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

chiropractic

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The use of the doctor title by chiropractors has long been a controversial issue. A recent statement from the UK General Chiropractic Council (GCC) is aimed at creating clarity for UK chiropractors. It is directly from the website of the GCC:

Recently, the GCC has received some queries regarding the use of ‘Doctor’ for chiropractors.

As a reminder, if the courtesy title of ‘Doctor’, or its abbreviation ‘Dr’ or ‘DC’ is used, any public-facing content must state clearly that this is not as a registered medical practitioner, but a ‘Doctor of Chiropractic’.

We urge all registrants to review their public-facing materials, on- and offline, to ensure that they fully comply with these requirements. To assist, we have published three communication-focussed toolkits on social mediaadvertising and websites, providing useful guidance and advice on how best to remain compliant to GCC and Advertising Standards Authority requirements.

Internationally, chiropractors seem keen on the doctor title. So much so, that they even claim that DD and BJ Palmer, the inventors of chiropractic, were doctors:

Chiropractic as a profession was established by Dr. D. D. Palmer in 1895 … The International Chiropractors Association (ICA) is here to serve the chiropractic community worldwide.  Established in 1926 in Davenport, Iowa, USA by Dr. B.J. Palmer, the ICA is the world’s oldest international chiropractic professional organization representing practitioners, students, chiropractic assistants, educators and lay persons globally.

In the US, it seems therefore entirely normal that chiropractors use the doctor title. In the UK, however, it is less common.

Remember the tragic case of John Lawler? He consulted a ‘Dr.’ thinking she was a medical doctor. She turned out to be a chiro and the patient paid with his life. Recently, the GCC found that the chiro was not guilty of any wrongdoing. It took me less than 10 minutes on the Internet to find plenty who do use the doctor title or allow it to be used on their website:

  •  Thanks to Dr Jasper for helping me to get rid of the terrible back pain
  • Dr. Mo is a chiropractor in Manchester and Stockport helping with back pain, sciatica, neck pain, headaches.
  • Dr Maria Madge is an experienced chiropractor working in Norfolk.
  • Dr James Shervell has 25 years’ experience to help with your pain…

So, in the spirit of goodwill and constructive criticism, may I make a suggestion to the GCC? Instead of issuing reminders like the one above, could you please invest a little time (a few hours would probably suffice), identify all of those of your members who still misuse the title, and instruct them to stop? It just might prevent tragedies like the above-mentioned Lawler case from happening again!

 

 

I have decided to herewith start

The ‘WORST PAPER OF 2022’ competition

And I have already come across an article that I can nominate for it. It is entitled ‘What is the goal of science? ‘Scientific’ has been co-opted, but science is on the side of chiropractic. It is worth reading it in full, but in case you are in a hurry, I have extracted some bon mots for you:

  • Most of what chiropractors do in natural health care is scientific; it just has not been proven in a laboratory at the level we would like.
  •  It might be useful to review scientific method here. First, you make an observation, then pose a testable question based on that observation. You state your hypothesis, then design and perform an experiment, collect data and draw a conclusion.
  • A lot of our information is based on observations or hypotheses, and that is not a bad thing.
  • [conventional] medicine fails to be scientific because it ignores clinical observations out of hand.
  •  the majority of the observations that we in the natural health community work with are not even taken seriously. We would like to think that this is not because the medical “scientific” journals sell ads to drug companies.
  • we have multibillion-dollar corporations controlling our observations and our conversations about health — not very scientific.
  • When something is labeled anecdotal, to the medical community it means it is unimportant. That is not necessarily true; it means a lot of people have made the same observation.
  • [the pharma industries] have positioned themselves to be the ones who decide what is or is not true in our health care system.
  • Combining the “anecdotal” information from colleagues and one’s individual clinical observations, elegant and effective models for disease and strategies for treatment begin to emerge.
  • everyone in natural health care knows to combine therapies and the effects are often cumulative. For example, many asthmatics respond to magnesium supplementation. Some respond to taking vitamin C or another antioxidant. Most of us know that combining the two supplements increases favorable results.
  • drugs have side effects and often harm the patient. They often work against each other. We don’t have that problem with vitamins and minerals; you will not harm the patient.
  • we are not treating a disease, we are correcting a deficiency. If the asthmatic is deficient in magnesium, symptoms will improve. Giving magnesium is not a treatment of the asthma; it is fixing infrastructure.
  • We don’t really treat disease; we improve infrastructure.
  • When our patients improve, we know we are on the right track. That is what the scientific method is all about.
  • Finding errors in physiology and correcting them may produce results where medicine has failed so miserably. We are following scientific method, but studies are expensive and some things, even though they seem to hold up anecdotally, have not been proven.

As the year is still young, this paper might not actually win the competition but I hope you agree that it is a worthy competitor.

Some of you will ask what is there to win in the ‘WORST PAPER OF 2022’ competition? I agree: a competition without a prize is no fun. Therefore, I suggest donating to the winner one of my books that best fits his/her subject. I am sure this will over-joy him or her.

Now we only need to determine how we identify the winner. I suggest that I continue blogging about nominated papers (I hope to identify about 10 in total), and towards the end of the year, I let my readers decide democratically.

In so-called alternative medicine (SCAM) we have an amazing number of ‘discoveries’ which – IF TRUE – should have changed the world. Here I list of 10 of my favorites:

  1. Diluting and shaking a substance makes it not weaker but stronger.

Homeopaths call this process ‘potentisation’. They use it to produce highly ‘potent’ remedies that contain not a single molecule of the original substance. The assumption is that potentisation transfers energy or information. Therefore, they claim, molecules are no longer required for achieving a clinical effect.

2. A substance that causes a certain symptom in a healthy person can be used to cure that symptom when it occurs in a patient.

The ‘like cures like’ principle of homeopathy is based on the notion that the similimum provokes an artificial disease which in turn defeats the condition the patient is suffering from.

3. Subluxations of the spine are the cause of most diseases that affect us humans.

DD Palmer, the inventor of chiropractic, insisted that almost all diseases are due to subluxations. These misplaced vertebrae, he claimed, are the root cause of any disease by inhibiting the flow of the ‘innate’ which in turn caused ill health.

4. Adjusting such subluxations is the best way to restore health.

Palmer, therefore, was sure that only adjustments of these subluxations were able to restore health. All other medical interventions were useless or even dangerous, in his view. Thus Palmer opposed medicines or vaccinations.

5. An imbalance of two life forces is the cause of all illnesses.

Practitioners of TCM believe that all illnesses originate from an energetic imbalance. Harmony between the two life forces ‘yin and yang’ means health.

6. Balance can be restored by puncturing the skin at specific points.

Acupuncturists are convinced that their needling is nothing less than attacking the root cause of his or her problem. Therefore, they are convinced that acupuncture is a cure-all.

7. Our organs are represented in specific areas on the sole of our feet.

Reflexologists have maps of the sole of a foot where specific organs of the body are located. They palpate the foot and when they feel a gritty area, they conclude that the corresponding organ is in trouble.

8. Massaging these areas will positively influence the function of specific organs.

Once the diseased or endangered organ is identified, the area in question needs to be massaged until the grittiness disappears. This intervention, in turn, will have a positive influence on the organ in question.

9. Healing energy can be sent into our body where it stimulates the self-healing process and restores health.

Various types of energy healers are convinced that they can transmit energy that comes from a divine or other source into a patient’s body. The energy enables the body to heal itself. Thus, energy healing is a panacea and does not even require a proper diagnosis to be effective.

10. Toxins accumulate in our bodies and must be eliminated through a wide range of SCAMs.

The toxins in question can originate from within the body and/or from the outside. They accumulate and make us sick. Therefore, we need to eliminate them, and the best way to achieve this is to use this or that SCAM

 

I could, of course, list many more such ‘discoveries’ – SCAM is full of them. They are all quite diverse but have one important thing in common: they are false (i.e. there is no good evidence for them and they fly in the face of science).

If they were true, they would have changed the world by revolutionizing science, physics, physiology, anatomy, pathology, therapeutics, etc.

ALL THESE UGLY FACTS DESTROYING SUCH BEAUTIFUL THEORIES!

WHAT A SHAME!!!

It has been reported that, after a majority of Canadian chiropractors attending a meeting of their regulator voted to oppose a COVID-19 vaccine mandate, B.C.’s health minister told a representative he was starting to doubt the wisdom of self-regulation.

On Dec. 1, the College of Chiropractors of B.C. (BCCA) held its AGM and registrants voted in favour of a non-binding resolution calling for the regulator to “take a stand” against an expected vaccine mandate for health professionals. Subsequently, Health Minister Adrian Dix then “expressed his extreme displeasure” about the remarks of some chiropractors.

“Minister Dix indicated it was an embarrassment that a health profession would in such resounding numbers … support such unfounded and false claims while people are dying from COVID-19,” said the BCCA’s executive director Angie Knott. In bold and underlined text, she added, “He also stated that it made him question the validity of self-regulation.”

During the meeting in question, 78% of those chiropractors in attendance had voted in favour of the motion. Chiropractors are not trained in treating or preventing infectious disease and are prohibited from offering advice on vaccinations in B.C.

This is not the first time health ministry officials have expressed concerns about the ability of chiropractors to adequately regulate themselves.

In my view, this story is a poignant reminder of something I have been saying often:

Even the proper regulation of quackery will merely result in quackery!

 

Compelling evidence has long shown that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcomes in patients with low back pain presenting for chiropractic care.

A matched observational study using prospective longitudinal observational data with a one-year follow-up was performed in primary care chiropractic clinics in Denmark. Data were collected from November 2016 to December 2019. Participants included low back pain patients presenting for chiropractic care, who were either referred or not referred for diagnostic imaging at their initial visit. Patients were excluded if they were younger than 18 years, had a diagnosis of underlying pathology, or had previously had imaging relevant to their current clinical presentation. Coarsened exact matching was used to match participants referred for diagnostic imaging with participants not referred for diagnostic imaging on baseline variables including participant demographics, pain characteristics, and clinical history. Mixed linear and logistic regression models were used to assess the effect of imaging on back pain intensity and disability at two weeks, three months, and one year, and on global perceived effect and satisfaction with care at two weeks.

A total of 2162 patients were included, and 24.1% of them were referred for imaging. Near perfect balance between matched groups was achieved for baseline variables except for age and leg pain. Participants referred for imaging had slightly higher back pain intensity at two weeks (0.4, 95%CI: 0.1, 0.8) and one year (0.4, 95%CI: 0.0, 0.7), and disability at two weeks (5.7, 95%CI: 1.4, 10.0), but these differences are unlikely to be clinically meaningful. No difference between groups was found for the other outcome measures. Similar results were found when a sensitivity analysis, adjusted for age and leg pain intensity, was performed.

The authors concluded that diagnostic imaging did not result in better clinical outcomes in patients with low back pain presenting for chiropractic care. These results support that current guideline recommendations against routine imaging apply equally to chiropractic practice.

This study confirms what most experts suspected all along and what many chiropractors vehemently denied for years. One could still argue that the outcomes do not differ much and therefore imaging does not cause any harm. This argument would, however, be wrong. The harm it causes does not affect the immediate clinical outcomes.  Needless imaging is costly and increases the cancer risk.

The effectiveness of manipulation versus mobilization for the management of spinal conditions, including cervicogenic headache, is conflicting, and a pragmatic approach comparing manipulation to mobilization has not been examined in a patient population with cervicogenic headache.

This study evaluated the effectiveness of manipulation compared to mobilization applied in a pragmatic fashion for patients with cervicogenic headache.

Forty-five (26 females) patients with cervicogenic headache were randomly assigned to receive either pragmatically selected manipulation or mobilization. Outcomes were measured at baseline, the second visit, discharge, and 1-month follow-up. The endpoints of the study included the Neck Disability Index (NDI), Numeric Pain Rating Scale (NPRS), the Headache Impact Test (HIT-6), the Global Rating of Change (GRC), the Patient Acceptable Symptoms Scale (PASS). The primary outcome measures were the effects of treatment on disability and pain. They were examined with a mixed-model analysis of variance (ANOVA), with treatment group (manipulation versus mobilization) as the between-subjects variable and time (baseline, 48 hours, discharge, and follow-up) as the within-subjects variable.

The interaction for the mixed model ANOVA was not statistically significant for NDI (p = 0.91), NPRS (p = 0.81), or HIT (p = 0.89). There was no significant difference between groups for the GRC or PASS.

The authors concluded that manipulation has similar effects on disability, pain, GRC, and cervical range of motion as mobilization when applied in a pragmatic fashion for patients with cervicogenic headaches.

Essentially, this study is an equivalence trial comparing one treatment to another. As such it would need a much larger sample size than the 45 patients enrolled by the investigators. If, however, we ignored this major flaw and assumed the results are valid, they would be consistent with both manipulation and mobilization being pure placebos.

I can imagine that many chiropractors find this conclusion unacceptable. Therefore, let me offer an alternative: both approaches were equally effective. Therefore, mobilization, which is associated with far fewer risks, is preferable. This means that patients suffering from cervicogenic headache should see an osteopath who is less likely to use manipulation than a chiropractor.

And again, I can imagine that many chiropractors find this conclusion unacceptable.

The following press release was published by the AMA on 16/11/2021. I consider it sufficiently relevant to re-publish it here in full and, as it is entirely self-explanatory, without further comment:

At its Special Meeting today, the American Medical Association (AMA) House of Delegates approved a resolution stating that only licensed physicians should determine whether a person should receive a medical exemption from vaccines.

The policy comes in the wake of tens of thousands of people seeking exemptions to state and municipal COVID mandates, contending they have medical reasons for remaining unvaccinated. The new policy states that only licensed physicians should have the medical authority and the power to grant these exemptions.

“Vaccine hesitancy has played an unfortunate role in extending the COVID-19 public emergency. Failing to get vaccinated has resulted in tragic and unnecessary deaths. To protect everyone, we must be sure that a trained, licensed physician is making the judgment on whether a person actually warrants an exemption,” said Willie Underwood III, M.D., M.Sc., M.P.H., a member of the AMA Board of Trustees.

The definition of “medical authority” varies from state to state, with some states allowing alternative practitioners, such as naturopathic providers, to approve vaccine exemptions. Surveys have shown that naturopathic providers and other alternative medicine providers (such as homeopaths and chiropractors) are less likely to recommend vaccines—or even recommend against vaccines—despite scientific evidence of safety and efficacy.

“State policymakers need to limit the definition to physicians who have the training necessary to recognize a medical condition that prevents a patient from receiving a vaccine,” Dr. Underwood said. “We shouldn’t jeopardize public health by listening to unlicensed and untrained providers.”

The AMA already has policy opposing nonmedical (religious, philosophic, or personal belief) exemptions from immunizations, since such exemptions endanger the health of the unvaccinated individual and the health of the community at large. The AMA supports the immunization recommendations of the Advisory Committee on Immunization Practices for all individuals without medical contraindications. It also supports legislation eliminating nonmedical immunization exemptions and encourages state medical associations to seek removal of nonmedical exemptions in states requiring mandatory immunizations.

“One of the unfortunate side effects of the COVID-19 pandemic and misinformation around it is the questioning of vaccine efficacy even though vaccines have nearly wiped out diseases that once plagued us. Physicians must make the argument clearly and loudly based on the science: Vaccines save lives,” Underwood said.

In a recently published study, the willingness to be vaccinated of parents of underage children and persons without underage children was examined. The study was based on a random sample (telephone survey, n = 2014, survey between 12.11.2020 and 10.12.2020).
The results revealed that parents consistently show a lower propensity to vaccinate with a COVID-19 vaccine than respondents without minor children (54.1% vs. 71.1%). Fathers showed a more pronounced own willingness to vaccinate than mothers. Furthermore, men were more willing than women to have their own child vaccinated with a COVID-19 vaccine.
The overall sample also showed that a rejection of so-called alternative medicine (SCAM) was associated with a significantly higher willingness to be vaccinated. There was also a significant correlation between the attitude towards homeopathy and one’s own willingness to be vaccinated. If homeopathy was supported, the willingness to vaccinate was lower. This correlation between the attitude towards homeopathy and willingness to vaccinate was also evident in the sub-sample of parents. Among the parents, it was again the women who significantly more often had a positive attitude towards homeopathy than men, who more often do not think anything of it.

This new evidence ties in neatly with many of my previous posts on the subject of SCAM and vaccination, for instance:

Collectively, this evidence tells us that:

  • the effect has been shown in many different ways,
  • it can therefore be assumed to be real,
  • it is not confined to COVID vaccinations,
  • it is not confined to one particular branch of SCAM,
  • it even affects MDs (who surely should know better) dabbling in SCAM,
  • it has a long history,
  • it is prevalent in many, if not most countries,
  • it does real harm.

So, the next time someone tells you that SCAM and SCAM practitioners have a positive influence on public health, tell them to think again.

 

As discussed regularly on this blog, there is plenty of evidence to show that many chiropractors, homeopaths, and naturopaths discourage their patients from getting vaccinated. Now, a further investigation from the US seems to confirm these findings.

This analysis aims to evaluate differences between categories of so-called alternative medicine (SCAM) regarding vaccination behavior among US adults.

The data from the 2017 National Health Interview Survey (NHIS; n = 26,742; response rate 80.7%) was used for this purpose. Prevalences of flu vaccination, consultations with SCAM practitioners in the past 12 months, and their potential interactions were examined.

A total of 42.7% of participants had received the flu vaccination in the past 12 months, 32.4% had seen one or more SCAM practitioners. Users of any type of SCAM were as likely as non-users to have received a flu vaccination (44.8% users versus 41.7% non-users; p = 0,862; adjusted odds ratio [AOR] = 1.01, 95% confidence interval [CI] = 0.95-1.07).

Regarding specific SCAMs, individuals consulting with

  • naturopaths (p < 0.001; AOR = 0.67, 95 %CI = 0.54-0.82),
  • homeopaths (p < 0.001; AOR = 0.55; 95 %CI = 0.44-0.69),
  • chiropractors (p = 0.016; AOR = 0.9, 95 %CI = 0.83-0.98)

were less likely, while other SCAM approaches showed no significant association with flu vaccination behavior. Independent predictors for a flu shot were prior diabetes, cancer, current asthma, kidney disease, overweight and current pregnancy. As well, higher educational level, age, ethnicity, health insurance coverage, and having seen a general physician or medical specialist in the past 12 months were also associated with a higher vaccination rate.

The authors concluded that SCAM users were equally likely to receive an influenza vaccination compared with non-users. Different complementary therapies showed varied associations with vaccination behavior. Further analyses may be needed to distinguish influencing factors among patients’ vaccination behavior.

This investigation confirms the prevalent anti-vax stance within chiropractic, homeopathy, and naturopathy. The effect is strongest by far with homeopaths. Nothing new! We knew this for a very long time. The question is WHAT ARE WE DOING ABOUT IT? Or more specifically, are the professional organizations of these SCAM professions finally going to take any actions against even the most rabid anti-vaxxers in their midst?

And the answer?

You guessed it: NO!

And the irony of all this must not get lost here: chiropractors, homeopaths, naturopaths, and their respective organizations all pride themselves regularly that they attribute particular importance to disease prevention.

The ‘International Chiropractors Association’ (ICA) has just issued a statement entitled “International Chiropractors Association Affirms Policy on Health Freedom“. On the background of the fact that US President Biden, issued a series of Executive Orders related to mandating federal employees and federal contractors to receive the COVID-19 vaccine, the ICA try to explain their position regarding vaccinations. Here are a few passages from this statement:

…In a world of public health that promotes evidence-based decision making, we see the importance of natural immunity being ignored and replaced with a totalitarian approach of compulsory vaccination.  At a time when the Surgeon General says misinformation has become an urgent threat to public health, misinformation is now being used in an attempt to discredit the chiropractic profession, the International Chiropractors Association, and all chiropractic patients who desire to focus on improving health naturally. After enduring 18 months of shutdowns, lockdowns, flattening the curve, masking, limitations of speech on social media; and a cancel culture environment that threatens the basic freedoms our country was founded upon in 1776, ICA will not compromise on the importance of protecting health freedom…

The ICA Policy on Immunization and Vaccination has remained unchanged for almost 50 years and clearly states:

“The International Chiropractors Association recognizes that the use of vaccines is not without risk and questions the wisdom of mass vaccination programs.  Chiropractic principles favor the enhancement of natural immunity over artificial immunization.

The ICA supports each individual’s right to select his or her own health care and to be made aware of the possible adverse effects of vaccines upon a human body.  In accordance with such principles and based upon the individual’s right to freedom of choice, the ICA is opposed to compulsory programs which infringe upon such rights.

The International Chiropractors Association is supportive of a conscience clause or waiver in compulsory vaccination laws, providing an elective course of action for all regarding immunization, thereby allowing patients freedom of choice in matters affecting their bodies and health.”

The International Chiropractors Association maintains that all healthcare interventions, including the chiropractic adjustment, are associated with some level of risk and that every individual is entitled to be informed of those risks, no matter how insignificant. All individuals must retain the freedom to accept or reject any healthcare product, procedure, or medication including vaccinations.  The International Chiropractors Association therefore strongly opposes the use of medical mandates that violate personal sovereignty, violate the principles of informed consent, and constrain the rights of patients to make their own health care choices…

The ICA encourages the recognition that natural efforts to enhance the innate immune system ability to adapt to novel viruses are grounded in science and rejects the notion that the patients’ freedom to rely on naturally acquired immunity is not based upon unscientific beliefs.

The ICA rejects the premise that the chiropractic profession’s long history of promoting health freedom and supporting conscientious exemptions is based upon unscientific or non-mainstream beliefs…

I find this statement clear as mud and have the following questions:

  • Do the ICA recommend vaccinations?
  • In particular, do they encourage their members to get vaccinated with the COVID-19 vaccines?
  • Do they advise to recommend COVID-19 vaccinations to their patients?
  • Or do they think that natural immunity is preferable and advise their members and patients accordingly?
  • Do they believe that spinal manipulation enhances natural immunity?
  • Do they think that spinal manipulations are an effective alternative to COVID-19 vaccinations?
  • Do they believe that scientific evidence trumps dogma or vice versa?
  • Which of the two should, according to their conviction, must influence the decision-making processes in healthcare?
  • If the ICA object to misinformation about COVID, why do they not stop their members from promoting it?
  • What makes them think that information about the possible adverse effects of vaccines upon a human body is unavailable?
  • If the ICA recognizes the risks of spinal manipulation, why do they not inform the public about them regularly and objectively?
  • If the ICA knows about the importance of informed consent, why do not all of their members adhere to it?
  • And finally, why do the ICA insist on the term ‘international’ in the name of their organization, if they purely deal with the US situation?

I do not expect the ICA to give me the answers to these questions. But perhaps their Wiki page goes some way towards answering some of them: “… The ICA supports the efforts of the National Vaccine Information Center (NVIC).[13] The NVIC is known for promoting false and misleading information about vaccines, in particular the discredited claim that vaccines cause autism.

The ICA’s annual conferences have featured anti-vaccination propaganda. In 2018 Guest Speaker Beau Pierce (Pierce co-produced a series entitled Vaccines Revealed) hosted a session entitled Vaccines Revealed.,[14] and Jeff Hays, known for producing the anti-Vaccine propaganda Vaccines Revealed, was invited to host a session the 2017 ICA Council on Chiropractic Pediatrics Annual Conference. In 2016 the widely discredited anti-vaccination propaganda film VAXXED was shown at a conference sponsored by the ICA’s Council on Chiropractic Pediatrics …”

SAY NO MORE!

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