These are my comments on the article professor Edzard Ernst had published in the New Scientist last summer about chiropractic.

April 30, 2010
By

super hero My comments on this article are in red.

What you should know about chiropractic ?

Just what is chiropractic, and do the claims of chiropractors stand up to scrutiny?

FOR many people, chiropractic appears almost mainstream. Some chiropractors even call themselves “doctor”. In the UK, chiropractors are regulated by statute, and in the US they like to be seen as primary care physicians. It is therefore understandable if people hardly ever question the evidential basis on which this profession rests.

I would argue there is more evidence in support of chiropractic than any other CAM intervention. Because there is more research it gives sceptics like Professor Ernst some research to criticise and write about. I have no problem with that, perhaps the chiropractic profession would get less criticism from Ernst if they did no research at all. I would have a problem with that and so would my colleagues.

The origins of chiropractic are surprising and rather spectacular. On 18 September 1895 Daniel Palmer, a “magnetic healer” practising in the American Midwest, manipulated the spine of Harvey Lillard, a janitor who had been partially deaf since feeling “something give in his back”. The manipulation apparently cured Lillard of his deafness. Palmer’s second patient suffered from heart disease, and again spinal manipulation is said to have effected a cure. Within a year or so, Palmer had opened a school, the first of many, and the term he coined, “chiropractic”, was well on its way to becoming a household name.

The only true cure

Palmer convinced himself he had discovered something fundamental about human illness and its treatment. According to Palmer, a vital force – he called it the “Innate” – enables our body to heal itself. If our vertebrae are not perfectly aligned, the flow of the Innate is blocked and we fall ill. Chiropractors speak of these misalignments as “subluxations” (in conventional medicine, a subluxation means merely a partial dislocation). The only true cure is to realign the vertebrae by manipulating the spine, and in the logic of chiropractic it follows that all human illness must be treated with spinal manipulations. Many chiropractors also assert that we need regular “maintenance care” even when we are not ill so that subluxations can be realigned before they cause a disease. In the words of Palmer “95 per cent of all diseases are caused by displaced vertebrae, the remainder by luxations of other joints”.

DD Palmers’s hypothesis was that interfering with nerve function would affect optimal well-being, he explained his theory around “displaced vertbrae”. Palmer’s understanding of the effects of spinal manipulation should be viewed in its time (the late 19th century) when surgery had a mortality rate of 76%. I know of no 21st century chiropractor who would explain chiropractic as Palmer did, or a surgeon who would operate in his street clothes without a mask.Perhaps Ernst does know some.

All diseases are caused by ‘subluxations’ blocking the flow of the ‘Innate’

This is bulshit! I have written many articles about this use of the word disease in relation to chiropractic and this is a classic example of people quoting Palmer selectively and out of context. In their efforts to teach medicine at many chiropractic colleges they avoid the history  of chiropractic. As a result many UK chiropractors are ignorant when it comes to discussing the origins of chiropractic and are embarrassed about it.

DD Palmer wrote one book “The chiropractic Adjuster” His son BJ wrote many and collectively they are called “Green Books. The book that most accurately describes the teachings of the Palmers was written by R.W. Stephenson’s in 1920 he compiled his list of “chiropractic principles” in his“Chiropractic Textbook”, BJ Palmer praised him for compiling the principles of “my writings into systematic organised manner so anyone could easily find “what chiropractic is, Is not; What it Does and does not; how and why it does what it does not” Lets see exactly what Palmer says about disease.

Modernist chiropractors and sceptics deliberately interpret the principles literally without reference to the time they were written in or the language of that time. The best example is the way they ignore the little weeny hyphen in Palmers dis-ease (Principle 30 “The Causes of Dis-ease”). Stephenson clearly states in the book “Disease” is a term “used by physicians for sickness. To them it is an entity and is worthy of a name hence diagnosis”.

Stephenson describes Dis-ease (with a hyphen) as “a chiropractic term meaning not having ease. It is a lack of entity It is a condition of matter when it does not have property of ease. Dis-ease is the condition of tissue cells when there is uncoordination”. Stephenson goes onto say, “if tissue cells are not coordinating some tissue cells will be made unsound, therefore they are sick and not at ease. By deconstructing chiropractic down to a vitalist level of cell communication we are going beyond nerve interference and into the realms of neuroscience that Candice Perth would describe as the “molecules of emotion” 80 years later. Anyone who would state “subluxation chiropractors” claim to cure all “disease” is either disingenuous or ignorant. I have no idea which one applies to Professor Ernst.

This bit of history is important because it explains why many chiropractors treat all sorts of conditions, not just back pain. In fact, in the early days, back pain was not an issue for chiropractors at all. Today they are divided into roughly three camps. One adheres religiously to Palmer’s gospel – indeed, at one stage Palmer considered establishing chiropractic as a religion. Another has moved on and now employs a range of non-drug treatments in addition to manipulations, mainly for treating back pain. The third group is situated somewhere in between these two extremes and, at least occasionally, treats many conditions other than back pain.

No problem with that I would be in the third group. Harder to tell you which association is in which, they tend to mix and match. BCA would be more group one and presumably why Tony Medcalfe was furious when Simon Singh lumped him in the first group (they are keen on chiropractors having prescribing rights). It was a bit like Simon Singh accusing a homophobe being of being gay and the homophobe needs to show everybody how macho he is and goes to court for defamation. Many chiropractors did laugh when they read the article.

If you find this hard to believe, here is the evidence. A 2004 survey by the UK General Chiropractic Council revealed that most chiropractors believe they can treat asthma (57 per cent), digestive disorders (54 per cent), infant colic (63 per cent), menstrual pains (63 per cent), sport injuries (90 per cent), tension headaches (97 per cent) and migraine (91 per cent). According to a 2007 survey, 69 per cent of all UK chiropractors see themselves as more than just back specialists, and 76 per cent consider Palmer’s original concepts to be “an important and integral part of chiropractic”.

Bloody right, empirical evidence its called. Chiropractic is a separate and distinct profession and those chiropractors who want to turn it into a bio medical speciality for the treatment of pain syndromes.  I say “Over my dead body”

Pre-scientific

So, are they right? Palmer’s concepts of the Innate and subluxation are pre-scientific and wacky, but that in itself needn’t mean that the treatment is not helpful. We therefore need to ask, how good is chiropractic spinal manipulation in treating anything?

What is pre-scientific and whacky about homeostasis and spinal joint dysfunction or innate and subluxation, someone please tell me. I have made some comments on subluxation on the discussion on Guardian.co.uk, and was wondering if any chiropractors have anything to add.

The answer is not clear-cut. For back pain, there is some encouraging evidence. Chiropractic manipulations have been shown in several clinical trials to be as effective as standard treatments. One needs to know, however, that standard care is not very effective for bad backs, and studies that adequately control for placebo effects tend to arrive at less positive conclusions. When my team in Exeter reviewed data from these more rigorous trials we concluded that “spinal manipulation is not associated with clinically relevant specific therapeutic effects” (Journal of Pain and Symptom Management, vol 22, p 879).

For virtually all the other conditions which chiropractors treat, where rigorous trials have been done, the evidence is weaker. In some cases, the most reliable studies have found that spinal manipulation is ineffective.

Chiropractic is a skill, some chiropractors are very good at spinal adjustment and some are crap. The crap ones are now looking for prescribing rights to see if that helps them get better results, if a chiropractor offers you NSAIDS run a mile. These chiropractors will probably end up doing research and teaching at chiropractic colleges (apologies to teachers like Alf, Kent and Chris and others who I know have a vocation to teach) Researchers are not the best judges of who is technically proficient for adjusting in a trial. Not so many variables when you compare a drug to a placebo in a trial. Some adjustments may be no more effective than the placebo adjustment, Just as Andy Roddicks service is more powerful than my service.

You need speed and control to do an effective adjustment some never master it in their entire careers. Chiropractic students are chosen on A level results when in fact the should be chosen on psychomotor skills. What can I say, the evidence is not good enough and does not reflect what some colleagues and I see in practise every day, especially in relation to asthma.

Not justified

Chiropractors and many of their professional associations often claim otherwise, but a few do acknowledge this problem. In 2001, one team of chiropractors looked at this issue, and their conclusion was blunt: “The largest professional associations… make claims for the art of chiropractic that are not currently justified by available scientific evidence”. Since then, several investigators have come to similar conclusions.

The issue is not just whether chiropractic treatments work. There is also the question of the safety of chiropractic spinal manipulation, a matter that few people seem to be aware of. Several big studies have shown that a large proportion of patients experience side effects after receiving chiropractic spinal manipulation. Luckily these complaints – mostly pain – are not normally very severe and are usually gone after a day or two.

There have, however, been several hundred cases of potentially very serious complications associated with this treatment. Extreme chiropractic manipulation of the neck can damage one of the two vertebral arteries that run roughly parallel to the upper spine and supply part of the brain. The consequence of such a “vascular accident” can be a stroke, and several deaths are on record. Such disastrous events are, of course, rare; this is one reason why it is difficult to investigate this phenomenon systematically and not all studies show the same result.

First let me first say, in 15 years, I have seen thousands of patients in a local community(North Kingston) and i have never hurt anyone and it has never been suggested to me that I have. There is “not a jot” of epidemiological evidence showing a causal relationship between chiropractic and stroke, in fact I would go as far to say this claim is “bogus”.  Ernst is relying on anecdotal evidence to support his claims. The exact same type of evidence he criticises the chiropractic profession for using to support the efficacy of chiropractic for treating children. When Ernst  uses anecdotes he attaches great weight to them. When chiropractors use them they are worthless as far as Ernst and the sceptics are concerned . Chiropractors are also accused of not presenting the negative studies with the positive. Ernst fails to mention the Cassidy or the Bolton studies, you know the ones which failed to report on what happened next. According to Ernst all the subjects may have died from stroke after their very last adjustment and as there was no follow up on them to see if they are still alive and well, Ernst will not take the studies seriously and presumably thats why they are not mentioned. Ernsts methodology for rigorous scrutiny would appear to rather inconsistent when it comes to his own research.

What’s the follow up in vaccination studies 60 minutes? If a reaction does not happen in the surgery within 60 minutes after the injection the side effect is coincidence according to most studies assessing vaccinations. Sally Clarkes son died three hours after his DTP vaccine and it took years before anyone would consider the possibility that she had not murdered her child and it could have been the vaccine.

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

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

There is no mention of Chiropractic in this report and despite the fact that there is no evidence of a causal relationship Professor Ernst keeps insisting there is one. Why? because it gets an academic with little to offer the scientific community publicity. He keeps repeating his claims and newspapers keep printing it. Its about as relevant to the health of the nation as Jordan and Peter Andres break up. It sells newspapers that all.

Warning

In the book I co-wrote with Simon Singh, Trick or Treatment? Alternative medicine on trial, we dedicate a chapter to chiropractic. After weighing all the evidence, our conclusions were not flattering: “Warning: this treatment carries the risk of stroke and death if spinal manipulation is applied to the neck. Elsewhere on the spine, therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions chiropractic therapy is ineffective except that it might act as a placebo.”

This chapter in Trick or Treatment devoted to Chiropractic has three Chiropractic references. Three. Even worse they all from the same person. You guessed it, the references are by the author of Trick or Treatment none other than the eminent Professor  Edzard Ernst. He is having a laugh isn’t he or does he think we are all like those clowns he presented his research to at the GCC in 2006.

So desperate was Ernst denigrate chiropractic he finishes the chiropractic chapter talking about homeopaths and vaccines, why was that not in the homeopath section? Because he wants to lump us together.  I have not vaccinated my children however that is a minority view in the UK chiropractic profession I believe the figure was 70% of UK chiropractors support the governments vaccination policy as this did not siut the point Ernst wanted to make it is not mentioned.

Simon later wrote an article in The Guardian newspaper about chiropractic. In it, he quoted from the website of the British Chiropractic Association which, at the time, made fairly clear claims that chiropractors can effectively treat a whole range of childhood diseases, including asthma. The evidence for treatment of this condition is less than weak: no fewer than three controlled trials have found that chiropractic spinal manipulation has no beneficial effect. The best of these studies, published in The New England Journal of Medicine, concluded that “the addition of chiropractic spinal manipulation to usual medical care provided no benefit”.

Not supported

For alerting the public to all of this, and possibly preventing harm to unsuspecting children, Simon deserves much credit. Instead, he is being sued for libel by the British Chiropractic Association. I think this is a serious issue that raises two crucial questions. Is it acceptable that scientists and journalists are restricted in their criticism by the legal muscle of those who are being criticised? And is it acceptable that professional bodies, such as the British Chiropractic Association – or indeed any other organisation – are able to make therapeutic claims that are not supported by scientific data? I leave it to the reader to decide.

Ezard Ernst should be allowed to express his opinions publicly, without the BCA calling their lawyers. I will leave it to the reader to decide how sensible his opinions are and wonderwhy the BCA were unable to rebut any of this without involving lawyers and making the chiropractic profession a laughing stock.

Profile

Edzard Ernst is professor of complementary medicine at the Peninsula Medical School in Exeter, UK. In his investigations of alternative therapies, he has found only about 5 per cent are supported by scientific evidence; the rest are either ineffective or have not been tested properly.

He would like funding to do research to disprove this 5% and then have his own reality TV show. “Britains got talented quacks”.

Otherwise it is difficult to know what he is suggesting. The health service should continue as is, and the collateral damage from side effects on pharmaceuticals war on disease are an acceptable price to pay.

Share Button

Related posts:

  1. Edzard Ernst Presents his views to the GCC
  2. GCC Fiddles While Edzard Ernst Burns
  3. Ezard Ernst is blaming Prince Charles for costing him his job? Seems Ernst can dish it out, but not so good at taking it.
  4. How can Edzart Ernst be considered an expert on clinical Chiropractic?
  5. Simon Singhs Guardian article and my analysis
  6. Check out sceptics blogs, they are getting very emotional about the fall of their great leader.
  7. Incompetent leadership unable to put Ernst down.
  8. Vacancy for a former medical doctor who did a bit of Woo on the side.
  9. Richard Brown Vice President of British Chiropractic Association argues that the criticism of his profession is wide of the mark
  10. If Simon Singh is not allowed to express his opinions in the UK, chiropractic is finished, in fact it would never have started.

Tags: , , ,

  • http://spinaljoint.com Richard Lanigan

    If I was to agree with you some might say I was a traitor to the cause of traditional chiropractic. Unfortunately I have to agree with most of what you say.

    The principles of traditional chiropractic are not threatened by anything you have said, however the representatives of traditional chiropractic are ever bit as reactionary and protectionist as the representatives of the medipractor wings of the profession. They dont want to give up their powerbase (which is their meal ticket) for the greater good of the profession.

    Eight years ago a consensus “Paradigm (the ACC) was developed to address many of the points you raise. The BCA not really understanding what consensus entailed rejected and produced their “Professional statement” of a “BCA chiropractor” it and chiropractors are still arguing and the BCA have recently replaced the “Statement” with the “Vision” after the Simon Singh debacle.

    All chiropractors should read Meridel Gatermans book Foundations of Chiropractic – Subluxation. It was first published in 1995 as part of the centennial of chiropractic where she gave a talk in Davenport. Not a great orator Meridel , mor like a bobbing head on a lecturn, however for me, the content is the future of chiropractic as a profession . Traditional chiropractors walked out not wishing to have a college academic lecture them about subluxation.

    I f all I do is make my clients have a bit of a laugh and thats what gets results rather than the adjustment, that fine by me. People pay for a service and I try to give them value for money, if it turns out spinal adjustments are only placebo and could not possibly effect the CNS, I will seek employment on the stage because I must be a very good entertainer.

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

    To be honest I don’t think traditional chiropractors do themselves any good at in terms of securing longevity. For example:-

    You use tambourine clapping hippy phrases like “innate intelligence”. This just puts people off. If you mean homeostasis, say it. There is absolutely nothing intelligent about it though; an amazing feedback/regulatory mechanism yes, but that’s it. The only emergent intelligence is consciousness.
    Ditto “wellness”. This is becoming (language evolves – it’s just fashion) synonymous with the fringes of CAM. Do you really want to be associated with crystal therapy and detox baths?
    Public in-fighting. For goodness sake decide what a traditional chiropractor is in the UK and project a consistent coherent message to the public. Including “subluxation”.
    Arrogance/denial. By which I mean ignoring the mounting negative evidence instead of developing a strategy to deal with it and coherently respond to it publicly. Be honest – how many of you have actually read the Bronfort report :) A repsonse of ‘clinical trials for chiro are not appropriate’ looks really really bad IMO, c.f. homeopathy.
    Flat out placebo denial. Related to the above but specifically important. You must find a strategy to deal with mounting evidence for (at least) some aspects of chiro being placebo, instead of sticking you heads in the sand and saying “no it’s not”.
    To the BCA – don’t react like a quack/B-celebrity when criticised – it makes you look like one.

    Apologies if this is offensive. It’s not meant to be. It’s frustration.

  • http://spinaljoint.com Richard Lanigan

    You may very well be right, I have often made fun of the leadership of the profession describing them as dinosaurs, when for all I know I may be the breed of chiropractor that is extinct in the UK ten years from now.
    It happened to the Osteopaths in the US and will happen here, unless traditional chiropractors resist the medicalisation of chiropractic and stand their ground. Many chiropractors are concerned about these developments, the question is do they have the courage of their convictions, many of those who represent the traditional chiropractic approach are too busy selling their seminars to become activists and dont want to alienate potential customers. My mother chained herself to the gates of the Irish parliament during the divorce referendum in the 80s, thats they way I was brought up, to stand up for what you believe in, people who sit on the fence get splinters in their arse.

    The GCC obviously believe the can keep things going and that its in the best interest of the chiropractic profession. I had a talk with a senior Chiropractor last week and despite everything he believes registration has been good for chiropractic, not much I can say to that point of view.

    Time will tell if medical manipulators on the NHS will be a good for the chiropractic profession, I suspect it may work out well for the Osteopathic profession in the UK.

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

    Hi Richard,

    “In my opinion chiropractors should focus on spinal health rather than trying to present themselves as “Medical” treating and diagnosing medical conditions.”

    “If the revolution is to be successful, then this shift will spread so as to include the majority of the relevant scientific community, leaving only a few dissenters. These will will be excluded from the new scientific community and will perhaps take refuge in a Philosophy department. In any case, they will eventually die.” – Chalmers in “What is thing thing called science

    I often think of this quote when I read what traditional chiropractors write and think about ‘the revolution’ at AECC, WIC.

    I struggle to see how traditional chiropractic can survive long term in the UK because the graduates are not learning traditional chiropractic; it’s become a fight for the label, but traditional chiropractor will by implication become fewer and fewer…

    (In the UK).

  • http://spinaljoint.com Richard Lanigan

    Dear Andrew,
    You may have noticed, I try not to rely on pieces of research to make points in this blog. Much of this years research will be out of date five years from now. Scientific evidence is not “truth” it is there to help less experienced practitioners, yes sometimes something like penicillin comes a long which changes the paradigm and then becomes the MDs silver bullet. As yet DD Palmers hypotheses is holding its own if not as he described it, everyone agrees movement is beneficial to wellbeing.

    Does a chiropractic adjustment restore motion to a joint that has lost its range of motion? I would say yes to that. Does loss of motion affect the function of receptors? another yes. Doe these receptors connect to the central nervous system? another yes.
    What will not change is that there is a relationship between the structure of the spine the function of the nervous system and wellbeing.

    In my opinion chiropractors should focus on spinal health rather than trying to present themselves as “Medical” treating and diagnosing medical conditions. Hope that answers your other question? I did not use the S word not wishing to offend you, however I think S£££££ outlines the theory and is well articulated by Gatterman as I have mentioned many times.

  • Andrew Gilbey

    Maybe you ought to have a think about “confirmation bias” and that stalwart of chiropractic ‘research’, the practitioner reported case-study.

  • http://worldvillage.com/the-rich-janitor9421 Wade Lytell

    appears fascinating.. depend myself in lol

  • http://spinaljoint.com Richard Lanigan

    It costs $35 to read the study and I thought it was a lot to read what I assume is a questionaire for people who died and the family ticked; had visited a chiropractor box.

    This “confirmation bias” seems to keep poping up with these skeptics. Thats their evidence for a “causal relationship” between chiropractic and death, how does that compare with the drugs body count?

  • fed up

    How is this statement backed up in his so called RESEARCH.
    “Twenty six fatalities were published in the medical literature and many more might have remained unpublished”

    where is your evidence EE that many more may have remained unpublished? As Biased as it gets.

  • fed up

    OMG I have seen some crap in my time but I think this shows EE really has a massive problem.

    http://www3.interscience.wiley.com/journal/123529462/abstract?CRETRY=1&SRETRY=0

  • http://spinaljoint.com Richard Lanigan

    Hi Richard,
    Thanks for your comments, the more the merrier.

    To be fair to Ernzt he has put himself up as a target ( The only professor of complementary…. etc etc)and CAM bureaucrats have not been very successful at shooting him down. A few years ago Ernst presented his research to chiropractors at the General Chiropractic Association and they said nothing to him not surprisingly he got a second wind for his book with simon Singh.

    He is good at cherry picking the research to suit his arguments. I hate people who present research as some kind of “truth” when the paper will be used for packing in a couple of years when new theories will replace the old.

  • http://www.rlkassociates.co.uk Richard King

    In Edzard Ernst’s response to you on his Pulse Blog “Anecdotal Evidence” (www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4125924&c=1) he writes, among other things:
    “When we talk about effectiveness or efficacy, anecdotes can be interesting but prove very little.”
    and:
    “So, relying on anecdotes for information about safety is not a question of double standards, it is a question of context and of common sense.”

    When people investigate, research, etc., subjects, areas, modalities, and they do not understand that which they are researching, their results can also be interesting, marginally, but prove very little other than that they are lost in that particular field; that is the case with many researchers in non-mainstream fields, including Edzard Ernst himself, with the likes of Richard Wiseman also being a prime example, while Richard Dawkins pontificates on that which he does not understand.

    In the second quote Edzard Ernst is relying on context and common sense, which makes a change from what seems to be the general thrust of blind, or semi-blind, obeisance to laboratory experiment and RCT. Edzard Ernst has experimented in, reviewed and pronounced on my own modality without being able to define it, let alone understand it; that tends to come over as both the heights of arrogance and the depths of incompetence. He also confuses my modality with others, thereby tending to confirm that he has not a clue about what is involved.

    In engineering we rely on anecdotes for many things, including safety, though only to give an indication that is to be confirmed, or otherwise, by experience, experiment, etc. Of course we use science but in context, along with other approaches; anecdotes are simply indicators, as is science; it is certainly not an absolute. Science is used, where appropriate, but engineering always comes first, above science; after all, engineering has existed for centuries whereas science is relatively recent; science is a tool, a method, an approach, recognised as fallible and un-provable. Whatever we do, whatever methods and aids we use, in the end it always comes down to engineering judgement. Moreover, we have to do without such approaches as RCT, even though lives depend on us, on our knowledge, expertise and judgement; of necessity we have a much more flexible approach; experiments are designed to provide relevant information to make progress; we have no room for so called experimental “Gold Standards”, we are only interested in that which provides useful, relevant information. We are a profession that uses science, when appropriate, but are not slaves to science.

    Engineering is far older than science and has been very successful. Over the last several years I have concluded that the engineering method, rather than science, is a better method to apply in areas that are intractable to science, or at least they are at the present level of science.

    I have an ambition to be involved with research in the CAM field myself, as well as related and nearby areas. At least I start from having a foot in both spheres, in both worlds; I am a Healer with open higher senses and decades of knowledge and experience in engineering, technology and science. Once I can “let go” of my book manuscript and get into the public domain, there will be funds available, by a number of routes. It would have happened many years ago but for a certain situation which is described elsewhere on the Internet; I would have been a Professor at a London University, on the engineering and materials side but would have used that position to launch my book and generate funds in other ways; that, I am sure, will still come about, though will have been much delayed.

    We are definitely in need of better and more knowledgeable researchers in both CAM and areas in which people like Richard Wiseman and Chris French currently “hold court” and far too much sway.

    I trust that this comment is amenable to your Blog. I tried to comment on one Edzard Ernst’s Pulse Blog posts last year but it was not allowed through. Admittedly, I did not make clear that I was a Healer as well as a Chartered Engineer, only the latter showing on my Pulse registration; maybe that would have made a difference. It would be invidious for Edzard Ernst to comment on CAM matters on his Blog if those of us who have knowledge in the field are barred from responding on the Blog.

    I may try posting a comment on Edzard Ernst’s Blog item on your views (www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4125924&c=1), though maybe, he will pick up on this anyway.

  • http://spinaljoint.com Richard Lanigan

    Hi Stefaan
    You are absolutely right. Having entered into discussion with sceptics I understand why they would think it was ridiculous that guys who are pretty good at treating back pain have decided they can treat every know disease while treating the back pain.
    Not only that they make their patients keep coming back for pain treatment they do need. And who told them we would do this dishonest fraud, chiropractors! Our colleagues who were not clever enough to get into med school and have seen an opportunity to gain entry to the NHS through the back door but need to redefine chiropractic in the biomedical model.

    Its too late to save the chiropractor title in the UK, just like osteopathy in the US. Chiropractors have to take the courage of their convictions and come off the register to practice chiropracTIC and marginalise the medheads left on the register.

    Its funny the GCC cant get over the fact I have been able to continue as normal having come off the register. Patients think I am very Courageous to stand up to these arseholes

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

    Isn’t much of the unniqueness of the chiropractic profession encapsulated by “illnesses may cause suffering but the body that heals is healthy”? The problem Richard, is that there are plenty of people calling themselves chiropractors but practice a credo which perceives pain to be problem, not even differentiating between pain which the body is perfectly capable of rectifying the source of, and pain the root cause of which is a systematic malfunction and which it is struggling or failing to rectify. Removing or recommending on how to remove this malfunction is the chiropractor’s job, the reductioin in pain (and I am only mentioning pain as that does tend to be the main reason for attendance nation-wide) is merely logical consequence of the correction being applied to a healthy body with an injury from which it is capable of recovering. Biomechanical, musculo-skeletal injury just happens to be the most predictable recovery pathway in my opinion, making the “science” more obvious. Equally we have a problem that some chiropractors think themselves to treat disease and not dis-ease giving Ernst, Singh, Lewis et al ammunition aplenty. And finally we have one very big problem and that is that a profession is what the majority of its population group do which may or may not be what was intended but is what it is. And that is where much hard work is needed and, for semantic clarity, am tempted to rename it all together!
    Kind regards,
    Stefaan

  • http://spinaljoint.com Richard Lanigan

    I could not help myself and responded to the article in pulse http://www.pulsetoday.co.uk/story.asp?storycode=4125924
    Professor Ernst, I am pleased you read my blog, engaging with clinicians will be a good thing after all those chiropractic academics. I have never understood why scientists spent so much time discussing what happens in my practice and never talk to me, especially the ones with little clinical experience themselves. I understand you have practiced spinal manipulation when you were in practice, was an arterial dissection something you encountered on a regular basis. Because in fifteen years of practice I have never come across it and I dont know anyone who has.
    I used to compare you to the boy who cried wolf, but I am forced to admit you may have done a service for chiropractic by highlighting the importance of being able to recognise a stroke in progress, which is a problem throughout the health service (not just chiropractors).
    Only last week I read about a women who saved the live of her son because she recognised the signs and symtoms of a stroke in progress in her child. The paramedic was saying, it was a trapped nerve he was too young to have a stroke. You could see him giving her the number of his chiropractor.
    No one would disagree that “relying on anecdotes for information about safety, is a question of context and of common sense.” However there are double standards compare the way vaccination adverse advents are reported in the US and in the UK. Even then reactions are dismissed as anecdotal and coincidence because vaccines are safe. Health care is not an exact science and usually its guided by empirical evidence and the experience of the practitioner.
    If I were hurting lots of patients and others were having strokes after an adjustment, surely with all the attention its had in recent years I would know about it. The alternative is I do know and ignore the lives I have destroyed because I love what we do so much and am happy to risk the lives of my children. Its daft but its a free country and you are perfectly entitled to your views and I can only hope the chiropractic profession improves at rebutting them.
    I have done a few posting on stroke http://www.chiropracticlive.com/?tag=stroke and look forward to your comments

  • http://spinaljoint.com Richard Lanigan

    Its good to know Professor Ernst reads my blog. “relying on anecdotes for information about safety is not a question of double standards, it is a question of context and of common sense.” I would not disagree about this however where are all these people who have had serious adverse events after chiropractic” In fifteen years of practice I had never hurt anyone till a week ago when I sprung a guys rib. I did a posting on this a few years ago http://www.chiropracticlive.com/?p=97

    I also hear these explanations in relation to vaccine side effects. They are anecdotal and coincidence because vaccines are safe. Health care is not an exact science and very usually its guided by empirical evidence and if lots of patients were having strokes after an adjustment, chiropractors working in close communities would know about it

  • fed up

    As usual it’s one rule for him and another for everybody else. Surely he has also just answered why chiropractic is working and expanding, a small study should not represent what may happen in the larger population, this is obviously the case with chiropractic but he still only uses small scale RCT’s to PROVE chiropractic doesn’t work.

  • dazed

    Ernst replies in Pulse today

    “Anecdotal evidence
    04 May 10

    When it comes to patient safety, anecdotes are often all we have to go on, says Professor Edzard Ernst

    I recently came across a blog where a 2009 article of mine was severely and, I think, not very fairly criticized.

    In it, a chiropractor wrote: ‘There is “not a jot” of epidemiological evidence showing a causal relationship between chiropractic and stroke, in fact I would go as far to say this claim is “bogus”. Ernst is relying on anecdotal evidence to support his claims. The exact same type of evidence he criticises the chiropractic profession for using to support the efficacy of chiropractic for treating children. When Ernst uses anecdotes he attaches great weight to them. When chiropractors use them they are worthless as far as Ernst and the sceptics are concerned.’

    As I hear this argument regularly, and as it is of some importance, it seems worth addressing in more detail. It would be entirely wrong to assume that anecdotal evidence is important only when I use it, while, from others, I demand evidence from RCTs. The point is quite a different one.

    When we talk about effectiveness or efficacy, anecdotes can be interesting but prove very little. We all know how many factors other than the therapy in question can affect the clinical outcome. Therefore we need more than anecdotes to convince us that a treatment works. However, when it comes to patients’ safety, anecdotes can be of great value. The precautionary principle demands that we ‘err on the safe side’. This means taking anecdotes seriously in relation to safety issues while taking them with a pinch of salt when evaluating efficacy or effectiveness.

    In fact, it would be irresponsible to discard anecdotes about adverse effects or other safety issues, particularly when they are reported repeatedly. Moreover, anecdotes are often all we have to go on.

    In post-marketing surveillance, several anecdotes eventually generate a ‘signal’ which can be sufficient, for instance, to take a drug off the market. As anecdotes usually originate from entire populations, the sample size which they are based on is normally huge (albeit undefined). RCTs, on the other hand, usually have far too small sample sizes to reliably inform us about adverse effects. If this or that adverse event did not show up in a tightly controlled study with 100 patients, it may still happen quite frequently in the population at large.

    So, relying on anecdotes for information about safety is not a question of double standards, it is a question of context and of common sense.”

  • http://www.infertilityhealthcenter.com Kathryne Mominee

    In order to cure bloating you ought to find out the real cause behind it. If it is constipation, then, laxatives or eating right food will help. If it is the gas that is causing you the trouble then you can drink some carbonated water so that gas will escape naturally from your body in the form of a belch. If you don’t mind taking pills then you can also pop in a couple of betaine hydrochloric acid tablets. Even simple things like inhaling air through mouth or taking calcium supplements can also lead to severe bloating. Exercise caution while eating. Take your time to chew and swallow the food properly.

Follow

Get every new post on this blog delivered to your Inbox.

Join other followers: