Value of chiropractors questioned

[brianp]

Does upper spinal manipulation cause vascular accidents? by Edzard Ernst

http://www.pulsetoday.co.uk/story.as...p_mid=35646645

[Blue Wode]

A quick update on chirowars in the UK.

AUKC v. GCC and BCA
http://www.surveymonkey.com/s/6GNST8B

Vitalism is alive and well. (For the time being anyway.)


GCC complaints update here:
http://www.zenosblog.com/2010/08/the...nd-part-three/

[Blue Wode]

A must read!

GCC under pressure over subluxations..

So what we have is a definition of what a subluxation is (functional derangement) combined with research reviews & GCC statements that there is no evidence to support such claims. We also have confirmation from the training establishments that they do not support or teach links between the subluxation and health concerns.

Clearly something has prompted the GCC to issue a revised guidance. Are the GCC in possession of updated research confirming a link, if so then this is truly a breakthrough and should be published ……. Or is there another reason for the U-Turn?

Read on...
http://skepticbarista.wordpress.com/2010/08/30/gcc-subluxation-pressure/

[Blue Wode]

Science Based Medicine has just published an interesting new article by Samuel Homola DC regarding the fictitious subluxation lesion:

Chiropractic Vertebral Subluxations: Science vs. Pseudoscience
http://www.sciencebasedmedicine.org/?p=6839

“Unlike the mysterious, undetectable and asymptomatic chiropractic ‘vertebral subluxation complex’ alleged to be a cause of disease, a real vertebral subluxation, that is, an orthopedic subluxation, can be a cause of mechanical and neuromusculoskeletal symptoms but has never been associated with organic disease….

A largely ignored landmark review of the literature by a Ph.D. and a chiropractor (Nansel and Szlazak), published in 1995, concluded that there is not a single appropriately controlled study to indicate that any dysfunction in structures of the spinal column is a cause of organic disease…

Unfortunately, the chiropractic profession in the United States continues to be defined by subluxation theory. Too few chiropractors are willing to ‘step out of line’ and announce that the theory (more accurately defined as a belief) is scientifically indefensible and should be dumped… the British Chiropractic Association advised its members to “refrain from making any reference to Vertebral Subluxation Complex in media to which their patients or the general public may have access,” adding that “this advice has no bearing on scope of practice”…

Without some identifying label or degree that distinguishes science-based chiropractors from subluxation-based chiropractors, medical physicians will continue to be reluctant to refer a patient to a chiropractor, lest they deliver a patient into the hands of a pseudoscientific practitioner whose philosophy embraces an anti-medical approach and endangers the patient...

It seems likely that subluxation-based chiropractic, like homeopathy and other belief systems, will be perpetuated to some degree by true believers…

Because the chiropractic profession seems unwilling to abandon these discredited concepts, reform of the state chiropractic practice acts to eliminate subluxation-based chiropractic practice may be the only viable solution to the perpetration of unscientific and unproved healthcare practices…

Good science-based chiropractors who do not subscribe to the vertebral subluxation theory and who use manipulation appropriately can offer a service of value. Unfortunately, such chiropractors are not easy to find.”

Despite the above, chiropractors still seem to be on a subluxation wild goose chase:

The great subluxation debate: a centrist's perspective

Christopher J. Good DC, MAEd
Professor, University of Bridgeport College of Chiropractic, Bridgeport, CT 06604

ABSTRACT

Objective
This commentary describes the debate and some of the associated issues involving the subluxation construct.

Discussion
The long-standing debate regarding the chiropractic subluxation has created substantial controversy within the profession. Currently, this phenomenon can be compared with a country with a 2-party system that has a large silent majority sitting between the 2 factions. It is argued that the position held by those in the middle (the centrists) may be the most rational view when considering all of the available evidence. It is also suggested that the subluxation construct is similar to the Santa Claus construct in that both have a factual basis as well as social utility. Ultimately, the centrists must become proactive if they want to protect the profession and further advance the evidence in regard to the subluxation. They must not only engage in the debate, but fund the research that will investigate various aspects of the subluxation and then help disseminate this evidence to fellow doctors of chiropractic, other practitioners, health care policy makers, and society at large.

Conclusion
The role of subluxation in chiropractic practice, the progression of this debate, and the future of the profession will be directly determined by the role that centrists choose to play.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B9HD4-512N9HK-1&_user=10&_coverDate=09%2F21%2F2010&_rdoc=1&_fmt= high&_orig=search&_origin=search&_sort=d&_docancho r=&view=c&_acct=C000050221&_version=1&_urlVersion= 0&_userid=10&md5=324e669837df4a009c06b6e16c00b773& searchtype=a

[JJM]

This

Conclusion
The role of subluxation in chiropractic practice, the progression of this debate, and the future of the profession will be directly determined by the role that centrists choose to play.

is rich. One would hope the progression would depend on facts.

[Blue Wode]

The value of chiropractic in the news again:
http://www.infonews.co.nz/news.cfm?id=59215

Medical researchers Professor Shaun Holt and Andrew Gilbey have issued a strong warning against parents taking their children to see a chiropractor for any reason. Many chiropractic practices and organizations, in New Zealand and overseas, advocate routine spinal manipulation in infants and children, for conditions ranging from ear infections, colic and asthma to ADHD and even cancer.

"There is no plausible explanation why high-velocity manipulation of the spine can help children with these medical conditions, it is an extraordinary claim" said Professor Holt. "Given that this is a multibillion dollar industry, the lack of good research that has been undertaken is staggering. There is also evidence that many chiropractors advise against routine childhood immunizations, which is irresponsible.”

Andrew Gilbey said that “there are some serious safety concerns related to the unnecessary use of x-rays and the manipulation of childrens’ spines and so we advise parents to instead consult their family doctor who has been trained to recognize and treat a wide range of medical problems. In Canada, an undercover researcher reported that 4 out of 5 chiropractors found serious problems with the spine of a child and said that these required urgent chiropractic treatment, whereas an experienced paediatric orthopedic surgeon who also examined the girl found her to be perfectly healthy.”

Holt and Gilbey's advice echoes similar warnings issued by paediatricians overseas. The Australian Medical Association has stated that chiropractic care for children is a waste of money and inappropriate. They advise parents who are worried about any aspect of their children's health to consult a medical doctor.

[Blue Wode]

Following on from the press release posted above, and staying with the topic of ‘paediatric chiropractic’, the following are excerpts from an interview with Joel Alcantra, Director of Research for the International Chiropractic Pediatric Association. In it he is asked about the differing views in pediatric chiropractic research:
http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54921

Alcantra:

The decision to pursue or recommend a trial of chiropractic care is based on many factors, with safety and effectiveness at the core of this decision and the principles of evidence-based medicine providing the overall guiding principle. So, what is a clinician to do when the research is not available? Evidence-based medicine allows you to rely on your clinical expertise and the needs and wants of the patient or the parent (in the case of pediatric chiropractic).

With such a slim evidence base, it would appear that chiropractors rely very heavily on the preferences of their patients and their own expertise. For example, here’s what Science Based Medicine’s Harriet Hall (MD) recently had to say on the matter:

The General Chiropractic Council, a UK-wide statutory body with regulatory powers, has just published a new position statement on the chiropractic subluxation complex: “The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.” They remind chiropractors that they must make sure their own beliefs and values do not prejudice the patient’s care, and that they must provide evidence-based care. Unfortunately, they define evidence-based care as cllinical practice that


incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners, including the individual chiropractor her/himself. [Emphasis added.]


This effectively allows “in my experience” and “the patient likes it” to be considered along with evidence, effectively negating the whole point of evidence-based medicine.

http://www.sciencebasedmedicine.org/?p=5339

Alcantra:

If one closely examines the clinical trials on chiropractic SMT and infantile colic, you will find that no study exists comparing chiropractic SMT versus sham therapy…Wiberg and colleagues found chiropractic superior to simethicone; Browning and colleagues found both techniques decreased the hours of crying compared to baseline; and Olafsdottir and colleagues found their chiropractic technique as ineffective. So, the bottom line is, there is some evidence in support of chiropractic care for infantile colic.

Nevertheless, it is apparent that the quality of evidence for the treatment of colic with chiropractic remains very poor, with the most robust systematic review to date reaching the following pretty damning conclusion:

Some chiropractors claim that spinal manipulation is an effective treatment for infant colic. This systematic review was aimed at evaluating the evidence for this claim. Four databases were searched and three randomised clinical trials met all the inclusion criteria. The totality of this evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials.

Ernst, E. Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials, Int J Clin Pract. (September 2009)

http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2009.02133.x/pdf

Alcantra:

The literature essentially indicates that medications like simethicone are no more effective than placebo and are associated with severe adverse events. Add to this the research that indicates parents may have thoughts of infanticide due to their crying baby. As a researcher and clinician, I think a trial of chiropractic care is warranted, in line with the principles of evidence-based medicine and the principles of biomedical ethics. That is, respecting a patient's autonomy, avoiding harm, placing their interests and well-being first and allowing them access to essential care like chiropractic.

It’s worth noting that Alcantra doesn’t take into consideration the following harmful effects of chiropractic for children, which also involve their parents:

(a) decreased use of immunisation due to misinformation given to parents
(b) psychologic harm related to unnecessary treatment
(c) psychologic harm caused by exposure to false chiropractic beliefs about "subluxations"
(d) financial harm due to unnecessary treatment.

Scroll to the end of this National Council Against Health Fraud link: http://www.ncahf.org/digest07/07-14.html

Alcantra:

Of course, as a researcher, I agree with Drs. Leboeuf-Yde and Hestbaek that we need more research, not only in quantity but also in quality. We differ in our direction and focus for research, but this is understandable given our different interests and methodologies.

One has to wonder how serious chiropractors are about undertaking further research when it could quite easily produce results that would not be welcomed by the lucrative chiropractic paediatric market. For example, it was recently noted that for a multibillion dollar industry, only 46 chiropractic studies were recruiting on clinicaltrials.gov, whilst ‘Big Pharma’ was running nearly 100,000.

Alcantra:

On another point: Vallone, et al., recommend that the inversion maneuver for infants and young children is a relative contraindication. My question is: On what basis do these authors make this recommendation? The scientific literature does not support them in terms of adverse events due to the procedure. Furthermore, their stated reasons for not performing the procedure (possible undiagnosed clinical entities) just does not make clinical sense. It takes clinical uncertainty to a different level and how it affects one's decision to perform a diagnostic test or treatment procedure.

View a chiropractic inversion maneuver on a newborn at 1min 11secs in here
http://www.youtube.com/watch?v=o5Swr4YlUnQ

then read, again, why researchers advise parents not to take children to chiropractors
http://www.nzdoctor.co.nz/un-doctored/2010/october-2010/14/researchers-advise-parents-not-to-take-children-to-chiropractors.aspx

[davidrodway]

http://www.facebook.com/l.php?u=http...e.html&h=7d4c6

[Blue Wode]

I wonder how the Alliance of UK Chiropractors (AUKC)/British Chiropractic Association (BCA) meeting with the General Chiroproactic Council (GCC) is going today?

The BCA approached the Alliance to work collaboratively which has culminated in a joint letter to the GCC advising them that we no longer have confidence in the ability of the GCC to regulate the profession. The Alliance and the BCA will be meeting with Council on 17th November 2010 to discuss this matter…
http://forums.randi.org/showpost.php?p=6564649&postcount=5

[Blue Wode]

The value of chiropractors continues to be questioned...

Chiropractors at War with their Regulator, the GCC
http://www.quackometer.net/blog/2010...r-the-gcc.html

...and newly caught out on the subject of evidence here:
http://www.zenosblog.com/2010/11/whe...vidence-leads/

[Blue Wode]

"Humpty Dumpty chiropractic" by the Editor of the Journal of Clinical Chiropractic
http://www.fnks.org/fnks/sites/defau...iropractic.pdf

...the time is fast approaching when chiropractic will have to decide whether it is informed by 19th century metaphysics or by 21st century science. If it chooses wrongly, then it may not be possible for all the king’s horses and all the king’s men to effect a repair.

[Blue Wode]

The regulation of chiropractors in the UK appears to have some very serious problems:

Humpty Dumpty regulation
http://www.zenosblog.com/2010/12/humpty-dumpty-regulation/


Why should a statutory body (GCC), charged with protecting the public set such low standards?

Do chiropractors now have carte blanche to advertise whatever they want?

[jimwalsh]

@bluewode

did you get that ernst response?

I can email it to you if you still need it...

[Blue Wode]

@ jimwalsh

Yes, I did thanks, and I've highlighted a chiropractic professor's dissatisfaction with it here:
http://forums.randi.org/showpost.php...1&postcount=93

So far, the chiropractic professor (Stephen Perle) hasn't published my comments criticising his misgivings about Ernst's paper and Ernst's subsequent response.

[Blue Wode]

@ jimwalsh

FYI, my comments still haven't been published by Prof. Perle, so I've posted them here:
http://forums.randi.org/showpost.php...1&postcount=96