Value of chiropractors questioned

[richard]

Rob, I think you need to read up a little more on what Chiropractic actually is.

Work through this: http://drspinello.com/chiropractic/Chiropractic%20New_files/frame.htm

Rob you are absolutly right much of the discussion is about semantics. Next someone will tell you you,that you are not a "real skeptic". They say chiropractors dont answer the questions. In the early part of the thread I answered everything, (I am behind reading the references Blue Wode presented about medicine) not that John paid any attention, then when Ralph and yourself came in they go over the same ground ignoring everything said previously. What is Innate, what is homeostasis? Its a nerve study its not chiropractic,its a physiotherapy study its chiropractic. SMT is not chiropractic, for convienence maybe it is.

For example if we go back to my posting no 34 I said.

The don’t like chiropractors who don’t reference, the highly respected researchers, Edzard Ernst MD, Stephen Barrett MD and Hariet Hall MD who have had thousands of articles published on the peer reviewed quack watch web sites. These researchers obviously believe in each other judging by the way they reference each other. They must have gone to the same school of research methodology. Not to forget Edmund Crelin Ph.D refferences from the 60s,which JCC is very attached to.

I must say I love the music from the 60s, however the science leaves a lot to be desired. I read somewhere that Stephen Barrett sued a chiropractor for libel and lost. Apparently the chiropractor wanted to clarify Barrett’s MD status “he's a psychiatrist who has never been board certified who failed his board certification 3 times. Apparently Barrett failed the neurology section which might go some way to explaining his lack of understanding of chiropractic. Now not being an expert on quacks perhaps some of our more learned forum members could clarify for me, does this lack of knowledge make Barrett a quack or a chiropractor, my Chambers dictionary describes a quack as a “boastfull pretender to knowledge and skill that he does not possess”.


What then does John use to show you proof that chiropractic is a sham, Hariet Hall MD of Quack Watch. Now I have nothing against Dr Hall and she does make some valid points about chiropractic practice in the US. Neurology however is not her best subject.

Have I said I am against Ezard Ernst doing research into chiropractic as stated by John? of course not. It might help however if Ernst did involve a few chiropractors and there was a bit more research to support his theory. The biggest study ever looking at risks associated with chiropractic was recently published in Spine a peer reviewed medical Journal. Professor Jenny Bolton PHd one of the authors is not a chiropractor. The study showed there are certain small risks with chiropractic, no strokes however. Cuts no ice with John, as its not been published on quack watch.

John you claim to have training in research methology, is that right. Did you also write the fact sheet? I am seeing more dogmatic argument than skeptic??

[Blue Wode]

The biggest study ever looking at risks associated with chiropractic was recently published in Spine a peer reviewed medical Journal. Professor Jenny Bolton PHd one of the authors is not a chiropractor. The study showed there are certain small risks with chiropractic, no strokes however. Cuts no ice with John, as its not been published on quack watch.

Richard, you said of that study in post #16:

I have not claimed that it proves anything

For the benefit of drive-by readers of this thread, Chirotalk, the skeptical chiropractic discussion forum (operated by a chiropractor, and moderated be several) has allowed the abstract of the study to remain in its ‘humor’ section under “Silly chiropractic research”:
http://chirotalk.proboards3.com/index.cgi?board=humor&action=display&thread=119413 7405

Regards research, would you please provide scientific evidence (systematic reviews, meta-analyses) in support of ‘chiropractic’ – otherwise this discussion is going nowhere.

[JJM]

the relation to proprioception is that if a muscle like the quads is inhibited it can lead to OA of the knee. {snip}

From the article

In persons with symptomatic osteoarthritis of the knee, quadriceps muscle weakness is common and is widely believed to result from disuse atrophy secondary to joint pain.

Bold added.

Even if your mis-understanding were correct, it still does not relate to chiropractic and proprioception. So, was that your best shot at validating some aspect of chiro?

[Admin]

What then does John use to show you proof that chiropractic is a sham, Hariet Hall MD of Quack Watch.

No, let's not add the Argument to Ignorance fallacy to the others you're making (!)

It is not anyone's position to prove that Chiropractic doesn't work, it's up to Chiropractors to provide evidence to show that it does - the Burden of Proof requirement.

What is telling is that the Chirporactors on here have neither answered questions relevant to their practises (things like - how do subluxations cause children to wet the bed and how does spinal manipulation cure this? Relevant questions as this addresses a claim that chiropractors make), nor provided any evidence to support Chiropractic in any way (preferring instead to introduce red herrings and talk about those instead).

That, of course, when they're not trying to belittle everyone who doesn't share their views.

Is there any quality evidence anywhere that supports the idea of subluxations blocking Innate Intelligence thus leading to disease and that spinal manipulation can free up the flow of Innate Intelligence to cure the disease?

After 112 years in existence: if not, why not?


For anyone wondering what Innate Intelligence is, it is explained here: The mystical nature of alternative medicine.

[JJM]

So it's ok if conventional medicine says it's a pinched nerve, but not if a chiropractor says it? That's not skepticism, that's prejudice

It is okay if you have a pinched nerve and a chiro says so. The problems include whether a chiro can reliably make such a diagnosis, and the fact that they cannot alter a pinched nerve. The only suggestion that they can do so comes from anecdotes (such as yours), and the oft-cited (above) article by Crelin saying it is physically impossible for them to do so.

Richard keeps harping that Crelin's work is old, hey- Palmer's work is older. The difference is- Palmer has been thoroughly discredited, and Crelin has not. In science, research does not have a shelf-life; it stands till it is disputed by further, credible research.

This thread is not about semantics, except for the chiro proponents here. All I want is some reliable evidence that there is some benefit from chiro (beyond what I have stipulated), and all I get are anecdote and spurious citations (and a video-clip, as if YouTube were refereed).

[Raph78]

who are you gentlemen anyway? whats your degree, your current position held? i just see repetition after repetition and no originality in your argument.

oh, and john. if there is evidence that smt works why are you producing so much hot air?

JJM:

did you get past the first sentence of my reference???? bold italic and underlined for you.......here for all to see:

Background: The quadriceps weakness commonly associated with osteoarthritis of the knee is widely believed to result from disuse atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis.

Conclusion: Quadriceps weakness may be present in patients who have osteoarthritis but do not have knee pain or muscle atrophy; this suggests that the weakness may be due to muscle dysfunction. The data are consistent with the possibility that quadriceps weakness is a primary risk factor for knee pain, disability, and progression of joint damage in persons with osteoarthritis of the knee.

my god you just again disqualified yourself again through your ignorance and incompetence. you clearly have got NO clue whatsoever.

to make it clear: as a chiropractor it is my privileged duty to diagnose and treat such proprioceptive weaknesses (NO PAIN, NO ATROPHY = asymptomatic) to PREVENT OA. much more than just the safe and appropriate application of SMT. You would not even think how much help can be given to people - not in your wildest dreams.

but, again: who are you and what qualifies your "contribution" to this topic?

[Admin]

who are you gentlemen anyway? whats your degree, your current position held? i just see repetition after repetition and no originality in your argument.

I see another red herring argument all set to lead on to another Ad Hominem point!

I'm a skeptic and I look for evidence for claims so that I can make an informed decision on them. I, indeed we, have asked several times for evidence that supports chiropractic - none has been provided.

oh, and john. if there is evidence that smt works why are you producing so much hot air?

Well as the world and its mother should know by now, SMT is NOT chiropractic - it's simply a technique that chiropractors have adopted.

We already know that there is supporting evidence for SMT (although it's no better than other standard treatments) but what we want is supporting evidence for chiropractic!

Come on guys!!!

How, for example, do you detect 'subluxations' and how could you prove it's actually there?

Simple question so how about a simple answer?

[richard]

Richard, you said of that study in post #16:



For the benefit of drive-by readers of this thread, Chirotalk, the skeptical chiropractic discussion forum (operated by a chiropractor, and moderated be several) has allowed the abstract of the study to remain in its ‘humor’ section under “Silly chiropractic research”:
http://chirotalk.proboards3.com/index.cgi?board=humor&action=display&thread=119413 7405

Regards research, would you please provide scientific evidence (systematic reviews, meta-analyses) in support of ‘chiropractic’ – otherwise this discussion is going nowhere.

I think the skeptics would agree the issue of safety is more important that whether chiropractic works or not so if everybody does not mind lets deal with this issue first.

One of my patients a GP recently published an article about her positive experience of chiropractic,her husband an ENT surgeon is alsoa patient. She has her spine checked every month for the Spinal dysfunction described by Professor Gorden Wadell. Should I extrapolate from that all GPs think chiropractic is wonderful. Should I extrapolate from that proof that chiropractic works or chiropractic is safe. Of course not that’s why I do not take the Spine study as proof that there is no risk. However the fact is it was a major study and no risk of stroke was found.

For the exact same reason I am skeptical when John attaches so much weight to Hariet Hall MD opinions and extrapolates so much from them. That is not EBM especially when the only place I have seen her work published is on quack watch.

The Spine study is now there now for another scientist like Professor Ernst to repeat. If he could get funding and see if he can reproduce the results or not as the case me be. If you and the others have genuine concerns about the safety of chiropractic raise funds for Professor Ernst to do some high quality research rather relying on case studies and presenting it as quality evidence.

Mr Andrew Upton a Neurologist was hired by the Canadian Chiropractic association to examined all the evidence linking chiropractic to stroke and concluded that the evidence suggesting a link were only case studies. Professor Earnst on his website calls case studies “the lowest standard of evidence” (anecdotes). Mr Upton stated until there is epidemiological evidence to support the stroke hypothesis it is wrong to suggest a link.

Mr Upton also reported on studies by Hertzog et al. ,who were unable to produce dissection on cadavers with the force of an adjustment. Dissection needed far greater force, like a karate chop.


Ariel Sharon's stroke was widely reported in the press. he had bad head pain was taken to hospital. It was later announced that he had suffered a mild stroke and was given anticoagulant medication. Four weeks later he suffers a massive hemorrhage which would have been considerably worsened by the medicine he was taken.

Now imagine if Sharon had happened to go to a Chiropractor for his head pain your reaction would have been completely different.

In November 2005 “The Stationery Office” www.tso.co.uk Published a report for the department of health Reducing Brain Damage: Faster access to better stroke care. The Report states Stroke accounts for 11% of deaths in England and Wales every year. Every five minutes someone in England will have a stroke, and one in four people can expect to have a stroke if they live to 85 years of age.

Many of these people are chiropractic patients and if they happen to visit a chiropractor prior to their stroke, and their neurologist is asked by professor Ernst had they been to a chiropractor the answer is yes. Does that mean the chiropractor caused the stroke. Is there a greater chance of someone with neck pain as a result of arterial disection consulting a chiropractor of course. These are factors Ernst did not look at in his study, There was also a barber and a number of non chiropractic patients included in the study.

The Risk of stroke are:
• High blood pressure
• Family history of stroke
• Atrial fibrillation
• High blood cholesterol
• Diabetes
• Smoking
• Advancing age
• Unhealthy diet .

There is no mention of Chiropractic in this report, there is no evidence of a causal relationship, yet you continue saying there is one without good quality evidence.

So before I turn to proof of chiropractic and I have not forgotten your 80% Lets deal with the safety issue. I have only three questions for the three Skeptics.

1) Do you have any epidemiological evidence of a causal relationship between chiropractic adjustments and stroke.

This is the criteria asked for when looking at risk from vaccination and studies show there is no causal relationship between autism and MMR.

2) Should case studies be accepted as evidence of a risk of autism from MMR.

3) Does the Ernst survey carry more weight as evidence, compared with thea prospective risk study published in Spine

Blude Wode can I also say while we have a difference of opinion on chiropractic, I do appreciate you remaining civil and not calling me a "quack" or an ”ignorant chiropractor”. John is under the impression that I am doing the name calling and now Ralph is getting agitated with them.

[Blue Wode]

One of my patients a GP recently published an article about her positive experience of chiropractic,her husband an ENT surgeon is alsoa patient. She has her spine checked every month for the Spinal dysfunction described by Professor Gorden Wadell. Should I extrapolate from that all GPs think chiropractic is wonderful. Should I extrapolate from that proof that chiropractic works or chiropractic is safe. Of course not that’s why I do not take the Spine study as proof that there is no risk. However the fact is it was a major study and no risk of stroke was found.

Richard, am I correct in saying that the Spine study involved 377 chiropractors?

Safety of chiropractic manipulation of the cervical spine: a prospective national survey

Thiel HW1, Bolton JE, Docherty S, Portlock JC
Department of Research and Professional Development, Anglo-European College of Chiropractic, 13–15 Parkwood Road, Bournemouth BH5 2DF, UK and Department of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, UK

Materials and methods

This prospective national survey involved the primary care practices of 377 chiropractors throughout the UK. A total of 19 722 patients provided individual recordings of 28 807 treatment consultations and 50 276 cervical manipulations. Serious adverse events were reported by the chiropractors and side-effects by the patients.

-snip-

Conclusion

Cervical spine manipulation is a common procedure carried out by chiropractors in the treatment of musculoskeletal conditions. Although minor side-effects were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low. This survey provides evidence that cervical spine manipulation is a relatively safe procedure when administered by registered chiropractors.

http://www.medicinescomplete.com/journals/fact/current/fact1105a13a77.htm

And am I also correct in saying that the study originally intended to recruit 500 chiropractors? This from March 2003:

Development and design of a study to document outcomes following cervical spinal manipulation treatments by chiropractors

Thiel HW, Bolton JE
Anglo-European College of Chiropractic, 13–15 Parkwood Road, Bournemouth, BH5 2DF, UK

Methods

A total of 500 chiropractors will be recruited into the study, each of whom will report on 100 consecutive cervical manipulation treatments.

http://www.medicinescomplete.com/journals/fact/current/fact0801a13a63.htm

What I’m getting at is did the study start with 377 chiropractors, or did 123 chiropractors drop out - possibly because of unfavourable results or, as Ernst touches on in his JRSM systematic review, because they failed to investigate patients who were lost at follow-up?

At present, there is no sufficiently large and rigorous prospective study to generate reliable incidence figures; previous studies have failed to investigate those patients which were lost at follow-up. This could be the subgroup which has been harmed. It is therefore essential that future studies follow up close to 100% of the initial patient sample.

http://www.jrsm.org/cgi/content/full/100/7/330

Or was the study made up of 500 chiropractors from 377 practices?

Incidentally, there does appear to be evidence of a causal relationship between neck manipulation and stroke.

Brain stem infarction due to chiropractic manipulation of the cervical spine

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li st_uids=6359460

Cervical manipulation, specifically chiropractic manipulation, is an important cause of vertebrobasilar and occasionally carotid distribution strokes. Neuro-ophthalmologic findings are a common and at times relatively isolated feature of cervical manipulation-induced stroke.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li st_uids=11130746

Wallenberg's syndrome secondary to dissection of the vertebral artery caused by chiropractic manipulation

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&li st_uids=14606051

German neurologists report the case of a 40-year-old woman who had a chiropractic upper spinal manipulation and immediately afterwards suffered increasingly severe symptoms of intracranial hypotension, e.g. headache, nausea and vomiting. After considerable diagnostic confusion a dural tear was found at the level of C1-C2. There were no other causes for the leak of cerebro-spinal fluid. The authors are thus certain that this is the first well-documented case of intracranial hypotension caused by chiropractic. They also speculate that a substantial amount of cases of 'spontaneous' intracranial hypotension may be related to upper spinal manipulation.

http://jnnp.bmj.com/cgi/content/extract/74/6/821

And in the Case Reports section (Table 1) of the study linked to below, 11 cases are listed where a chiropractor was the therapist involved in administering cervical spine manipulation in which the causality of the adverse event is listed as 'certain’. In two of these cases (Corazzo 1998 and Siegel 2001), the adverse event was vertebral artery dissection and stroke.

Cerebrovascular Complications Associated with Spinal Manipulation
[Full text is subscription only]
http://www.ingentaconnect.com/content/maney/ptr/2004/00000009/00000001/art00002


Regards the evidence for ‘chiropractic’, please would you answer the questions already put to you by John Jackson in post #48. Here they are again:

• What is Innate Intelligence?
• What is a subluxation?
• How are subluxations detected?
• Can a single patient’s subluxation be reliably found by more than one Chiropractor?
• Can subluxations be seen on x-rays?
• How do subluxations cause bed-wetting in children and how does spinal manipulation cure this?
• How does manipulating the spine of a child with ADHD cause an improvement in behaviour?
• Do you recommend vaccinations? If not, why not?

I would also add one more request: Would you please provide the safety data that justifies administering chiropractic treatment to infants and children under 12.

Thank you.

[richard]

Incidentally, there does appear to be evidence of a causal relationship between neck manipulation and stroke.

And in the Case Reports section (Table 1) of the study linked to below, 11 cases are listed where a chiropractor was the therapist involved in administering cervical spine manipulation in which the causality of the adverse event is listed as 'certain’. In two of these cases (Corazzo 1998 and Siegel 2001), the adverse event was vertebral artery dissection and stroke.

Cerebrovascular Complications Associated with Spinal Manipulation
[Full text is subscription only]
http://www.ingentaconnect.com/content/maney/ptr/2004/00000009/00000001/art00002


.

These are the case studies Mr Upton investigated they are CASE STUDIES why dont any of you listen to the answers and prevent us going over the same ground again and again.These studies are What Professor Ernst calls "anecdotes" the lowest form of evidence. There is anecdotal evidence that a chiropractor cured deafness in 1895, no Chiropractor in the UK would present that as evidence of a causal relationship between chiropractic and deafness. JJM thinks we believe it is evidence he is wrong.

If a parent claims her child developed autism after having an MMR vaccination, is that proof of a causal relationship?

Blue Wode I have still not had time to reply to your 80% claim and anumber of other questions and now you are firing more questions at me. I have answered lots of your questions, not always to your satisfaction nevertheless I have made the effort.

So I repeat my question from my last posting, then I will deal with the 80% and all your other questions. In that order.


I can see how these 3 questions cause you "skeptics" some difficulty.

My three questions for the Skeptics are: and I ask them mainly to point out how you are using scientific principles in different ways to support your beliefs rather than establish better evidence, which you all claim is your goal.

1)Do you have any epidemiological evidence of a causal relationship between chiropractic adjustments and stroke. This is the criteria asked for when looking at risk from vaccination. Studies show there is no causal relationship between autism and MMR. 2)Should case studies be accepted as evidence of a risk of autism from MMR. 3) Does the Ernst survey carry more weight as evidence, compared with a prospective risk study published in Spine. ( I don’t know the answers to the questions you have asked about the study. I would have thought the peer review board of Spine would have asked these exact questions before publishing the article or it would not be a credible medical journal.

If you are not willing to answer them fair enough, then we can leave the discussion there, and agree to disagree.

[Admin]

Chiropractors and stroke:

A Canadian study by the Institute of Clinical Evaluative Sciences in Ontario found that patients younger than 45 who had experienced stroke related to posterior circulation are "5 times more likely than controls to have visited a chiropractor within a week of the event" (Stroke 2001;32:1054-60).

Chiropractors admit that neck manipulation can cause strokes; however, they claim that the risk is one in a million. The exact risk is not known, but there is evidence that the likelihood of neck manipulation causing strokes is far higher than the one in a million figure they suggest.

Another study states, "The researchers reported that patients under age 60 who had strokes or transient ischemic attacks from tears in the vertebral artery were six times more likely to have had spinal manipulative therapy in the 30 days prior to their stroke than patients who had strokes from other causes." (Source: eurekalert - opens is a new window).


The big problem regarding the number of strokes caused by chiropractors is that there is no proper reporting system to keep track of the number (!) and, indeed, the problem is believed to be under reported because of this.

Chiropractors always deny there's a link between chiropractic neck manipulation and stroke but risk is definitely there. Any doubt about the actual numbers involved is not due to lack of risk, it's down to the failure of chiropractic to take the risk seriously enough to investigate it properly.

See also: http://www.quackwatch.org/01Quackery...irostroke.html

Oops quackwatch - that means it can be instantly dismissed by chiropractors.

[JJM]

the relation to proprioception is that if a muscle like the quads is inhibited it can lead to OA of the knee. {Snip}

{snip}JJM:

did you get past the first sentence of my reference???? {snip}

Background: The quadriceps weakness commonly associated with osteoarthritis of the knee is widely believed to result from disuse atrophy secondary to pain in the involved joint. However, quadriceps weakness may be an etiologic factor in the development of osteoarthritis.
{snip}

Bold added.

You interpret the authors as saying that weak quads "can lead to OA" (as in- "causing"). However, they say it may be a factor in the "development" (worsening of) of OA which already exists. You gotta read the whole thing, that is their position (note the word "may" as in- conjecture; i.e., not yet proven); but I digress.
http://www.annals.org/cgi/content/full/127/2/97

You have not established the relationships among quad weakness, proprioception, and the specific value of chiro in treating either condition.

You cited articles about a reflex to close the jaws when a tooth was tapped (!!??), and about muscle weakness; but you have not demonstrated their relevance to chiro.


This is not a difficult concept. I want to know, specifically, what chiro can do that massage cannot do as well.

Let us try another tack. What, specifically does chiro do? We know it has nothing to do with altering spinal joints and nerve conduction (innate intelligence). I hope that will not be your claim. Pick a complaint, any complaint, that would lead someone to your office and cite the (legitimate) literature that justifies your treatment (beyond what I have already stipulated for headache and low back pain- where you can do as well as a masseur).

[JJM]

{snip} Chiropractors always deny there's a link between chiropractic neck manipulation and stroke but risk is definitely there. {snip}

It is equally important to note that there is no evidence that chiro treatments are more effective than safer treatments. Therefore, the risk/benefit ratio is an unacceptably large number (division by zero).

[JJM]

{snip} There is anecdotal evidence that a chiropractor cured deafness in 1895, no Chiropractor in the UK would present that as evidence of a causal relationship between chiropractic and deafness. JJM thinks we believe it is evidence he is wrong.

That is the foundation of chiro- read the history. So, cite the reliable evidence for your current practice. Wait, I asked this before, and you cannot supply any except in the vaguest (and unsupported) terms.

{snip}

1)Do you have any epidemiological evidence of a causal relationship between chiropractic adjustments and stroke.{snip}

Yes.

2)Should case studies be accepted as evidence of a risk of autism from MMR.

No; they can be a basis for inquiry; but that question has been answered in the negative.

3) Does the Ernst survey carry more weight as evidence, compared with a prospective risk study published in Spine.

Yes.

{snip}

[Blue Wode]

Richard, Raph78, and Rob, I think this is what you’re going to have to eventually face up to:

there is no evidence that chiro treatments are more effective than safer treatments. Therefore, the risk/benefit ratio is an unacceptably large number (division by zero).