis was to establish how chiropractors could help to address the unmet need of people with MSK [musculoskeletal] conditions, who are currently absent from work due to these conditions, on NHS MSK physiotherapy waiting lists …
To assess the available evidence on the relative effectiveness of chiropractors, physiotherapists and osteopaths a pragmatic literature review was undertaken. This consisted of a rapid, pragmatic search of existing literature evidence to explore the effectiveness of chiropractic interventions (in terms of productivity/return to work) compared with physiotherapists and/or osteopaths … The strategies were not designed to be ‘comprehensive’ but focused to target records for relevant studies whilst retrieving record numbers that were manageable within the project timescales and available resources…
The results of the analysis are based on the assumption that there are equivalent work-related outcomes associated with MSK physiotherapy and chiropractic care…
1,270 records were retrieved from the database searches and 41 records were sent by the BCA. 101 duplicates were removed, and the remaining 1,210 references were screened for inclusion. 18 studies met the eligibility criteria and were included in data extraction (see Appendix B for the study flow diagram). Included studies had the following study designs: five systematic reviews [29-32] (of which one was only a summary [33]), three non-systematic reviews [34, 35] with one running a meta analysis [36], five randomised controlled trials [37-41], three cohort studies [42-44], and two case series studies [26, 45]…
A pragmatic review of literature found that evidence of the effectiveness of chiropractors in helping people with MSK conditions to get back to work is sparse and poor quality. There is weak evidence to suggest that chiropractors treating MSK conditions would be able to achieve equivalent return-to-work outcomes as physiotherapists. If more robust evidence could be developed, it is feasible that chiropractors could be used to address supply shortages in treatment for MSK conditions. This would require the NHS to consider closely the clinical governance arrangements it would need to put in place to ensure patient safety. It would also need to review the type of treatment and advice that chiropractors were able to provide for people with MSK conditions.
The initial analysis carried out for this study estimated that there are almost 1.6 million people unable to work due to an MSK condition in the UK. Spare capacity in the chiropractic profession indicates that around 114,000 more people per year could be treated by chiropractors. This represents around 7% of the current waiting list. Chiropractors have an average waiting time of 1.5 weeks compared with a minimum of 11 weeks for physiotherapists.
If the spare chiropractor capacity was used to address MSK conditions preventing people from working, then this could improve workforce productivity by reducing the time people are waiting for treatment. Adopting a simple analysis, assuming that all of the spare capacity could be used in the most efficient way, the estimated value of the improvement in productivity is £612 million per year. Using the Markov model to factor in a wider range of potential outcomes provides a more conservative, more robust estimated value of £399 million per year. If minimum rather that median wages are used to value the productivity gain based on an 11 week wait then it would reduce to £258 million.
A range of factors may increase or decrease the potential productivity gains. If the 11-week waiting time for physiotherapists is an under-estimate and the waiting times are 18 or 24 weeks, then the productivity gain would increase to £713 million and £1 billion respectively.
This analysis focused on productivity costs only, but people may also potentially have better health outcomes and lower treatment costs if they are treated more quickly.
Recommendations
Key recommendations emerging from this research are:
- The NHS should consider commissioning pilot research studies to generate evidence to make the case for the use of chiropractors in providing treatment for people with MSK conditions to allow them to return to work more quickly.
- The NHS should consider how the potential use of chiropractors to provide treatment and advice for people with MSK conditions can help to address the demand, capacity and financial challenges facing the health and social care system. This would need to be within the constraints of clinical guidelines and governance, to ensure safety and effective outcomes.
_______________________________________
And here are a few critical points:
- What on earth is a “pragmatic literature review”; was the term invented to disguise tha fact that the review is not systematic and thus is a bonanza in cherry-picking? I had a look at the cited literature and can confirm that any critical assessment of chiropractic has been excluded.
- “The results of the analysis are based on the assumption that there are equivalent work-related outcomes associated with MSK physiotherapy and chiropractic care.” Are you kidding me? I thought the aim was to “assess the available evidence on the relative effectiveness of chiropractors, physiotherapists and osteopaths”. How can you then assume equivalent outcomes as a basis for conducting the research?
- “Included studies had the following study designs: five systematic reviews [29-32] (of which one was only a summary [33]), three non-systematic reviews [34, 35] with one running a meta analysis [36], five randomised controlled trials [37-41], three cohort studies [42-44], and two case series studies [26, 45].” So, just 5 RCTs are the basis of the evaluations? What did you do with the dozens of other RCTs in this area? Did they perhaps not fit your conclusions?
- “If more robust evidence could be developed, it is feasible that chiropractors could be used to address supply shortages in treatment for MSK conditions.” However, I predict that more robust evidence will show the opposite of what you seem to wish!
- “Ensure patient safety”. Yes, thanks for mentioning safety. The report neglects safety completely. In view of the known risks of chiropractic this seems a serious mistake!
- “The estimated value of the improvement in productivity is £612 million per year.” From my comments above, it follows that this wild and largely unsubstantiated estimate was guided by little more than wishful thinking.
- “This analysis focused on productivity costs only, but people may also potentially have better health outcomes and lower treatment costs if they are treated more quickly.” More likely people experience health outcomes that are very similar to those of doing nothing at all. In this case, it would follow that a lot of money might be saved if we scrap MSK treatments altogether.
This report is a transparent and dilettante attempt to push more chiropractic on the NHS, a move that would not improve much and could even put a few patients in wheelchairs.
A long article on chiropractic casts doubt that chiropractic is useful. Here is an abbreviated version of it:
The chemistry and biology graduate from the University of Georgia, 28-year-old Caitlin Jensen, visited a chiropractor to sort out her lower back pain. During the session, the therapist performed an adjustment. It severed four arteries in her neck. She collapsed shortly after, unable to speak or move. The injury had caused her to suffer a series of strokes. Today, she has regained some movement in her head, legs and arms but she is still unable to speak, is partially blind and relies on a wheelchair.
- One 66-year-old grandmother said a visit to a chiropractor to treat her sore shoulder left her covered in bruises, hearing ringing in her ears and with a splitting pain in her jaw. She was later diagnosed by doctors with trigeminal neuralgia – a chronic pain disorder caused by a trapped or irritated nerve in the neck that causes sudden, electric shock-like pain in the face. She believes the condition – which, three years later, still sometimes leaves her unable to open her mouth wide enough to speak to her grandchildren – was triggered by a chiropractic adjustment of her neck.
- A 55-year-old woman was left with chronic neck and shoulder pain after visiting a chiropractor for a sore back. The pain was so bad she once spent 72 hours immobile and unable to sleep despite taking a concoction of painkillers.
- And a 66-year-old man says his back went into spasm as he was leaving his first chiropractor appointment – which left him hospitalised and bedbound for weeks. The intense treatment, he later learned, had pushed one of the discs of his spine out of place, causing him to lose feeling in his right leg for ever.
It has been reported that a woman who suffered a severe headache after injuring her neck during a workout died following a visit to a chiropractor. Joanna Kowalczyk, aged 29, declined a procedure at hospital for her injury and chose instead to try chiropractic. Her medical history showed she regularly suffered migraines and joint hypermobility issues. She also had an undiagnosed connective tissue disorder which made her susceptible to arterial dissections.
Ms Kowalczyk told the chiropractor that she had discharged herself from hospital. The chiropractor was unaware of her medical history but nevertheless manipulated her neck. It is thought Ms Kowalczyk suffered an arterial dissection when she injured her neck in the gym and that she suffered acute dissections to the same location when a chiropractor cracked her neck. She died on October 19, 2021, at Gateshead’s Queen Elizabeth Hospital several days after her chiropractic treatment.
Now her coroner has raised concerns that chiropractors aren’t required to check patient medical records after Ms Kowalczyk’s death. Specifically, the coroner’s report raised two matters of concern:
1. The evidence from the attending paramedic was that she was not aware that symptoms of a stroke can stop after a short time as clearly set out on NHS website and guidance, and that this was not part of her training. This was directly contrary to the Head of Operations’ evidence that this was part of both paramedic training and annual continuing professional development. This was a concerning feature given the accepted evidence of the time critical period to treat patients with symptoms potentially indicative of stroke.
2. The evidence on behalf of the treating chiropractor was that he did not consider it necessary to request GP records or hospital records, before assessment or treatment despite being informed about the Deceased’s recent hospital attendance, investigation which was recommended, and her discharge against medical advice. Even in the updated consent form I have been provided with, which was designed by the British Chiropractic Association, there is no prompt or question designed for the chiropractor to ask to consider obtaining medical records before assessment or treatment, and when this may be appropriate, and the only reference to medical records is a consent to communicate as deemed necessary for the treatment, and for a report to be sent to the GP after treatment. I am concerned that consideration to obtaining medical records should always be given before assessment, particularly where recent medical treatment or investigations has been undertaken.
Receiving a Regulation 28 (Prevent Future Deaths) report from the coroner, the GCC stated that the case may raise some concerns for chiropractors and their patients and published the following additional comment:
The chiropractor involved is subject to a GCC investigation, which was paused to allow for the coronial process. This is standard procedure.
It is not appropriate for us to comment further as it could prejudice proceedings. It is inappropriate and unprofessional for chiropractors to speculate publicly on the details of the case, or the identity of the individual involved.
All matters brought to the attention of the GCC are risk assessed and are considered by an Investigating Committee. More about the investigation process.
In her report, the Coroner has asked the GCC to consider the following concern.
(I am) “concerned that consideration to obtaining medical records should always be given before assessment, particularly where recent medical treatment or investigations has been undertaken.”
We will give full and careful consideration to her concern. Given the clinical matters involved, we are seeking expertise (from across the profession, and beyond) to consider the impact of such a step – including on the care and safety of all patients. The Registrar will be writing to the coroner in the next week to set out how her concerns will be considered, and the expected timing of that work.
We have been in contact with leaders from across the profession and are grateful to them all for their support of our proposed approach.
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The GCC’s main task is the protection of consumers. I have repeatedly pointed out that they seem to have forgotten this and seem to think it is to promote chiropractic in every way they can, e.g.:
- The UK General Chiropractic Council (yet again) protects the chiro rather than the patient
- The General Chiropractic Council “regulates chiropractors to ensure the safety of patients” … well, you could have fooled me!
- Hurray! The new professional standard by the General Chiropractic Council protects UK chiropractors
- Death of a chiropractic patient prompts a reaction by the UK General Chiropractic Council
- The UK General Chiropractic Council: fit for purpose?
- The GCC “seems to be a little self-regulatory chiropractic bubble where chiropractors regulate chiropractors.”
- The death of Mr Lawler highlights the scandals of chiropractic
Let’s hope the GCC takes the occasion of yet another tragic and unnecessary death as a wake-up call for finally getting its act together!
The ‘Code of Professional Practice‘ for UK chiropractors (applicaple from 1.1.2026) has just been published by the UK General Chiropractic Council (GCC). It demands in no uncertain terms numerous things from chiropractors:
- You must put the interests of patients first
- You must ensure safety and quality in clinical practice
- You must act with honesty and integrity and maintain
- You must provide a good standard of clinical care and professional practice
- You must establish and maintain clear professional
- You must obtain appropriate, valid consent from patients
- You must communicate professionally, properly and effectively
- You must foster collaborative healthcare, effective professional relationships and safe, supportive workplace practice
- You must maintain, develop and work within your professional knowledge and skills
- You must maintain and protect patient information
It seems obvious to me that many of these demands cannot possibly met. Let me just pick two examples. The code explains that, as a chiropractor, you must:
- protect patients by promoting and maintaining a culture of safety, seeking to prevent harm before it occurs.
- use the findings of the clinical assessment and the best quality of evidence that is available at the time, to propose (and record) a plan of care for the patient. You must tell the patient where your proposals are not supported by evidence of accepted quality and record your rationale and discussions.
Ad 1
Chiropractors administer spinal manipulations to well over 90% of their patients regardless of their condition or complaint. As we have often discussed on this blog, such treatments are not free of serious risks. It follows that preventing harm from patients and earning your living as a chiro is not really possible. Either you do one or you do the other; to be able to do both at the same time seems pure fantasy.
Ad 2
If chiropractors were to use the findings of the best quality of evidence that is available at the time, they would have to stop using spinal manipulation, a treatment that is, for many indications chiros use it, not supported by the best available evidence. But, as I already mentioned, spinal manipulation is the main therapy of chiros. Following the GCC’s demand is therefore an impossibility.
What is the solution?
Will the new code really disallow UK chiropractors to practice?
No! I fear that the solution is much simpler than it may look at first glance.
The GCC has in the past issued similar demands only to then do nothing to enforce them. Like past documents, the new code will turn out to be a document that changes nothing, except that it makes GCC members feel good: it allows them (and some consumers) the illusion that UK chiropractic an evidence-based, ethical and well-regulated profession.
The General Chiropractic Council (GCC) has signed a memorandum of understanding with NHS England, the Crown Prosecution Service and the National Police Chiefs’ Council to collaborate where there is suspected criminal activity on the part of a GCC member in relation to the provision of clinical care or care decision-making.
I find this interesting and most laudable!
But I also have seven questions, e.g.:
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor explains that the patient’s problem is caused by a subluxation of the spine, an entity that does not even exist? Apparently this happens every day.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor treats a patient without prior informed consent? Apparently, this happens regularly.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor fails to warn a patient that his/her manipulations can cause harm and even put him/her in a wheelchair? Apparently this (the lack of warning) happens all the time, and some chiropractors even insist that their manipulations are entirely safe.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor claims that spinal manipulations are effective for curing the patient’s problem, while the evidence does not support the claim? Apparently this happens more often than not.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor persuades a patient to have expensive long-term maintenance therapy for preventing health problems, while the evidence for that appoach is less than convincing? Apparently this happens rather frequently.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if the chiropractor issues advice that is both outside his/her competence and detrimental to the health of the patient (for instance, advising parents not to vaccinate their kids)? Apparently this happens a lot.
- Does it amount to criminal activity in relation to the provision of clinical care or care decision-making, if a chiropractor advises a patient not to do what a real doctor told him/her to do? Apparently this is far from a rare occurance.
I would be most grateful, if the GCC would take the time to answer the above questions.
Many thanks in advaance.
Since the introduction of their new Education Standards in March 2023, the General Chiropractic Council (GCC) has been working with chiropractic education providers to support them in implementing the changes to their curricula. Recently, the GCC have stated this:
We expect students to be taught evidence-based practice: integrating individual clinical expertise, the best available evidence from current and credible clinical research, and the values and preferences of patients. Chiropractors are important members of a patient’s healthcare team, and interprofessional approaches enable the best outcomes. Programmes that meet these Standards will teach ethical, professional care and produce competent healthcare professionals who can serve the needs of patients.
These are indeed most encouraging words!
Basically, they are saying that chiropractic education will now have to be solidly based on the principles of evidence-based medicine (EBM) as well as sound medical ethics. Let me spell out what this really means. Chiropractic courses must teach that:
- The current and credible clinical evidence suggesting that spinal manipulations, the hallmark intervention of chiropractors, are effective is weak for back pain and negative or absent for all other conditions.
- The current and credible clinical evidence suggests that spinal manipulations, the hallmark intervention of chiropractors, can cause harm which in many instances is serious.
- The current and credible clinical evidence thus suggests that the risk/benefit balance for spinal manipulations, the hallmark intervention of chiropractors, is not positive.
- Medical ethics require that competent healthcare professionals inform their patients that spinal manipulations, the hallmark intervention of chiropractors, may not generate more good than harm which is the reason why they cannot employ these therapies.
So, the end of chiropractic in the UK is looming!
Unless, of course, the GCC’s words are not really meant to be translated into action. They could be just window dressing and politically correct bullshit. But that’ s really far too far fetched – after all they come from the GENERAL CHIROPRACTIC COUNCIL, known for its excellent track record, e.g.:
- The GCC “seems to be a little self-regulatory chiropractic bubble where chiropractors regulate chiropractors.”
- A 5-year strategy for UK chiropractors: not fit for purpose
- Chiro behaving badly… is the GCC fit for purpose?
- The UK General Chiropractic Council: fit for purpose?
- Farcical Chiropractic Council: Chiropractic Patient Satisfaction and Experience
- The General Chiropractic Council “regulates chiropractors to ensure the safety of patients” … well, you could have fooled me!
- Death of a chiropractic patient prompts a reaction by the UK General Chiropractic Council
The concept that the outcomes of spinal manipulation therapy (SMT) – the hallmark intervention of chiropractors which they use on practically every patient – are optimized when the treatment is aimed at a clinically relevant joint is commonly assumed and central to teaching and clinical use of chiropractic. But is the assumption true?
This systematic review investigated whether clinical effects are superior when this is the case compared to SMT applied elsewhere. Eligible study designs were randomized controlled trials that investigated the effect of SMT applied to candidate versus non-candidate sites for spinal pain.
The authors obtained studies from four different databases. Risk of bias was assessed using an adjusted Cochrane risk of bias tool, adding four items for study quality. Between-group differences were extracted for any reported outcome or, when not reported, calculated from the within-group changes. Outcomes were compared for SMT applied at a ‘relevant’ site to SMT applied elsewhere. The authors prioritized methodologically robust studies when interpreting results.
Ten studies were included. They reported 33 between-group differences; five compared treatments within the same spinal region and five at different spinal regions.
None of the nine studies with low or moderate risk of bias reported statistically significant between-group differences for any outcome. The tenth study reported a small effect on pain (1.2/10, 95%CI – 1.9 to – 0.5) but had a high risk of bias. None of the nine articles of low or moderate risk of bias and acceptable quality reported that “clinically-relevant” SMT has a superior outcome on any outcome compared to “not clinically-relevant” SMT. This finding contrasts with ideas held in educational programs and clinical practice that emphasize the importance of joint-specific application of SMT.
The authors concluded that the current evidence does not support that SMT applied at a supposedly “clinically relevant” candidate site is superior to SMT applied at a supposedly “not clinically relevant” site for individuals with spinal pain.
I came across this study when I searched for the published work of Prof Stephen Perle, a chiropractor and professor at the School of Chiropractic, College of Health Sciences, University of Bridgeport, US, who recently started trolling me on this blog. Against my expectation, I find his study interesting and worthwhile.
His data quite clearly show that the effects of SMT are non-specific and mainly due to a placebo response. That in itself is not hugely remarkable and has been suspected to some time, e.g.:
- Chiropractic manipulation for migraine is a placebo therapy
- Chiropractic treatments are placebos
- Chiropractic spinal manipulation = placebo!
- Manual therapy (mainly chiropractic and osteopathy) does not have clinically relevant effects on back pain compared with sham treatment
- Manual therapies for back pain: not better than a placebo
- Is spinal manipulation a placebo therapy?
What is remarkable, however, is the fact that Perle and his co-authors offer all sorts of other explanation for their findings without even seriously considering what is stareing in their faces:
SPINAL MANIPULATIONS ARE PLACEBOS
CHIROPRACTIC IS A PLACEBO THERAPY
This might be almost acceptable, if chiropractic would not also be burdened with significant risks (as we have discussed ad nauseam on this blog) – another fact of which chiros like Perle are in denial.
What does all that mean for patients?
The practical implication is fairly straight forward: the risk/benefit balance of chiropractic is negative. And this surely means the only responsible advice to patients is this:
NEVER CONSULT A CHIRO!
We have repeatedly discussed the fraud committed by many chiropractors. A recent article provided further information on this lamentable issue. Here are a few excerpts:
Fraud in US chiropractic care is on the rise. A shocking 82 percent of the chiropractic services billed to Medicare is unallowable, according to a recent audit by the Office of Inspector General. The audit found a lack of effective controls allowed an estimated $358.8 million in taxpayer funds to be improperly billed to Medicare.
Chiropractors engage in fraudulent billing practices in a variety of ways. Sometimes they target environments like nursing homes or substance abuse rehabilitation centers, looking for new patients who may – or may not – require their services.
In one case, a St. Louis-based chiropractor bribed police officers to get access to personal information about individuals who had been in car accidents. The chiropractor then contacted the accident victims and claimed to be from an insurance company or the state to arrange appointments at his practice.
In another case, a Houston-based chiropractor and his medical group settled with the federal government for $2.6 million and were also banned from billing federal programs for 10 years due to their involvement with a fraudulent billing scheme.
Lastly, in 2021, a chiropractor was found guilty of federal criminal charges, including five counts of healthcare fraud. The chiropractor was accused of defrauding health insurers by submitting $2.2 million in billings for chiropractic services that were never provided, office visits that never occurred, false diagnoses, and falsely prescribed medical devices.
Although other medical specialties also have bad actors, certain specific reasons can be identified as to why fraudulent billing and abuse have been increasing among chiropractors. These practitioners have fewer lower-cost codes to bill for, which means they need more patients to boost their earnings. For example, a service may only be billed at $25 or $50, but if this is billed to every patient on every visit, it quickly adds up. Because employers often have limited resources, it’s easy for minor charges to go unnoticed.
According to a 2018 report, the inspector general has conducted numerous evaluations and audits of chiropractic services since 2005 and has identified hundreds of millions of dollars in overpayments for services that did not meet Medicare requirements. The report also noted that the OIG’s investigations and legal actions involving chiropractors have demonstrated that chiropractic services are susceptible to healthcare fraud.
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Personally, I am not surprised by such reports. Sure, not all chiropractors committ financial fraud. But arguably ALL chiropractors are dishonest when they tell their patients that their spinal manipulations are effective and safe for a wide range of conditions. To put it bluntly: chiropractic was founded by a crook on a bunch of lies and unethical behavior, therefore, it is hardly surprising that today the profession has a problem with honesty and fraudulent behavior.
Infant colic is a sensitive subject for chiropractors in the UK. In case you forgot, here is why. Consequently, the subject has featured regularly on this blog – and now there is new evidence:
A systematic review and meta-analysis were conducted on infantile colic studies that used SO-CALLED alternative medicine (SCAM) techniques as interventions. The outcome measures were hours spent crying and/or sleeping. The authors used the PubMed, Physiotherapy Evidence Database, Cochrane Library, Embase, Web of Science, Scopus, Osteopathic Medicine Digital Database, and Google Scholar databases from inception to 11 November 2022.
The methodological quality of the randomized control trials ranged from fair to high. The authors focused on five studies with 422 babies using the following interventions: cranial, visceral, or structural osteopathy or chiropractic manipulation or mobilization. These treatments failed to decrease the crying time (mean difference -1.08, 95% CI -2.17 to 0.01, I2 = 92%) and to increase the sleeping time (mean difference 1.11, 95% CI -0.20 to 2.41; I2: 91%), compared with no intervention. The quality of the evidence was rated as very low for both outcome measures.The authors concluded that osteopathy and chiropractic treatment failed to reduce the crying time and increase sleeping time in babies with infantile colic, compared to no additional intervention.The 5 included studies were the following:
- Miller JE, Newell D, Bolton JE. Efficacy of chiropractic manual therapy on infant colic: A pragmatic single-blind, randomized controlled trial. J Manipulative Physiol Ther. 2012;35(8):600–7.
- Castejón-Castejón M, Murcia-González MA, Todri J, Lena O, Chillón-Martínez R. Treatment of infant colic with craniosacral therapy. A randomized controlled trial. Complement Ther Med. 2022;71(February 2021).
- Olafsdottir E, Forshei S, Fluge G, Markestad T. Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation. Arch Dis Child. 2001;84(2):138–41.
- Holm LV, Jarbøl DE, Christensen HW, Søndergaard J, Hestbæk L. The effect of chiropractic care on infantile colic: results from a single-blind randomised controlled trial. Chiropr Man Ther. 2021;29(1):1–11.
- Hayden C, Mullinger B. A preliminary assessment of the impact of cranial osteopathy for the relief of infantile colic. Complement Ther Clin Pract. 2006;12(2):83–90.
This means that, in recent years, several new studies have emerged. I find this surprising: there is no plausible mechanism of action and the previous reviews were negative.
Why flog a dead horse?
But – come to think of it – this is a question one might ask about most of the research into cranial, visceral, or structural osteopathy or chiropractic manipulation or mobilization.
My new book has just been published. Allow me to try and whet your appetite by showing you the book’s introduction:
“There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking.” These words of Fontanarosa and Lundberg were published 22 years ago.[1] Today, they are as relevant as ever, particularly to the type of healthcare I often call ‘so-called alternative medicine’ (SCAM)[2], and they certainly are relevant to chiropractic.
Invented more than 120 years ago by the magnetic healer DD Palmer, chiropractic has had a colourful history. It has now grown into one of the most popular of all SCAMs. Its general acceptance might give the impression that chiropractic, the art of adjusting by hand all subluxations of the three hundred articulations of the human skeletal frame[3], is solidly based on evidence. It is therefore easy to forget that a plethora of fundamental questions about chiropractic remain unanswered.
I wrote this book because I feel that the amount of misinformation on chiropractic is scandalous and demands a critical evaluation of the evidence. The book deals with many questions that consumers often ask:
- How well-established is chiropractic?
- What treatments do chiropractors use?
- What conditions do they treat?
- What claims do they make?
- Are their assumptions reasonable?
- Are chiropractic spinal manipulations effective?
- Are these manipulations safe?
- Do chiropractors behave professionally and ethically?
Am I up to this task, and can you trust my assessments? These are justified questions; let me try to answer them by giving you a brief summary of my professional background.
I grew up in Germany where SCAM is hugely popular. I studied medicine and, as a young doctor, was enthusiastic about SCAM. After several years in basic research, I returned to clinical medicine, became professor of rehabilitation medicine first in Hanover, Germany, and then in Vienna, Austria. In 1993, I was appointed as Chair in Complementary Medicine at the University of Exeter. In this capacity, I built up a multidisciplinary team of scientists conducting research into all sorts of SCAM with one focus on chiropractic. I retired in 2012 and am now an emeritus professor. I have published many peer-reviewed articles on the subject, and I have no conflicts of interest. If my long career has taught me anything, it is this: in the best interest of consumers and patients, we must insist on sound evidence; not opinion, not wishful thinking; evidence.
In critically assessing the issues related to chiropractic, I am guided by the most reliable and up-to-date scientific evidence. The conclusions I reach often suggest that chiropractic is not what it is often cracked up to be. Hundreds of books have been published that disagree. If you are in doubt who to trust, the promoter or the critic of chiropractic, I suggest you ask yourself a simple question: who is more likely to provide impartial information, the chiropractor who makes a living by his trade, or the academic who has researched the subject for the last 30 years?
This book offers an easy to understand, concise and dependable evaluation of chiropractic. It enables you to make up your own mind. I want you to take therapeutic decisions that are reasonable and based on solid evidence. My book should empower you to do just that.
[1] https://pubmed.ncbi.nlm.nih.gov/9820267
[2] https://www.amazon.co.uk/SCAM-So-Called-Alternative-Medicine-Societas/dp/1845409701/ref=pd_rhf_dp_p_img_2?_encoding=UTF8&psc=1&refRID=449PJJDXNTY60Y418S5J
[3] https://www.amazon.co.uk/Text-Book-Philosophy-Chiropractic-Chiropractors-Adjuster/dp/1635617243/ref=sr_1_1?keywords=DD+Palmer&qid=1581002156&sr=8-1
