An historical concept? Damn right!

June 28, 2010
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Part mischief to this site and part poke-in-the-eye to zeno’s blog this title is nothing short of how I feel about the whole GCC-statement…

Thing is, let’s look at what the wording of the GCC’s “controversial activities” could mean:

GUIDANCE ON CLAIMS MADE FOR THE CHIROPRACTIC VERTEBRAL SUBLUXATION COMPLEX
The chiropractic vertebral subluxation complex is an historical concept (well, it is a concept which was created in the past, isn’t it?) but it remains a theoretical model (which must be the most significant endorsement of the GCC’s alignment with the principles of the chiropractic profession I have ever heard or read). It is not supported by any clinical research evidence that would allow claims to be made (that’s an ASA issue, not a GCC issue, ie the GCC can’t do anything about that other than comply) that it is the cause of disease or health concerns.

Chiropractors are reminded that

  • they must make sure their own beliefs and values do not prejudice the patients’ care (GCC Code of Practice section A3) (ie the GCC is reminding us that we cannot advertise. communicate or otherwise promote our approach for anything other than that for which there is ASA-standard evidence)
  • they must provide evidence based care, which is clinical 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 (GCC Standard of Proficiency section A2.3 and the glossary) (ditto)
  • any advertised claims for chiropractic care must be based only on best research of the highest standard (GCC Guidance on Advertising issued March 2010) (ditto)

My interpretation? The GCC acknowledges the chiropractic profession has a theoretical model revolving around the chiropractic vertebral subluxation complex. It also acknowledges this theoretical model’s weakness (its lack if high-end research evidence) and the restrictions such a weakness impose on us as a UK-based profession.

Fundamentally I take away form this two things:

  • the chiropractic profession is working off a theoretical model which has not yet been rigourously tested
  • unless it gets tested you can’t publicise claims in this country under ASA regulations

I don’t think that’s unfair, if anything I think it is largely overdue that the UK’s chiropractic profession came to the conclusion it can’t make claims unless it does its homework. Noone is saying it can’t be done, or that no work at all has been done, just that the work necessary to make claims in this country hasn’t been done.

This, in contrast is the interpretation of the GCC statement by zeno, a blogger who like two other bloggers skepticbarrista and skepticat (I have questioned them both on their topic and never received an answer to the contrary), still believe that chiropractors today practice for the(ir understanding of) reasons given 120 years ago:

just an historical concept, consigned to the history books as an outdated and irrelevant concept that explains absolutely nothing and based on no evidence whatsoever; something dreamed up 120 years ago by a magnetic therapy salesman

Cute but utterly irrelevant as no-one is actually agreeing with their interpretation of the subluxation model (claiming that subluxations cause all diseases and that all subluxations are spinal). This is where they seem to be a little more than confused. I don’t think it says either of these statements anywhere in the green books, nor could you sanely come to any of these conclusions based on what has actually been said or written. I know some people have come to these conclusions, but I think they were being silly, playing silly or just plain silly. Ergo; these inane bloggers hold a skeptical position about their own interpretation of the meaning of the chiropractic subluxation concept which is not shared with the vast majority of the chiropractic profession in the UK … and so they should, because as far as I can see it their position is a very dangerous one and we have much more sense than that.

Thanks for reading. Do post, anonimously if you fancy it, but whatever you do: don’t be apathic. Let the profession know that although we are a group, a profession is also a collection of individual people. It is the people that give it its identity, not the collection. Stand up for your interpretation of the subluxation complex and let’s get to work on figuring things out… my personal suspicions are that we’re really not that different deep down…

Just remember: if these so-called skeptics can make you think they have a point by telling the world they have one, then it is clear to me that it is the individual apathy towards this debate that is the sword our profession will end up throwing itself onto.

Many kind regards,

Stefaan Vossen

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  • Stefaan Vossen

    David
    definitely some very good points and will be incorporating your thoughts in my work.
    Many kind regards and looking forward to more debate
    Stefaan
    (sorry for the brief reply, will elaborate more extensively shortly)

  • davidp

    OOps, I lost a semicolon before “several surveys”

    Another interpretation of “they must make sure their own beliefs and values do not prejudice the patients’ care” is that it’s boilerplate from medical standards that mean doctors must not let disagreement with the patient over religion, or the doctor’s beliefs about things such as contraception, abortion, or the appropriateness of women being seen by men make the doctor let the patient go untreated or badly treated (although they can refer the patient to someone else if you disagree with the proposed treatment, they must not prevent it from happening, actively or passively). This could occasionally apply to Chiropractors, but less often than it does to GP’s.

  • davidp

    G’day Stefaan,

    Another good post. Thanks.

    I agree with the first two thirds. The last third let me understand why you repeatedly asked people like Zeno what they thought chiropractic theory is. It had seemed like a red herring, but I think I understand its relevance now. Richard Lannigan’s early comment quoting Richard Brown is interesting support for your argument against Zeno & Skepticat’s interpretation several surveys of chiropractors are evidence for their interpretation, although the word subluxation has been a very slippery beast with multiple meanings, making survey results unreliable because those surveyed apply different meanings to the questions and answers.

    I disagree with your interpretation of the GCC’s “they must make sure their own beliefs and values do not prejudice the patients’ care.” I think it means that even if you strongly believe a theory, or strongly believe some aspect of conventional medical care is ethically wrong or incorrect, you must not let this objectively harm the patient. Since some chiropractors hold loopy beliefs (as do some GP’s) this is an important rule.

    An extreme example to show what this can mean: If someone believes that surgery harms the body’s ‘innate healing energy’, they must not tell a patient to not have their cancer operated on, without actual evidence that this will (on average) result in a better outcome for the patient. We have a case of a homeopath doing this in 2003 going through the coroner’s court in Australia at the moment.

    I think good research (carefully excluding possible misleading effects) is a real need, especially sorting out what really works and what doesn’t. Even a proven theoretical basis doesn’t mean treatments actually work, a lesson medicine has learnt over the last 40 years. That’s why they are moving from “scientific medicine” (this should work because …) to “evidence based medicine” (this was tested in many equivalent cases and did work).

    I posted a couple of comments about your research ideas at Zeno’s blog
    here first then just after the sketched proposal here after reading it carefully. Your work on orthognathic malocclusion and gait dysfunction sounds valuable, and being able to provide solid evidence of its utility will allow the techniques to spread and benefit people more widely.

    Regards, DavidP

  • Andy

    @Richard and George

    The GCC may have decided not to prosecute chiros who repeated the claims contained in their owm leaflet and may persue other chiros who made claims for treating conditions for which there is in fact more evidence. This is a perverse situation.

    More importantly, the fact that the GCC had claims in their owm leaflets demonstrates how they were interpreting their owm code at the time, and how they interpreted evidence based practice. They (the GCC) have clearly changed their interpretation of their owm code. Chiropractors are only guilty of following the lead of the GCC.

    If chiropractors suffer losses as a result of the GCCs own mismanagement then they will be able to make claims against the GCC.

    The GCCs position is now untenable and their appraoch makes me wonder if they have seriously considered the consequences of their actions.

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    @stefaan et al, catch you again – let thread drift happen…

  • George

    Perhaps we could ask Sepp Blatter to chair the GCC. Can’t see he would do any worse.
    They (the GCC) are in the process of compiling letters to all those concerned informing them of their epiphany. They will still conitnue to prosecute all other claims that they themselves have not endorsed. Perhaps, this is thought necessary to keep Zeno’s and Perry’s blood pressure down and make them look as though they are, somehow, doing their job? Potecting the public that is, not their reputation.

    I have a mole in the GCC that’s how I know.

  • dazed

    well, yet anothe sorry tale from the GCC. If there had been a screener in place, this farago would never ave occured. The registrants will be paying for the BCA’s hubris for years to come.

    My confidence in the GCC has never been high, but what little credibilty they ever had has just disappeared down the toilet.

  • http://spinaljoint.com Richard Lanigan

    They leave all that to the chief executive Margaret Coats. Members of the GCC are there to be members and rubber stamp what she says.

    If this is true them you would have to ask questions about the legal advice the BCA gave their members, when they were just trying to help out the GCC.

  • George

    Hi Richard,
    Just heard that the GCC have been told by their legal beagles that they cannot prosecute chiro’s for claiming to treat colic; asthma; sciatica etc. Anything that they themselves were promoting in their literature or website, up until Feb 10 when they published their new leaflet. So, my question why did they not consult with their legal reps. last year?

    Not sure how Zeno or Perry are going to take this news!

  • bemused

    Rather than postulating about why patients get results with chiropractic care why not look at what actually happens? Such as decreasing inflammation as was shown in the Song paper that was presented at the International pain Conference a couple of years ago! Every scientist and researcher from all creeds out there realise that inflammation causes disease and illness, which is why the NSAID business is worth billions of dollars! Personally that knowledge is enough justification for me and it is alot more than mere placebo!!

  • http://spinaljoint.com Richard Lanigan

    They say there is one?? however its only homeopaths that recognise the mechanism or claim to understand it. For me to say there is not one would be saying they are liars and I dont believe they are, I am happy to say I dont understand what they are talking about when they say water has memory because presumably all the sewage that has passed through, would have polluted the water if this were the case.

    Chiropractic is different in that respect. No one disputes the fact spinal joints have receptors and stimulating them has an effect on the nervous system. That effect can very from one person to another just like medical interventions.

    Chiropractors have to get better at removing confounders from there studies and having more positive results. When medipractors take the money from the pharmceuticle industry they will pick up a few tricks I am sure.

  • http://www.chiropractorswarwick.co.uk Stefaan Vossen

    @Colin
    just having re-read your comment I guess that we are in much agreement in so far that the science at present “ain’t showing much good” and I fully agree that in the face of that it would only be reasonable to start asking poignant questions. At the same time I would also say that the science is flawed in a severe way in that it doesn’t actually test the model, just manipulation. Testing the model is what it’s all about and I think it is possible to work out a testable model (although many people seem to be adamant that it can’t-but I disagree)
    Stefaan

  • http://www.chiropractorswarwick.co.uk Stefaan Vossen

    @Colin
    I don’t think it can ever completely consume the entire “presumed” scope of mode 1. Thing is Mode 1 doesn’t actually have a scope as such, hence why my referring to it as the presumed scope (as I am presuming you are crossing the concept of scope of practice in mode 2 over to be significant in mode 1. Mode 2 is the process of testing and finding by trial and error which and how many conditions (and to be more precise what the predictors are for those people with the condition) do respond positively above and beyond placebo to receiving chiropractic care (whatever that means). Thing is, I personally don’t feel mode 2 has done such a great job of doing that even for back pain. Just thinking about the number of chiropractors who do not even look at gait dysfunction and malocclusion dysfunction as contributing factors (or subluxations of a non-spinal origin if you wish) makes me slightly uncomfortable about my profession, even just in the back pain field.
    I am working out a testable model, and every bit of discussion is welcomed with open arms, so please do keep on given you input, it’s valuable to me.
    Kind regards,
    Stefaan

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    Homeopaths for example complain that’s it’s too early to disregard homeopathy because they just need more time to develop the science (of water memory!). But they are completely missing the point.

    Regardless of mechanism, if you test homeopathy against placebo and nobody can find anything really wrong with the study design and the statistics say homeopathy is no better then placebo (or even no treatment at all) – and this happens agian and again – then that’s it – end of chat – forget trying to work out a mechanism – there isn’t one…

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    @stefaan,

    OK, love generalisation, even better. So the $64k question is: to what extend can mode 2 can develop? (and can it ever completely consume mode 1).

    And that is probably where we part company because much as love the idea of chiropractic and accept hypothetical plausibility, I have to start pointing at studies that exist even now suggesting that the answer is probably ‘not much’.

    That is the beauty of such studies; they cut through the plausibility issues to see if there is actually any mechanism at all (c.f. homeopathy).

    To follow your vision through from the other end; i.e, to improve the science/predictors, you have to deal with them (the studies) somehow…

  • http://www.chiropractorswarwick.co.uk Stefaan Vossen

    on your addendum: I am not sure, but personally the differentiating factor between a chiropractor and a medipractor is not what you do but why you do it. In my view
    Stefaan

  • http://www.chiropractorswarwick.co.uk Stefaan Vossen

    I can go with that… one minor proviso though: the understanding that mode 2 is deduced from 1 and is only distinct in that the expectation for improvement in that arena can be considered reasonable due to more research having been done in that area. Otherwise they exteriorly don’t really differ that much technically. They differ vastly in other ways, but those are packaging differences. My expectation is that over time and lots of work the scope of mode 2 will widen, possibly to the point of reversing the original attitude of not treating but adjusting due to lack of ability to predict. The acknowledgement of need for predictability is the only distinguishing factor between modes 1 and 2. That said mode one never spoke of treating anyway, for the very reason mentioned earlier (lack of availability of predictors).
    Kind regards,
    Stefaan

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    …and

    some people call chiropractors who only practice modality 2 medipractors.

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    @stefaan,

    It goes back to my first point of confusion, which I think I get now. Let’s see if I do :)

    There are two distinct modalities to chiropractic:-

    1. Generically optimise spinal structure/functionality with an assumption that to some extent – (and with the expectation of that extent differing from chiro-to-chiro and case-to-case) – there will be a contingent/causative increase in overall wellbeing.

    2. Specifically treat (and I mean treat) a spinal problem that the patient has identified, either by localised pain or by obvious mechanical compromised function/structure. There is no expected increase in overall wellbeing.

    Traditional chiropractors practice both modalities.

    Some chiropractors only practice modality 2.

    The AECC/WIC only teach the modality 2.

    Some students graduate having only been taught modality 2, but gradually start to embrace modality 1 over time.

    Is that right?

  • http://www.chiropractorswarwick.co.uk Stefaan Vossen

    @Colin
    Not sure I am understanding your last point?

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    @stefaan, yep I got that previously – but :) – say somebody comes in with an obviously restricted movement somewhere in their spine, presumably you would work on that specific condition? In which case you are treating a specific condition at least some of the time. It seems to hinge on whether or not we’re talking about specific MSK conditions or ‘side-effect’ conditions – which may (or may not) be improved by optimal spinal functionality.

  • http://www.chiropractorswarwick.co.uk Stefaan Vossen

    @Colin
    understood, and this distinction is a very delicate one, hence why I thought it worthwhile responding. I would make one further comment on what you said in this previous post: “adjust people exhibiting X”. Logically and grammatically completely correct but emotively tempting to conclude broader meaning from, hence why possibly contentious. Chiropractors in their most dogmatic and at the same time most liberated “adjust people’s subluxations, not conditions, the natural healing ability of the body takes care of the rest”. In effect that renders chiropractic completely and utterly non-committal in its effects and benefits. For obviuos commercial reasons that may be a difficult position to hold. Some mistakes made in the past (and believe you me they were necessary to get to this point) revolved around upping the commercial viability by lazy means, ie just “saying” that it results in X, Y or Z, rather than doing the home work.
    The problems started when the first chiropractic patient came back and said “hey you know what? I can hear now!” (poetic license used) Before that, chiropractic was perfect…
    Aaah… the human condition
    Stefdaa

  • http://spinaljoint.com Richard Lanigan

    No problem Colin, I enjoy a bit of discussion where the people involved are listening to each other and can agree to disagree about their conclusions. What I hate is where people are so dogmatic and certain of their beliefs there is no point discussing. The Asthma example was an observation not intended as proof of anything. Has happened a number of times and why I would say chiropractic is worth a try if someone has asthma, I dont advertise that I treat Asthma or Back pain.

    The quote from Bronfort is interesting:
    “It is not unexpected, however, that numerous claims
    made by chiropractors over the years, based on their
    clinical observations, have not stood up to critical analysis
    and the results of studies often suggest that these
    observations are due to placebo or the natural course
    of the disorder rather than the actual treatment. This
    has been true of a vast number of medical treatments.”

    The final sentence is the key the body has an innate healing ability. That is the basic principle behind chiropractic not that you crack every bone in their body or treat conditions. The chiropractor help creates an environment where the human body can express optimal well being. I would put the those factors in the following order in relation to their importance and how long before health would be severly compromised.

    1 O2 do ( a few minutes)
    2 H2O (seven days)
    3 Food (70 days)
    4 Love and Friendships (??)
    5 Exercise and physiological and spinal health (??)
    6 Dis – ease, or stress
    7 Illness
    8 Chronic
    9 Disease

    CAM practitioners tend to involve them selves in the first six to varying degrees, because by promoting the importance of these factors comes strong immunity and wellbeing.

    The biomedical model is called in when the self regulatory mechanism has broken down. Homeostasis is a negative regulatory feedback loop. Disease is positive feedback which leads to a break down of the system. BJ Palmer made his case for chiropractic care in relation to Dis – ease or lack of ease/stress in homeostatic regulatory process.

    The biomedical model would put vaccination as number 2 in terms of importance at preventing disease. I believe disease is very important for developing immunity and I have not vaccinated my kids and I have travelled throughout the third world with only a polio vaccine. Then again from the age of seven until I was 17, I slept in a dormitory with 100 other boys. The point I am trying to make is we are not dealing with an exact science and the human organism is not a test tube that can be relied on to obey lays of chemistry and physics.

    I dont believe in God. On the other hand I dont say God does not exist, because the vast majority of people in the world do believe and no doubt feel the benefits of having God in their lives. Who am to say they are mistaken and they must be deluded. I have no idea what they are and nether do the skeptics. Its not important in the whole scheme of things. 4 is more important that medicine to a healthy person and if the they find love and friendship in their church, or from a homeopath a chiropractor or a medical doctor, I say great because it must be better than taking anti depressants

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    @stefaan, fair enough. I’ve been using “treat” to mean adjust I guess and when I say “treat X” I mean adjust people exhibiting X (e.g. the breast cancer sentences). I’ll will take that on board. Presumably treat can also be used in a preventative way reducing incidence too.

  • http://www.chiropractorswarwick.co.uk Stefaan Vossen

    @Colin Jenkins
    I think that in your very valid point there is one more shade of grey to be added: to “treat” means to purposefully and predictably reduce the prevalence of a condition. This means I must not only know what the condition is but what causes the condition. I think we can agree that say asthma (although that is a moot point as I don’t believe anyone (chiropractor wise)actually “claims to treat asthma” even if their advertising might have said otherwise, and those who do really need to read this blog) can have many causes. Some of these asthmatic presentation might (I am just theorising here) be influenced directly or indirectly by spinal well-being or lack thereof. In those cases that changes in spinal well-being are sufficient to alter the total sum of stressors to equate be below threshold (which are likely to be individual and multifactorial, not to mention genetic) it could be that improving spinal well-being influences the experiences of the presentation. The crux of the matter as I see it is that I see the challenge to reside in the ability to identify which presentations are significantly affected by lack of spinal well-being (and neurological stress produced there-from) and which ones are not. Secondly; to reliably predict from this distinction which individual or group of individuals belonging to the greater group of, say asthmatics, are likely to improve in their symptomatic experiences. Once these predictions are found to be reliable it would, in theory, be possible to say “chiropractic care treats” certain types of asthma (hypothetical point). As it stands chiropractors seem to be able to go through this process fairly reliably in regards to back pain neck pain etc. but to a lack of clinical focus on this distinguishing process in these other arenas they are not reliably able to do this (in my opinion) in other fields. It’s a failing of the practice, but not of the theory.
    I am sure there are ways of improving this and I am fairly certain that it will produce interesting results. In my view and understanding the chiropractic theory is so far advanced that it will take some time and very specialised technology to provide tools to make these distinctions. Knowing or sensing these restrictions DD et al didn’t even bother (although they did try their hand at some technological developments) and just by-passed it by saying: we don’t diagnose, we don’t treat, we just adjust. In the light of the time,… I think it was genius. In the ligth of this time,… well, we need to get our skates on.
    Kind regards,
    Stefaan

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    …Actually we’re at that point with homeopathy now; the data is overwhelming and homeopaths are not dealing with the situation very well, they have been in denial for so long. Homeopathy is surely a dead duck.

    Given that data is starting to point in the same direction for some treatments of chiropractic (and people will use induction however often you tell them it’s not valid) does it not make sense to plan how to deal with it just in case the data spirals…?

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    @fed up

    One last try at clarification. You seem to be arguing that some chiro treatments cannot be placebo because they don’t match your quote.

    Read your quote carefully and it says “In medical research…”.

    Yes, of course, in medical *research* placebo will always be given knowingly and thus involve deception.

    In clinical *practice* things are different. You treat a patient and they report back – but if sham/no-treatment studies result in the same reports back (statistically) the (tentative) conclusion is that your treatment is either ineffective or placebo.

    And if placebo – of the best possible kind because you do not believe you are giving it – the perfect administration of placebo! Your integrity is intact.

    But read the article you quoted from further and it explains that homeopathy is (at best) placebo. Now I know there are some homeopaths that are quacks knowingly ripping off their patients, but I’m sure you’ll agree the majority probably truly believe in what they are doing, but it’s still (at best) placebo.

    My point is that, to me, the studies are tending to indicate that some chiro treatments are (at best) placebo and traditional chiropractors should start taking this on board just a bit and work out a way to deal with the data, rather than flatly denying it as we have seen in this thread, because otherwise it may all come back and bite you later (because people will question how on earth you cannot know of the data and question your integrity) and I don’t want that to happen to members of my family.

    Does that make sense…?

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    @richard

    Could be just a coincidence that it coincided with chiropractic care. I meant to write it up as a case study, I never got around to it.

    I think up to 20% of breast cancers spontaneously remiss. If you treated breast cancer the chances are you’d get some correlations with chiro treatment. Probably more than your single asthma case study. Looking at it like that and considering the probably thousands of people you have treated with asthma, yes, surely coincidence has to figure in there; if 90% of your asthma patients has the same response then we’d be cooking with gas, but I don’t see the relevance of one single case.

    c.f. MMR/autism – the maths tells you there are bound to be temporal correlations because of the age MMR is given to the child and the typical age of onset of autism. And parents are wonderful pattern matching machines…

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    @fed up,

    I’m not consciously avoiding anything, apologies if I gave that impression. The mechanism of placebo is irrelevant (and to be honest I don’t know what it is – does anybody really know?) as is the mechanism of the treatment if you are testing them side by side.

    Here’s a comment from a chiropractor on the Bronfort report:-

    “It is not unexpected, however, that numerous claims
    made by chiropractors over the years, based on their
    clinical observations, have not stood up to critical analysis
    and the results of studies often suggest that these
    observations are due to placebo or the natural course
    of the disorder rather than the actual treatment. This
    has been true of a vast number of medical treatments.”

    Your argument that it can’t be placebo (at best) because you don’t tell the patient what you are treating simply doesn’t stand up because that’s not where the conclusion of placebo (at best) comes from – it comes from the studies. The fact you don’t tell the patient is irrelevant.

    The whole point about testing self limiting conditions like asthma and colic is that if chiropractic treatment is effective the statistics will show significance over sham or no treatment. If they don’t then the treatment is placebo or the condition is running it’s normal course and chiropractic is having no effect (depending on how you tested it).

    @richard – I have been careful to stick to self limiting conditions like colic and asthma because I thought it would be a relatively easy route into a (even hypothetical) conversation about the ethics of treating placebo, ha :) But we can’t get past even a nod in the direction of placebo (which in hind sight as a philosophy of science enthusiast I should not find surprising) so I will desist; perhaps I’m being rude anyway. I came for clarification, not debate – it just kinda sorta happened.

  • fed up

    colin, you repleid to my viagra annalagy but avoided the actual meaning and mechanism of placebo. I don’t think you will find many “regression to mean ” with asthmatics. Is every side effect/change null and void unless a gold standard rct proves it’s so? We are right back at the beggining. No gold rct=no proof.

  • http://spinaljoint.com Richard Lanigan

    Most people who go to a chiropractor go because the have heard it helps with back or neck pain. When they come in you take a history and other conditions show up. After a few weeks you do a reassessment and you might ask them about their asthma. I had this guy who had been on steroids for thirty years would go to the Brompton every six months for respiratory tests. They thought the machine was broken and he wondered if it could be something to do with the chiropractic. They poo pooed the idea. He asked me next time he came in. I said I would like to think so and why not see what happens if you just use the inhalers as a prophylactic, he has not used the inhaler now for six years. Since he stopped taking the steroids his skin has become very sensitive so something has happened here beyond placebo. Could be just a coincidence that it coincided with chiropractic care. I meant to write it up as a case study, I never got around to it.

    A guy with Parkinsons came in a wheelchair with sciatica. He was told not to exert himself, I put him on a training programme fit for an elite athlete combined with chiropractic care. Its transformed his life. Is it chiropractic, exercise his diet, his new found optimism. I have lots of these anecdotes and I believe I can help anyone with a spine.

    Now if someone was to show me that my adjustment did not stimulate receptors and was dangerous. I would not do it, I check my kids every month. Now there are nutters out there who torture kids by burning them with cigarettes and the like and no doubt sceptics would view what I do as a form of child abuse, I have never adjusted a child who did not want to have it done. Parents make the choice with babies and babies dont know what they are getting or what its for. A problem with colic is the diagnosis, colic babies dont stop crying when they are picked up, so one could take an other view as to why chiropractic care was no better than placebo in these studies. You can always find something wrong with the methodology of a scientific study, thats why the measure efficacy with a bell curve because nothing works every time and there are few absolute truths, if any, in health care.

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    PS: I say at the very best because it could just be regression to mean and cog bias.

  • cj

    Hi fed up,

    Using your viagra example. I think viagra was found by accident but ignore that…

    “No sorry colin that doesnt fit. Its like saying erections after the 1st viagra trials were placebo.”

    As I see it…

    Give viagra, result erection, got correlation, studies test against placebo, +ve for viagra, got causation, not got placebo.

    Treat spine, feedback of improvements for “regression to mean” conditions, got correlation, studies test against sham treatments, +ve for both, not got causation, got placebo.

    Patient visits chiropractor with conscious and unconscious expectation, notices beneficial correlation for asthma later, concludes chiro causation but at the very best it’s placebo because of the above studies.

    Assume for the moment that chiro treatments for colic/asthma etc are placebo – I accept I’m not arguing my case very well. Would you be happy treating them in that knowledge. I think this is an interesting question that many (“alternative”) areas of the health sector are going to have to ask themselves soon…

  • cj

    @fed up – having trouble posting – did reply – didn’t show up – reposted – didn’t shoew up but says duplicate. weird. will wait and see it it shows up. thanks for the conversation today.

  • http://welshandgrumpy.blogspot.com/ colin Jenkins

    Hi fed up,

    Using your viagra example. I think viagra was found by accident but ignore that…

    “No sorry colin that doesnt fit. Its like saying erections after the 1st viagra trials were placebo.”

    As I see it…

    Give viagra, result erection, got correlation, studies test against placebo, +ve for viagra, got causation, not got placebo.

    Treat spine, feedback of improvements for “regression to mean” conditions, got correlation, studies test against sham treatments, +ve for both, not got causation, got placebo.

    Patient visits chiropractor with conscious and unconscious expectation, notices beneficial correlation for asthma later, concludes chiro causation but at the very best it’s placebo because of the above studies.

    Assume for the moment that chiro treatments for colic/asthma etc are placebo – I accept I’m not arguing my case very well. Would you be happy treating them in that knowledge. I think this is an interesting question that many (“alternative”) areas of the health sector are going to have to ask themselves soon…

  • fed up

    i still don’t agree that these cases are placebo.

    “A placebo is a sham or simulated medical intervention that can produce a placebo effect. In medical research, placebos depend on the use of controlled and measured deception. Common placebos are inert tablets, sham surgery,[2] and other procedures based on false information”

    No information given and it certainly isn’t deception.

    “A placebo has been defined as “a substance or procedure … that is objectively without specific activity for the condition being treated”.

    Again if an improvement in a condition is reported,but the condition wasn’t treated how can it be placebo?

  • http://welshandgrumpy.blogspot.com/ colin Jenkins

    Hi Stefaan,

    Yes I think cognitive bias is probably involved like it is in other areas. Richard explained to me how a chiropractic treatment works – optimise the spine functionally and hope for improvements later.

    Even if patients go in with no conscious expectation (unlikely?), they will be unconsciously affected by a lifetime of experience that kind smiley people in white coats help make stuff better.

    So the patient will make temporal correlations later and assume chiropractic causation, and cognitive bias will kick in too with patients remembering when treatments seemed to help more than when they didn’t, which may also mean that feedback to the chiropractor is slanted positively by the bias.

    One comes to this conclusion for conditions like colic and asthma because of the evidence. Obviously for conditions where there is no data one can say nothing at all; induction is seductive but it would be naughty!

    So this is yet another reason why the GCC bailed too soon – some conditions have absolutely no associated evidence at all, so if the patient is happy, keep on treating them.

    Like I said before I think the interesting question is: if some chiropractic treatments are largely placebo, is it ethical to continue to treat them…? I think a case for Yes could have been made but it’s too late now given the GCC position.

  • Stefaan Vossen

    I think that to some extent Colin is saying (please correct me if I am wrong) that we all see what we expect to see and ignore those things that do not fit our expectations. It’s a human trait which is unavoidably providing bias in all we do. As an academic aside: it is also a trait which has promoted cerain survival strategies and has evolved to something rather aptly name the X-factor gene (ie the personality trait of thinking you’re good at something where you really aren’t, but in doing so acquire a perceived and temporary advantage over the less boisterous which can be capitalised on with eager mating).
    The one thing we cannot ignore however is that entire businesses and reputations (an argument very strongly held by those who have built their practices primarily by word of mouth, but word of mouth might indeed increase the placebo effect) are built on the benefits acquired or at least perceived to have been acquired by patients. One of the arguments is that it is not really relevant whether or not they have been acquired by means of placebo process, but that they have been acquired full stop. Many chiropractors will hate me for acknowledging this but I must also add that I simply cannot believe placebo to be a significant contributor. A contributor, yes. A significant one,… not likely, due to the shear percentage level of improvements.
    Kind regards,
    Stefaan

  • http://welshandgrumpy.blogspot.com/ colin Jenkins

    A friend of mine was offered a free reki massage. She said she went with no conscious expectation. Had the massage and felt weirdly good afterwards, therefore perhaps there is something in reki.

    What she forgot is that we have unconscious expectations too – especially to people in white coats being nice to you.

    And people are natural pattern matching machines – we seek out correlations everywhere…

  • http://welshandgrumpy.blogspot.com/ colin Jenkins

    Hi fed up,

    I suspect we are going to have to agree to disagree. You seem to be denying the existence of data pointing to a tentative conclusion that chiropractic treatment for colic is placebo. Given that, my explanation fits. Without that data, you are right of course; a conclusion of causation after chiropractic treatment would be perfectly reasonable, though not necessarily correct.

  • http://welshandgrumpy.blogspot.com/ colin Jenkins

    To clarify, I am not arguing that chiropractic is placebo, just that, to me, the evidence seems at point at chiropractic treatment for classically self regulating “regression to mean” conditions like colic and asthma is likely to be placebo and it would no harm for trad chiros to give a nod in the direction of the evidence…

  • fed up

    If the patient had no preconceptions as to chiro and asthma its a side effect.

  • fed up

    No sorry colin that doesnt fit. Its like saying erections after the 1st viagra trials were placebo.

  • http://welshandgrumpy.blogspot.com/ colin Jenkins

    Hi fed up,

    But the patent will have expectations. Go to chiro – notice correlation with asthma some time later – assumes causation – tell chiro.

    It all points to placebo to me given the “regression to mean” ailments involved which always tend to pop up when the treatment is in fact placebo and the data summarised in studies like the Bronfort report.

    Richard, please be assured I am not questioning the integrity of anybody.

  • http://welshandgrumpy.blogspot.com/ colin Jenkins

    “Of course they wont [studies affect trad chiro] because chiropractic is not a treatment for back pain no more than its a treatment for colic, a chiropractor tries to maintain spinal function as best as he can and hopefully observes improvements to a persons wellbeing as a result.”

    Assume for the moment that studies overwhelmingly support the hypothesis that chiropractic treatment for colic is no better than sham treatment for colic (placebo) and somebody comes in asking for colic treatment, and just colic treatment. Would you be happy to provide it?

  • http://spinaljoint.com Richard Lanigan

    Colin,
    I dont believe for a minute that chiropractic is a placebo however there is always the posibility that an intervention could be a placebo or a nocebo and the benefits should outweigh the risks. I have had one patient who stoped care because I hurt his rib. The thing about chiropractic is when you adjust someone you are actually stimualting joint receptors. You are actually doing something that is measurable so you can not compare it with taking a sugar pill. Stimulating receptors has an inhiitory efect on pain transmission and pain affects the Central Nervous System. For these reasons people always feel a difference, it may be worse it may be better. If its worse you do something different.

    I worry when they report they feel better after an adjusment but it only lasts a few hours, and I have been seing them for a few weeks.Patients are guided by their pain levels whether I like it or not. Do I do ask them to bring in the deeds of their houseand and pay up front for a years treatment? Or say I dont know what going to happen when the joints are moving symetricly and they have to decide whether they want to give it a few more weeks. I would hope all chiropractors would say they latter because even with pain syndromes and decent evidence or asthma and weak evidence, clinicians will never know how its going to pan out. If your doctor, chiropractor, lawyer, banker, lacks integrity you have a problem. I can not stop skeptics saying I lack integrity. I would worry if people who knew me said I lacked integrity.

    Many in the chiropractic profession do not like me, no one has ever accused me of lying or lacking integrity, a chiropractors integrity is far more important than his evidence.

  • fed up

    Hi Colin, I don’t see how it can be classed as placebo if there has been no mention of the disorder being treated. I don’t say I will hopefully help with your low back, but your asthma may improve. They convey to me that these disorders have improved without prior mention of them. Placebo can work if you think you are taking/getting something for that particular problem.

  • http://welshandgrumpy.blogspot.com/ colin Jenkins

    Hi Richard,

    Thanks for answering.

    “I dont hear people criticising the use of Sports Psychologists as being only a placebo,”

    As far as I can tell it’s to do with whether or not the treatment is considered as potentially dangerous. Homeopaths have for example starting to claim all sorts of nonsense like curing cancer, aids and malaria – it deserves the attention it’s getting – it’s dangerous. But I agree that “we don’t care if it’s placebo, our patients are happy” is a valid platform to argue from if the treatments are safe and not applied inappropriately. But then there are great counter arguments…

  • http://welshandgrumpy.blogspot.com/ colin Jenkins

    Hi fed up,

    “I have no rct that I can point to to confirm any of it, but every chiro you speak to will see similar changes. How can it be explained?”

    Well, take asthma/colic for example. There seem to be good studies coming back that say chiropractic does no better than placebo, so it can be explained by placebo. I know that is not what you want to hear, but that is the inescapable conclusion. Unless the studies are crap. Does it matter that it’s placebo? – I think that’s a much more interesting question. Richard says he doesn’t care and I think one can make a case for that approach if you can demonstrate beyond any doubt that chiropractic treatments are both safe and not performed inappropriately. The GCC could have done that but they bailed instead.

  • http://spinaljoint.com Richard Lanigan

    Hi Colin,
    You raise lots of great points that the entire profession should be disussing, all wings of the profession fear being wrong so they concentate their efforts on preaching to the converted, hence the mess.

    What is the USP of chiropractic and what will it be if the profession goes down the route of medicalisation, that is critical, even if only from a business perspective. The World Federation of Chiropractic defined chiropractics USP in 2005 http://www.wfc.org/website/index.php?option=com_content&view=category&layout=blog&id=64&Itemid=93&lang=en
    The BCA/GCC alliance did attach much importance to it because a major part of this WFC “brand chiropractic” is chiropractic does not involve the use of drugs, when necessary these patients should be referred to a medical doctor. This is my view I am not saying patients should not have drugs, I am saying , I became skilled at what I do by practising and gaining experience. Some people will never be any good because the dont have the psychomotor skills. Just like some people will never be any good at football or tennis.
    Question is do we create a vehicle for those who dont have the skills to perform skillfull chiropractic adjustments so they can prescribe instead and use electro therapy, like physiotherapists for example. Chiropractors can then boast our package includes X-ray and manipulation. The bonus being the chiropractic needs funding for research and we could gets lots if we were to include a few Nurofen with our adjustment s. The pharmaceutical industry is the goose that will lay the golden eggs for the UK chiropractic profession.
    Ultimately chiropractors themselves will have to choose and it will be down to numbers. The skillfull ones will want to remain separate and distinct from medicine because they know they have a USP, thats why I was not worried and resigned from the register. I am good at what I do no matter what people call me and the cleare the divisions are the better for my businesss. The crap chiropractors will want to blend into medicine and where it does not matter how good you are. In the NHS system you will get patients and earn a decent living and you would have to do something really bad before they would strike you off.

    Chiropractors have been suspended by the GCC for criticising a medical doctors treatment, I spend at least 30 minutes with a client on the first visit the average GP has 7 minutes to do an examination and assessment. A proper history takes at least ten minutes. There is no comparison in the service I provide and what people get going to their GPs, many GPs would starve if they were relying on patients to pay for the service they provide.
    Dentists are leaving the NHS in droves because it is very difficult to provide the service people need. The NHS needs to offer spinal manipulation for lots of people at a knocked down price and the GCC/BCA alliance are happy to provide it.

    So to your question “What will happen to traditional chiropractors” they will be succesfull as they always have been, and UK chiropractors will go the way of Osteopaths in the US?

    “Are the studies thus far really good enough to kill of traditional chiropractic”? Of course they wont because chiropractic is not a treatment for back pain no more than its a treatment for colic, a chiropractor tries to maintain spinal function as best as he can and hopefully observes improvements to a persons wellbeing as a result.

    “The libraries at AECC/WIC must be full of traditional chiropractic books – where are the medipractic teaching materials coming from? Have they burned all the traditional chiropractic books?” They are not “medipractic” books they are medical books and focus on treating musculoskeletal pain syndromes. I have no problem with that, but why ignore the principles of chiropractic to ensure your students will follow the medipractor path.

    “If the GCC is so confident of medipractic, why do they allow traditional chiropractic to continue in practice (even if you can’t advertise it) – that seems unethical if they are right” Mooooooooooooooooooney” what Sid Williams called the money hum.

    “Why the hell did the BCA sue Simon Singh when in fact they agreed with him”! Because Simon direct his comments at the wrong association. For the BCA it was like a homophope being called gay and they were furious and reacted rightously as you would expect a biggot to react.

    “No doubt much of this is naive because it’s not my field but it should give you a feeling for how confusing it all is to those of us looking in”.
    I have been in it for 20 years and I am confused.Thats what you get when you are led by donkeys. Last week the BCA hated the McTims. Now they use them to give credence to their rejection of subluxation theory and even worse the MCtim Association goes along with it.

    “I really want to know how the universe and everything emergent from it actually works and the only way I can think of doing that is to not follow any predilections, keep an open mind and tentatively follow the best (minimally subjective) evidence to date. As far as I can tell, applying that to chiropractic leans one towards placebo except for some very specific conditions..”

    If what I do works because I have a nice smile, rather than the adjustment, thats fine by me, it fits in with the traditions of chiropractic that each person has an innate intelligence that regualtes and heals. The point is something I do helps people or we all believe it does and we are all happy believing that. I dont hear people criticising the use of Sports Psychologists as being only a placebo, people needs all sorts of help and people should be free to choose what works for them. My Granny fractured her hip in the 60s went to Lourdes and came back transformed, should we as a society stop people going to Lourdes, when there is no proof that God exists? The Priest that advised her to go is he a criminal. Should the skeptics now go after all the people who pray before they go to bed because it will get them into heaven.

    I am pretty sure a few skeptics have checked me out as have the GCC private investigators. I am probably the most checked out chiropractor in the world and no one has found me doing anything unethical or dishonest because I never have and never would rip of a client.

  • Stefaan Vossen

    HI Colin,
    I have decided to make a post in reply to your questions (as you can guess there is quite a big load behind some of even the fairly straight forward questions you asked)which will be posted on the skeptic pit shortly (tomorrow I think). I think you made it really worthwhile to respond to them in this way and look forward to bringing you my view on matters.
    Kind regards,
    Stefaan

  • fed up

    Hi Colin, I know I alter joint position, range of movement and function and if I want to say I have corrected a subluxation then I should be able to do so. Nearly everybody I see is for neck or back pain but the amount of times I’ve told the patient feels happier, they can think clearer, their asthma has improved, their IBS is loads better, their PMT and menstrual cycle has improve and become regular, their eye sight has improved(backed up by the optician). I see footballers that after treatment they tell me the ball goes where they want it to, golfers who after a visit can hit the ball straight. Years ago when a child with aspergers was seen by a mct chiro and improved I saw several kids(over 8yrs old)with aspergers and autism. I told every parent I have no idea why it worked and that I had no experience with it but I will try if they wanted me too. Every one improved from improved motor skills to sleeping through the night and not wetting the bed.
    I have no rct that I can point to to confirm any of it, but every chiro you speak to wil see similar changes. How can it be explained? is it desire? or do you need more data?

  • http://welshandgrumpy.blogspot.com/ colin Jenkins

    Hi fed up,

    Apologies; I have to admit to getting the impression you were a more traditional chiropractor…

  • fed up

    Hi Colin, here is my side of the research argument as posted on skeptikats blog. Have a read of my comments and let me know what you think.
    http://www.skepticat.org/2009/10/chiropractic-is-crap/#comments

  • fed up

    Hi Colin, I would describe myself as a chiropractor. I have never used the title Dr. and I don’t use the term subluxation. Iam probably more akin to the medipractors,BUT I still would defend the right for chiros to use the term. I still cannot accept a skeptic with no formal training in the subject or education in research can dictate to a profession what it can and can’t do. What I also find difficult to comprehend is the view that chiros spend a majority of their days applying a placebo to certain conditions. In the whole of june EVERY patient that has come into my room has done so for low back or neck pain. Every single one. So Iam actually practising EBM backed up by rct’s. But get this, so is every other chiropractor. Some may want to defend the subluxation and thats fine, I would defend it, but even those wellness chiros will spend 95% of their time dealing with Low back and neck problems.

  • http://welshandgrumpy.blogspot.com/ colin Jenkins

    Hi fed up,

    Chiropractic is of course anecdotally effective, as is homeopathy.

    But as I said to my sister, the problem traditional chiropractors (healthy spine can improve general well being) have is that more and more good (effectiveness and efficacy) studies are coming in showing that it is probably nothing more than placebo for the majority of conditions.

    The GCC’s response to that is to bail and reinvent chiropractic as medipractic. But that ignores the obvious psychology and is too quick. Traditional chiropractors are not going to just say “oh yes you’re right, what I’m doing is just placebo, I’ll stop now”.

    You/they are going to fight tooth and nail and quite rightly too – it’s what any human beings would do when something they love and believe in is questioned and it’s naive to expect any other response.

    However, I think traditional chiropractors do need to at least start taking on board the research a wee bit and come up with robust arguments, either validly criticising the research (because it will have varying quality) or robustly arguing for knowingly treating placebo (tricky).

    It’s going to be a slow process, but surely you have to at least give a nod in that direction. I think if I was a chiropractor I’d be becoming on expert of statistics very quickly.

    This is a bit jumbled, sorry. I know that traditional chiropractors have an awesome knowledge of the body, I know you passionately believe in what you do and that your patients are happy, but I believe you have to start acknowledging the impassionate data coming back; if even a little bit for now.

    I understand the appeal of chiropractic. Wouldn’t it be great if the spine was a device which if kept physiologically optimal helped to maintaining overall well being. And the appeal is buffered by multiple hypothetical plausibilities because of the mass of nerves involved… But I really think traditional chiropractors need to start considering whether or not that appeal is rooted in desire or data…

  • fed up

    “If a treatment has some plausibility there are at least two ways to test it. Verify the physiology/science and/or do efficacy and effectivemness studies – because of course a plausible treatment is not necessarily effective or efficacious (I think this is the flaw in fedup’s arguments).”

    Hi Colin, as a chiropractor I am judged totally on my effectiveness. Not because what I say or do is plausable. Chiropractic has only survived because it is effective.

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    Actually I should have said confusing to *some* of us looking in and apologies for all the typos… I’m sure you don’t in fact treat patents :)

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    Hi Stefaan,

    My sister is a chiropractor (AECC) and my nephew is currently at WIC, so I am interested in the subject. While I don’t self-identify as a skeptic, I do let empericism, rationalism and skepticism guide my worldview. I am as confused as hell about chiropractic in the UK. Perhaps I can explain how I see it and tell you what confuses me, because I’m probably not alone…

    Any named area of medicine (ot anything else for that matter) needs a USP to justify it. As far as I can tell the chiropractic USP is something like – the structure of the spine can compromise (spinal) neural activity which in turn can compomise overall wellbeing – chiropractors keep backs at optimal functionality which can help to achieve optimal wellbeing.

    I think that unlike homeopathy, chiropractic actually does have some plausibility. The nerves do go through the spine, it seems plausible that nerual activiy can be affected and it seems plausible that in turn other parts of the body can be affected. Chiropractors have various physiological hypotheses about how that can happen (like affecting homeostasis) but nobody really knows what is going on. However, patents seem to feel the benefit so everybody is (was) happy. But of course it could be placebo. And in today’s context *knowingly* treating placebo would be unethical (homeopathy), so steps have to be taken to discover to what degreee chiropractic is placebo.

    If a treatment has some plausibility there are at least two ways to test it. Verify the physiology/science and/or do efficacy and effectivemness studies – because of course a plausible treatment is not necessarily effective or efficacious (I think this is the flaw in fedup’s arguments).

    As far as I can tell there is no good validation of the science/plausibility but good efficacy/effectiveness studies have been done and summaried in the Bronfort report, which concludes chiropractic is really only beneficial for lower back pain (and headaches). So the evidence is pointing in the direction of placebo.

    These studes have been pointing at this conclusion for ages, which presumably is why GCC/BCA/AECC/WIC have been moving away from the traditional chiropractic USP and completely redefining it as a local manual therapy – what Richard calls medipractic.

    The interesting thing is that (as Richard has said before), today’s students may well be graduating as medipractors but soon turn into chiropractors and my sister would not be upset to say she is an example of this.

    It’s worth mention that there are some that oppose the medicalisation of chiro at AECC – the guy that does the golf research (I forget his name), but lone wolfs cannot be used to claim that traditiional chiropractic is still being taught at AECC – it’s not – it really isn’t.

    Confusing things to me…

    Do tradiitonal chiropractors ‘fix’ the structure/functionality of the spine in general for all ailments, or have you found that some ailments benefit from manipulation of specific areas of the spine?

    The GCC/BCA/AECC/WIC have effcticvely killed chiropractic – it does not exist anymore. To exist with a unique name you need a USP and modern chiro does not have one – it will have to merge with something else, or something else merge with it or loose it’s identity completely.

    What will happen to traditional chiropractors?

    Are the studies thus far really good enough to kill of traditional chiropractic? My brother is a dentist and he says there are lots of treatments that while plausible have no quantitative or qualitative evidence base, but he’s not not forced to stop advertising them and students are still taught them. Have the GCC/BCA gone too far?

    The libraries at AECC/WIC must be full of traditional chiropractic books – where are the medipractic teaching materials coming from? Have they burned all the traditional chiropractic books?

    If the GCC is so confident of medipractic, why do they allow traditional chiropractic to continue in practice (even if you can’t advertise it) – that seems unethical if they are right.

    Why the hell did the BCA sue Simon Singh when in fact they agreed with him! To placate members?

    No doubt much of this is naive because it’s not my field but it should give you a feeling for how confusing it all is to those of us looking in.

    I really want to know how the universe and everything emergent from it actually works and the only way I can think of doing that is to not follow any predilections, keep an open mind and tentatively follow the best (minimally subjective) evidence to date. As far as I can tell, applying that to chiropractic leans one towards placebo except for some very specific conditions…

    Colin J

  • http://spinaljoint.com Richard Lanigan

    The difficulty we have as a profession is when someone like Steffan or any traditional chiropractor makes a good case to Zenos narrow interpretation of Subluxation and along comes the president of the British Chiropractic Association and announces that he agrees with practically everything Zeno says. Richard Brown does this in the Summer edition of Contact; Brown states that chiropractors claim “subluxation is the cause of illness and disease” THis is the piece:

    “Chiropractic’s seemingly indissoluble attachment to the concept
    of the Vertebral Subluxation Complex (VSC) has at last, in
    the UK at least, been challenged, resulting in a clear statement
    that there is an absence of evidence to support claims that it is
    the cause of illness and disease. Progress in the profession has
    been hampered for decades by a blind adherence to unproven
    theories and ambiguous terminology. The very fact that the
    concept of VSC has been discarded by AECC, WIOC and the
    MCC and is taught only as an historical concept, sends a strong
    message that as a profession we should be embracing a clear
    model of evidence-based care, away from historical principles
    and speculative theory.

    Perhaps now that Richard Brown has said this Zeno et all will forgive Richard and Tony Metcalfe for hiring lawyers to argue the case for their version of chiropractic to Simon Singh. I read the Zeno blog and what struck me about it, was how credible their arguments are sounding in the light of the incompetence we have seen by the BCA/GCC alliance.

    In the comments Blue Wode has attached a copy of a letter from Margaret Coats when she was defending the Subluxation which makes a mockery of their recent statement “The General Council has never considered the research evidence for the chiropractic vertebral subluxation complex” , They told me in a FOI in 2007; “The GCC subluxation was based on the WHO definition of subluxation and 160 people, including experts and national authorities and professional and NGO’s, in over 54 countries had reviewed this document prior to publication”. Margaret Coats told Blue Wode “That there is evidence for many of the interpretations of the word, especially those that refer to dysfunction of the spine as a source of pain and disability” No doubt Margaret Coats has had a bang on the head since writing all of this; http://web.archive.org/web/20060924185126/www.chirovictims.org.uk/images/GCC+letter+Page+2+17+June+2004.pdf

    Perhaps the skeptics should reconsider there use of such unreliable sources to support their arguments against subluxation theory. We have the chief executive of the GCC making it up as she goes along and we all saw what happened to Richard Browns plethora of evidence last year. Or have they now become reliable?

  • CDC

    Good work so far, Stefaan and GREAT work Richard. I am proud of you and truly impressed by the hard work you have put in! You are a chiropractic warrior.

    It seems that there are active skeptics all around the West world at the moment. I once read that Wilks (in Wilks et al vs AMA) said that whenever the allopathic medicine is in trouble they always increase their attacks towards other health care practitioners, usually chiropractors.

    With multi-resistance bacteria and total-resistance bacteria and a medical system that is about to collapse they are in trouble. The public are not buying it anymore like they did in the days before internet. They are vaccinating rubella, measles etc that we (at least I) had as a child. These “diseases” are to strengthen our immune system and make us ready to be able to fight off more serious conditions in our adult lives. Vaccination leads to a weaker immune system which causes an increase in chronic diseases later on in life. We are getting there now and it is just getting worse. They are inventing new diseases to sell more pills to the adults. Adult ADHD might be the next big one. For example if you have forgotten your keys the last month, have trouble concentrating sometimes and if you get angry once in a while you will soon be diagnosed adult-ADHD. This and other conditions like this does not make sense to the public.

    We as chiropractors practicing chiroprac-tic are on the cutting edge and the chiropractic life-style makes sense to the public. Cutting off body parts and giving people life time drugs, does not. If we do not protect our principles and our rights to practice true chiropractic someone else already in the system will take our position. They tried to exterminate us in the past, now they will try to assimilate us in a physio-therapy low back pain corner and some of our colleagues are happy to sit there. The Danish chiropractic association seem to have lost the battle. Which countries might follow next? UK? Belgium? Sweden? Norway?

    I just read in the paper the other day that the most powerful man in the world is the president of USA. The THIRD most powerful man is the president of the European Medicines Agency (EMA). Lets face it, whatever we lack in power, financial resources, practicing members etc our profession make up in common sense towards health. Let´s not give that up.

    Keep up the good work! :)

  • fed up

    The GoC is damn good, this is how it describes osteopathy. Pity we can’t join.

    What osteopathy is
    Osteopathy is a system of diagnosis and treatment for a wide range of medical conditions. It works with the structure and function of the body, and is based on the principle that the well-being of an individual depends on the skeleton, muscles, ligaments and connective tissues functioning smoothly together.

    To an osteopath, for your body to work well, its structure must also work well. So osteopaths work to restore your body to a state of balance, where possible without the use of drugs or surgery. Osteopaths use touch, physical manipulation, stretching and massage to increase the mobility of joints, to relieve muscle tension, to enhance the blood and nerve supply to tissues, and to help your body’s own healing mechanisms. They may also provide advice on posture and exercise to aid recovery, promote health and prevent symptoms recurring.

  • fed up

    I posted this on Skeptic baristas blog, never got a reply.

    I’m not hoping or expecting, as I’ve said many times in the past I don’t use the term subluxation. But chiros and osteos correct “something” with an adjustment/manipulation. Agreed? If the something they found and then adjusted, which was shown to be positive in a RCT, was given a name then whatever that “thing” is has to be there. Agreed?

    .
    “BUT I could show you what a chiropractor means when he talks about subluxations, or when a osteopath talks of a lesion, “The osteopathic lesion is not ‘a bone out of place’ but any obstruction to physiological processes or irritation” or when a physio talks of malalignment syndrome “The Malalignment Syndrome describes a newly recognised syndrome that commonly occurs in patients seen by physicians, chiropractors, physiotherapists, massage therapists and veterinarians.” by “Wolf Schamberger, Clinical Associate Professor, Department of Medicine, Division of Physical Medicine and Rehabilitation and The Allan McGavin Sports Medicine Center, University of British Columbia, Vancouver, Canada”
    They all mean the same thing.
    “In this book the author presents the evidence for looking at the group of symptoms involved and treating them as a single syndrome with a single cause – biomechanical malignment.”

    So, there is evidence to show that manipulation works, so as far as I can see watever the practitioner calls what he’s manipulating it has to be real. Agreed?
    We could all call it a Higgsluxation.

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