Value of chiropractors questioned

[Admin]

usually the body repairs itself. sometimes not. as in chronic back pain. and there is good evidence that chiropractic can help that.

We've already established that SMT (which has been adopted by Chiropractors) does indeed have some evidence to support it.

Edit: As Blue Wode has pointed out however, SMT is no better than other standard treatments.

can you quote anybody else apart from "edzi oops ive done it again"?

Do you actually think that childish name calling advances your cause in some way?

I've pointed you to the section on the Ad Hominem fallacy. I suggest you read it.

i remember his quote that st johns wort is dangerous because if someone with depression taking it got better then they would have the strength to commit suicide. great scientist...

That's actually a well known problem with severe depression (!)

St John's Wort has supporting evidence that it is useful for mild depression. With severe depression, however, it can lift the depression just enough to raise the sufferer's motivation levels enough to allow them to carry out the thoughts of suicide they were having. This is a potential problem because it is available over the counter and people can take without medical supervision.

Medical professionals are well aware of this problem.

[richard]

hi richard, buddy! how is it going?

Ralph you are really going over their heads with this neuroscience mumbo jumbo. I gave a reference from Kendal and Schwartz Principles of Neuroscience and they just ignored it. So I tried to keep it simple KISS, hand, fast push, Spinal joint, receptors, spinal cord and brain.

If you have read the skeptic fact sheet on chiropractic they dont realise that the nucleus of the cranial nerves are in the brain stem and attaches to the spinal cord. Why they spent time producing a lovely looking fact sheetlike that when they could have just referred everyone to chirobase or quack watch is beyond me.Nice picture of DD all the same.

I would love to know what these guys do for a living. Blue Wode I suspect has something to do with the NHS. and John nice suit, tie, big smile lots of time on his hands. JCC seems very aggressive compared to the others, I bet he voted Bush.

Ralph dont tell me you are American and voted for him as well. If thats the case we will have to rise above our differences and stick together for the profession.

[Admin]

Ralph you are really going over their heads with this neuroscience mumbo jumbo. I gave a reference from Kendal and Schwartz Principles of Neuroscience and they just ignored it. So I tried to keep it simple KISS, hand, fast push, Spinal joint, receptors, spinal cord and brain.

If you have read the skeptic fact sheet on chiropractic they dont realise that the nucleus of the cranial nerves are in the brain stem and attaches to the spinal cord. Why they spent time producing a lovely looking fact sheetlike that when they could have just referred everyone to chirobase or quack watch is beyond me.Nice picture of DD all the same.

I would love to know what these guys do for a living. Blue Wode I suspect has something to do with the NHS. and John nice suit, tie, big smile lots of time on his hands. JCC seems very aggressive compared to the others, I bet he voted Bush.

Ralph dont tell me you are American and voted for him as well. If thats the case we will have to rise above our differences and stick together for the profession.

Hmmm....

Another attempt and condescension and name calling.

And these guys expect people to believe they are serious medical practitioners!

We get this sort of crass argumentation from psychics.

Any chance we can actually talk about chiropractic?

How about some answers to:

1. What is Innate Intelligence?
2. What is a subluxation?
3. How are subluxations detected?
4. Can a single patient's subluxation be reliably found by more than Chiropractor?
5. Can subluxations be seen on X-rays?
6. How do subluxations cause bed-wetting in children and how does spinal manipulation cure this?
7. How does manipulating the spine of a child with ADHD cause an improvement in behaviour?
8. Do you recommend vaccinations? If not, why not?

I'll stop there for now but there's plenty more questions like these that I, and I'm sure readers of this thread, would like to see answers to.

These are all things chiropractors claim or believe in but that evidence doesn't support.

Let's see some answers please.

[JJM]

{snip}

now, your homework will be to understand Turker et al (1994). Reflex response in motor units in human masseter muscle to mechanical stimulation of a tooth. Exp rain Res 100 (2) 307-15 and Slemenda et al (1997) Quadriceps weakness and OA of the knee. ann int med 127 (2) 97-104. and to see the relevance IN TERMS OF PROPRIOCEPTIVE MEDICINE.

{snip}

Türker KS, Brodin P, Miles TS.
Exp Brain Res. 1994;100(2):307-15.
http://www.ncbi.nlm.nih.gov/sites/en...ubmed_RVDocSum

It is concluded that stimulation of periodontal mechanoreceptors usually activates an excitatory reflex pathway to the jaw-closing motoneurones.

I don’t see any mention of chiro or proprioception. These guys tapped a guy's tooth to see how fast his jaw would close!?

Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, Wolinsky FD.
Ann Intern Med. 1997 Jul 15;127(2):97-104
http://www.ncbi.nlm.nih.gov/sites/en...ubmed_RVDocSum

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.

I don’t see any mention of chiro or proprioception.

The objective is to provide reliable evidence of a problem that is helped by chiro. I will stipulate that acute low back pain and some headaches are amenable to manipulation, as long as the neck snap is not fatal.

[Rob]

And yet the McTimoney College of Chiropractic course in the UK apparently instructs its students in the following:


Quote:
By correctly training the hands as an instrument of innate intelligence, healing can be encouraged to take place by the detection and correction of bony subluxations (slight displacements).

http://www.mctimoney-chiropractic.org/mca_objectives.htm



Incredibly, that course (which has produced 500 practising chiropractors) is validated by the University of Wales as a BSc (Hons) Chiropractic degree:
http://www.mctimoney-college.ac.uk/cofc.htm

I don't want my first post to be a downer, i'm a skeptic through and through - but, the point you seem to be making is that it's "incredible" that the course is validated in light of that single quote from a website. Isn't that a bit....well, weak?

I've had McTimoney chiropractic, and I personally know lots of intelligent people whose back problems have been written off by their GP's who have had excellent outcomes from it. When it was explained to me what was occuring, it added a bit more context to that admittedly ambigous quote above. The "in-the-flesh" version (and this applies not just to McTimoney chiropractic) of the explanation goes on to explain that the body is regulated in part by nerves, that bones can impinge nerves and cause dysfunction/pain, that the bones do know their optimum position (and yes, they do, if all structures and connective tissue were in good form but the bone slightly out of position due to soft tissue fixation, an abormal rotation etc), then providing a small input of kinetic energy, in the right direction, may overcome that fixation and allow the "system" to return to stability.

This makes perfect sense to me and doesn't offend my scientific sensibilities or set off my skeptic spidey-sense. In terms of a mathematical system, it's like a ball in a textured bowl getting stuck on the inside edge, and gravity lacking the energy to pull the ball to equilibrium. A tap on the right part of the bowl kickstarts the system, giving it the energy it needs to overcome the abormal rest-state it has achieved. I *think* this is what they mean when they say innate intelligence - that the system does have an optimum state, like "it knows what's best for it." Before you start pounding the keyboard - the body doesn't really "know", but the "system" does, through a million variables, have an optimum state we casually regard as "normal", that a chiro might see as unsubluxated. Semantics is all.

Blue Wode, you quoted from a cochrane report

There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain

Great! SMT is not superior.....that is NOT the same as saying it has no effect, or that the value of a chiropractor is questioned. How about the chiropractors who have gone into hospitals and got spinal surgery waiting lists down from 2 years to 2 weeks? How about the chiropractors who diagnose life-threatening illnesses in their primary care role that have been consistenly missed by mainstream medics? That is value.

We're talking about lots of different issues here but let me try and spell them out:

SMT is not Chiropractic and Chiropractic is not SMT - they may relate in varying degrees ffrom chiro to chiro.
Evidence-based medicine is not the same as scientific proof - particularly where the only thing that really counts is results. If the evidence shows that people are getting better, by objective measures, then they're getting better.
The value of a chiropractor is NOT dependent upon the availability of convincing research on technique. What it is dependent upon is a debate in itself i'm sure.
It is not good scientific practice to extrapolate an ambigously worded website into an opinion on the standard of chiropractic education at any given college.

Now i'll admit I only skim-read this topic, but as I did, I got the idea that these issues were getting confused a little. As a skeptic I get very sensitive to confusion - I like to plot statements out a bit more to see if they stack up and then try and apply logic to them.

Nice to be here too, post number 1. Hurrah.
Rob

[Admin]

The "in-the-flesh" version (and this applies not just to McTimoney chiropractic) of the explanation goes on to explain that the body is regulated in part by nerves, that bones can impinge nerves and cause dysfunction/pain, that the bones do know their optimum position (and yes, they do, if all structures and connective tissue were in good form but the bone slightly out of position due to soft tissue fixation, an abormal rotation etc), then providing a small input of kinetic energy, in the right direction, may overcome that fixation and allow the "system" to return to stability.

This 'pinched nerve' theory was discredited a long time ago.

I posted a link to a presentation by Harriet Hall MD which deals with this.

Evidence-based medicine is not the same as scientific proof - particularly where the only thing that really counts is results. If the evidence shows that people are getting better, by objective measures, then they're getting better.

No, you're mistaken there. Evidence-based medicine looks for people getting better above and beyond the placebo control group (or comparison group).

People tend to get better with time anyway and this can cause the illusion of ineffective treatments working. This is why scientific testing procedures were developed - to eliminate such false positives.

It is this illusion of causality that placebo treatments like Chiropractic rely on.

And I'm talking Chiropractic - not SMT.

[Rob]

Ahhh, this IS one of those websites where people just argue semantics the whole time.

If the pinched nerve theory is discredited, why do people have surgery to decompress or fuse discs that are "pinching nerves?" Only, I was stupid enough to be suckered into this by one of the top spinal surgeons in the country. He said "your disc is impinging a nerve and it's causing pain and dysfunction." Was he wrong? Does Cauda Equina syndrome not exist? Did I have my surgery for nothing? Don't I feel a fool now!

[richard]

So, what is the difference between homeostasis and innate intelligence?

What's the difference between the body's own self-repair mechanisms and pseudo-medical intervention (Chiropractic manipulation, Acupuncture, Homeopathy, etc.)?

As far as I can see all of these pseudo-medical interventions actually do nothing as the body repairs itself anyway; however, they do seem to have some positive effect on patients (placebo effects in other words).

Here is the essential problem with these placebo interventions: in order for them to 'work' they have to be believed in by the patients (i.e. there needs to be a 'perceived authenticity' about these practises) so the practitioners have to maintain the belief that there really is something medical going on - which leads us to the dilemma at the heart of alternative medicine.


Those, like skeptics, who are interested in evidence-based medicine however, can see through the (necessary from alternative medicine's point of view) façade presented to us.

John this article is about "alternative medicine" and mentions, Homeopathy, Reflexology and Acupuncture. Chiropractic is neither alternative or medicine. It is not mentioned in the article and no matter how often you say it, it will still not be true.

You keep telling us about all your evidence unfortunatly it keeps comming back to the same people. On this site you have refered us to there is only one small mention of chiropractic. Guess what Edzard Ernst is also there and a link to quack watch,what a surprise. I have given you Spine 2007 and you are not interested. Waddel 2007 you are only interested in Ernst or the quack Stephen Barrett. You claim to be "interested in evidence-based medicine and can see through the façade presented to us"

You may be interested in evidence based medicine, however I would bet my house you have never done a piece of research , and have never done a course in research methodology.

Because Edzard Ernst says something it does not make it true, Do you really believe Ernst would state his survey invalidates the Spine study,and it should be confined to the joke section of quack watch, I think not.

For all its worth I have a masters in Public health and Health Promotion from Brunel University. Not bad for an "ignorant chiropractor"

[Admin]

Ahhh, this IS one of those websites where people just argue semantics the whole time.

If the pinched nerve theory is discredited, why do people have surgery to decompress or fuse discs that are "pinching nerves?" Only, I was stupid enough to be suckered into this by one of the top spinal surgeons in the country. He said "your disc is impinging a nerve and it's causing pain and dysfunction." Was he wrong? Does Cauda Equina syndrome not exist? Did I have my surgery for nothing? Don't I feel a fool now!

OK then!

The pinched nerve theory of chiropractic subluxation.

[Raph78]

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

i showed you a clip of an inhibited deltoid upon neck flexion. the neck flexion did not proof any further interference with her ability to abduct the shoulder. her chronic shoulder problem got "fixed" as soon as her body used full muscular support of the rotator cuff. (spot the mistake? )

the neck vertebra that required treatment to fix her proprioception is the subluxation (in this case structural), the resisted testing was the best way of providing evidence for its presence. the "subluxation" (i hate this word) is the part of the neurological interference most chiropractors go on about without being able to prove it. i hope the clip proves this.

no you dont see subluxations on xrays. maybe areas that could be restricted due to OA and osteophytosis, scoliosis etc

no, im not trying to be a medic. i simply apply known neurophysiology and know my indicators/contraindicators, and use common sense. its fun actually!

blue, youre quoting ernst again. thats your mantra, isnt it?

the flu jab works in 4-5 out of 100 cases according to medical evidence. and, isnt it BELIEVED to prevent flu?

[Rob]

OK then!

The pinched nerve theory of chiropractic subluxation.

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

[Admin]

Chiropractic is neither alternative or medicine.

Well I agree with 50% there. It certainly is 'alternative' and it certainly isn't medicine.

You keep telling us about all your evidence unfortunatly it keeps comming back to the same people [.....] Edzard Ernst

He's a leading researcher into alternative medicine and therapies. Why would you not want research from a top scientist in the field being quoted?

Well I know the answer, he's looked at chiropractic and can find no evidence that it is of any use and that it carries significant dangers.

The evidence doesn't support your system of 'health care' and so you resort to attacking the person who's against you and not the evidence.

You may be interested in evidence based medicine, however I would bet my house you have never done a piece of research , and have never done a course in research methodology.

Then you'd lose your house.

Anyway, how about giving us some answers to the questions I posed above?

How do you detect subluxations, for example?

[Blue Wode]

Hello Rob, and welcome to the UK Skeptics forum.

How about the chiropractors who diagnose life-threatening illnesses in their primary care role that have been consistenly missed by mainstream medics?

And how about the mainstream medics who end up caring for the (occasionally seriously) injured patients that present to them following chiropractic treatment?

It is not good practice to extrapolate an ambigously worded website into an opinion on the standard of chiropractic education at any given college

Then perhaps that college, and others, should be more specific with their wording and also provide the evidence for 'chiropractic'.

Now i'll admit I only skim-read this topic, but as I did I got the idea that these issues were getting confused a little. As a skeptic I get very sensitive to confusion - I like to plot statements out a bit more to see if they stack up

I don't think the issues are getting confused at all. It's really quite simple - where is the scientific evidence for 'chiropractic'?

[Admin]

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

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

Work through this: http://drspinello.com/chiropractic/C...iles/frame.htm

[Rob]

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

Work through this: http://drspinello.com/chiropractic/C...iles/frame.htm

Don't patronise me John.
What you mean to say is you think I need to read up a little more on what someone who may or may not be qualified to speak for thousands of people thinks chiropractic is.

I'm only telling you, from a patients perspective, that a spinal surgeon told me a nerve was being impinged, and he caused me a lot of pain and got no results. A chiropractor told me the same thing, and the theory behind it was the same. That chiro also told me that the nerve impingement due to nerve distrbution wasn't necessarily guaranteed to be in the place the MRI showed it (there was a study that showed 75% of cadavers showed major herniations on MRI that were ASYMPTOMATIC), and that it could be piriformis syndrome. A stretching programme later, and problem solved. Nice one.

I don't suppose there is one document showing what chiro is anymore than there is one and only one definitive document showing what conventional medicine is.