Value of chiropractors questioned

[Neuromuscular Therapist]

Actually, osteopathy and chiropractic are different.

Most osteopaths, as well as using some thrusting techniques, do use soft tissue techniques too, which I believe are beneficial, rather than one or the other.

I am a physical therapist and also do sports massage. When I did sports massage, I learned a lot of advanced techniques for stretching tissue, such as MFR (Myofascial Release Technique), Muscle Energy Technique and so on and so forth. Osteopaths learn most of these techniques when they are training and they are of proven value.

Please don't lump osteopaths and chiropractors together in the same breath. They are different and in the States a DO (Doctor of Osteopathy) has the same status as an MD. However, osteopathic training in Canada and European countries is different and is not the same as the States.

In Europe, DO stands for what was the old Diploma of Osteopathy before the training achieved degree level status.

[Blue Wode]

Hello Neuromuscular Therapist, and welcome to the UK Skeptics forum.

Actually, osteopathy and chiropractic are different.

-snip-

Please don't lump osteopaths and chiropractors together in the same breath.

I don’t think that present-day osteopathy is quite so mired in quackery as chiropractic, however they are quite similar in that both use spinal manipulation – although it’s probably true to say that osteopaths tend to use it less in favour of soft tissue work (which is gentler).

For anyone who has read ‘Suckers’ it’s really quite understandable why Bindeweede lumped osteopaths and chiropractors together. Here’s a reminder of what he said:

I hope people won't mind this. I am about half way through Rose Shapiro's "Suckers". Her chapter on osteopathy and chiropractic I found fascinating, as I didn't really know much about either. Unless I've got it wrong, they were both established by ignorant conmen with spiritual overtones, simply as money-making cons. Not really like MLMs, but with a similar objective - conning the gullible. Chiro seems especially dangerous.

In support of Bindeweede’s comments, the following is a summary of pages 130-135 of the ‘Bad Backs’ chapter of Suckers - the pages which look specifically at osteopathy:

Chiropractors are more likely to manipulate the spine directly; osteopaths may use the limbs as levers and in this way try to mobilise the spine.

Both osteopathy and chiropractic originated in America. They were a development of the medieval folk medicine practice of bone setting.

In America today there are more than 49,000 Doctors of Osteopathy (known as DOs) who are trained in orthodox scientific medicine with additional training in manipulative therapies. They have the same entitlements to prescribe and perform surgery as mainstream medical practitioners and make up 20% of all general practitioners is the US.

The UK’s 5,000 or so osteopaths, require no scientific medical training and so are more firmly established in the ‘alternative’ camp. Very few are MDs and many combine osteopathy with dubious practices such as naturopathy and cranial osteopathy. They are regulated by statute.

In a review of current research that ‘enraged’ osteopaths and chiropractors, Professor Edzard Ernst concluded that here was no evidence to suggest that spinal manipulation was an effective intervention for any condition and that the finding applied to both osteopathy and chiropractic.

Osteopathy and chiropractic were invented, or ‘discovered’ by a pair of determined and charismatic Americans in the late 19th century – Andrew Taylor and Daniel David Palmer. They both could be described as chancers and fantasists who had tried and failed to make their fortunes in a variety of jobs and get-rich-quick schemes. They saw themselves as visionaries and spiritual leaders and believed they had discovered a single cause and a single cure for all diseases.

Andrew Still claimed he had been a battlefield surgeon, but no record of it exists. He found phrenology and mesmerism interesting and following the deaths of three of his children he became a magnetic healer. He went on to have a ”prophetic vision” which apparently revealed a truth to him that if bones could be manipulated back into alignment then the nerves would “properly conduct the fluids of life” and so-called diseases or effects would trouble the patient no longer. In the mid 1880s he coined the word ‘osteopathy’ and business was booming.

Not exactly reassuring.

As for chiropractic, for the benefit of any drive-by readers of this thread, this recent video presentation (42 mins) is well worth viewing:

The Kinsinger Report on Chiropractic 2008
http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv

WARNING: Chiropractors won’t like it.

[JJM]

{snip}
For anyone who has read ‘Suckers’ {snip}

Not exactly reassuring.

They have not even announced the release date for that book in the USA.

As for chiropractic, for the benefit of any drive-by readers of this thread, this recent video presentation (42 mins) is well worth viewing:

The Kinsinger Report on Chiropractic 2008
http://ph-ms.ouhsc.edu/ah/rehab/kinsinger.wmv

WARNING: Chiropractors won’t like it.

In that video, Kinsinger makes a clear distinction between chiros and osteos (but, only in passing, the topic is chiros). However, there are still some dubious osteo practices:
http://www.quackwatch.org/04Consumer.../QA/osteo.html

[Mongrel]

They have not even announced the release date for that book in the USA.

Amazon.co.uk deliver to the States, use the link and UKS gets a few pennies

Alternatively I'd be happy to get it and post it across the pond for you if you want to PM me

[Neuromuscular Therapist]

Where have all the Chiropractors gone?

[Blue Wode]

Could they be looking for the evidence for chiropractic?

It’s interesting to note that the author of an article in the current online issue of Dynamic Chiropractic (the print edition of which is sent to every chiropractor in North America) thinks that skeptical chiropractic websites are...

“…opinionated, biased and prejudicial…based mainly on opinion, apologetics, cherry-picking of data, testimonials and hyperbole…"

and that

“Chiropractic also should maintain high-quality evidence-based sites that specialize in back pain, neck pain, public health, wellness and the risks of CVA following manipulation.”

However, he fails to mention where his profession can find the evidence for ‘chiropractic’. See here:

Our profession has been suffering from asymmetrical cyber attacks by a small group of activists seeking to bring about public doubt and to change public opinion – and our losses have been substantial. Go to your favorite search engine and key in the word chiropractic. Check out the results on the first page…on that crucial first page where most searchers linger are two to three extremely critical Web sites maintained by only a few individuals. If you were a member of the public, a student or a medical doctor interested in finding out about chiropractic, you would be exposed to the most opinionated, biased and prejudicial sites you can imagine while searching the word chiropractic.

-snip-

If you visit these condescending sites, you will find they are sustained by only one or two strongly opinionated cynics. These sites are based mainly on opinion, apologetics, cherry-picking of data, testimonials and hyperbole.

-snip-

It does not matter how many people are enticed to learn more about chiropractic through our outreach efforts if they are exposed to the extremist views of a group of cynics when they search the Internet. To have a comprehensive outreach program that covers all aspects of modern media, the chiropractic profession needs to dominate the first 20 sites that appear when the word chiropractic is entered in a search engine. Chiropractic also should maintain high-quality evidence-based sites that specialize in back pain, neck pain, public health, wellness and the risks of CVA following manipulation.

-snip-

While every health care provider has the right to establish a Web site, every provider also has the responsibility to temper their Web site with an adherence to evidence and ethics. The use of hyperbole or inaccuracies is a violation of the public’s trust and gives the entire profession a public-opinion black eye.

http://www.chiroweb.com/archives/26/09/02.html

More here:
http://chirotalk.proboards3.com/inde...7286860&page=1

Interestingly, similar search results can be obtained for the UK. For example, if you do a ‘pages from the UK’ Google search for “chiropractic”, listed third on the first page of results is the superb UK Skeptics critique of chiropractic which was written by John Jackson in 2004. Better still, if you do a search for “chiropractic evidence” the critique appears at the top of the first page!


Invitation to chiropractors

With regard to the above, UK Skeptics can help you. If you can produce the scientific evidence for ‘chiropractic’ (not the sparse evidence base for spinal manipulative therapy – that’s not chiropractic), then I’m sure that John Jackson would be only too happy to include it in his UK Skeptics chiropractic article. After all, here’s what he said on this very thread in the recent past:

Modern skepticism works just like modern science; skepticism being at the heart of the scientific method.

We look at claims, look at the supporting evidence, and if there's nothing to support the claim we conclude that it is false unless/until it's ever proved otherwise. i.e. we take an a posteriori position on matters. See: Are skeptics disbelievers?

This is why we keep asking you chiropractors for evidence that chiropractic (not SMT) actually works. If you can provide any evidence that subluxations exist, how you detect them, how they cause illness and disease and how you put them right then I, and I'm sure other skeptics, will be more than happy to re-evaluate our stance on chiropractic.

http://www.skeptics.org.uk/forum/sho...&postcount=106

So, if you’re a chiropractor, and you have the scientific evidence for chiropractic, one of the most popular chiropractic articles on the internet is waiting to be updated with that information. Here’s the article:

‘What is chiropractic and does it work?’
http://www.skeptics.org.uk/article.p...iropractic.php

We look forward to hearing from you.

[JJM]

It always strikes me, when chiros complain about critical information, that all they have to do is show us what is wrong with the criticism. However, they cannot do that any more than they can justify their own claims.

[Giddy]

Sorry for the absence folks we have had a new addition to the family and my wife is doing 50 + hours working at hospital. Yep she's a medic!

I'm just going to make a couple of quick points with regard to the latest few postings here.

The evidence for the existence of the subluxation as a specific entity depends on which component of the hypothesis you want to look at.

There are Physical- anatomical, neurological and biomechanical
Chemical-physiological changes at nerves, joints and end
organs
Mental-psychological, emotional responses.

From a purely physical point of veiw altered spinal biomechanics can be classed as a subluxation. Palpation of the mobility of spinal segments, pelvis and other joint systems is pretty simple way of assessing this.

Long term reduced joint mobility affects articular cartilage and intervertebral disc nutrition and results in osteoarthritic changes. The term "wear and tear" is used to describe the condition and implies that overuse is underlying cause. More correctly it is poor and abnormal mobility, chondrocyte nutrition with subsequent release of inflammatory agents and invasion by the immune system that leads to the changes.

Specific adjustments/manipulations would aim to correct the joint mobility (Does it work? That's the question). Chiropractors are probably the first group to sytematically seek out the hypomobile segments and attempt to correct them.

It is interesting that now SMT has been adopted by other professions that postive outcomes from investigations into it are considered not to be relevant to chiropractic. Who cares who does the research. Most other non health professions are drawing data from across fields to improve their models of the world.

This is an example of a simplified version of subluxation theory and by no means have I expanded into enough detail, there are neurological and physiological changes that should be remember as well. Most of it is accepted orthopaedic knowledge albeit from the other end of the spectrum, that is, prior to medical relevant pathology. Dentistry changed lifestyle habits and went from barber tooth extraction to scale and cleaning by focusing on early intervention. To me preventitive care has been the essence of the chiropractic approach.

Chiropractic is not a disease treatment healthcare approach. The fact that apparent disease states respond is a phenomenon that has to be confirmed but does happen anecdotally. Ive seen regularly it in my clincal work. To ask for proof that it leads to a cure of a disease is to misunderstand the approach. Research that looks at disease specific treatment outcomes are only useful for examining any apparent effects that adnormal spinal biomechanics and neurological feedforward and feedback mechanisms have on body.

There is no validity that chiropractic is a disease treatment method.
However I believe we are dealing with misdiagnosis of symptoms that may in some cases mimic well known pathological conditions. In other cases the medical diagnosis is based on flawed concepts with regard to the origin of the symptomatology.

Last but not least, here is a recent paper with regards to the association between cervcal spine adjustments and stroke. The findings point to the case of random chance of presenting for care whilst experiencing stroke symptoms rather than causation.
http://www.spinejournal.com/pt/re/sp...195628!8091!-1

[Giddy]

Sorry for the absence folks we have had a new addition to the family and my wife is doing 50 + hours working at hospital. Yep she's a medic!

I'm just going to make a couple of quick points with regard to the latest few postings here.

The evidence for the existence of the subluxation as a specific entity depends on which component of the hypothesis you want to look at.

There are Physical- anatomical, neurological and biomechanical
Chemical-physiological changes at nerves, joints and end
organs
Mental-psychological, emotional responses.

From a purely physical point of veiw altered spinal biomechanics can be classed as a subluxation. Palpation of the mobility of spinal segments, pelvis and other joint systems is pretty simple way of assessing this.

Long term reduced joint mobility affects articular cartilage and intervertebral disc nutrition and results in osteoarthritic changes. The term "wear and tear" is used to describe the condition and implies that overuse is underlying cause. More correctly it is poor and abnormal mobility, chondrocyte nutrition with subsequent release of inflammatory agents and invasion by the immune system that leads to the changes.

Specific adjustments/manipulations would aim to correct the joint mobility (Does it work? That's the question). Chiropractors are probably the first group to sytematically seek out the hypomobile segments and attempt to correct them.

It is interesting that now SMT has been adopted by other professions that postive outcomes from investigations into it are considered not to be relevant to chiropractic. Who cares who does the research. Most other non health professions are drawing data from across fields to improve their models of the world.

This is an example of a simplified version of subluxation theory and by no means have I expanded into enough detail, there are neurological and physiological changes that should be remember as well. Most of it is accepted orthopaedic knowledge albeit from the other end of the spectrum, that is, prior to medical relevant pathology. Dentistry changed lifestyle habits and went from barber tooth extraction to scale and cleaning by focusing on early intervention. To me preventitive care has been the essence of the chiropractic approach.

Chiropractic is not a disease treatment healthcare approach. The fact that apparent disease states respond is a phenomenon that has to be confirmed but does happen anecdotally. Ive seen regularly it in my clincal work. To ask for proof that it leads to a cure of a disease is to misunderstand the approach. Research that looks at disease specific treatment outcomes are only useful for examining any apparent effects that adnormal spinal biomechanics and neurological feedforward and feedback mechanisms have on body.

There is no validity that chiropractic is a disease treatment method.
However I believe we are dealing with misdiagnosis of symptoms that may in some cases mimic well known pathological conditions. In other cases the medical diagnosis is based on flawed concepts with regard to the origin of the symptomatology.

Last but not least, here is a recent paper with regards to the association between cervcal spine adjustments and stroke. The findings point to the case of random chance of presenting for care whilst experiencing stroke symptoms rather than causation.
http://www.spinejournal.com/pt/re/sp...195628!8091!-1

[Blue Wode]

Welcome back, Giddy.

The evidence for the existence of the subluxation as a specific entity depends on which component of the hypothesis you want to look at.

Sadly, it would appear that all the components have already been looked at, otherwise the conclusions of the most recent critical evaluation of chiropractic wouldn’t give us this:

With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition.


More…
http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Giddy said:

Dentistry changed lifestyle habits and went from barber tooth extraction to scale and cleaning by focusing on early intervention. To me preventitive care has been the essence of the chiropractic approach.

Then why are so many chiropractors against childhood vaccinations?

Also, just because you consider preventive care to be the essence of the chiropractic approach, it doesn’t justify its use. See here:

Most chiropractors sell the idea that patients are better off with lifetime care as a kind of preventive maintenance that catches small problems and keeps them from becoming bigger. However, because no chiropractic method currently in existence really corrects biomechanical problems of the spine, it makes no sense that this would be true. What usually happens is that a person receives some temporary relief for tight muscles which relaxes them and provides some stress relief. They probably like the chiropractor and buy his pitch about needing care. As treatment progresses, they become used to care and fearful that if they stop their spine will get worse. The truth is that regardless of the short term pain relief they are getting if they have a problem which is not addressed and corrected then their spine is degenerating regardless of how they feel.

http://chirotalk.proboards3.com/v45i...ad=2431&page=1

Indeed, at least one big insurance company in the U.S. (which has the largest population of chiropractors in the world) refuses to cover chiropractic preventive care:

The appropriateness and effectiveness of chiropractic manipulation as a preventive or maintenance therapy has not been established by clinical research and is not covered.

Clinical Policy Bulletins
Number: 0107
Subject: Chiropractic Services
Reviewed: March 11, 2005
http://www.aetna.com/cpb/data/CPBA0107.html

Furthermore, as previously discussed in this thread, if chiropractors’ provision of preventive care really did work, then wouldn’t you expect chiropractors’ own longevity to be on a par with that of medical doctors or, at the very least, the general population? Interestingly, according to this recent survey from the U.S. (which was carried out by a chiropractor), chiropractors’ life-spans are shorter than both:

Two separate data sources were used to examine chiropractic mortality rates.

One source used obituary notices from past issues of Dynamic Chiropractic from 1990 to mid-2003. The second source used biographies from Who Was Who in Chiropractic – A Necrology covering a ten year period from 1969–1979.


The two sources yielded a mean age at death for chiropractors of 73.4 and 74.2 years respectively.

The mean ages at death of chiropractors is below the national average of 76.9 years and is below their medical doctor counterparts of 81.5.

Morgan, L. Does Chiropractic ‘Add Years to Life’? J Can Chiropr Assoc. 2004 September; 48(3): 217–224
http://www.jcca-online.org/client/cc...3-P217-224.pdf

Giddy said:

Last but not least, here is a recent paper with regards to the association between cervcal spine adjustments and stroke. The findings point to the case of random chance of presenting for care whilst experiencing stroke symptoms rather than causation.
http://www.spinejournal.com/pt/re/sp...195628!8091!-1

That study was looked at in post #206:
http://www.skeptics.org.uk/forum/sho...&postcount=206

However, it would be interesting to hear your thoughts on this part of that post:

My daughter walked into a chiropractor’s office, had her neck manipulated for lower back/tailbone pain and started to bleed into her brain right on the table.

- snip-

…the principal author [of the Spine study cited by Giddy], David Cassidy…has been sued in Saskatchewan, in 1999, by his research assistant for falsifying data, and [is] one whose work is stated in the New England Journal of Medicine as "all of the study’s authors conclusions are completely invalidated by their methods".

David Cassidy, before he was dismissed from the University of Saskatchewan, was called as an "expert" witness by the Chiropractic Association of Saskatchewan (CAS) at my daughter’s inquest. In the Globe and Mail article co-author David Cassidy is quoted "Has it ever happened that a chiropractor has caused a stroke? I can’t say it’s never happened. But if it’s happening, it’s not happening at a greater risk than when it is at a GP office".

Well guess what, chiropractor David Cassidy admitted on the stand into the death of my daughter they he had manipulated the neck of a woman and caused a stroke, a very severe one called Wallenberg’s syndrome. Did he say it never happened because this poor woman also saw her doctor in the past year?

http://www.chirowatch.com/Chiro-stro...120stroke.html

[JJM]

{snip} The evidence for the existence of the subluxation as a specific entity depends on which component of the hypothesis you want to look at.

There are Physical- anatomical, neurological and biomechanical Chemical-physiological changes at nerves, joints and end organs
Mental-psychological, emotional responses.

From a purely physical point of veiw altered spinal biomechanics can be classed as a subluxation. Palpation of the mobility of spinal segments, pelvis and other joint systems is pretty simple way of assessing this.

This is nonsense, it suggests that a sub is anything you want to bill people for pretending to correct.

Long term reduced joint mobility affects articular cartilage and intervertebral disc nutrition and results in osteoarthritic changes. The term "wear and tear" is used to describe the condition and implies that overuse is underlying cause. More correctly it is poor and abnormal mobility, chondrocyte nutrition with subsequent release of inflammatory agents and invasion by the immune system that leads to the changes.

Do you have proof of this in legitimate, medical publications?

Specific adjustments/manipulations would aim to correct the joint mobility (Does it work? That's the question). Chiropractors are probably the first group to sytematically seek out the hypomobile segments and attempt to correct them.

As you ask- does it work? After 113 years, you still don't know; I suggest that is because it is as imaginary as the sublux, itself.

It is interesting that now SMT has been adopted by other professions that postive outcomes from investigations into it are considered not to be relevant to chiropractic.

Actually, after medical science showed benefit for some SMT, chiros said- "Yeah, that's what we've been doing." When, in fact, they were chasing the fairy-tale sublux.

{snip} To me preventitive care has been the essence of the chiropractic approach.

Great, show some proof that chiro prevents something ...

Chiropractic is not a disease treatment healthcare approach.

Show us the valid data (not anecdote or chiro magazine publications) that demonstrate that it is a "healthcare" approach in any sense. Keep in mind that SMT is not chiro.

{snip} Last but not least, here is a recent paper with regards to the association between cervcal spine adjustments and stroke. The findings point to the case of random chance of presenting for care whilst experiencing stroke symptoms rather than causation.
http://www.spinejournal.com/pt/re/spine/abstract.00007632-200802151-00019.htm;jsessionid=LGLNhn2nYTprspCjRjd2zhTGj0WLf VT1lVrT7v6prmcK52Kkl7x5!-1990489359!181195628!8091!-1

The abstract does not have enough info, and I will not pay for the article. Therefore I cannot discuss it beyond noting that there is a lot of research at odds with it.


There is no doubt that chiros cause strokes. The overriding consideration is that the chiro neck-snap is unnecessary. Therefore, chiros are killing people gratuitously. Watch the Kinsinger video linked (above) by Blue Wode.

[Neuromuscular Therapist]

Giddy,

Was it you that said that your wife used to be a chiropractor and then went and re-trained as a medic?

Now why did she want to do that? Was it perhaps that she saw the error of her ways becoming a chiropractor in the first place and so decided to go and train to be a real doctor?!!

[Blue Wode]

As ‘Chiropractic Awareness Week’ gets under way, here’s what scientist and broadcaster, Simon Singh, has written about it in the Comment is Free section of today’s Guardian:

‘Beware the spinal trap’

This is Chiropractic Awareness Week. So let's be aware…

-snip-

You might think that modern chiropractors restrict themselves to treating back problems, but in fact they still possess some quite wacky ideas. The fundamentalists argue that they can cure anything. And even the more moderate chiropractors have ideas above their station. The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.

-snip-

But what about chiropractic in the context of treating back problems? Manipulating the spine can cure some problems, but results are mixed. To be fair, conventional approaches, such as physiotherapy, also struggle to treat back problems with any consistency. Nevertheless, conventional therapy is still preferable because of the serious dangers associated with chiropractic.

-snip-

…I will leave you with one message for Chiropractic Awareness Week - if spinal manipulation were a drug with such serious adverse effects and so little demonstrable benefit, then it would almost certainly have been taken off the market.

http://www.guardian.co.uk/commentisfree/2008/apr/19/health

[Neuromuscular Therapist]

Hey, aren't chiropractors all wannabe doctors?!! They just couldn't make the grades to get into med school and become real doctors!!

Perhaps they could all go and re-train as Physical Therapists?

[JJM]

Hey, aren't chiropractors all wannabe doctors?!! They just couldn't make the grades to get into med school and become real doctors!!

We (anyway, I) don't know those statistics. I once had a very good student, in chemistry, who was an athlete and had been exposed to chiros in high-school sports, he naievely accepted their claims.

Perhaps they could all go and re-train as Physical Therapists?

I think massage is closer to reality (than PT) for most of them.