Oh dear! The tyranny of evidence David Sackett spoke of is upon us.

October 26, 2010
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 12 A new skeptic campaign has been launched against CAM by Simon Singh, and humanists Alan Henness and Maria MacLachlan. They aim to put the “SCREWS” on alternative medicine. Unfortunately Simon was unable to attend the official launch, but they presented a very small women who had been told by a chiropractor she would grow if she was adjusted every week for a year. I am including a link to to the page on how Richard Lanigan practices chiropractic in Kingston, case skeptics wish to report me to the ASA

Having treated the lady for a year the chiropractor presented the lady with six inch second hand platform shoes. The chiropractor claimed the shoes were worth the £2,000 she paid as Elton John was the previous owner. Alan Henness and Maria MacLachlan are here to protect the little people of this world and the not so bright now the government have had their bonfire of the quangos.

I love the  introduction  to this Florence Nightingale Collaboration  ; “Misinformation about complementary and alternative therapies is rife on the Internet, in newspapers and magazines and on the high street and this misinformation misleads the public. It is particularly important that the public have accurate information about healthcare so they can make informed choices.”

I have no quarrel with their aspiration, however I would ask why stop there when you are talking about “health care”, and you claim to be a skeptic. Far more people use the biomedical model which is far from a paragon of virtue when it come to making false claims.

Bullies always seek out individuals and small groups to pick on and in a way its chiropractors own fault that they refuse to stick together.  Alan Henness and Maria MacLachlan are humanists and claim  their mantra is The Golden Rule ; apparently they believe that “people should aim to treat each other as they would like to be treated themselves – with tolerance, consideration and compassion” The Franciscan friar Ronald Bennett who abused in the region of 200 boys at my old school, would say something similar to eleven year olds to gain their confidence.

I would at least hope the read an understand what Evidence Based Medicine is before pontificating to the world with their righteous claptrap about chiropractic.

David Sackett the father of Evidence Based medicine states   “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient”. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.”

Below is the press release for this new collaboration: I would be  more than happy any time to debate with them on the subject of evidence and best practice. Particularly in relation to chiropractic. I supported Simon Sings right to express his opinion about chiropractic and the BCA even though his article was not well informed as I have previously stated. I have told Simon to his face that he knows very little about anatomy and physiology and the biological basis the principles of chiropractic are based on and how my ego would love to have a public debate with such a high profile celebrity scientist. Simon knows there is not a great deal of evidence to support subluxation theory, the BCA are very litigious and the profession is very polarised and thats basically all he knows about chiropractic.

I did ask Blue Wode editor of EBM First why there was a need for another anti cam website, when he had done all the work for the collaboration  on EBM first. He paraphrased the words of George Bush Junior you have go to keep repeating the propaganda over and over then people start to believe it.

Press Release for the Florence Nightingale, Zebedy and Jackanory, collaboration

Misinformation about complementary and alternative therapies is rife
on the Internet, in newspapers and magazines and on the high street
and this misinformation misleads the public. It is particularly
important that the public have accurate information about healthcare
so they can make informed choices.

This misleading information won’t disappear by itself: it needs to be
challenged.

Complaints about chiropractors’ website claims, made by Alan Henness,
Simon Perry and others, have shown that it is possible to confront and
highlight misleading information, have it withdrawn and those
responsible held to account.

The Nightingale Collaboration will continue this work and will share
knowledge and best practice with others and give them support and
encouragement.

Florence Nightingale is well known for her commitment to using robust
evidence to decide what worked in improving healthcare. As the first
woman to be elected to the Royal Statistical Society and on the
centenary of her death in 1910, the Nightingale Collaboration
acknowledges her great legacy.

Aims

The Nightingale Collaboration will work to improve the protection of
the public by ensuring claims made about complementary and alternative
therapies are not misleading. We will do this by:

challenging misleading claims made by practitioners on their websites,
in adverts and in their promotional and sales materials and subjecting
these to scrutiny by the appropriate regulatory bodies;
striving to ensure that organisations representing complementary and
alternative practitioners have robust codes of conduct for their
members that protect the public and that these are rigorously
enforced.

Methods

There are several different methods of working that will be used to
achieve the Aims:

A. Nightingale Collaboration Campaigns: conducted by Nightingale
Collaboration personnel, gathering information, planning and executing
the campaign, with the support of volunteers where required. This type
of campaign would clearly be carried out in the name of the
Nightingale Collaboration.

B. Associated Campaigns: we will collaborate with volunteers on
campaigns by providing advice and authorisation to ensure maximum
impact and liklihood of success. These campaigns will be publicised as
being conducted in association with the Nightingale Collaboration.

C. The Nightingale Collaboration will make tools and resources
available so that others can pursue their own individual campaigns
with maximum effect. These campaigns will be entirely separate from
the Nightingale Collaboration.

Volunteer roles

There will be differing roles for volunteers, allowing for varying
levels of commitment. Volunteers will be able to contribute according
to their skills and whatever time commitment suits them.

It will be very much a collaborative effort.

Possible tasks include:

Locating misleading information, whether that is on the
Internet, in national or local press, in local clinics, etc.Gathering this misleading information in a legal and intelligent manner.Coordinating local campaigns.Submitting complaints to the appropriate regulatory bodies.

Volunteer training

The Nightingale Collaboration will provide training for key volunteers
to help them in their roles.

Tools and resources

There will be Nightingale Collaboration tools, resources, advice and
guidance available to volunteers, some of which will also be publicly
available to anyone who wants to act wholly independently.

Code of Conduct

There will be a code of conduct on how we obtain information and how
we deal with others so we maintain the moral high ground and keep
within the law. All personnel and volunteers will be required to abide
by it.

Experts

We will have access to various experts who can advise us on legal
matters and supply authoritative advice on scientific evidence to use
in our campaigns.

The Nightingale Collaboration

The Nightingale Collaboration must be seen to be ethical, legal,
authoritative, thorough and tenacious. This is so that we attract good
volunteers and so that the Nightingale Collaboration is taken
seriously — providers of misinformation must be clearly aware that we
mean business. We must gain a reputation for effectiveness.

More information will be released on the website over the coming weeks
and months. To be kept informed, send an email to
info@nightingale-collaboration.org or follow @NightingaleC on Twitter.

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  2. Sceptics are making complaints

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  • fedup

    David Sackett the father of Evidence Based medicine states   “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient”. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.”
    Never has this sentence been proved more than by the news piece I have just seen. Black Wednesday is when new doctors start on wards in hospitals. On this day, described as the most dangerous day to be admitted to hospital, deaths go up by 6%. Now I’m sure these new doctors are very clued up on EBM, but the figures speak for themselves.

  • Richard

    Osteopaths have a number of those courses and i suspect its one reason why Ostopathy is growing much faster than chiropractic in the UK

  • Franh49
  • dazednconfused

    The McT undergrad courses now  have pretty much the same curriculum and content as AECC & WIOC but teach McT technique as the primary skillset, plus a range of other chiro techniques. All have the same patient contact hours and clinic entrance/exit exams. 

    I note with interest that the CCE in the US is considering the option of permitting mixed mode/ flexible learning in order to reduce college contact time and costs to students.

  • Richard

    The AECC curriculum was much broader and deeper than what  was on offer at McTimoney. We had much more contact hours. having read John McTimoneys biography I understand the differences and why i became frinds with Tony Gilmore and Dana Greene However these should have been ironed out before registration went through.There was a gap in standards.We did neurology to the level of medical doctors and this  
    was not happening at Mctimoney  One of the Mctimoney tutors came on our course in 1990 and  she did not get through year one exams. In the late  90s I was invited to visit McTimoney and she was teaching motion palpation to students and it was obvious to me she did not have the required dept of knowledge. McT accepted they had to make improvements in their course back then. The thing was this was never going to be enough for the BCA old boys club, many of whom had graduated from AECC when the education standard was not that high. Obviously now that ECCE is considering validating the course, I am assuming there have been changes and bringing people like Dave Newel on board helped

  • Liam M

    Just another point Richard, you say were not happy to be regulated with |Mct when you graduated. What did you base that decision on? What info did you you have and where did you get it from that made you come to the conclusion that McT was bogus? And of course what do you think of your stance when you graduated now? Now that you have some understanding of chiropractic, McT and McT chiropractors? If your decision back in the 90s was based on what you were told at college then if that same message is being passed on now then no wonder some new grads feel the same now as you did when you graduated.

  • Liam M

    Hi Richard hope you are well, Iam going to be off for a month following an accident, check passion for chiro for my post. Now back to the comment, Richard you trained as a chiro and are obviously very good at it though you cannot legally call yourself a chiro because you are not on the register. And I respect that. Does that make you a better or worse chiro because you are not on a list or don’t fullfill some criteria? To be fair in the 90s you only got a diploma of doctor of chiropractic tagged onto a human science degree from AECC, where the Mct College handed out just a diploma in chiro. I wasn’t saying the standards of education have always been the same but if someone stipulates McT is “tosh” they are describing the McTimoney Technique as tosh, and you and I both know that is not the cases. Keep Well.

  • Richard

    To be fair Liam there was a huge difference between the academic program at AECC and McTim in the 90s, whether that made better chiropractors is another question. I was not happy being registered with you guys when i graduated, then I was not happy been registered.

  • Liam M

    Hi Colin, I think you will find the aecc grads that describe McT as a load of tosh are no different from people that describe chiropractic as a load of tosh. Basically they don’t really know what they are talking about and rather than investigate and gather some knowledge about the technique they fall back on “past teachings” or just remain ignorant. I have run the Cof C PRT for a number of years and have seen on feedback forms from aecc and wioc grads many times “changed my opinion of McT chiropractors”. I suppose we need to discover where they got these negative opinions from in the first place.

  • Richard

    I think you make a good point, and why not being able to call myself a chiropractor is not exactly a burden. I have said for many years the professions “enemy” are not skeptics or the medical profession, the enemy are the righteous within who will eventually destroy the chiropractic profession. 

  • http://twitter.com/vaxfax vaxfax

    Is there not also debate about technique? I know AECC chiros that say McT is a load of tosh. There is so much in-fighting.  I wonder how chiropractic can survive internationally – I see it more likely to implode…

  • http://www.chiropractorswarwick.co.uk Stefaan A.L.P. Vossen

    Just comes to show skeptic barrista’s skepticism does not preclude him from not informing himself about the topic of discussion…. No news there at least in as far as chiropractic goes

  • Fedup

    “Oddly enough, Professor Higgs’ landmark work almost never saw the light
    of day as it was initially rejected by the editor of ‘Physics Letters’,
    who failed to see its importance. Higgs tinkered with his exposition and
    sent the piece to ‘Physical Review Letters’, who published it later
    that year.

    Despite a mass of intrigue surrounding the work of
    Higgs and his contemporaries, it was not until 1976 that CERN’s
    Professor John Ellis hinted that the research should be put to the test.
    What followed was 36 years of conception and construction of the Large
    Hadron Collider- a £6bn project to find the elusive Higgs boson.”

  • Fedup

    LOL you may be counting chickens, there is still not “evidence” it excists. They have found a particle that may or may not be the Higgs, After all they have only been looking for it for 40 years and spent billions trying to find it. And that after a team of skeptics wouldnt publish Higgs work in the first place as it didn’t seem possible!!!! Sounds a bit like you. If Higgs had run up against you he would never have gone any further.

  • Richard

    I dont understand the point. Subluxation is a name for spinal joint dysfunction . There is some debate within chiropractic whether chiropractors should continue to use the term as it may confuse some people, as medics use it in the context of hypermobility and chiropractors use it in the context of hypermobility. There is no question as to whether it exists, its whether the theory that spinal subluxation has an effect on well being that is in dispute

  • Skeptic Barista

    @Fed up

         ” I once compared a subluxation to the Higgs bosson”

    Poor comparison – There is good quality, verifiable proof for the existance of Higgs.  If only the VSC could get anywhere near that level of proof!

         ” Science beleives the higgs bosson exists”

    I think you’ll find that belief was perfectly justified :-D

  • Pingback: First we went for the homeopaths…

  • Anonymous

    The SI joint is practically fused. They Cannot sublux……. Are you for real? Of course they fucking move you idiot it’s called nutation and counter-nutation and is essential for tandem gait. And yes these large and sometimes troublesome joints do cause Pseudo Sciatica and if you understood anything about the embrylogical begginings of the body you would understand the basis for Sciatica mimicking pain referal patterns. You might also be interested to know that morphological differences in the orientation of the joints between individuals can give rise to a shearing phenomema which is one many reasons why the public come to chiropractors because (“yep thats right Truthwillout me old “tagnut”) A Chiropractor will be able to ADJUST and resolve this problem.

    Oh yes fused SI joints have been routinely found… In 80 year old plus men. (perhaps your one of em!

  • Garland Glenn

    For some Chiropractic is a way of treating particular conditions while for others it’s a way of looking at the patient. Much confusion and tension arises when one perspective doesn’t want to allow the other to co-exist. Particularly when those who see it as a form of treatment, as opposed to a paradigm for understanding the nature of healing, don’t gracefully give quarter to those whose picture is larger. If your goal is to treat low back pain, than any therapy that is or has the potential for being efficacious could become acceptable. What I have come to appreciate over the years is that the broader the definition the happier the family. I started out as a very Newtonian practitioner with a back ground in electrical engineering. What I’ve become is a person who realizes that the mechanical paradigm does not and cannot explain everything I see in my clinic. As such I have had to embrace a more “holistic” perspective of healing. In the process I have become more tolerant of those whose perspectives are not exactly like mine. There is a difference in practice style and implementation and moral ethics. Ethics are never to be compromised but it is myopic to try and impose my practice style on someone else for they may be either behind me or ahead of me in searching for the truth.

    I have previously posted the “What is Chiropractic” page from the Florida Chiropractic Associations web site. What you’ll find here is a haven for all to find a home while allowing for others to find one as well. It’s not too long and well worth the read. It should be pointed out that the FCA has about 3500 members and has successfully created a home for a wider version of chiropractic than any other group I’m aware of while offering an exceedingly unified presentation to the “outside” world.

    What is Chiropractic?
    Chiropractic is an approach to health care that relies on the body’s inherent and natural recuperative powers — a healing science that places emphasis on maintaining the structural integrity of the body — a method of healing treatment that is conservative and that does not use drugs or surgery.

    Chiropractic is the second largest of the three primary health care provider segments in the United States. In order of size, based on the number of practitioners and public use, they are the medical, chiropractic and osteopathic branches of the healing arts. The chiropractic approach to human health is based on the premise that the relationship between structure and function in the human body is a significant health factor and that relationships between the spinal column and the nervous system contribute to the disease process.
    A doctor of chiropractic (D.C.) is a physician who considers man an integrated being but gives special attention to spinal mechanics, musculoskeletal, neurological, vascular and nutritional relationships.

    A chiropractic physician is considered a primary health care provider, and as such a portal of entry to our health care delivery system. The practice of chiropractic is the utilization of the relationship between the musculoskeletal structures of the body, the spinal column and the nervous system, in the restoration and maintenance of health, in connection with which patient care is conducted with due regard to first aid, hygienic, nutritional and rehabilitative procedure and the specific vertebral adjustment and the manipulation of articulations and adjacent tissues of the body. The chiropractic physician offers a natural, drugless, and non-surgical approach to health care and readily refers to the allopathic (M.D.) physician when drugs or surgery are indicated.

    Through their education, D.C.’s are qualified to treat a large variety of health problems. They do this non-invasively, i.e. without the use of drugs or surgery. As chiropractic has developed, many practitioners have chosen to specialize in treating certain types of disorders of the human body. Many chiropractors limit their practices to treatment of musculoskeletal disorders. Others treat neurogenic disorders and the neurophysiological components of many varied conditions via body mechanics. Some chiropractors concentrate on finding and correcting vertebral subluxations only. Many practitioners provide immediate crisis care only, while others specialize in treating and rehabilitating chronic or degenerative disorders. Chiropractic treatment of sports injuries is on the rise, and, in fact, many doctors are team physicians for various sports at the amateur, professional and Olympic levels.

    Chiropractic physicians, by virtue of their education, are qualified to evaluate permanent impairment and disability, as well as render a professional opinion regarding permanency of that impairment or disability

    The Doctor of Chiropractic

    …interviews and consults with the patient, employing every measure of observation that will more substantially profile the patient.

    …conducts a systematic physical, neurologic and orthopedic examination, using methods, techniques and instruments standard with all health professionals. He/She also includes a postural and spinal analysis unique to chiropractic diagnosis.

    …performs or prescribes patient tests, measurements and evaluations of health status, impairment and disabilities in establishing or revising treatment and preventive programs.

    …arrives at a differential diagnosis using diagnostic roentgenology and standard and special laboratory procedures and tests.

    …corrects, reduces, mobilizes or immobilizes particular abnormalities, particularly of the spine and pelvis, to normalize structural and functional relationships and relieve attendant neurologic, muscular and vascular disturbances. These methods do not include the use of prescription drugs or surgery, thus avoiding the dangers therein.

    …when deemed necessary, prescribes dietary regimens and nutritional supplements to prevent the onset or assuage the existence of some types of dysfunction of the nervous system and other tissues.

    …frequently uses physiotherapeutic methods and procedures as adjunctive therapy to enhance reception to and the effects of the chiropractic adjustments.

    …evaluates the effects of therapy at various intensities and duration during case management and revises therapy to achieve maximum results.

    …often uses first aid, taping and strapping in treating injuries of the extremities, and supportive collars, braces or corsets may also be used during recuperation to assist healing and strengthening.

    …provides counseling in such areas as dietary habits, physical and mental attitudes affecting health, personal sanitation, occupational safety, posture, rest, work, rehabilitative exercises, health habits and many other activities of daily living that would enhance the effects of chiropractic health care.

    …orients, instructs, directs and evaluates work activities of administrative assistants and paraprofessional clinical assistants.

    …may plan and conduct lectures and training programs on health care related subjects for chiropractic staff, students, patients, community groups and industrial plants.

    …may plan, develop or participate in research programs and/or in the development of technical articles for publication.

    …may limit practice to a specialized area of interest, such as orthopedics or diagnostic roentgenology and attain diplomate status through certified postgraduate and evaluation.

    If you would like to know more about Chiropractic, Florida Chiropractic Association is pleased to offer one of the finest publications we have ever come across on the subject:
    Dr. Louis Sportelli’s Introduction to Chiropractic

  • http://spinaljoint.com Richard Lanigan

    @colin. I have no problem with any of that, however I would not limit myself to being “rooted” in the EBM paradigm.

    The only thing I have a problem with in your posting is when you refer to the “vaccination stance”, the vast majority of UK Chiropractors support vaccination according to a survey conducted a few years ago.

    Yet because I have a view on vaccination based on having read the evidence, the majority of chiropractors who are not remotly interested in the subject are constantly being sterotyped by the likes of Ernst, Simon Sing, and Blue Wode as “anti vaxers” I am not even anti vaccination, I am just not convinced it makes people healthier and made an informed decision not to vaccinate my children. The fact they have never had antibiotics or needed them is rather strange dont you think and worth investigating.

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

    Wish list: As a potential punter I’d love to see one properly regulated – coherent – “manual therapy” profession – without any new age speak – without aggressive marketing and maintenance contracts and habitual x-rays – rooted firmly in the EBM paradigm – which is not to say you need ‘RCTs’ for everything (that’s a caricature of EBM) just that when ‘RCTs’ do come along and start contradict experience, that experience is gradually adjusted (ha) accordingly…

    Is that too much to ask…

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

    I cringe when I see anybody trying to tell chiropractors about A+P. I may debate endlessly about chiropractic public projection, vaccination stance, spectrum, advertising, philosophy, marketing and bias – and get incredibly frustrated and angry – but one thing I know for sure – chiropractors are experts in A+P.

    Surely this is just a good example of what is likely to be modern manual therapy in action – big nerve – functional problem – pain – improve functionality – less pain…?

  • http://spinaljoint.com Richard Lanigan

    Garland there are far too many doctors that do not know these things and do not understand the physiology. Thats the problem.

    Check out this one for example. Credit must go to Blue Wode and Zeno for making me aware of this “comedian” http://sciencedigestive.blogspot.com/2010/06/email-to-university-of-glamorgan.html

    Its true, Dr Dean Burnett is a recently qualified Doctor of Neuroscience. He is also a stand-up comedian. Apparently he has a PhD but it is not clear if its for comedy or Neuroscience, if it was in Neuroscience you would have thought he would have come accross the Kendal and Schwartz text book.

  • Garland Glenn

    @twaza
    Please don’t take offense, but my must not be a docotr or you would know these things.
    1. You notice that I put the word subluxated in quotation marks. Like this “subluxated”. And that the chiropractic definition of “subluxation” can be anatomical OR physiological in nature. And yes she had a physiological dysfunction of her rt SI joint.
    2. The nerve does not require physical compression to send pain signals to the brain. Irritation due to the proximity of inflamed tissue is quite enough to achive threashold.
    3. Look up the facet and SI joint mapping research done by Paul Dreyfus, MD published in the mid 1990’s mostly in SPINE. You will see that mapping patterns are variable. I helped with this research and we were very surprised to see the range as it differed from patient to patient. Basically what we did was to inject joints with saline under fluoroscopy and map the pain distribution patterns.
    4. SI joints are not “practically fused”. They actually move quite a bit, 10-15 degrees is considered normal by some. This is what I usually feel in motion palpating a normally functioning joint. And that according to Kirkaldy-Willis and others, SI joints account for as much as 30% of “back” pain.

  • twaza

    Richard Lanigan: “Because I was aware people were waiting for me to slip up, I give much thought to every word I write.”

    Your concentration span is less than the length of your sentences.

    ===========

    fed up. “I think it rather sad that he has sciatica and because he has reviewed the evidence that manipulation can’t help he won’t bother trying it!!!”

    When you get an email offering you a 50% cut of to move millions of $$$ out of Nigeria, do you give them your personal and banking details? Or, do you check the evidence that they might not be reputable?

    =================

    Garland Glen: ” She had a “subluxated” rt. SI joint.”

    Have you ever looked at the anatomy and physiology of sacro-iliac joints? SI joints are practically fused. They cannot sublux without very severe disease or trauma. Moreover, there is no way a subluxated SI jt could impinge on a nerve root without complete destruction of the whole pelvis. Look at this: http://tiny.cc/SIjt

  • Garland Glenn

    Funny in an odd way. An MD sent his wife into see me Monday. She’s had sciatica for 3 months and after 2 MRI scans and a CT scan 3 rounds of joint injections and endless medications. About $5000 worth of speacilist treament here in the US. She had a “subluxated” rt. SI joint. 1 adjustment she’s 60% better and slept through the night for the first time in 3 months. 2nd adjustment and she’s as close to 100% as she has ever remembered being.

    Better not advertise it though. Someone could be misled into safe and effective treatment.

    Neither she nor her doctor husband asked for RTCs before seeking care.

  • fed up

    Recently saw this on an anti cam blog.

    “There is no reliable evidence that chiropractic, osteopathy, or spinal manipulation provide any useful benefit for people with sciatica. And there is reason to believe that chiropractic may aggravate sciatica. I have a double personal interest in this issue because (i) I have sciatica, and (ii) I wrote this evidence summary.”

    I think it rather sad that he has sciatica and because he has reviewed the evidence that manipulation can’t help he won’t bother trying it!!! TRY IT MAN FFS!!!!!

  • http://spinaljoint.com Richard Lanigan

    The chiropractic profession has learned much from the Simon Singh skeptic debate. Chiropractors have not given enough thought on how they marketed their services, mostly using methods which work in the US where you can say anything.

    I was Tedd Korens representative in Europe for ten years and we talked a lot about what he wrote, when I felt he crossed the line we went our separate ways. I also had the advantage of being the expert in the Jesper Jensen case which was specifically about the claims being made on a chiropractors web site. The complainant was Margaret Coats mother of Zeno.

    Because I was aware people were waiting for me to slip up, I give much thought to every word I write. Interestingly Simon Sing and many of the skeptics have read this article I wrote about chiropractic and colic http://www.chiropracticlive.com/?p=50 and they have had nothing to say about it. The chiropractic profession has nothing to fear, from skeptics its our own who play in to the skeptic generalised view of chiropractic that cause the profession problems.

  • fed up

    LOL.
    This has really upset the skeptics. Medical doctors referring babies to chiros because they are crying !!!!!! Colic? The important bit, as Steffan keeps asking blue wode,is
    “All children had previously presented for medical care for the same condition.”
    So what are you to do if medicine hasn’t helped???

    “Considering the increasing use of alternative therapies for children, it is appropriate to determine the demographic profile of pediatric patients entering a chiropractic clinic.

    Methods: Collection of demographic data including age, gender, condition at presentation, previous clinicians consulted and medical referral rates of pediatric patients presenting to a chiropractic teaching clinic between 2006 and 2010.

    Results: Over-all, 20.5% of patients were aged between two days and 15 years and classified as pediatric patients. The most common presenting complaint was musculoskeletal (35%).

    Excess crying (30%) was the most common complaint in the largest presenting age group which was under 12 weeks of age (62.3%). All children had previously presented for medical care for the same condition.

    Most (83%) of the infant patients under 12 weeks of age were referred for care by a medical practitioner.

    Conclusion: Parents commonly presented their child for care at this chiropractic clinic with a recommendation from a medical practitioner. The most common complaints were musculoskeletal and excessive crying conditions and the most prevalent age group was under 12 weeks of age.

    Author: Joyce Miller
    Credits/Source: Chiropractic &Osteopathy 2010, 18:33″

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

    After reading Richard’s list of “prefixed” chiropractic names and the nitty gritty about “treat” on the mega thread, I couldn’t resist.

    http://welshandgrumpy.blogspot.com/2010/12/traditional-chiropractic-appointment.html

  • fed up

    He we go again. It doesn’t matter what evidence Proff EE is shown his bias comes shining through.

    Dr Theysohn said: “Acupuncture is supposed to act through at least two mechanisms—nonspecific expectancy-based effects and specific modulation of the incoming pain signal.

    “Our findings support that both these nonspecific and specific mechanisms exist, suggesting that acupuncture can help relieve pain.”

    But Edzard Ernst, professor of complementary medicine at the Peninsula Medical School in Exeter, urged caution.

    He said: “Studies like this might go some way to explaining how acupuncture works.

    “We should remember, however, that we are currently not sure whether acupuncture does,in fact,reduce clinical pain.

    He questions the evidence and advises caution even though the evidence is good? Is that a scientist or skeptic trait? or just a biased one.

    http://www.telegraph.co.uk/health/healthnews/8168134/Acupunctures-effect-isnt-just-psychological.html

  • fed up

    Prof EE’s latest blog is disputing all the evidence that mistletoe helps cancer.

    “Systematic research started about 50 years ago and produced surprisingly positive findings.” Not good enough for EE.

    “Today there are ~40 ‘clinical trials’. I put the term in inverted commas because many are called trials but, in fact, they are merely observational or retrospective studies. Only 20 or so are RCTs.” So 50%, or more, are the the holy grail of research a RCT, the type of research EE requires for anything, still not good enough for EE.

    “The evidence is further complicated by the fact that well over a dozen vastly different preparations of mistletoe are on the market (the best-known and most frequently tested is Iscador®, Weleda). Numerous systematic reviews have evaluated the available trial data, but they all struggle with these complexities.”

    Lots of types and preperations? Bit like lots of types of chiropractic, but on chiro research EE doesn’t even bother with the complexities, he just falls back onto his natural bias. All bad.

    http://www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4127911&c=2

    Though, the only reason I mention this is because he finishes the article with-

    “I call it the ‘they would say that, wouldn’t they’ bias.”

    very rich coming from him!!!!

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

    @Colin,
    you mean when I tell them I need to charge the subluxarboneutritionalizer?
    :)

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

    so this is what you get up to when you tell patients you are off to research the best clinical evidence for 5 mins… :)

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

    Oh look at what you’ve done now
    http://elfyourself.jibjab.com/view/2JhjaWACClHU4OZ3

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

    @Colin,
    Quackometer was a lot of fun. I learned a lot from it (primarily that people mix philosophy and reality up sometimes)
    Thanks, glad you liked it, I like playing the pedant whilst blogging (it comes quite natural to me, and costs me no effort at all)
    Regs,
    S

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

    I just like the way that the skeptics and chiropractors (some of us anyway) are actually talking about the same thing, the same problems and the same arguments, but just differ in that we have a job doing it and lots of patients wanting us to do it, whereas they don’t. They look at it in the stark light of day, without the face of human suffering which demands from those who do work there, and lack cold hard evidence, a certain amount of post-rationalisation to lend credence and value to what we do beyond the individually observable. I think it’s a human need thingy.
    S

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

    @steffan – i tweeted it – hope that’s ok – you don’t seem to tweet often – still laughing – it is exactly what’s been happening on the quackometer thread lol

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

    @steffan – lol – awesome – and a lot less verbose too… :)

  • fed up

    i like that stefaan!!! lol

  • fed up
  • http://www.chiropractorswarwick.co.uk Stefaan Vossen
  • http://www.skepticat.org Skepticat

    And when is Richard going to update the time settings on this website?

  • http://www.skepticat.org Skepticat

    Good as far as it goes, fed up, but when are you going to finish it?

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

    I’ll make some for you… :)

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

    :) It’s a very cool tool. Useful for clinicians to make Q and A videos for patients to watch in waiting rooms…?

    @eugene – hi.

  • http://spinaljoint.com Richard Lanigan

    Hi Colin,
    I thought it was very funny, the guy pontificating looked like George Bush.

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

    I mean literally ;)

  • Eugene Pearce

    Dont take that litellay:)

  • Eugene Pearce

    “Perhaps the WFC should lock us in a room in Rio, instead of everybody going to the conference and see what we could come up with”

    Fistfight?

  • Eugene Pearce

    Read the UCA article http://www.chiropracticlive.com/?p=154.

    I think it is devisive as the BCA’s anti UCA stand point. I have difficulties with chiropractic biophysics, a popular technique with UCA members. I know they have done some good research in if you trawl through the massess, a great one on measuring scoiliosis, the good ones on occasion have appeared in Spine.

    It is understandable that a higher level of evidence should be expected for this technique because it promotes a serious finiancial outlay for the patient and lifetime care. This precisely is why he produces research in such volumes. I wonder if anything has been published showing any aspect of biophysics doesnt work, or whether the follow the Pharmaceutical model of supressing negative research. CBP also promotes breaking ionising radiation law in the UK. Deed Harrison has to justify the technique and need to x-rays to change IRMR rules.

    I understand why chiropractors might be seriously tempted by this approach, and I can see how many might be even more tempted in a recession, crunch the numbers, and everyone visits a chiropractor for life, or until they get fed up and never go again.

    There is no Doubt Suing Simon Singh was a mistake, (easy to say in hindsite but I did mention this when we appeared to be winning the case). It seemed to me the BCA’s defense loosely base on “we werent deliberately dishonest, just ill informed.” Even if we had won we hardly came out smelling of roses.

    With regard to evidence we need to look at what standard the “medical” equivolent’s of our profession need to provide, podiatry, physiotherapy are probably the most appropriate initially as they deal with biomechanical issues. Whatever that standard is it should be the same for everyone.

  • http://spinaljoint.com Richard Lanigan

    Perhaps the WFC should lock us in a room in Rio, instead of everybody going to the conference and see what we could come up with.

  • Eugene Pearce

    Well Richard I think you just closed the debate perfectly. I cant disagree with a word you just wrote. Its absurd the profession continuing to “pretend” because no one is happy. We need to respect the differences.

    I really think there is room in the UK for both Swiss / Danish model and the Traditional approach. It is important that at either end we dont throw the baby out with the bath water, prescribe instead of what we do best, and at the other extreme, diagnose subluxations ignoring medical diagnosis.

    I think that position would be a good starting point for a genuine coming together of the two views of the profession. Maybe as Traditional Chiropractor and Chiropractic Physician, but that might be a step too far. I would hope we could all just be chiropractors.

    Not all surgeons agree on the best way to go about things, but they discuss the differences rationally and measure and document their outcomes in detail. Being unregulated and unscrutinesed for years, together with the self assurance of seeing people consistently improve has made us really lax in that respect. A lot could be learned.

  • http://spinaljoint.com Richard Lanigan

    Simons article made me laugh, because I had always argued to throw all your eggs into the basket of quantitive research was risky. Then you have politicians like Tony Metcalfe arguing the case for chiropractic as though there was a gold standard of education that everyone had reached, when in fact most of the politicians themselves did not achieve that standard of education. No doubt when Simon Singh attacked the BCA there was an element of what comes around http://www.chiropracticlive.com/?p=154.

    However once the amusement had passed the UCA and McTimoney should have got behind the BCA rather than pursuing their own agendas. The UCA hoped no one would notice them and the McTims advised their members to remove their websites which energized the campaign against the BCA. Then the BCA council has not much good will out there even within their own ranks. Hopefully these politicians will realise that they have to work together and be pragmatic in future negotiations. First the regulator has to be sorted, and the negotiations taking place now will show us whether the chiropractic profession can regulate itself.Then we have to decide how we want to present chiropractic to the public, pretend we are all the same or explain the different approaches so the public can recognise what is ethical and the chiropractic care that is in their best interest.

  • Eugene Pearce

    Richard, here here.

    I wonder what would have happened to the chiro profession if Singh chose to attack the UCA. I sinserely hope the BCA would be magnanamous enought to have supported them without imposing their chiropractic view.

    What do you reckon!!

  • Eugene Pearce

    @ colin (and any other skeptics who genuinely want to openly debate).

    re using the Bigots and Bullies terms.

    You have to understand when the likes of Alan Henness asks the General Chiropractic Council to investigate me on the grounds of lack of evidence for providing Orthotics for plantar fasciitis (inflammation sole of foot) achilles tendonitis, or supports for sprained ankles, they are acting as bullies purely beacause my role doesnt fall within conventional medicine. I use the same approach as the hospital for both these conditions, amongst others. It seems that because as a profession our first port of call isnt a prescription pad, we I need to sit up for hours trawling through evidence because of a bully. Are the words “moron baiting” Ben Goldacre, the words of a bully, bigot, Scientist or Skeptic.

    Maria MacLauchlan registered the Discoverchiropractic website shortly after Ross MacDonald president of the SCA unfortunately let it expire, and filled it purely with antichiropractic propaganda. I emailed them to ask if they wouldnt mind posting some of the good quality postive evidence for back pain for balance, as well links to the GCC and BCA. I wasnt even given the curtosey of a reply.

    Then you get the situation in the research, where nearly medical researchers use the evidence for Golfers and Tennis elbow interchangeably. Yet because the RCT’s have only been done on tennis elbow, as its far more common, we get charged with unprofessional conduct. All we have done is apply the same level of evidence for our treatment as medicine or Physiotherapy. This is partly the fault of the workings of the GCC but nonetheless makes our profession feel we are being victimised, by a bunch of Bullies and Bigots.

  • http://spinaljoint.com Richard Lanigan

    Colin I on the other hand would describe myself as a traditional chiropractor, who corrects subluxations in spinal joints. For me drugs are a last resort and prescribing should be limited to medical doctors. I dont see myself as a doctor more like a personal trainer.

    It irritates all chiropractors that bigots chose to lump all chiropractors into one homogenous group of new age practitioners of WOO, which is plainly ridiculous and shows clear ignorance about the chiropractic profession. It does not bother me personally if people go to church or use homeopathy thats their choice, it does not make sense to me so I dont do this things. Presumably its similar to the way chiropractic does not make sense to people who know little about neurophysiology.

    Nothing helps me when I have a gout attack except Diclofenac so I take it, I would not deny that there are benefits to medications, however I think people should give there body a chance to adapt to stressors before more invasive interventions are used. Its fair to say Eugene and I are poles apart on this and the irony is not lost on me that Simon Singh attacked the BCA, the very body who were attempting to be “scientific” in their approach.

  • Eugene Pearce

    @ Colin Jenkins

    Probably something of a rarity here but I consider myself to both be able to be skeptical and a chiropractor. I think your posts are interesting, I like that you use the term “traditional chiropractor”. There are a lot of us out here that choose to practice where we believe the evidence is stronger and not on an ideological basis. And do modify our treatments along the lines of current evidence be that in Chiropractic Phystherapy Osteopathy Podiatry or Acupuncuture, (I cant count homeopathy in there unless as placebo mediated psychotherapy, I am bigotted when it comes to nonsense, we all have our limits!).

    This is why some of us feel limited prescribing could be a useful adjunct as we deal with painful musculoskeletal conditions every day, and to suggest this would not be useful is denial on the basis of ideology and not in the best interests of our patients.

    I would however still defend the right of any chiropractor to practice traditionally when the treatment is safe and no better medical alternative exists, that seems only logical even as a skeptic.

    An we do debate the stuff noted, (over manipulation, standard of evidence etc), in your previous blogs, you should have been at the ECU conference, or BCA debating these issues. The idea we dont is wrong

  • http://spinaljoint.com Richard Lanigan

    I would add I am not an advocate of Eugenics. All I am saying is there is no question that illness makes you stronger http://www.bmj.com/content/330/7503/1294.full/reply#bmj_el_104800
    I would always say what I think and its up to others to provide a better argument and evidence to support their view. I am very open minded and told the children’s GP that we would vaccinate my children if they provided proof that vaccinated children were healthier. I am still waiting and the girls are seven.

    I am a very proactive person and it is not unusual for me to be the elephant in the room. My latest campaign is to get people to remove snow from their footpaths as they do in Denmark, the British cant be arsed to get up 15 minutes earlier and sweep it off the the path because they think the council should do it for them. Even though I have got people who are willing to do it in Thames Ditton, Surrey Council see an opportunity to generate revenue on my efforts and want £2,500 to supply us with grit another body of bureaucratic fools with to much time on their hands.

    I try to pick my battles and this one with the GCC has been going on now for ten years, what I have no doubt is eventually I will prevail and return to the register and Coats and Dixon will leave the GCC in disgrace.

    Perhaps its boarding school that has made me like that, sensitive children could not cope. There was a guy who told tales and we still refer to him as “squealer”, however bullying was not tolerated and those who would bully would have the shit kicked out of them by the stronger members of the group.

    We stuck together our families had no involvement in our day to day lives and the bonds we formed are there to this day. This is what I find most frustrating about being a member of the chiropractic profession, they inability to work as a group, the lack of leadership.

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

    Colin,
    it is important to understand that the view point reflected by Richard above is in my view product of an ideology, and idealistic society where wealth and health are divided equally and where it is acceptable to (and not acutely politically incorrect-Rich is not the most PC at the best of times) to hold, what is in humanitarian terms, quite a brutal appreciation of the natural world. It is one of these views that would say that fertility treatment is not a good thing as infertility is nature’s way of selecting those who should have children. It’s quite Spartan and stark, quite intellectual and according to some soulless. It’s a bit like the difference between Catholicism and Paganism. It got James Watson into trouble and Dawkins wouldn’t in principle disagree but due to the sentiment that humans are not just animals but also humane it remains contentious. A feeling from which I assume your comment “bloody hell!” would have come from.
    Regards,
    Stefaan

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

    bloody hell!

  • http://spinaljoint.com Richard Lanigan

    @ Colin Absolutely, thats the society I grew up in I have had all these “Killer diseases” and am alive to tell the tale.My dad is 84 every year they try to get him to have flu vaccination he refuses. Last year they realy tried to scare him with swine flu and as he is having treatment for cancer he refused.My granny had seven sisters all lived well into their 90s. My granny died at 80 she was the only smoker among them.

    I believe in natural selection when it comes to health. Humans adapt the problem with germs they adapt and mutate much quicker than humans, so while antibiotics were once a wonder drug their over use is now a problem. Not the drug of course the bacteria which have mutated through natural selection. However this approach would not be so nice for those living on estates in the inner cities where many children might die.

    The question therfore is? Is vaccination the answer to the health problems of many children, I dont think so. However it is a very cost effective intervention and helps cover up the health inequality within our society.

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

    @Richard – I have to be misinterpreting you. You would be happy to live in a UK where nobody was vaccinated and let natural selection rip?

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

    Out of comfort zone.

    I agree that EBM is about using the best available evidence to date, it does not mean don’t treat without meta analysis or systematic reviews of RCTs – that would be a caricature of EBM.

    If all you have at the time is experience and anecdotal evidence and theoretical plausibility then that’s fine – as my bother, a dentist has reminded me.

    From what I can gather, there is an accumulation of good quality study evidence that is negative for traditional chiropractic and some ailments. In that context clinicians surely have to start taking it on board regardless of their experience and anecdotal evidence.

    What you see as bigotry I see as a reflection of that accumulating negative evidence, with the accusation of bigotry a reaction to something some traditional chiropractors simply don’t want to hear.

    Which is perfectly understandable I guess. Let’s face it if the study evidence started pointing to homeopathy positively us skeptics would in a short timescale probably go into denial, but we would have to yield eventually and in one particular instance have a very painful willy.

    http://www.youtube.com/watch?v=UB_htqDCP-s

    It seems to me the whole thing hinges on what the current minimally subjective evidence base is suggesting and it is not surprising that there is argument about it because it takes time for these things to settle down.

  • http://spinaljoint.com Richard Lanigan

    @ Colin “It’s well known that statistically you are safer to be unvaccinated in a herd than vaccinated but I have to say it seems more than a little selfish to do so”.

    If you mean safer as in less likely to get the illness you may be right, however that does not mean the heard is healthier and then there is the question are these vaccines as effective as the government would have you believe. http://www.bmj.com/content/333/7560/174.abstract The pertussis vaccine is the one that has traditionally had problems (thimerosal) . The risk of death is estimated as 75% in newborns who contact whooping cough. My three kids were diagnosed with whooping cough at Kingston Hospital. One of them was a week old and despite having the illness she never showed any symptoms and we would never have known she even had a cough if the swab test had not been done. So what you have with the scientific evidence is that there is a 75% mortality rate in known incidence of whooping cough which is probably a small percentage of the actual cases.

    In the survey I performed for my dissertation 6 of the 200 surveyed had a reaction that required children going to A&E coincidence? Possibly. Do you remember Sally Clarke the Lawyer convicted of murdering her two children. One of them died three hours after the childs DPT and the medical experts would not consider it as a possibility in the UK, even though in the US the consent forms parents sign say there is a small possibility of death and brain damage. I saw the report compiled by epidemiologist Richard Meade for Sallys second appeal. It was not needed because the pathologist report was found to be flawed but if that had been published so soon after the questions had been raised about MMR it would have been very damaging to the governments vaccination programme.

    If I lived in Cuba I might vaccinate my children to protect the weak, thats is the philosophy of their society. However to ask me to take that view in a country that is cutting benefits for the disabled and refuses to help the poor and vulnerably by paying higher taxes and then to top it by saying I am selfish no tot vaccinate my children I would have to disagree. I was happy to pay 60% tax in the 12 years I lived in Denmark, to practically eliminate poverty. I may be a lot of things selfish is not one of them.

    “Maybe you could go to a Skeptics in the Pub meeting and do something there…? Delighted to if they invite me”?

    I have suggested it to Simon Singh, he has not got back to me.

    I agree with Dr Bilbo, and do not disagree with the statements you have made as would any sensible chiropractor. I would debate Absence of “evidence” is not evidence of absence or RCTs are not a “truth” they are evidence of a certain outcome at a trial which may be significant.
    Because something does not work “significantly” better than a placebo does not mean that intervention does not work. There is no scientific evidence to support subluxation theory” There is no biological rational why an adjustment could help otis media. These are the topics I will debate anyone on.

  • Dr Bilbo Baggins

    @ Colin

    I don’t think anyone would disagree with your above statement. The problem the chiropractic profession has, if pro chiropractic posters on the skeptic sites are to be believed, is that the stringency of critique used to evaluate chiropractic is not mirrored by the ‘skeptics’ actions to critique medicine, physiotherapy, dentistry or podiatry for instance. These professions are left well alone, simply because in many cases, and I include medical procedures in this, there exists no or very little high positive evidence. 

     I am certainly not suggesting that attacks should be made on the above professions, however it does highlight the perceived bias and level of playing field that these ‘skeptics’ have set out.

     As I understand it, the current feeding frenzy  has been stimulated purely by the BCA-Singh case, which is  freely admitted by such posters as Zeno, Gilbey, BW, skepticat and of course the guy with the coffee shop, and seems agenda driven. If this is the case, and I have no reason to disbelieve these individuals, there motives are driven, not by a need to find the truth, which is my understanding of skepticism  but by personal agenda.

    It is therefore the old adage, changed slightly for the moment, that if skeptics fly with those who may be perceived to be bigots, they  may get shot with those who may be perceived to be bigots.

     I hope you can now understand why some would make the comments they do. 

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

    @Richard – just out of interest, say somebody like EE agreed to a debate, you know, re-vote, debate, post vote, what sort of title would you be prepared to argue?

    Any of these?

    Traditional chiropractors are ignoring recent clinical evidence and manipulating some patients unnecessarily.

    Or

    There is mounting good quality clinical evidence that manipulations performed by some traditional chiropractic perform no better than placebo.

    Or…?

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

    @Colin, you are entirely right, I meant of course to refer to people who call themselves sceptical vs people who actually are. I can call myself strawberry blonde but I will of course always be ginger. Similarly some people call themselves sceptical in their attitude but are in fact bigoted.
    Stefaan

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

    @Richard, I think you are conflating skepticism as a worldview with being sceptical about topics you are biased with, like some denialists do. It’s well known that statistically you are safer to be unvaccinated in a herd than vaccinated but I have to say it seems more than a little selfish to do so. Maybe you could go to a Skeptics in the Pub meeting and do something there…?

    @Steffan, I disagree – a (the true is redundant) skeptic/critical-thinker/free-thinker/rationalist is one who *attempts* rationalism in the full knowledge of biases and uses devices like consensus to eliminate them. Clearly one cannot completely eliminate bias and attaching that property to a ‘true skeptic’ is thus meaningless. c.f. objectivity. One of the reasons I always say minimally subjective.

    Please use the k in skepticism/skeptic – it means something and minimises the risk of conflation with simply being arbitrarily sceptical as I believe Richard is.

    @fed up, I dunno – in general I’m happier talking ‘meta’ than specifics because I do not work in the heath industry. Which is not to say I always succeed. I think I understand science and the philosophy of science. And since the heath industry via EBM/SBM has poked it’s nose into science (not the other way round!!) I feel justified in engaging in general, just get uneasy when I wander into specifics.

  • http://spinaljoint.com Richard Lanigan

    Colin, I suppose the problem here is labels have been attached to groups and generalisations made and now we have succumbed,

    Bearing in mind I have considered myself a skeptic since I was 11 when I kept the host in my mouth and bit it to show my friends it did not bleed and was unlikely to be the body of Christ as I was not struck down dead. In 1972 I was sceptical about the reason the Paras opened fire on civil rights marchers in Derry and my mother was arrested in there houses of parliament for calling the Home Secretary a “Murdering Tory Bastard”. I was sceptical about WMD’s in Iraq and went on all the marches. I was being sceptical when I took my children out of RE recently after a reverend came in and prayed with the children in a state school. Did you know “collective worship” is compulsory every day in state schools. I am still trying to figure out what is the difference between the way RE is thought in faith schools and state schools and CAM practitioners are the problem??

    When I was asked to vaccinate my children I was sceptical, I have travelled all over the world and the only vaccine I ever had was the polio in 64. I am never sick, I would describe myself as extremely healthy.

    So why am I so healthy? Obviously its not due to vaccines and I would remind advocates of vaccination there is no evidence that vaccinated children are healthier than unvaccinated in fact it would appear vaccinated children have higher levels of autoimmune disorders and allergies than vaccinated. ( I wrote my dissertation on the DPT for my masters in health promotion if you want me to talk about the“evidence”) I followed the evidence, I am pretty sure I have read a lot more that most (Brunel dont give MSc for referencing from quack books) and the fact is I came to a very different conclusion to you Colin, I am not offended by someone vaccinating their children, most people do what they “believe” is in their childs best interest.Most people do it, most people stayed on the chiropractic register. Its a choice we take.

    I believe, I rarely get sick because I slept in a dormitory with 96 boys for eight years until I was 16. I believe that getting exposed to dirt, bacteria, and viruses is in fact good for the immune system. So while on the face of it reducing incidence of a disease with a vaccine would seem like a good thing especially in communities without access to clean water and good nutrition. In leafy Surrey where everything is sanitized children are not being exposed to germs it may not be such a good thing after all.

    When I was a kid you were lucky to get a nut when they were in season now I hear kids are allergic to nuts, strawberries, kiwis , but they can eat processed foods until they go pop. I am anything but a touchy feely “newager”, Sex drugs and rock and roll, the Fonze was my hero. I dont believe in fairies, like you I want to see evidence. I am very skilled at what I do, yet there are many who would deskill me by assesing my ability to perform a skilled activity, using students and academics.

    I see the evidence of the efficacy of spinal care every day in practice, you are welcome to come into my practice and see it for yourself, you can even feel it if I put you hand under min e when I perform an adjustment.

    According to the bigots I can not be a sceptic because I am a chiropractor and this makes me a quack and some kind of “newager” anti science anti vaxer. These bigots get very little ammunition to throw at the profession from things I say, so they take things I say about others out of context, they scrape the barrel of anti chiropractic websites, they cherry pick their research, I dont do that I would never do that, because its dishonest and as you point out not the activity of a true skeptic.

    I would love to stand on a platform and debate the issues (the evidence) that make them so confident to call me a quack sitting hidden behind their computer. I dont share the bigots view of scepticism thats all and I realise thats being unfair to you Colin who has always been polite and argued his position well. My dictionary defines a bigot as “a person who is utterly intolerant of any differing creed, belief, or opinion” I would say this definition applies to Zeno, Andy Price, Blue Wode (editor of EBM first) Andrew Gilby, JJS and a few others. I have engaged with them and they are not interested in explanations. There is a biological basis for performing “a spinal adjustment” either they dont understand it or dont want to understand it. Nevertheless I cant be arsed trying to explain it to them any more because they are so “utterly intolerant of any differing creed, belief, or opinion”

  • fed up

    Why do you feel you are not qualified to answer about levels of evidence? RCTs, etc?

  • fed up

    String theory I like that, I once compared a subluxation to the Higgs bosson!!! Check it out on skeptic baristas blog. Science beleives the higgs bosson exists, it teaches it across the world, I asked everybody on that blog (skeptics) if they thought the Higgs Bosson was real. But yet it is a theory. Nobody has any evidence to prove it exists.

    I like how you describe everything that is a skeptic, it just doesn’t (and you know this really) describe the 2 persons I mentioned earlier.

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

    Love the post Colin,
    one caveat: a true sceptic is no bigot and cannot be a bigot, I agree, but true sceptics are rare. It is an extremely difficult mental and intellectual state and one which often leads to neutrality and passivity. Something which few humans are particularly good at.
    Kind regards,
    nice posts

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

    To clarify.

    No skeptic can be accused of bigotry – it’s simply completely opposite to their world view.

    We will be in agreement about knowledge that has stood the test of time.

    We may be in disagreement about more recent knowledge, like climate change and EBM/SMB – and yes this *is* where bias can creep in – but it not a bias implemented because of ideology as the bigot label implies.

    Which is why I don’t understand the name calling.

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

    Here’s another way to look at what it means to be a skeptic.

    Imagine you want to understand how the universe works, whether or not there is a realm of the supernatural, what our history is, what the best medical treatments are.

    You don’t really care about any of these outcomes specifically, rather you are prepared to put aside your biases and predilections because you are more interested in the truth.

    In a way skeptic is a bad name – it does not mean going around questioning everything.

    How do we find out the answers? We find out what provides the minimally subjective (reliable) knowledge in each domain and tentatively go with it, adapting as necessary.

    The scientific method applied to many contexts seems to provide reliable knowledge so a skeptic will tentatively accept the results of science (being inclusive) – and adapt as things change.

    This does not mean believing in cold fusion because of one experiment or that water has memory because of a few studies, nor even that chiropractic *doesn’t* work because of one or two studies.

    It means going with the knowledge that survives replication and criticism over time. It means tentatively accepting knowledge regardless of bias if it would be perverse to do otherwise, or it would show ideology or denial.

    It doesn’t always work like that of course – I think some famous skeptics are climate deniers (Randi?) regardless of the consensus, or possible deny the consensus. That will always happen – we are not automaton – while bias can be eliminated in science over time through competition and replication etc (the ‘scientific method’ – really just a set of heuristics) it will still exist in judgements of reliable knowledge.

    Does that make sense…?

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

    lol, maybe string theory is not a good example, how about smoking is a major cause of lung cancer, for which aiui the accumulation of evidence is such that it would be perverse to believe otherwise.

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

    The Intersection podcast this week is interesting WRT evidence in a health care context, especially about RCTs and is related to your question which I am not really qualified to answer. This rams home that one has to be careful about engagement – that it can be premature – and that ‘science’ take times to deliver reliable knowledge.

    http://www.rationallyspeakingpodcast.org/show/rs22-steven-novella-on-lies-damned-lies-and-medical-science.html

    Do I think Blue Wode and Zeno would change their minds? – :) sure – like I said they have no choice.

    If the scientific consensus drifted to for example manipulation improving organ-ic function in some beneficial way they would have no choice. But the quality of evidence would have to be the same quality as that required for a consensus on say string theory. Science is an incredibly competitive arena, which is in part why is works so well; a consensus being a good indication of reliable knowledge, as opposed to a group huddle…

  • fed up

    “Scientists can be plain bigots when considering concepts they don’t favor. We are not the first to recognize this. Another top scientist, Dr. Philip Abelson, noted this fact years ago.

    One of the most astonishing characteristics of scientists is that some of them are plain old-fashioned bigots. Their zeal has a fanatical egocentric quality characterized by disdain and intolerance for anyone or any value not associated with a special area of intellectual activity.”

    Sounds like blue wode.

  • fed up

    “A skeptic (rationalist) must (tentatively – otherwise it becomes an ideology) follow the evidence regardless of any innate bias. And by evidence I mean consensus acquired over time – the scientific coalface (for example) is a messy and highly subjective business.”

    Does this mean without gold standard RCT there is no evidence? Again without Gold RCT,z and BW, state chiropractic has no evidence.

    “not limited by bias and predilection”

    Do you think blue wode or zeno have these attributes regarding chiropractic? Do you think these 2 would change their minds?

    I will read massimo.

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

    “but in these discussions” == “but in these discussions with traditional chiropractors”

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

    “Can a skeptic change his mind?”

    Has to…

    A skeptic (rationalist) must (tentatively – otherwise it becomes an ideology) follow the evidence regardless of any innate bias. And by evidence I mean consensus acquired over time – the scientific coalface (for example) is a messy and highly subjective business.

    You will find that all the skeptics here are (or believe they are) following the current minimally subjective evidence.

    A skeptic is thus truly open minded – not limited by bias and predilection – they are willing to give those up for ‘the truth’ (or don’t have many). Which often causes confusion, because people who have an innate bias to believe things without evidence, or with just anecdotal evidence think *they* are being open minded – when in fact they are being close minded in not allowing themselves to be swayed by (good) evidence – and just sticking to their predilections.

    I recommend everybody reads this:-

    http://www.csicop.org/si/show/bridging_the_chasm_between_two_cultures/

    Karla McLaren is (was) a New Age guru turned skeptic. She vividly explains the complete ‘non-concept’ of rationalism to ideologists. It’s not directly related to chiropractic but in these discussions I see ideology as I’m sure do my fellow skeptics.

    If you really want to understand skepticism, Massimo Pigliucci’ poscast is IMO the best place to do it. Chris Mooney’s The Intersection is good also.

    Here for example Massimo asks why be rational and what does it mean to be rational.

    http://www.rationallyspeakingpodcast.org/show/rs01-why-be-rational.html

    Why not look into it – it’s fascinating…

  • fed up

    Colin, I was not generalising about skeptics. True skeptics will discuss, agreed? Can a skeptic change his mind? Do you really believe Zeno, blue wode etc would ever change their minds on chiro? They do not post as a skeptic, their views are reinforced by massive bias and nothing will change their minds. They may say show me the evidence, but no evidence is good enough, because as the posts on skeptic barista shows blue wode will just resort to IMO when her biased blinkered arguments are shown to be wrong. debate is fine but when you are talking to somebody who no matter what, has made up their mind that what you do has no benefit and is dangerous,even though they don’t understand what you do and can offer no real alternative, because a Prof. EE (who is a biased as they come) has written several papers about it, then in my opionion they are a biggot. i suppose it’s no different to skeptics calling us chiro trolls. :-]

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

    fed up,

    Actually I apologise, I’m being a bit emotional and doing some name calling myself; I’ll go away and clam down. Perhaps I’m misinterpreting what I perceive as generalisation about skeptics…

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

    For goodness sake.

    Firstly, you are wrong about the skeptic perspective on vaccination and that site, which Eugene correctly pointed out is championing herd immunity. But you just ignored the fact you were wrong.

    Secondly, I had moved on – I would have though “some of you” would give it away – i.e. I am not directly replying you you any more but commenting generally on the site. And I maintain that some of you are generalising. Here is an example:-

    “Bloody obvious to chiropractors :) but a great help to those people who like to think of themselves as skeptics. I think that a crucial problem the fellows of B.I.G.O.T. have, is that it is all rather complicated and requires a lot of studying of high-end topics.”

    I like think of myself as a skeptic.

    It especially disappointing to me that Steffan said this.

    There are lots more examples.

    Please. Stop generalising on this site. Name a person you think is a bigot.

    And in case it’s not clear, that last sentence was again not specifically at fed up.

  • Fedup

    No Colin you are wrong please read my post again. Guys(realguysimmunuze) like Zeno is what I said are you like zeno? Is the word skeptic in that post? I’m talking about people we now regard as bigoted , see Richards quote I think, not true skeptics who do engage in rational discussion without their ebm and bias blinkers.

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

    fed up, as usual (yes, that’s a deliberate generalisation) you present a self-serving caricature of the skeptic perspective – all skeptics know vaccines can cause injury – they also know the benefit vastly outweighs the risk. I am really disappointed by this blog recently. I’ve debated with you all, but here came admitting ignorance – with humility – weith a tradiitonal chiropractic sister I understood some of the human elements. Now some of you generalise and brand all skeptics bigots – it’s exactly the sloppy reasoning some skeptics (including me) accuse you of in the first place – but the irony seems to be completely lost on you. And as for this latest nonsense about bullying – iquite frankly is pathetic. Provide a rational reasoned argument – stop this name calling silliness.

  • fed up

    All I’m saying is that guys like zeno will slate anything that does not have total gold standard rct and then talk about about risk/benefit of chiropractic adjustments, without,it seems, paying any attention to the possible negative and sometimes serious side effects of vaccines. This is why they are now called biggots on this site because they do not apply the same standards to what they beleive is good or what they beleive is bad. any evidence that chiropractic is safe and effective is torn to pieces but any evidence that vaccines can harm isn’t given a second glance.

  • Eugene Pearce

    @ fed up

    Can you not appreciate that the mad sect as you put it, are trying to promote herd immunity. I dont see anything wrong in that, they obviously mean well but the way they go about things is a little strange. I find it far worse when we get a chiropractor / homeopath clamining a sugar pill or adjustment can somehow prevent disease in the same way as a vaccination.

    Its up to the individual to decide whether vaccination is right for them and their family, you need to live with the consequences if your child gets damaged by a vaccine, or an illness. I just hope people act sensibly and selflessly, Anything that promotes acting responsibly is good, anything that pressurises and removes patient / parent choice is that necessarilty good? I’m not sure where I would place this GuysImmunise crowd.

  • fed up
  • fed up

    the so called skeptic alan henness, aka zeno the sperm, is a member of this mad sect,

    http://www.facebook.com/GuysImmunize?ref=sgm

    has he no questions to ask? or is he a real man.

  • fed up

    Great post from a n other that shows Blue wode bases everything on her OPINION.
    @ Blue Wode,

    So with the highlighted flaws in research i have shown, you would be happy to let peolpe suffer with their low back pain. Is that ethical?
    Again the words highlighted by yourself confirm the point that no form evidence should be viewed as 100% certain, which is something you seem to do e.g low back pain is a self limiting complaint (when there is evidence to the contrary).

    Blue Wode November 14, 2010 at 11:54 am | #11 Reply | Quote A N Other :@ Blue Wode,
    So with the highlighted flaws in research i have shown, you would be happy to let peolpe suffer with their low back pain. Is that ethical?

    Where chiropractic is concerned, due to its unfavourable risk/benefit profile, yes. Better to learn coping strategies, IMO.

    A N Other November 14, 2010 at 1:30 pm | #12 Reply | Quote @ Blue Wode,

    What sort of treatment do chiropractors do?
    Also opinion is not evidence. But there is evidence for using coping stratergies in low back pain.

  • Oliver Dowding

    good luck to everybody fighting this crazy bunch of nutcases. I particularly like to think that they can now be referred to as bigots.

    I wish they’d look into conventional medicine and its many problems with as much zeal as they like to use against anything they deem to be alternative. Yes, but they deem. Certainly the conventional pharmaceutical corporations are paying some big bills at the moment. I noticed recently GSK were fined $750 million for adulterating a line of vaccines. I wonder what the bigots thought about that. I didn’t notice any of them posting enthusiastically.

  • Eugene Pearce

    The Nightingale Collaboration

    The Nightingale Collaboration must be seen to be ethical, legal,
    authoritative, thorough and tenacious.

    Ahh what a joke.

    So Maria MacLauchlan notices the http://www.discoverchiropractic web address has expired for the clinic owned by Ross MacDonald (president of the SCA). So they steal it (morally not legally). Did they do the polite and ethical thing and ask it was any longer in use? Nope. Ethics sadly will go out the window when dealing with narrow mided biggoted bullies. Alan Henness asks the GCC can plantar fasciitis be treated with orthotics, when this is routine in hospital, why, because its done by a chiropractor. These people are simply bigotted bullies, but its fashionable to bully comp. medicine and religeons just know.

    If they opened there agenda to misinformation in general medicine, physiotherapy, and specifically challenged the information most chiropractor baulk at we could take them seriously. Perhaps a medically orientated expert chiropractor for balance, my door is open!

    Still now they have a name and a face perhaps the AECC could extend an open invite, if they dont go, they are bigotted. If they go, maybe they might get their heads around the fact that over 5 years we learn enough to be perfectly able to diagnose and treat muculoskeletal conditions as effectively as any physiotherapist.

  • Dr Bilbo Baggins

    Enough Already on November 9, 2010 at 11:38 pm
    Don’t forget to tune into BBC Wales at 10.35pm tonight – channel 972 – which is probing the University of Wales’ validation activities. Wonder if this will ultimately affect the McTimoney College.

    REPLY

  • fed up

    Hi Richard, don’t know if you have seen this mad anti vaxer who happens to be a chiro, damn black magic mumbo jumbo.;-)

    http://www.youtube.com/watch?v=JbNRdx1_7aU&feature=related

  • Dr Bilbo Baggins

    Hi Colin

    It is difficult for the chiropractic profession to be able to differentiate those who wish to debate, and thus are willing to consider both sides, with those who misuse the title skeptic and who just wish to decry and destroy for their own political ends and personal agenda. Dealing with latter group, who have been described as the ‘British Institute of Great Orators, Thinkers and Skeptics on another blog, or BIGOTS for short, is a total waste of time and energy.

  • http://spinaljoint.com Richard Lanigan

    Colin I am happy to debate with people who wish to question and debate with me and I am happy to agree to disagree. I would be happy to go anywhere and participate in public debates with skeptics. I am a skeptic, but because I am skeptical about vaccination among other things I am not a true skeptic, because thats “scientific”.

    There is not much I can do about people who are convinced I believe in vodoo and nothing I do or say is going to convince them otherwise. Biggot, Blue Wode for example is not interested in explanations he has a view I am just a quack without a proper education who kills people. He is entitled to his opinion and it is pointless debating with him because his opinions are biggoted: “One who is strongly partial to one’s own group, religion, race, or politics and is intolerant of those who differ”.

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

    Very sad – the bigot labelling. I enjoyed debating with you all but never expected to be called a bigot.

  • Garland Glenn

    “The British Medical Journal’s “Clinical Evidence” analyzed common medical treatments to evaluate which are supported by sufficient reliable evidence (BMJ, 2007). They reviewed approximately 2,500 treatments and found:

    13 percent were found to be beneficial
    23 percent were likely to be beneficial
    Eight percent were as likely to be harmful as beneficial
    Six percent were unlikely to be beneficial
    Four percent were likely to be harmful or ineffective.
    46 percent were unknown whether they were efficacious or harmful”

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

    It became a national sport of mine (the nation of Stefaan-like in the seven seas adverts) when I had to give up on fascism, bear-baiting, racism, chauvinism, and gay-bashing, oh, and pigeon fancying (my wife objects to the droppings). This sport, I am told, is more PC and doesn’t harm any of the animals that were involved in the making of the movie. I do sometimes feel bad for them though…
    Stefaan

  • http://spinaljoint.com Richard Lanigan

    Fed up we dont call them skeptics any more on this blog. They are bigots not skeptics.

    I like that phrase “moron-baiting”

  • Fed up

    And Any real sceptic reading that blog will see the true face of vad and just how much bias blue wode has.

  • Fed up

    I know I said I would ignore them but when they start to brandish that. German crap were otrthopods using chirotherapy as chiropractic it makes me angry. U wouldn’t like me when I’m angry.

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

    Yeah, but no, but,…
    playing with bigots is not dissimilar to what Ben Goldacre calls “moron-baiting” and it can be jolly good fun.
    What I find most hilarious is that they don’t pass their own test, but in an acknowledgement of the shear magnitude of obscenity I would add one important thing: as a profession we may very well have a core of high-value statements and concepts, but that does not mean that we should descend into fantasy as, quite frankly has happened, should never have happened and hopefully will never happen again.
    Stefaan

  • Paul

    Richard like Glenn why bother wasting time replying – just keep tabs on their bullshit and once and a while hit them with a real world fact – past masturbation they have small lives of no benefit to anyone past toilet / shower deposition.

    @ex McStudent – why not get on the Barcelona program and get on with a chiropractic career rather than getting stuck in a rut – not getting on your back rather I ‘d like to see you complete your goal of a chiropractic career

  • Garland Glenn

    Richard

    Couldn’t agree more. No more time wasted talking to them. They don’t know and don’t know that they don’t know. They have no idea what thier talking about and no desire to learn. Bigot is a very appropriate title. There’s something charming and endearing in a quack. There’s nothing redeeming about a bigot.

  • http://spinaljoint.com Richard Lanigan

    Its like a war of attrition and chiropractors have a huge advantage. We know they know fuck all about chiropractic how it works and why people visit our practices. The chiropractic profession will have many more people with more knowledge than the skeptics, they can just pound them with information rather than trying to rationalise with them which I have found to be a complete waste of time. I really thought I could win Skeptic Barista over so its fair to say one of us is an idiot.

    Do as they do dont answer questions just say what you want to say ( cut and paste so as not to waste too much time on it.

    Andy Lewis did not like being called a “bigot”; A bigot is a person obstinately or intolerantly devoted to his or her own opinions and prejudices, especially one exhibiting intolerance, irrationality, and animosity toward those of differing beliefs” if that is not an accurate description of these people I dont know what is and from this day forth I will no longer bestow the curtsey title of skeptic on them but urge everyone to use the more appropriate title of Bigot instead.

    Must be better to be a quack than a bigot.

  • fed up
  • Ex McStudent

    @ Richard No, not yet but my mother is….

  • fed up

    I’ve just posted this on SB website after blue wode but a link to a VAD pdf. As usual his bias shows. This was in the research he linked to. Funny how he missed it.

    “One retrospective study looking at vertebral artery dissections after chiropractic manipulation/chirotherapy in the cervical region reported that 18 of the 36 patients were treated by orthopedic surgeons, and four were treated by chiropractors. [8] Unfortunately, the qualifications of the individual practitioners were not described in the paper, but to our knowledge there were no chiropractors who graduated from a CCE-accredited program who performed one of the reported chiropractic treatments.”

    I like how neck manipulation done by a surgeon is still classed as a chiropractic adjustment!! As usual blue wode bias shows again.

  • http://spinaljoint.com Richard Lanigan

    I hope you are not a fan of the O Reily factor on Fox news.

  • Ex McStudent

    @ Fed Up I’ve already had a 5 year discussion and I’m truly fed up with it now. Spin free zone here.

  • Paul

    @ Andy Lewis

    thank you for confriming you are a bottom feeder amongst other things

  • Fed up

    I’m afraid you missed out. The mct tech is amazing. I gave u my email. Contact me if u wish to discuss.

  • Ex McStudent

    @ Bags. Thank you x

  • Dr Bilbo Baggins

    @ex mcstudent

    No problems, talk to Stefaan, he sounds like at the very least he is a sympathetic ear. I genuinely wish you well and I am saddened to hear of your experience in a UK chiropractic institution.

  • Ex McStudent

    @ Dr BB terribly sorry, a thousand apologies – I meant that for Dr McD who did the PR post and who states ‘my colleagues’ suggesting that they are a McT grad.

  • Dr Bilbo Baggins

    @ ex mcstudent

    Sorry my friend, are you even reading my posts. You said;

    ‘Paul, you will find out in due course. Look first to Dr McBB’s cold, hard ass attitude in their last post. IMO they clearly think it is acceptable to sacrifice, crush and bully a few students each year to uphold the brand. With an attitude like that, they do not deserve to have representation on the GCC education committee.’

    If you think my posts cold and hard does that mean that you feel you are not getting the sympathy you feel you deserve or you can’t comprehend simple English. I have never suggested it was good practice nor appropriate behaviour to sacrifice, crush or bully anyone and I want you to retract that statement. As for upholding the brand, university education is not a simple right of passage. As for ‘they’ with regards representation I presume you think I am a McTimoney grad, well good luck with that one.

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

    Hi ExMcStudent; my email address is stefaan@tcpn.co.uk you can contact me there anytime.
    Regards,
    Stefaan

  • Ex McStudent

    Thank you Stefaan.

    As the board controller, Richard has a contact email address for me. I give permission to Richard to let you have it.

    Paul, you will find out in due course. Look first to Dr McBB’s cold, hard ass attitude in their last post. IMO they clearly think it is acceptable to sacrifice, crush and bully a few students each year to uphold the brand. With an attitude like that, they do not deserve to have representation on the GCC education committee.

  • Paul

    @Ex McStudent

    If you mean the McTimm spin – I would have to agree …

    If not please do enlighten us instead of having us all having to drag info from you

  • Ex McStudent

    The spin has landed.

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

    @ExMcStudent;
    I understand the sentiment in part as I have been invited to talk to new grad students and last year’s students on a few occasions. I am not too sure what you mean exactly by the “wholesale chiropractic student mindf**k” and would love to do my best to help you if I can get to understand a bit more about what you mean.
    Regards,
    Stefaan

  • dr.dynamic

    Dear Glen, the McTimoney College of Chiropractic (MCC) has been continually accredited by the GCC and the university of Wales for over 8 years. The course on offer now is an undergraduate Masters degree with the basically the same syllabus as AECC and WIOC. The MCC has recently been awarded candidate status by ECCE and when the first cohort of full time students graduate in 3 years time, it is hoped that full ECCE accreditation will be awarded subject to the necessary standards and inspections being achieved to the required level. McTimoney College graduates fully trained chiropractors with the clinical skills and knowledge to safely practise chiropractic in the UK and many other parts of the world. Colleagues of mine are now licenced to practise in Austrailia, New Zealand, Thailand and parts of Europe.

    The 2 animal postgraduate Masters degree courses are open to fully licenced chiropractors and non chiropractors with bachelors degrees in a relevant subject such as osteopathy, animal sciences/ therapies. MCC offered the first postgaduate Masters in Animal chiropractic in the world. You are correct in that animal manipulation is not subject to regulation by the GCC. Therefore, those who do the Animal courses are not necessarily able to practise chiropractic on humans. Their training and education is more akin to vetinary science in that they study animal anatomy, physiology, differential diagnosis and manipulative techniques specific to animals.

    As with all training and education, not everyone has a positive learning experience. Every year a few people on every course in the world will drop out, fail their exams or just scrape by gritting their teeth. Sadly, these experiences often scar people and leave them with an axe to grind.

  • Ex McStudent

    Hi Stefaan,

    My cause is the wholesale chiropractic student mindf**k

    x

    @ Dr BB re. researching the course beforehand, I believed the spin.

    @ GG Thank you for clarifying. Sounds like we really are the poor relatives here.

  • Garland Glenn

    Ex McStudent

    I am now beginning to appreciate an underling perspective which might be contributing to the “skeptic situation“ in the UK . It may be in part due to a perception of the quality of education. Actually it’s not a perception. National College was the first program to require a Bachelors degree before admittance. Here a Bachelor degree is 4 years at university. Then chiropractic school is 4 more. 8 years full time study. There is a difference. Am I correct in hearing you infer that I’m not able to make a clinical decision because of my training as a chiropractor? I did write to the BCA in 1999, warning them that including Mc Timmony practitioners who did not have the same training as chiropractors in the rest of the world could create a huge problem. Here the McTimmony school could not exist. That’s not to say it isn’t valuable. But in the global picture, it’s not chiropractic. It’s similar but not the same. The litmus test for me is, can you take your degree and practice in any jurisdiction where chiropractic is licensed? If you can, then you’re in the game. If you can’t, why not? Important question. Keep in mind that this whole skeptic thing really doesn’t exist here in the US. There may be a few people out there pontificating, but nobody pays them any attention. Here, unlike there, I have access to all of the diagnostic tools the GP has access to. Blood testing, enzyme profiles, GI studies, CT scans, MRI etc. Also because of the way the health care laws are written here, the GP has to share his records with me and vice versa. The GP doesn’t have any information I don’t have. With our move towards electronic records, I can access his records from my computer in my office. As I recall from practicing in the UK, GPs can’t even order CT studies, MRI, nerve conduction studies etc. (if somebody can confirm or refute, please do).

  • Dr Bilbo Baggins

    @ ex mcstudent

    Actually, the regulator whom you suggest is at fault, that is if my understanding is correct, is only responsible for the course, content, delivery and outcome which graduates UK chiropractors to the standard required by The GCC. It therefore has no control over post grad courses or in fact animal related courses as British chiropractors are regulated to treat humans only.

    Do I blame you, the question in part is; why blame the whole chiropractic profession? Do I blame the fee paying student or the course provider, I don’t know enough about your circumstance to comment but re my last post, did you research the course well before you signed up for it, was it really what you wanted?

    @ Andy

    You’re all heart, your comment ‘quackometer.net might be interested’ is a bit strange, because isn’t that your own site?

  • Dr Bilbo Baggins

    @ ex mcstudent

    Actually, the regulator whom you suggest is at fault, that is if my understanding is correct, is only responsible for the course, content, delivery and outcome which graduates UK chiropractors to the standard required by The GCC. It therefore has no control over post grad courses or in fact animal related courses as British chiropractors are regulated to treat humans only.

    Do I blame you, the question in part is; why blame the whole chiropractic profession? Do I blame the fee paying student or the course provider, I don’t know enough about your circumstance to comment but re my last post, did you research the course well before you signed up for it, was it really what you wanted?

    @ Andy

    You’re all heart, your comment quackometer.net might be interested but isnt it your site?

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

    Hi ExMcStudent,
    what cause are you rallying support for?
    Regards,
    Stefaan

  • http://www.quackometer.net Andy Lewis

    There’s a contact address on the web site.

  • Ex McStudent

    @ Andy, I sure could use the support. True to form, there is none coming from here.

  • http://www.quackometer.net Andy Lewis

    @Ex McStudent

    If you want a platform to tell your story, quackometer.net might be interested.

  • Ex McStudent

    @ GG Why refer to a GP? So that the 10 to 20% of babies whose condition is not resolved by chiropractic (and that is a high number IMO) can be checked for something more insidious. The GP would have their notes and be able to make a clinical decision. The other reason is that if the treatment resolves as many case as 90%, more babies would benefit from the GP knowing about it and so they would feel inspired to refer more often. Ultimately you would have more GPs standing up for your cause. Ultimately, more babies would be helped.

    @ Dr BB Yes of course I complained and I am far from finished yet. You will get to know my story in due course. How is that the responsibility lies with me for making a bad choice? It is up to the regulators to oversee course quality, not the paying students.

  • Dr Bilbo Baggins

    @GG

    I am certain no one would take offense,as I said I can only really speak for what I know of WIOC and AECC and they are both good schools. I think that AECC had not a dissimilar reputation to National, but it has also been around for a long time.

    @ ex mcstudent

    Sadly once again your understanding of chiropractic is not anything I would recognise. White coats, drugs, stethoscopes, please !!

    You obviously made a bad choice, you had a bad time, but you can’t blame a whole profession for that. Did you complain to anyone, if not why not. Did you research the course, check out the website, the syllabus, the course content, visit the college, talk to tutors, talk to students, talk to other chiropractors, once again if not, why not?

    My last question is simple but in two parts; why did you want to do the post grad course (in treating animals I believe), and what did you hope to gain out of it?

    As I understand it, people who graduate in the UK as chiropractors are only licensed by the General Chiropractic Council to treat humans, the animal thing is something I really cannot comment on?

    With regards the colic thing, I was speaking to a midwife the other day, who advises and utilises not a dissimilar approach to treating colic than the chiropractors I know do, interesting, huh?

  • Garland Glenn

    Why?

  • Ex McStudent

    @ GG Ask the parent to ask their GP for a clinical referral for their child to have a chiropractic treatment.

  • Garland Glenn

    Just want to make certain that graduates of AECC are not offended by my previous comment on education quality. While practicing in the UK, I meet many fine and competent chiropractors who where trained there. Where you take your training has a profound impact on your experience and the quality of doctor you become. There are colleges here in the US that don’t qualify you to practice in all states. Why anyone would attend there is beyond me.

    Skeptica

    Here’s a real world situation. Over the years I’ve probably treated 100-150 infants with colic. I probably don’t see as many kids as Richard or some others. I haven’t kept stats but conservatively 80-90 % success rate. So my clinical experiance says chiropractic is a resonable tretment for colic. The report says that even though there is the Danish study which supports chiropractic treatment for colic, the other studies do not , according to the criteria for evaluating research. My treatment is safe. Actually safer than driving home in the car. It is inexpensive and the mother wants me to treat the child and there are no contraindications to treating the child. What should I do?

  • Ex McStudent

    @ Dr BB Thank you for the careers guidance. Gleaning from Garland Glen’s training, would you like to share with us how yours compares and how you have earned the right to wear a white coat and stethoscope, prescribe x-rays, use the doctor title, dispense pills etc. using little more than philosophy to validate your treatments?

  • Dr Bilbo Baggins

    @fed up/ Andy

    Yes, sadly it would seem that when the cry is for RCT’s, because the ‘ skeptics’ believe chiropractors don’t have any, that is ok

    When chiropractors give them RCT’s that are weak, they climb all over them

    When a reasonably robust review shows chiropractic has medium to high positive evidence in the treatment of some disorders, the skeptics talk of drugs and risk.

    To put it all in perspective drugs, yip a safe option…. Who isn’t reading the research now.

    Risk, compared to many drugs and medical procedures, the risk involved with chiropractors is very low eg.

    Colonoscopy, a normal and accepted medical procedure done 1000 times a day up and down the country, carries a 1/1000 risk of complications and of those complications a 1/300 chance of a fatality. Puts it all in perspective possibly.

    So Andy, you actually sound reasonable on occasion and as if you could, with evidence, change your mind. But it seems it will never be good enough. That’s not skepticism that’s bigotry. I hope I am wrong, otherwise as both Richard and myself mentioned earlier, their is no real point in continuing with any dialogue. Of course where is skeptic barista, he throws in a biased statement, then goes. How is that adding to any debate.

    Finally, not certain you are right about the demise of chiropractic, but that will be for the chiropractic profession to rise to the challenge, and I think they will.

  • Dr Bilbo Baggins

    @ ex mcstudent

    Please don’t use the royal ‘we’ in your comments regarding British chiropractic education. It is obvious that your experience was poor, that the quality of the education you received, you believed to be poor, but don’t lump all UK graduates in with you. I get the impression you feel you made a bad call, either take it up with the institution or get over it but please, at least research other options and courses, not to sign up for but to get your facts straight.

    Personally I only have experience with the courses given at WIOC and AECC and, excluding any philosophy argument that some may pose, both these colleges have excellent academic standards and outcomes, in undergraduate and postgraduate education.

    So to reiterate ‘ we’ only seems to include you, sadly.

    Gleaning from your posts, and that of others here, it would seem that you joined a post graduate course at the McTimoney College, is that true? I also get the impression, you you did not finish the course/ left before graduation and if that is the case then at least you followed your convictions, rightly or wrongly . But to reiterate, your experience and your perception of the standard and quality of education, and delivery/ outcomes of the same is not one many if us will recognise.

  • Ex McStudent

    @ Garland G There seems to be so much variation within the profession. I would have far more confidence that you could evaluate and treat medical conditions and would have the confidence to refer when needed because of the quality of teaching you received. You sound very proud of your training. IMO we are the poor relatives over here.

    @ Dr Dy. This situation is far more serious for the animal patients whose owners are even more in the dark about the efficacy of treatment. That’s a whole other thread.

  • Fed up

    ” Of course, even if there is positive evidence in an RCT, that does not mean that the treatment is clinically meaningful. ”

    Lol you just can’t win with you guys.

  • Fed up

    Wow mr Lewis. You must be a politician! You still have not answer the questions asked mr baggins.

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

    This Nightingale exercise is brilliant! (sorry for the delay, was away) No more need for regulators or parliamentary recognition… power to the people with the onus on the practitioner to state truth, explain assumption and get agreement on process. This seems a lot more truthful and karma-neutral than a lot of previous efforts I have seen… good luck to the boys and girls involved in it as their whole exercise will be incredibly vulnerable but very worthwhile in my opinion.
    Anyway, chiropractors should never have made claims in the first place and should be comfortable with the concept that with benefit comes risk. I think it is time to shake things up a little!
    Stefaan

  • dr.dynamic

    I believe this Ex McT student to be someone who did the animal masters rather than the human degree. And, if it is CL who used to post here, she did not gain her Masters and graduate. She has a special axe to grind.

  • Garland Glenn

    @Ex McStudent

    I’m very sorry to hear about your educational experience. From what you say, you deserve to be disillusioned and angry. I attended the National College of Chiropractic in Chicago, now the National Health Sciences University and my experience couldn’t have been more different. I chose National for three reasons
    1. National had at that time and continues (to my knowledge) score the highest National Board scores for all schools throughout the world. It was my assumption that the board scores were an indication of quality education and it was proven to be so.
    2. We shared our basic medical science faculty namely anatomy (2 semesters of human dissection), histology, medical physiology, pathology and others with the Loyola University School of Medicine in Maywood (suburb of Chicago). We had fantastic faculty with every professor possessing a terminal degree in their field.
    3. We had 4 clinics in the greater Chicago area in which to intern and we had a 30 bed hospital for admitting the very acute for over night care.

    I know almost nothing about chiropractic education in the UK but I do know this, some (not all) chiropractic school graduates from outside the US are not eligible to practice here. I can tell you that what you experienced didn’t exist at National. Your experience is not universal in chiropractic schools.

  • Andy Lewis

    OK. Very quickly – depends on what the RCT was measuring. If results, showed similar effects to paracetamol (say) over the short term only, why spend large amounts of cash on a procedure that carries risk? RCT evidence is the beginning in the discussion of whether a treatment is clinically appropriate.

    Nighty Night.

  • Dr Bilbo Baggins

    @ Andy

    But surely, if the RCT’s ( the gold standard of evidence, which, in part, is the basis if this thread) suggests that chiropractic care is a viable treatment for certain conditions, why then would you discount them and therefore the viability of chiropractors to treat those conditions.

    I am sure that your statement will come across as a little ridiculous to many readers. But as you have bowed out, I guess they must make their own minds up on it’s meaning.

  • Ex McStudent

    Back

    @Fed up – ask if my wellbeing is more important than the destination and I would say ‘Hell, yes’. I paid for a postgraduate University education not a complete recycling of my scientific thinking and professionalism. No student should have to go through that ‘journey’ as you call it.

  • Dr Bilbo Baggins

    Andy

    Thank you for the response, it was appreciated. All roads begin somewhere.

  • Fed up

    Ex mct. Is the route more important than the destination?

  • Fed up

    Lol goodnight run for cover. Incoming. No answers given. Not your best.

  • Andy Lewis

    I think too for now this has run its course too. I have not been here for a while and I remember what a wonderland it is. Best not get too comfortable.

  • Andy Lewis

    It’s a long time since I looked at Brontfort and if I remember correctly it was a good start. I thought some of it was flawed, but largely in the right direction. Of course, even if there is positive evidence in an RCT, that does not mean that the treatment is clinically meaningful. So, simple(s) interpretations are not the order of the day.

  • Ex McStudent

    Unbelievable…….I’m outta this thread.

  • Fed up

    Brontford? Robust evidence. Yes no. Gmc right or wrong?

  • Fed up

    What a great side step by the skeptic al. He did not answer 1 question. As usual he shows the selective(bias) shown when answering questions.

  • Dr Bilbo Baggins

    Come on Andy

    Is Bronfort robust or not

    Do RCT’s exist that show chiropractic care in some areas as being medium to high positive

    Simples

  • Dr Bilbo Baggins

    @ ex mcstudent

    I am neither defendive nor was I deliberately attempting to patronise, I wrote;

    Although alluded to by others, may I be so bold as to ask which college you attended and when you graduated. I ask simply because sadly I don’t recognise your educational experience nor in fact your understanding of chiropractic, which I must assume came from that very educational experience. This of course may have occurred due to many variables to include content and outcomes of the course, as well as a misunderstanding of the information communicated.

    As you can see, I did not suggest you misunderstood, I offered a spectrum of reasons for your understanding of chiropractic. Your response, which seemed a bit defensive in itself, did not in fact answer my question. It was however answered by fed up. As I have no experience of that institution I cannot comment, nor would I deem it appropriate to comment on either the content/ outcomes or your ability to assimilate information. Your previous posts however do not reflect the education and understanding of many UK chiropractors, whatever the reason.

  • Ex McStudent

    @ Andy who said ‘My personal belief is that young chiropractors would be better off in sports therapy or somesuch other. To spend four years (at vast expense) studying a pseudoscientific subject that gives marginal effects to other people is a waste of the aspirations of the students. They are the first victims here – they have to go through the mind-fuck – as was said earlier.’

    Amen

  • Ex McStudent

    @Fed up – I did not criticise the technique. Just the teaching of it.

  • Ex McStudent

    @Dr BB How patronising. Great example of how defensive chiropractors talk down to people who question them. I did not misunderstand any information communicated, I am appalled at the quality of it.

  • Andy Lewis

    So many points and I have rather lost track.

    Richard, I think I have answered your questions before. It does not matter what mechanisms and names chiropractors put to things: what matters, is if your interventions actually achieve things. Having grand theories counts for nowt.

    It is not for Nightingale to push for research. In many areas, like homeopathy, research can only be unethical as it is such obvious junk. For chiropractic, that too would apply to many of its claims: for its more moderate claims, it must be up the the trade to do that research. You will need it, if you want to make specific claims.

    It is somewhat shameful of you to call my views “bigotry”. I merely ask that people like chiropractors have good reasons to make the claims they do so that they do not mislead their customers. I find it hard how you characterise such as position as bigotry.

    However, I may indeed laugh at some of chiropractors more absurd positions, such as admirably displayed by Dr Glenn and his “chiropractors are energy” and his quantum singing nurses. I see no-one has leapt to his defence.

    I am also under no illusion that chiropractic will disappear. My personal belief is that young chiropractors would be better off in sports therapy or somesuch other. To spend four years (at vast expense) studying a pseudoscientific subject that gives marginal effects to other people is a waste of the aspirations of the students. They are the first victims here – they have to go through the mind-fuck – as was said earlier.

    But it will survive. Maybe more marginalised. The Singh-BCA affair may have damaged it in the UK for a generation and the ramifications will play out for many years yet. We shall see.

    But I would suggest it was folly to ignore sceptics of chiropractic. They will always exist as it is not a defined group, but the emergence of many individuals with similar views being enabled to enact on those views by the internet. That is not going to go away any time soon.

  • Fed up

    FMct student. I’m really sorry u are an x student. You have missed out on a fantastic technique. To understand how chiro works , mct or any other , takes experience and practice. You would have left the mct college with a great technique that would have helped many people. I will happily let you know how I and I mean my own opinion how the mct tech works and why. I have been using it for 20 years and can only try to explain how I think itcworks. fedupchiro@yahoo.com if you would like a chat.

  • Dr Bilbo Baggins

    @ ex mcstudent

    Although alluded to by others, may I be so bold as to ask which college you attended and when you graduated. I ask simply because sadly I don’t recognise your educational experience nor in fact your understanding of chiropractic, which I must assume came from that very educational experience. This of course may have occurred due to many variables to include content and outcomes of the course, as well as a misunderstanding of the information communicated.

  • Dr Bilbo Baggins

    @fed up

    Not sure about it being on a sceptic site, I read it in the Guardian.

    @ Richard

    I think the inability of the ‘skeptics’ to answer simple questions, and cherry pick information, would suggest that debate is not a priority, so I sadly must agree with you. Scanning the sceptic websites, it would seem that without a pro chiropractic input, the debate either freezes, or becomes a ‘ back slapping’ party. Let them get on with it.

  • rod macmillan

    Andy has a point of view I am interested in; we can disagree politely.

  • Ex McStudent

    @ David who said: ‘I’m afraid that what your post reveals is that you don’t actually have an understanding of chiropractic.’

    I’m afraid I wouldn’t be alone then. I hold my hands up to being bloody confused especially as Chiropractors don’t even have an understanding of their own profession either. Yours is the attitude that I encountered at college – if you don’t understand it you must therefore be terribly thick. Hmmmm let’s go a little further and say that if you don’t believe it you are not one of us. That is not postgraduate education. That is student abuse.

    Where else would a student gain a certificate in not knowing what they do?

    @ Garland G: I agree that it all used to be so simple: pain reduction, increased mobility of joints. However, times have changed; the spine has many, many more stressors now than 40 years ago.

    Many chiropractors want to move into clinical medicine. WTF has philosophy got to do with EBM? It’s subjects like health psychology and quality rehabilitation that chiropractic education needs, not courses padded out with weird, woolly explanations in place to defend the technique rather than help vulnerable people. Then again, God forbid efficacy of the technique is ever attributed to effective physical rehab.

  • http://spinaljoint.com Richard Lanigan

    Andy its you dont get it or you would have answered my question. You refuse to answer my question because you can not deny something actually happens when one restores motion to a spinal joint with an adjustment and the adjustment has an affect on mechano receptors in the joint which communicates with the CNS.

    By all means debate the effect this has on wellbeing and the lack of evidence for the effect of chiropractic on certain conditions. But for you guys to keep to the mantra “chiropractic is a cult of believers in psudo science shows incredible ignorance and thats coming from someone with a degree in quackery which must be hard to take.

    If the Nightingale Collaboration is true to its core values it will help raise money for research and challenge CAM to do that research. I suspect it wont do anything of the sort and just be a collaboration of like minded intolerant bigots, who like winding up touchy feely practitioners who just dont know how to deal with your intolerant attitude towards an unorthodox approach to wellbeing .

    Perhaps it does not phase me the same way having been active in left wing politics since the 60s when marching against the apartheid regime was seen as being disruptive. I have experienced biggotry from the catholic church in my childhood. In 70s I was picked up un an anti Irish sweep of squats, in the 80s experienced it in Nicaragua from the US, and now muslims are getting it in the neck.

    What they all had in common is that we were minority’s. In the whole scheme of things who is going to give a shit about a views of a few arsey skeptics and there collaboration in ten years. You guy will be the Ralph Lee Smiths http://www.chirobase.org/05RB/AYOR/00c.html of my generation a mere footnote in chiropractic history. Smith was one of ther AMAs poster boys in the 60s in the Wilk case and the efforts of the AMA to put chiropractic out of business. The AMA spent $20,000,000 and I doubt very much if you guys have those resources at your disposal.

    Last year I realised talking to skeptics was like talking to Miami Cubans about the excellent health service in Cuba. Anything with Fidel’s name on it is bad as far as they are concerned and they cant see beyond Fidel as far as health and education in Cuba is concerned, just like skeptics cant see beyond “water with memory” as far as CAM is concerned.

    This discussion will be an eye opener for many chiropractors as a major coming together of the UK associations has been announced. I wanted to let this discussion run before posting about it so people can see how narrow minded sceptics are unfortunately Blue Wode did not join in but his views can be on his views can be read on http://www.ebm-first.com or check out the recent discussion with David http://skepticbarista.wordpress.com/2010/10/24/subluxations-who-said-what/#comments remember David is no evangelical subluxation chiropractor. To the skrptics all chiropractors are arseholes no matter where you went to college or whether you are on the register or not. I have always hoped their antagonism towards the profession could be the making of the UK Profession and Thursdays announcement from the four chiropractic associations suggests it may be happening.

    Cropractors should not waste one more minute of their time on skeptics. Its pointless they are not interested in anything we have to say. Its the public we need to present the case for joint dysfunction and its effect on health and leave Andy et al to their symptomless view of health and wellbeing.

  • Fed up

    Please tell me al how a gp can decide what is best for their patient if they don’t adhere to ebm? I would lovevto know how they judge what is right or in the best interest of their patient without relying on evidence gained from gold standard random controlled studies?

  • Fed up

    In fact I think I found that quote and posted it on a skeptics site. Is that right bilbo?

  • Fed up

    “May I remind you of what the GMC stated in the Guardian, July 5th 2010, when asked what level of evidence they require medical doctors to use and it states: ‘We do not require doctors to use only evidence based treatments in any form of medical care, but we do expect doctors to do their best to ensure that any treatment they offer is in the patient’s best interests. This will generally mean that any known risks of the treatment are outweighed by the potential benefits to the patient’.”

    Is the gmc wrong? Is this ebm? If not are you saying the gmc does not follow ebm? Are YOU saying the gmc is not following ebm? Should the gcc recommend higher standards of ebm for chiropractors than gmc does of gp’s? Is the brontford report robust evidence?

    Barista and Andy please answer. Do REAL doctors only follow ebm ?

  • Fed up

    Is brontford solid research? Yes no. Is the gmc wrong in it’s reasoning? U have not answered.

  • rod macmillan

    1. Andy Lewis on October 29, 2010 at 9:07 pm
    @rod macmillan
    You know – the difference between me and you is that I do not assume I have answers

    Hi Andy I still don’t understand how you know what I think?

    Going on about randomized trials is not the same as answering a simple question.

  • Andy Lewis

    You directed a point at me. I responded.

  • Dr Bilbo Baggins

    @AL

    Sorry, can I clarify, was that answer in response to my post?

  • Fed up

    So still not answered. Poss not read.

  • Andy Lewis

    The fact that the GCC states that it does not require doctors to use only EBM does not mean that they can do what they like, and in particular practice in ways that condradicts a rational and evidence based worldview. This statement does not let you off the hook of evidence. If there is negative evidence or a lack of plausibility for what you claim then it is quite right the GCC hold you to account on your ethical standards.

  • Dr Bilbo Baggins

    @ AL and SB

    I note no comment with regards my posting

  • Andy Lewis

    Or her.

    And it is precisely the attitudes displayed above as to why the Nightingale Collaboration exists. Glenn will never get it. Others will have to ensure chiropractic is kept on the straight and narrow.

  • Garland Glenn

    @Ex McStudent

    This has already been done. Dr. L John Faye and Dr. Henry Gillet did this in Belgium in the 1970’s. Using cineradiography, they demonstrated, by using motion palpation, the detection and correction of fixations. The spine was put through ranges of motion and cineradiographed documenting the aberrant joint function. The joint was adjusted with a manual high velocity low amplitude force (chiropractic type) adjustment and then re-cineradiographed. I have seen the films (25 years ago) myself and they are brilliant and would be worth searching out if you’re really interested. Before and after x-ray documentation showing fixated joints corrected by adjusting. What’s fantastic is there’s no measuring involved or subjective interpretation involved. You can actually see the change. I wouldn’t be surprised if the films are not shown at MPI seminars. You could check with MPI to find out.

    You make this statement: “Why would the profession not want to be associated with such simple studies I wonder? Why would they want to maintain mystique?”
    These simple studies were done years ago. I think what many who are new to chiropractic or who are examining it for the first time think is that we’ve existed for years without ever looking critically at what we do. This isn’t true. For most of the simple stuff the investigation was done long ago. Like the above mentioned cineradiography. I wouldn’t be surprise if the people who performed the GCC’s literature review even knew it existed. You won’t find it on a Medline search. It’s kind of like the original research for penicillin. We all know it works. We know with good confidence how it works and so there’s no need to go back there again. I would doubt, though I haven’t looked, that the original research for penicillin could be found digitized and on line. Would you actually go into the GPs office and ask for documentation proving penicillin works. Of course not. I don’t know much about what is taught in schools now as far as supportive evidence, but when I was in school, we went through all this stuff.
    I get the impression that those who are coming to the game late, so to speak, think we’re just making stuff up. Have you actually been to Palmer in Davenport and seen the exhaustive collection of spines that BJ Palmer amassed and did research on over 60 years ago. As I said earlier, we didn’t just crawl out from under the cabbage. Most of this stuff has already been done which is why some of us get frustrated having to continually go back to square one.
    There is one other thing that is very important when examining research support for chiropractic. Who’s going to pay for it? Quality research is expensive. Medicine has the luxury of government supported institutions (universities) and multi billon dollar pharmaceutical companies to foot the bill. Chiropractic doesn’t have the deep pockets medicine has. Chiropractic research in the past has been paid for by chiropractors. How much does your local GP give from his annual turn over funding medical research? Probably not too much. When you look at it from that point of view, chiropractic should be praised for producing the research it has. See it from the point of view of the chiropractors in private practice. Why should they spend money doing research on stuff they already know works. Chiropractors are in some ways held to a higher standard then research. It’s the patient. If what we did didn’t work, patients would stop coming to see us. It always comes back to the patient. Patients don’t care about research, they care about results. Most chiropractors understandably feel the same way. Earlier in this blog I may have given the impression that I don’t care about research. That’s not accurate. What I care about are results. My overriding concern is for the patient. The person standing in front of me in the clinic. Can I help him.

  • Fed up

    I would like to see a response from Sb and al to billow baggins. Great post that conveniently was not answered.

  • David

    @ ex McStudent

    I’m afraid that what your post reveals is that you don’t actually have an understanding of chiropractic. I don’t know what they taught you at the school you attended or how long you were there, but I would have thought that they must surely have told you that Chiropractors don’t change the position of vertebrae, they alter function. Which is why, unless the injury/dysfunction that they have been treating has caused a physical derangement that will correct itself once the injury/dysfunction has been repaired, you’re not going to see the changes on an x-ray.

    As for posture, every single one of my patients starts their examination with an assessment of posture. As part of the management regime, they will automatically be given postural advice and exercises if necessary. Which I have to say is nearly always.

    I think you should have gone to a better chiropractic training facility.

  • Ex McStudent

    So, there must be zillions of studies which measure patient flexibility following treatment.

    Why not measure spinal misalignment before and after treatment?

    This is information which is simple to illicit, on the basis that the vertebrae are stimulated to move back into their neat little grooves to form a perfect anatomical fit and restore mobility.

    None of it is rocket science to study.

    Why would the profession not want to be associated with such simple studies I wonder? Why would they want to maintain mystique?

    I have never known a chiropractor to look at causes for poor posture and remove it. Generally speaking, they keep applying the same techniques to a variety of problems. That’s not medicine. Methinks that’s business.

  • http://spinaljoint.com Richard Lanigan

    @Mc Student not being a Mactimoney practitioner it would be unfair of me to comment on the technique. However I believe the technique focuses more on stimulating nerve receptors that cavitating the spinal joint. There are many different chiropractic techniques, they all have one thing in common in trying to stimulate nerve receptors which communicate with the central nervous system.

    I am focusing on joint function and range of movement because its easier to explain here than go into the Central Nervous System which no one fully understands how it all works and is still very theoretical at this moment in time.

  • http://spinaljoint.com Richard Lanigan

    Andy and SB I am not talking about “back pain” I am talking about “spinal joint dysfunction” which of course can produce back pain and interfere with nerve impulses. Pain is generated by nociceptor stimulating the sensory part of the brain according to Melzak and Wall you can block those messages going to the brain with pills and many ways. Its why movement is important especially in spinal joints when pain has become chronic. If the joints capsule and surrounding tissue has developed adhesions exercise alone or pills wont do it permanantly chiropractic might do it.

    My question is simply do you believe spinal joint dysfunction gets better by itself and does loss of spinal joint motion result in pathological changes to the joint surface. Its a straight forward question. I have never avoided any questions you have asked and to keep answering question with question becomes tiresome. When you answer that question I will explain how and what happens when you restore motion to the joint. If you are not interested just say so and I wont bother trying to explain it, and everyone will understand better where you are coming from.

  • Andy Lewis

    Marvelous stuff ‘Dr’ Glenn. A complete descent into Chopra-esque quantum wibble. “Chiropractors are energy”. I must remember that one.

    The fact that everything in the universe can be described in energy terms is trivially true. It is a true as it is for chiropractors as it is for a bowl of cornflakes. It does not help you one bit describe how quantum mechanics makes RCTs impossible.

    So, Mr Physicist/Chiropractor – when you effect a patients ‘energy’, precisely what is the form of that energy? Is it kinetic energy when you hit them hard? Potential energy when you raise your massage bed? Or chemical energy when you give them a cup of tea? Maybe it is ionising energy when you unnecessarily X-ray them? Maybe it is the electronic energy in the semiconductor chip in their credit card as you deduct your fee?

    A whilst on the subject of semiconductors, do you think I am stupid? I do check references you know – and none of them even mention semiconductors. I am not sure why I am telling you, as you claim to have written a doctoral thesis on electronics, but a semiconductor is a material with specific intermediate conductivity properties for electron flow. It is bulk property of the material due to the specific way electronic energy bands form in the material. Cell membranes, on the other hand, are complex biological structures, which highly complex ion channels that regulate the flow of specific ion groups through the membrane. The fact that such membranes have electrical properties does not make them a semiconductor.

    Despite your claims to be qualified in these subjects you sound like someone who has learnt all their quantum theory from Deepak Chopra and Frijof Capra.

    As for your challenge for me to provide you with a neutral control – that is a straw man. Controls need not be neutral, they just need to provide a meaningful benchmark. I fully admit that a perfume wearing, singing, cuddly nurse is not neutral, but if chiropractors cannot do better than them in a trial, then you do look rather silly, or even (your words) like “a bunch of soft brained morons sitting around waiting to be picked off by people like [me].”

  • Ex McStudent

    What I found odd about my particular brand of training is that results of the treatment, ie. increased mobility, were not checked by the practitioner immediately afterwards. Patients are told to expect ‘healing’ to happen over the subsequent days.

    Can anyone throw some light on that one?

  • http://skepticbarista.wordpress.com/ Skeptic Barista

    @Richard:
    You said:
    “Anyway what do you think of Andys and Blue Wodes idea that spinal dysfunction subluxation gets better all by itself.”

    If you are refering to back pain – then check the WHO’s advice on treating back pain!

    If you are refering specifically to subluxations, then I can only assume you meand the ‘medical subluxation’, the WHO say that the ‘chiropractic subluxatiion’ is a hypothesis as described by chiropractors!

    Difficult to decide if a hypothesis actually justifies treatment!

  • Garland Glenn

    Lewis

    References:
    For cell membrane as a semiconductor
    Cornell, B.A., V.L.B. Braach-Maksvytis, et al. (1997). “A biosensor that uses ion-channel switches.” Nature 387:580-583

    For EMF interaction
    Blackman, C.F., S.G. Benane, et al (19930. “Evidence for direct effect of magnetic fields on nuerite outgrowth.” Federation of American Societies for Experimental Biology 7: 801-806
    McClare, C.W.F. (1974). “Resonance in Bioenergetics.” Annals of the New York Academy of Sciences 227: 74-97
    Rosen, A.D. (1992). “Magnetic field influence on acetylcholine release at neuromuscular junction.” American Journal of Physiology-Cell Physiology 262: C1418-C1422

    How many more do you need? You see Mr. Lewis it’s actually you who don’t know what you’re talking about. Matter is energy. Einstein said it first. All energy is contiguous. Patients are energy. Chiropractors are energy. An adjustment real or sham is ENERGY. It is impossible to have a neutral sham. It affects the control. You can’t do anything to a patient that doesn’t affect his energy. Everything has an affect and that effect might be significant. You must think I’m some idiot out here making this up. When it comes to science and its application to patients, it’s you who hasn’t a clue. The tragedy you don’t even realize it. You obviously have some axe to grind with Homeopathy and you’ve translated that to chiropractic. Your must think we’re a bunch of soft brained morons sitting around waiting to be picked off by people like you.

    Now back to your hypothetical case. My contention all along has been that it is impossible to have an RCT, because it is impossible to have a neutral control. Your argument actually supports my premise. There is no control in your hypothetical case. That’s what the “C” in RCT requires. By definition there can be no control. And yes medical science IS stuck in a Newtonian world and physicists have been telling them that for over 50 years. Ever since Nobel Prize winning Szent-Gyorgi, A. published “Introduction to a Submolecular Biology” in 1960 and greatly expounded upon by Pagels, H.R. (1982). “The Cosmic Code: Quantum Physics As the Language of Nature.” New York, Simon and Schuster.

    Now it’s your turn. Provide the documentation that proves it’s possible to have a neutral control. Prove it’s possible to have a neutral control and that’s it possible to have a sham with NO affect on the subject. It can’t be done. And I, like Richard, would like to see the documentation that fixated joints spontaneously rehabilitate. Unless you can bring something new to the table as opposed to your demeaning rhetoric or demonstrate a sincere desire for intelligent dialog, I’m out on this one. Go read.

  • Dr Bilbo Baggins

    @Skeptic Barista

    It is interesting that you quote the Brontfort report with regards current evidence/RCT’s against chiropractic validity/efficacy:

    ‘You know the evidence review that actually reporte moderate quality NEGATIVE evidence for chiro and colic: “Moderate quality evidence that spinal manipulation is no more effective than sham spinal manipulation for the treatment of infantile colic”’.

    ‘So when a report published by chiropractors, for chiropractors says there in actually NEGATIVE evidence for colic and chiro …. you just resort to saying ‘just their opinion’.’

    Whether an opinion or not, whether it is accepted by all Chiropractors or not, the Bronfort report is either accepted as a solid piece of research or it isn’t. Therefore to include ‘chiro’ in general as well as the one pathology eg; colic, is a both a sweeping and an obviously biased statement, especially when the Bronfort report actually states that their is medium to high ‘positive’ evidence for chiropractic care, as well as favourable indicators in other areas. (Many chiropractors are trained to use and do use a raft of interventions to treat their patients, not just simply manipulative/adjusting techniques, but then again I must presume you knew that, but chose to exclude it for some reason or another).

    So either the Bronfort report is accepted as a robust piece of research, in which case quoting it is acceptable, or it is not. But cherry picking, through the the eyes of the reasonable and fair observer, cannot be a reasonable approach to this debate. Personally, based on current RCT’s, I believe Bronfort et al to have looked at evidence available, based on the guidelines given for their research by the General Chiropractic Council, and they have carried it out fairly and without bias.

    Does that mean that chiropractic cant help colic, well this is what the evidence would currently suggest, but clinical experience amongst the chiropractic profession would suggest otherwise it seems. It is therefore up to the chiropractic profession to step forward to the line, and conduct further robust research to prove their validity and retain their place in 21st century healthcare and I believe they can do this…given time, improved tools and methodology, which is no different from some medical or dental treatments and techniques. The attack by the skeptics, may be the wake up call that was necessary and should be seen as such.

    @ SB and AL

    May I remind you of what the GMC stated in the Guardian, July 5th 2010, when asked what level of evidence they require medical doctors to use and it states: ‘We do not require doctors to use only evidence based treatments in any form of medical care, but we do expect doctors to do their best to ensure that any treatment they offer is in the patient’s best interests. This will generally mean that any known risks of the treatment are outweighed by the potential benefits to the patient’.

    Kinda puts it all in perspective for the reasonable mind, I think?

  • Andy Lewis

    And Richard, do you also agree with ‘Dr’ Glenn on the impossibility of the RCT due to semiconducting cell membrane, perfume wearing, quantum singing nurses? or do you agree he has no idea what he is talking about?

  • Andy Lewis

    Richard – yes, but the key question is if chiropractic can do anything about any condition – rather than, say, just advising a patient to keep mobile.

    My personal opinion (and it is just an opinion) is that all chiropractic does is help people be more mobile through the theatre of an intervention. The actual intervention does little – but the fact that something is happening encourages patients to be more active than they might otherwise be.

  • http://spinaljoint.com Richard Lanigan

    Andy I am repeating what is accepted in orthopedics and by anybody who knows anything about the bio-mechanics of human joint which obviously you are not one of them. This fact has changed rehabilitation and surgery techniques dramatically the last twenty years. The key is maintaining joint motion and poping pills just does not cut the mustard.

    Yes chiropractors have been saying it for 100 years years and you must really want it to be untrue but ask any physio or medical doctor who knows his elbow from his knee joint if its true.
    Pathological changes occur in a joint that is immobilised (degeneration)? The hyaline cartilage on the articular surface starts to degenerate after a few days and if the joint is immobilised for say six months you will be able to see the degeneration (osteoarthritis) on x ray.

    So where is your evidence that joint dysfunction will improve by itself I am happy to say the evidence for colic is weak and I have never tried to justify anything I do on the basis of a “scientific study. No if you have evidence that joint dysfunction gets better by itself lets have it and I might stop practicing. So Andy what evidence are you relying on for your theory on joint dysfunction (subluxation)????

  • Andy Lewis

    Richard – you are just repeating what chiropractors (some of them anyway) believe. We are talking about the need to have some good evidence for this, such as evidence that the the chiropractic brand of subluxations actually exist. (I understand the UK trade is coming round to a common definition that they are invisible fairy subluxations rather than the ones you can actually get physical evidence for on x-rays, for example).

  • http://spinaljoint.com Richard Lanigan

    @barista; Well if you have any interest in UK chiropractic”

    To be fair to Garland your allies at the GCC dont allow him to practice in the UK because he pissed off a chiropractor for not buying his clinic. The GCC have been dumbing down chiropractic for years making it easier for the skeptics

    Anyway what do you think of Andys and Blue Wodes idea that spinal dysfunction subluxation gets better all by itself.

  • Andy Lewis

    @Glenn So I take it you do not have any references discussing cell membranes as semiconductors – and so you resort to bluster. Cell membranes have plenty of fascinating electrical properties: ion channels are amazing – but I fear you have just brought up the semiconductor thing in the same way you brought up quantum mechanics – to appear erudite. Neither concept has any role in what we are discussing.

    For example, I ask you to describe how the quantum nature of the world undermines RCTs. You do not mention quantum theory, but instead just demonstrate you do not understand the nature of medical evidence and the role of the trial.

    So, you list lots of factors that may be different between the chiropractor and the control. RCTs assume here will be many uncontrolled factors such as these. That is why large numbers of recruits are needed and they are randomised to ensure that on average the difference between groups is minimised. If chiropractic had an effect then on average the back cracking should be the only significant difference and its results would shine through over all the other factors that have been averaged out.

    Now of course, poor trial design can occur when factors between groups might influence results (such as lack of proper blinding), that is why critical appraisal of trials is important to see how reliable any results might be. It is clear though, that if this stuff was taught to you at chiropractic school, it did not sink in. And instead you base your beliefs on hand waving quantum flapdoodle. What amazes me is to think that you might really believe that if RCTs were so readily flawed that lots of the most amazing medical minds around had failed to spot your supposed simple error.

    (By the way, in your trial design, it does not require a doctor to adjust the child, it could be a chiropractor.)

  • http://skepticbarista.wordpress.com/ Skeptic Barista

    @Garland:
    You had not read the Bronfort report!
    Well if you have any interest in UK chiropractic it is important to at least have read it and be aware of its contents.

    So when a report published by chiropractors, for chiropractors says there in actually NEGATIVE evidence for colic and chiro …. you just resort to saying ‘just their opinion’.

    Clearly Evidence Based Practice is of little or no interest to you!

  • rod macmillan

    @ Andy ( You know – the difference between me and you is that I do not assume I have answers)

    Hi Andy can you justify how you know – I assume I have the answers? a big step from suggesting you do evidence based medicince in a clinic yourself?
    Why not try to put the theory into practice and help people?

  • Garland Glenn

    Mr. Lewis

    Here is the honest response to your hypothetical test. You have hypothetically decided that the outcome was equivalent. It would be impossible for the outcome to be equivalent. The children haven’t been exposed to the same environment or stimulus. The environment and stimulus haven’t been qualified or quantified and they can never be equal. All of these things are relevant and important though to what degree is impossible to state. And until they are defined it is impossible to even entertain a response.

    Re: the Nurse cuddling
    1. what is she doing while cuddling
    2. is she talking to the child while cuddling
    3. is she singing to the child
    4. does she want to be cuddling
    5. is she wearing any perfume that the baby can smell while cuddling
    6. has the baby smelled this before, was it a pleasant experience, was it stessfull
    7. is she moving about carrying the baby or sitting still
    The point is all of these things is an endless list. All are important and significant though the extent can’t ever be appreciated.

    Re: the Doctor providing the adjustment
    1. What is he adjusting
    2. Is he competent in how he administers the adjustment
    3. Does he want to be adjusting the child
    4. What is the environment like (also applies to the cuddled child) What are the colors of the room. Are the colors of the room exactly the same? Are the background noises exactly the same?
    5. Did he have an auto accident on the way to the clinic that morning
    6. Did the parents have an auto accident on the way to the clinic that morning
    7. Did the child get his nappy caught in the car seat buckle irritating his leg
    8. What did the children have to eat and on and on
    The list is endless. But unless everything is exactly the same and the variables are exhaustively accounted for, you can’t compare the results. The results are arbitrary otherwise.

    You haven’t provided for a control and a control, as I’ve stated earlier, is impossible. Two living organisms can’t interact without change.

    In deference to Skeptic, at the end of the day, you must trust the informed application of the practitioner. There is no other alternative.

  • http://spinaljoint.com Richard Lanigan

    @Andy: “getting better after a bad back is a routine experience – and one that happens of its own accord”

    What you mean to say is symptoms go after sensory centres in the brain adapt to the abnormal stimulus from receptors in the spinal joints. All you sceptics seem to believe this and I would like to know what evidence you have for this cure, presumably it was produced before MRI.

    Skeptics believe that to do nothing is the best course of action for spinal joint dysfunction which produces pain. This dysfunction (subluxation) could range from a fused joint to a partially dislocated joint and the sceptics believe it will get better all by itself, because no symptoms means everything is fine. How many people I wonder die of a heart attach never having had any symptoms, one day they are walking down the street and boom. How many people have strokes no symptoms never even heard of a chiropractor.

    Andy what do you think happens a joint that is immobilised? The hyaline cartilage on the articular surface starts to degenerate after a few days and if the joint is immobilised for say six months you will be able to see the degeneration (osteoarthritis) on x ray. Which costs the NHS how much each year? If you dont know this you have a bad memory because we discussed this last year. My knee surgery in 82 is what got me interested in maintaining joint function and chiropractic.

    Tell me again why you should do nothing with spinal joint dysfunction (subluxation) and just take a few Vioxx until the pain goes away. Andy I dont need any evidence for this, its is just common sense, like putting a coat on in the cold to stay warm. My back feels a lot better after an adjustment especially since I passed 50. I should point out it would cost you more than £60 a week in the acute phase of back pain to see me. I do feel bad when people say they cant afford it, then I think what we pay in taxes for GPs who know as little as you do about spinal joint dysfunction and I dont feel so bad.
    I am still available to do your quack challenge if you ever change your mind. Or a public debate would be really appealing. If you dont fancy it bring a few GPs who know about spinal joint dysfunction and the nervous system, they are bound to be confident debating a dyslexic quack with no “scientific” medical education. What about Dr Ben Goldacre does he know anything about the mythical “subluxation”. The BCA boys made it far to easy for you guys and you are getting way ahead of yourselves. Admit it all you know about chiropractic is that there is not a great amount of research supporting it. Then again there was a great amount of research supporting Vioxx for arthritis to name but a few.

    PS A crying child may stop crying when picked up by the mother, a child with colic will not, because it is not a behavioural problem and to do any study on colic they have to get the diagnosis right and when you need numbers for your study a baby who cries a lot may do.

  • Garland Glenn

    @Mr Lewis

    I’m sorry but you obviously don’t have the back ground to continue. A cell membrane is a semiconductor. It allows for electron flow through an insulator due to a build up of charge in a specific direction. It is by definition a semiconductor. You claimed to be a doctor. I’ve asked you on several occasions in what. You refuse to respond. If you were up to speed you would understand my statements. The fact that you call it derogatory names indicates you don’t know what you are talking about. If you would like to have a discourse on another level, that would be fine but you aren’t prepared to enter into one at the level you’ve pursued. Mr. Lewis, unless you change your tactic, I will not respond to you again.

    @Skeptica

    Thanks for the link. I had not read the article and therefore didn’t understand the rational behind the “grading system”. Or the credibility and interaction of various verification parameters the authors are trying to use. In the end it still remains “just their opinion”. The colic study doesn’t perform well because of two factors. One is it’s being combined with other studies of poor quality which obviously devalue it. Also the sham adjustment concept comes into play. I maintain that it is impossible to have a neutral sham treatment. Whether or not that treatment is significant becomes another issue. But a neutral sham is not possible.

  • Andy Lewis

    Let’s be specific Dr Garland Glenn PhD.

    Take the trial that compares chiropractic with a nurse cuddling an infant for colic. The trial is blinded to the parents.

    In what sense does the quantum nature of the world make this RCT invalid?

    Specific answers please.

  • Andy Lewis

    Glenn – you do speak a lot of incoherent rot. Let me try to take some of this apart.

    Firstly, yes controls in studies may have effects. It may not be entirely neutral. For example, you may test chiropractic for colic by comparing chiropractic with a nurse cuddling the infant for half an hour. The trick is to blind the parents so they do not know which treatment the infant received. If, as has been found, the results appear equal between cuddling and chiropractic you can say that bone cracking is no better than a cuddle from a nurse. Now a cuddle may have some effect, but it does make the claims of chiropractors look daft if the best they can do is match the effects of a cuddle. It is a fair test whatever the nature of the control.

    But none of this has got anything to do with electrical fields of the human body. And their supposed quantum effects. That is pure flim flammery on your part. A cell membrane is a semiconductor? Do you have a reference for that or have you just made it up? And you have still not explained how RCTs are effected by quantum effects. You are stringing words together without making any coherent sense.

    And when you mention Pert, I hope you don’t mean Candace ‘What the Bleep Does She Know’ Pert, the scientist now turned Chakra meditation CD healing guru?

    Do you any other chiropractors want to bail at out this point before you all get dragged down deep into the land of quantum woo?

  • Garland Glenn

    @ Mr Lewis (you never did tell us what your doctorate is in)

    My thesis was on: Transconductance and Capacitance in Field Effect Transistors as it Relates to Proximity of Inductance Field Variations with Signal Transmission in MOSFET Amplifiers. Sorry but I don’t have an electronic copy.It would make great bedtime reading if you’re having difficulty falling asleep.

    Afterwards I taught electrical engineering at The Radio Engineering Institute in Sarasota, Florida for several years before going to chiropractic school.

    EMFs have nothing to do with the price of fish unless or course EMF exposure has a negative effect on the fish population. Like an EMF or EMP bomb.

    The point is this: RCTs with true neutrals are not possible because it is not possible to render a sham treatment that does not affect the control. Any time an EMFs is exposed to another EMF, it is changed because the cell membrane is a semiconductor. People have EMFs (this is how EEGs and EKGs work). If you expose a patient to a practitioner, the interaction will permanently change both. If you expose the cell membrane to an EMF, it will be changed. Maybe for the better, maybe for the worse, but there will always be change and even the act of trying to measure the change, changes the affect. Therefore it is impossible to have a true neutral control. If you have a background in physics, you would understand this. It is a given in measuring particle level experiments. It is a fact like the earth is round. Of course there was a time when intelligent men thought it was flat. The fact that you don’t know this casts a brood shadow over your claim to understand the energy nature of quantum effects.

    Pert’s work on mapping non-neural communication pathways in the body (while at The National Institutes of Health in the Brain Chemistry Department) clearly demonstrates the significance of this.

    Summation: True neutrals are not possible. Therefore RCTs are not possible.

  • Andy Lewis

    @rod macmillan

    You know – the difference between me and you is that I do not assume I have answers. For many conditions, like colic and bad backs, we have limited knowledge of causes and treatments. And a good doctor will say that. The problem is that this is when all the quacks step in saying “doctors can’t make money out of you’, ‘they can’t patent [insert my treatment here].’, ‘I can explain your pain with my theory of [insert pseudoscientific trash here]], and ‘For £60 per week, I can do something about it’.

    I am resigned in my ignorance (although unhappy as such). Others are only happy to exploit that gap.

  • Andy Lewis

    Dr Glenn

    The thing is, I do know quite a lot about quantum theory. Your bluster is nor washing. You have failed to state how mentioning ‘quantum’ in the same breath as RCTs has any relevance. I doubt you can delve any deeper. Prove me wrong. I am up for it…

    So, big numbers hey? 800,000,000 visits? To repeat: many more dogs have barked at many more postmen.

    As for your specific ad hoc calculation about headaches: a particularly susceptible condition to the transient distraction of some chap cracking your neck. This does not mean that you have done anything more substantive than a slap round the chops. Your patient may leave your practice less concerned about a headache but you have not really achieved much.

    I will answer your question about “two or more EMFs interact neutral is not possible” when you can coherently state what it has to do with RCTs of chiropractic. Picking random physics acronyms is not going to intimidate me.

  • http://skepticbarista.wordpress.com/ Skeptic Barista

    @Garland:
    Oh that trial. I’d forgotten about that trial …. Thankfully Bronfort took that one into consideration when conducting his evidence review.

    You know the evidence review that actually reporte moderate quality NEGATIVE evidence for chiro and colic: “Moderate quality evidence that spinal manipulation is no more effective than sham spinal manipulation for the treatment of infantile colic”.

    What was it you said “Chiropractic works for colic” – They totally disagree with you!

    http://www.chiroandosteo.com/content/18/1/3

    There ya go …. Enough said…end of!

  • rod macmillan

    Hi Andy

    Why not open a clinic, treat real people and show the rest of us how to do it? Use the best evidence available and act as a centre of excellence.

  • Garland Glenn

    OK Lewis I’ll play. As for as the person that is feeling better two weeks after an adjustment, I can’t make an informed comment without more information. Now, on to my personal clinical experience.

    I treat 3-6 occipital headache patients per day. I treat a lot of headaches. Let’s say to keep it conservative, 3 patients x 5 days per week x 50 weeks per year x 25 years = 18,750 patient treatments for headaches. If 90% of those patients get off the adjusting bench without the headache they laid down with 5 minutes earlier, is it reasonable to conclude that the adjustment “fixed” the headache? That’s 16,875 positive results out of 18,750. Is this reasonable? And if other chiropractors see the same results, is it reasonable to conclude chiropractic is effective for cervicogenic headaches?

    Do you realize that chiropractic has seen over 800,000,000 patient visits in its history? Do you honestly think its all smoke and mirrors? 800,000,000

    As to your comment “The fact that experiments involve patients and that experimental conditions can effect how patients respond has absolutely nothing to do with the ‘Quantum’ nature of the world or that the world is ‘not Newtonian’ (whatever that means: step out of a 2nd floor window and your plummet will be more than adequately described by Newtonian mechanics). ” I’m afraid if you don’t have the background to know what my statement about Newtonian vs Quantum referrences, then we’ll have to restrict our discussion to things you can participate in or you’ll need to stay out of the game. About semiconductors (you must be googleing). What the hell do you think a cell membrane is? It’s a semiconductor!

    Again please respond directly to my statement about when two or more EMFs interact neutral is not possible.

  • Andy Lewis

    Richard – getting better after a bad back is a routine experience – and one that happens of its own accord. Stroke is very rare -especially in the young and if it occurs after a neck manipulation, there is cause for concern. Yes, it is not proof – but if there are reports then the trade needs to take this very seriously.

  • Andy Lewis

    Firstly, you need to explain very specifically what you mean about how the Quantum world has anything to do with an RCT of chiropractic. You are so vague that there is nothing even to refute. What have EMFs got to do with the price of fish? Are you sure you are not just talking quantum flapdoodle?

    The more I hear the more I sincerely doubt you have a PhD in physics. What was your thesis title?

  • http://spinaljoint.com Richard Lanigan

    Hi Andy its been a while since we dueled

    You said “Let me ask you a direct question. A patient comes to you. A few weeks later they get better. Do you understand that this ‘outcome’ cannot be used alone to create a causal association between the two events”?

    I think chiropractors understand that point, however skeptics dont seem to understand and are constantly a making causal association between spinal manipulation and stroke?

    I would say if the vast majority of patients felt better or if a couple of patients had a stoke it would be reasonable to draw some conclusions from that anecdotal evidence. At least thats how I practice. In fifteen years of practice 1 hurt a rib, the only adverse reaction. Then you are unlikely to take the word of a lying cheating quack.

  • Garland Glenn

    Lewis (of the Quackometer I assume) being on the visiting faculty of a school doesn’t discount something the man wrote years before. If you’re going to play by those rules than medicine doesn’t get to write about what it does.
    You’ve challenged me twice about physics. Would you be so kind as to very specifically and in particular and accurate language point out exactly what about my statement is incorrect.
    After looking at your web site, the indication is that you have some very deep issues primarily with homeopathy. You haven’t the foggiest idea of what you’re talking about. Please and without any denigration of homeopaths, refrain from venturing off topic. We’re talking about chiropractic here not all alternative therapies.
    Again please explain to me in exact terms and language how it is possible to have the interaction of EMFs without change occurring to both. Please be very specific. Do not take me out of context. Respond to exactly what I have stated. If you want to get scientific about, let’s go. I’m up for the task.

  • Andy Lewis

    Dr Glenn

    The fact that experiments involve patients and that experimental conditions can effect how patients respond has absolutely nothing to do with the ‘Quantum’ nature of the world or that the world is ‘not Newtonian’ (whatever that means: step out of a 2nd floor window and your plummet will be more than adequately described by Newtonian mechanics).

    Indeed, semiconductors do require a quantum mechanical description – that is because the physics involved is at the quantum/microscopic level. No such situation arises when you treat patients. Your confusion is common amongst those who try to appropriate the mysteries of the quantum world to explain their pet theories about why their medicine fails trials. I find it incredible that a PhD physicist could conflate these issues.

  • Andy Lewis

    Dr Glenn

    I think you will find that Bruce Lipton is currently employed by the New Zealand College of Chiropractic. He obviously knows nothing about quantum theory – and despite your claimed PhD in the subject, neither do you.

    You said “I not only understand but agree with your analogy of the dog barking and it would be relevant if I were an isolated delusional nut case championing some truly bazaar cause. ”

    It is quite possible for lots of delusional nutcases championing some truly bazaar cause to all fall for the same logical fallacy, just as lots of dogs can all believe that they scare away the postman. An increasing number of dogs holding the same belief does not make their position any more tenable.

    An the longevity of chiropractic is not convincing either. Homeopathy has existed for 200 years and that is just the administration of water drops and sugar pills. Reiki has existed for about as long as chiropractic and so has reflexology. The major religions of the world appear to persist for centuries. But that does not mean the concept of God is any more real than the concept of Zeus (whose followers also worshipped him for centuries).

    Let me ask you a direct question. A patient comes to you. A few weeks later they get better. Do you understand that this ‘outcome’ cannot be used alone to create a causal association between the two events?

  • Garland Glenn

    Lewis

    I did not say that Quantum Physics undermines the RCT. What I said was: “The idea of an RCT with a true neutral is a Newtonian concept that is not attainable in a Quantum world.” The world is not Newtonian. The very fact that you’re typing on the internet is due to the quantum world. Your computer and the internet would not be possible if Newtonian laws applied to the subatomic world. This is a true a factual statement. It is because of the molecular interactions of electromagnetic fields. It is not possible to have a neutral control when a patient is involved. Any interaction of any kind with the patient, changes the patient. In the case of attempting a “sham” adjustment, the very act of attempting the sham will change the patient. It could make them better or it could make them worse but it can’t be neutral. It’s physics pure and simple.

  • Garland Glenn

    @Lewis
    The book (Bruce Lipton PhD The Biology of Belief) mentioned was not written by a chiropractor. Dr. Lipton is a molecular biologist who was a professor of molecular biology and histology at the University of Wisconsin Medical School and at the Stanford University Medical School. (Stanford being one of the most top rated medical schools in the world) He is not, unfortunately a chiropractor. I not only understand but agree with your analogy of the dog barking and it would be relevant if I were an isolated delusional nut case championing some truly bazaar cause. But, I’m not. Look for a moment at these facts: chiropractic has existed for over 100 years in spite of the vehement opposition of allopathic medicine see the Wilk vs AMA case (you need to feel this to understand our passion), it is currently practiced by over 100,000 doctors worldwide (there have over 1,000,000 DCs in the history of the profession), it is the third largest health profession in the world (we didn’t just crawl out from under the cabbage), it has been kept alive by the enthusiastic support of its patients who experienced firsthand what it can do, and these people have freely paid privately for the care. I’m not the only one who gets fantastic results with colic, sciatica and many other things.

    @Skeptic

    Sorry went off a bit on RCT as oppossed to EBM.
    OK, live by the sword, die by the sword. Can I assume you’re an intellectually honest person? If your opinion is strictly based on an honest desire to see the truth (as demonstrated by the current research available) prevail. And that if we (chiropractors) produce “research” that supports what we do, you will, with just as much conviction as you’ve shown in opposition (you too Lewis), rally to the defense of the chiropractic cause. AND, you’ll focus your energy on treatments that really are unsupported or dangerous or take advantage of patients vulnerability. Here is a review of the study Richard has referenced repeatedly along with a reference to the publication

    Chiropractic Found Effective for Infantile Colic

    Randomized Controlled Trial Shows Manipulation More Effective than Drug

    By Editorial Staff
    A randomized, controlled clinical trial on colic in Denmark that compared chiropractic adjustments to daily doses of dimethicone has concluded: “Spinal manipulation has a positive short-term effect on infantile colic.”1
    Infantile colic is a curious and mysterious condition.
    It is estimated that, on average, 22.5% of all newborns suffer from colic, defined as “uncontrollable crying in babies from 0-3 months old, more than three hours a day, more than three days a week for three weeks or more, usually in the afternoon and evening hours.” But only “47 percent of infantile colic cases have disappeared by the age of three months, a further 41 percent disappeared before six months of age, and the remaining 12 percent of cases persevered until between the ages of 6 and 12 months.”
    First described in 1894, colic has no verified cause(s). Countless studies have, however, determined what it is not caused by: air or constrictions in the intestines; gastrointestinal transit time; intestinal hormones; intestinal microflora; method of delivery (vaginal, Cesarean section or vacuum extraction); use of pudendal block; epidural analgesia; general anesthesia; or intravenous oxytocin.
    Numerous medical and nonmedical treatments have been studied, including: music and sounds; vibration; dicyclomine hydrochloride; gripe-water; alcohol; atropine; skopyl; phenobarbital; merperidine; homatropine; and merbentyl. These treatments have shown either “no effect when compared to placebo treatment” or “serious side effects.” Treatment with sucrose does seem to have a “generalized analgesic effect in infants and may therefore also help in infantile colic.”
    Dimethicone, the drug used in this randomized trial, has been shown to be “no better than placebo treatment” in several good controlled studies.
    The first retrospective chiropractic study on treating colic was conducted in 1985, followed by a prospective multicenter study in 1989. “Both studies suggest that there seems to be a positive effect of spinal manipulation for infantile colic,” but since neither study had a control group, it was impossible to assess whether the chiropractic treatments were significantly better than placebo.
    The Danish National Health Service recruited 50 infants meeting the criteria for colic. After they were reviewed and monitored, they were randomly assigned to two groups: dimethicone daily for two weeks or spinal manipulation for two weeks by a local chiropractor. The 25 infants under chiropractic care received motion palpation to locate “articulations” mostly found in the upper and mid-thoracic area. The infants in the chiropractic group received an average of 3.8 adjustments.
    During the two-week treatments, the parents kept a colic diary and nurses visited the families to administer a weekly “infantile colic behavior profile.” The results were:

    The dimethicone group would have fared much worse than these results suggest if not for the dropout rate of the medicated group. All 25 infants in the manipulation group completed the 13 days of treatment, but there were nine dropouts in the dimethicone group: five dropped out before the first week’s diary could be completed, and thus there was no data on the hours of crying for those five subjects. But the study did register the subjective evaluation of four of the five in the dimethicone group that quit in the first week: two described their child’s condition as “worsened” and two others described it as “much worsened.” Had these four infants completed the study, they would have significantly affected the limited positive effect of dimethicone. To quote the authors:
    “By excluding data from the dropouts, we are excluding more severe cases from the dimethicone group, and this has the effect of making that group appear better than it actually was.” The authors make another comment that speaks directly to the issue:
    “Spinal manipulation is normally used in the treatment of musculoskeletal disorders, and the results of this trial leave open two possible interpretations. Either spinal manipulation is effective in the treatment of the visceral disorder infantile colic or infantile colic is, in fact, a musculoskeletal disorder, and not, as normally assumed, visceral. This study does not address this issue.”
    Reference
    1. Wiberg JMM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 1999;22:517-22.

    OK great now we can put this one to bed. Chiropractic works for colic. Enough said…end of any more need for wasted energy on this.

    Now let’s look at the real world of health care and use open heart bypass surgery as an example. There are no RCTs for bypass surgery. Actually would anyone in their right mind sign up for the trial anyway? BUT your position is we shouldn’t be doing anything for which there’s no research support. In addition, I don’t think it’s much of an assumption to conclude that patients and their families are vulnerable to the recommendation of the heart surgeon. After all he’s paragon of virtue and couldn’t possibly be self serving. After all he’s a real doctor and dedicated to saving the sick and dying. So… what we have here is a truly dangerous treatment, that’s very expensive (and you the tax payer have no choice in having to foot the bill in the UK as opposed to chiropractic care which is totally voluntary and is private pay), and takes advantage of patients and their families at their most vulnerable time. Maybe all of these little self appointed watch dogs should go after the really bad boys that are costing the state tons of money and killing people to top it off. Sounds ridiculous doesn’t it.

    From Wikipedia
    While there have been a handful of RCTs[20][21] comparing CABG (Cardiac Artery Bypass Graph) with other surgical procedures, an exhaustive review of the medical literature reported in 2002 found no RCT had ever been conducted to demonstrate the efficacy of CABG to that of placebo.[28] In fact, as Daniel Moerman has pointed out the combined results of two RCTs comparing an earlier surgical procedure for angina – bilateral internal mammary artery ligation (BIMAL) – to a sham surgery clearly show that patients “experienced significant subjective improvement,” with both BIMAL (67% substantial improvement) and the sham procedure (82% substantial improvement).[29] Surgery as a meaningful experience (placebo effect) was most likely the cause of improvement for patients in both of these studies with the sham surgical procedure actually proving slightly more effective.

    The “Gold Standard” is not the RCT. For some things RCTs can’t even be performed. The standard is the patient outcome. Always has been and always will be. What we need to focus on are patient outcome studies. Let’s call them POSs. If the patient is better, the patient is better. Of course these can’t be done by researchers they have to be done by clinicians. Researchers don’t see enough patients to do studies. They don’t see enough patients and that’s why most researchers are in research.

  • Barney

    …..but then if one continues on the line that RCT’s are the gold standard and nothing else could be even considered, this could happen…http://articles.mercola.com/sites/articles/archive/2010/10/29/high-dose-iv-vitamin-c-found-useful-for-near-terminal-swine-flu.aspx

  • http://skepticbarista.wordpress.com/ Skeptic Barista

    Oh almost forgot:

    @Richard.
    With regards to Mike Adams (A.K.A Health Ranger) I would simply refer to this article:
    http://scienceblogs.com/insolence/2010/10/whats_in_a_placebo_mike_adams_certainly.php

  • http://skepticbarista.wordpress.com/ Skeptic Barista

    @Glenn
    1) I don’t think Andy Lewis has hijacked this thread. The topic is the Nightingale Collaboration, references to Sackett are secondary to the main topic …. If anything I could be classed as the one who hijacked it!

    2) Your definition of the ‘gold standard’ and your views of RCT’s clearly show you disagree with Sackett on what constitutes EBP.
    The figures you quote come from patient feedback surveys – I believe this comes in at the lowest level of Sackett’s heirachial evidence list!

    ………. And NO I am not a doctor and have never claimed to be, but I do have professional (non medical) experience of dealing with research and testing claims.

    @Ex McStudent:
    Fascinated by your experiences and views of chiropractic training/philosophy. Would love to hear more!

    There are some interesting views on chiropractic and evidence / research here:
    Chiropractic and children: Is more research enough? http://www.chiroandosteo.com/content/18/1/11
    This is a current study published in Jun 2010, done by chiropractors for chiropractors, but it’s conclusions are worth noting. Richard may like the link to Danish chiropractors.

    “The essence of the decision making process for responsible patient care in evidence-based practice is that it relies on the integration of 1) clinical expertise,2) patient perspectives, and 3) the best evidence (i.e. research findings) [4].”
    Note: [4] refers to Sackett. ‘Best Evidence’ = research findings.

    An important message to ALL practicing CAM therapists!
    “However, it is important to keep a humble attitude to one’s own clinical experience and not to think that it overrides the evidence obtained in a good quality RCT. Also, one or even several persons’ clinical experience is not synonymous with clinical expertise.”
    Note: RCT’s override clinical experience – In full agreement with Sackett’s evidence hierachy.

    From Conclusions:
    “We must not be satisfied with quantity but strive towards high standards of quality of the published research and work harder at all levels on implementing research into practice.”
    Note: Practice should follow the findings of high quality research,not ignore it!

    Any ‘Tyranny of evidence’ applies not to those who question it, but to those who demand that thier personal views/philosophy/experience take precedence over higher quality, properly conducted and reviewed trials.

  • Andy Lewis

    Dr Glenn – I am not sure I hijacked the thread – just explaining why I am helping Nightingale – the actual topic of the blog post.

    You are now claiming that Quantum physics undermines the RCT. This claim is at odds with your claim that you have a PhD in physics because you are showing a complete lack of understanding of quantum theory. Your claim is pure quack nonsense. And indeed, I see the book you recommend is not by a physicist, but another chiropractor. Are alarm bells not going off?

    It may indeed be true that the patient experience is a ‘gold standard’. However, you are confusing this with your interpretation of this experience. In short, when you claim you KNOW, you are suffering from a very naive epistemology. You no more KNOW that a patient’s pain has improved because of you back cracking than my dog KNOWS the postman goes away because of his barking. You may interpret your customers’ experiences of health improvement as cause and effect, but you may well be wrong. This is the basic mistake that all alternative medicines make. I KNOW because I have seen people get better!

    It is ironic that the alternative practitioners who like to espouse that they help the natural healing processes of the body are most unable to accept that the body might actually heal itself without their pseudo-medical flim-flam.

    We shall see how Nightingale gets on. The GCC still have a lot of worksorting out the current mess. But it will be interesting to see if spinal manipulation has an effective treatment for anatidaephobia.

  • Ex McStudent

    Taking back the ‘merely’ word – replace with ‘often profoundly’.

  • Ex McStudent

    Chiropractic training does not focus on medical issues, in my experience they get what they know from textbooks and apply philosophy to explain what they don’t know, or don’t want to know. My experience is that emphasis is on applying chiropractic technique: medical symptoms and how best a patient may be helped is secondary.

    Chiropractors do not have to work in the medical profession as part of their work experience, yet many want recognition as doing a medical job and resolving medical problems, even though some actually do a better job in resolving some conditions, yet that’s not enough for them – they want to earn the right to wear white coats. I can deadhead my plants – it doesn’t make me a gardener.

    Andy questions whether chiropractic is a cult or a profession. He is right to question it. On the whole I had dark, cult style, highly damaging training, no support, nothing even approaching University standards in place to protect and nurture students. Upholding the brand seemed to be more important than progress. All in all a complete and highly damaging mindf**k for an allied medical postgraduate.

    Chiropractic is almost certainly a square peg trying to fit into a round hole. Their fear seems to be based on never being able to fit and so they just keep pushing and pushing.

    Why can’t they just accept that what they do is not medical in the pure sense of the word, that sometimes what they do merely acheives medical resolution?

  • Garland Glenn

    Skeptic
    Back to the points I was trying to make yesterday before the thread was hijacked by Lewis.

    1) It is not possible to have a sham adjustment. Any interaction with the patient has an effect on the patient. The idea of an RCT with a true neutral is a Newtonian concept that is not attainable in a Quantum world. Read Bruce Lipton PhD The Biology of Belief.
    2) The experience of the patient is the “Gold Standard”.

    See the article below. All this rubbish about chiropractic being ineffective and ripping of patients is not supported by the experience that the patients actually report.

    Where are all of these reports that “prove” chiropractic doesn’t work? I keep reading where you and others write the “research” proves chiropractic doesn’t work. Where are these papers? I’ve been in practice for over 25 years and chiropractic does work for the things it does work for. And please stop comparing us with DD Palmer unless you’re going to play by the same rules and make modern MD’s responsible for leaches and blood letting to “let the vapors out”.

    Patient Satisfaction with Chiropractic Continues

    Patient satisfaction affects patient compliance and treatment results; studies have shown that chiropractic patients tend to be more pleased with their care than patients of medical doctors.

    This study examined aspects of clinical care in diverse chiropractic practices and determined patient satisfaction with chiropractic care.
    One hundred seventy-two DCs participating in a practice-based research program, and 2,987 of their adult patients who had sought treatment at least once previously, completed questionnaires during a visit. The patients answered questions on demographics; primary complaint; aspects of the clinical encounter; and satisfaction with treatment. Chiropractors answered questions on routine procedures and services; practice and practitioner demographics; and estimates of patient volume and session length.

    Results: Visits for primary complaints were usually pain-related (61.6%); another 31.4% appeared for follow-up maintenance care only. The median number of annual visits to a chiropractor was 13. The data obtained on patient satisfaction are listed below:

    * 88% felt their DC always respected their opinion (9% responded “usually”);

    * 85% said their DC always listened carefully and explained treatment clearly (12% responded “usually”);
    * 82% felt that their DC never recommended more visits than necessary (11% responded “sometimes”);
    * 78% said their DC always spent enough time with them (18% responded “usually”); and
    * 76% claimed their DC involved them in decisions “as much as they wanted” (19% responded “usually”).

    The authors suggest, “It appears that interpersonal aspects of the clinical encounter… play a larger role in patient satisfaction with chiropractic care than actual time spent or specific procedures used.”

    Hawk C, Long CR, Boulanger KT. Patient satisfaction with the chiropractic clinical encounter: Report from a practice-based research program. Journal of the Neuromusculoskeletal System 2001:9(4), pp. 109-117.

  • A N Other

    Hello,

    Please read this excerpt by Karel Lewit as i feel it explains the difficulties of using RCT in musculoskeletal care.

    Managing common syndromes

    “By far the most common painful conditions of the motor system are those called non-specific or idiopathic because no pathology can be found. The vast ever increasing number of patients labelled in this way are in no way malingerers and adequate clinical examination furnishes a wealth of signs and symptoms to prove the somatic origin of their complaints. Because some motor function can be shown to be impaired, this being mechanical disturbed biomechanics are thought to be the cause, hence the term mechanical disorder is frequently used. This term however is inadequate because the organism invariably reacts through its nervous system:
    In fact any mechanical change is a source of information processed by the nervous system which makes the motor system react in a co-ordinated fashion. Therefore, however, any mechanical disorder may be prominent or even measurable and we have to deal with disturbed function or dysfunction.
    If we apply the methods of rehabilitation including manipulation, relaxation etc. our objective is dysfunction, even in cases in which we find pathology i.e. in disc lesions, treated by conservative methods. In rehabilitation, therefore our task is to improve or if possible normalise function.
    Hence a good understanding of the functioning of the motor system and of “functional pathology” is essential.

    Our first task when dealing with a patient is therefore to decide whether he suffers mainly from a disturbance of function or one of structure.
    • We have to insist that function (physiology) is as real as anatomy (pathology)
    • Even if there is structural pathology there are also changes in function which cause clinical symptoms
    • The clinical picture correlates mainly with changes in function, much less with structural pathology. Very frequently pathological changes do not manifest themselves so long as function is not impaired. However, changes in function by themselves may cause clinical changes in the absence of any (structural) pathology.
    • For the same reason, even clearly diagnosed pathology can be clinically irrelevant (disc herniations, spondylolithesis), whereas dysfunction that can be usually be diagnosed only by clinical means can be of decisive importance
    • If we directed our therapeutic efforts at the pathological changes, our therapy would fail in such cases; however, even if the pathological changes are important, we may still improve the patient’s condition if we improve the function, because this is exactly what can be achieved by rehabilitation. It is , however, necessary to be aware of the limits of what can be achieved
    • The diagnostic task in pathological diagnosis is to localise the lesion exactly and determine its nature
    • The diagnostic task in dysfunction is to determine the pathogenetic chain and to assess the correlation and relevance of the individual links (holistic principle)
    • In pathological conditions, success is achieved by effective drugs, or possibly by surgery. In dysfunction success depends on the correct choice of the relevant link or links of a chain at the right moment.
    • The functional approach is much more difficult, we may compare pathology to the hardware and dysfunction to the software of the motor system
    • Therefore, he who only treats dysfunction at the point where pain is felt is lost and certainly the patient is.
    • Because changes in function are reversible in nature, it can be expected that, if adequately treated (and the case is not complicated), the effect of the treatment is immediate, giving the impression of a “miracle cure”, which however is predictable
    • The relationship between cause and effect usually presents no major problem in conditions caused by structural pathology. However, it can be very subtle in changes caused by dysfunction; what was originally the cause may become secondary and vice versa. Chronic pain of any region will produce changes in motor patterns or stereotypes, which, in turn, will cause dysfunction perpetuating pain. Chronic joint movement restriction and trigger points cause impaired mobility of fasciae, which, in turn, produce joint restriction and muscular trigger points.
    • Statistical methods are very useful in well defined pathology and should be mandatory in this field. It is, however, much more difficult to apply them in changes of function. Even for diagnosis, the same clinical condition (e.g. headache) can be the result of a long chain of various disturbances, the relevance of each link constantly changing. In therapy, if we have treated one link successfully, it would be nonsensical to repeat the same treatment. If, therefore, there are still symptoms left, we have to treat another link in the chain. If the patient is then without symptoms, this by no means implies that the first treatment was of no avail. However, this is very difficult to assess by statistics.
    • Psychology is very important in every type of patient for its influence on the autonomous nerve system, e.g. stress. In dysfunction, however, psychology is part of the pathogenetic chain because the locomotor system is the effector of our mental activity, the organ of voluntary movement. This further borne out by the fact that pain is the most constant symptom and that tension and relaxation play a very important role. It is, however, necessary to decide how relevant the psychological factor is in each case and how amenable to treatment.
    • Modern technology enable us to diagnose pathological lesions much more effectively, even if irrelevant, and also to objectify them. In dysfunction, technology is usually of little use and very cumbersome. Clinical skill remains decisive. This, however, is considered “subjective”.

    The Holistic principle

    This approach was characteristic for all ancient medical systems based on “humours” and for herbal medicine. It is most prominent in traditional Chinese medicine, with its systems of “meridians” stressing interplay and connections between internal organs and points at the extremities and the importance of physical exercise and diet. The shortcomings of this approach was its pure empiricism, sometimes bordering on superstition, and complete lack of scientific proof. This was also true for diagnosis considered in modern times to be the basis of rational therapy.
    It was the success of pathological anatomy that has seemed to prove the true cause of disease in structural, well defined and localised changes which could be demonstrated and verified. This became the hallmark of scientific medicine. Therapy, mainly by drugs and/or surgery, was judged by its effectiveness in normalizing these well defined and verifiable changes. Modern technology not only greatly enhanced our ability to diagnose structural changes but also produced drugs that were much more powerful in specific situations and made surgery much more effective and safe at the same time. These incontestable successes brought about the current belief of the medical establishment, that all medical problems will be solved when we find the pathological (structural) cause of every disease and the specific drug to cure it and hence, their complacence. Anyone who does not accept this model is branded as denying “modern science”, trying to revive the old obsolete empiricism and promote some sort of “alternative” or “complementary” medicine, held to be “unscientific”, even if treatment by their methods proves to be successful.

    This is the reason why many of those who practice methods considered “alternative” are not prepared to adopt whole-heartedly the “functional approach” or “functional pathology”, although they are aware that (at least) 90% of their cases with motor symptoms have to be classified as “non-specific”. They still hope that the “true pathology” will be revealed at any moment. For the same reason, most adherents of the numerous sects of alternative medicine who proclaim a holistic approach do not really know how to implement it. This is no mere coincidence. We have pointed out that the functional approach is more complicated i.e. more demanding than structural pathology, comparing it software in contract to hardware. This also explains why most schools or sects of alternative medicine are system-forming and dogmatic i.e. they simplify the more demanding functional truly holistic approach. This can only be an open system, based on physiology, which after all is even more complicated than anatomy.

    DD Palmer’s “hole in one” theory offers a good example from chiropractic history. He thought that all the problems of the spinal column (if not the whole organism) can be solved by adjusting the atlas/axis or of Illi (the Swiss Chiropractor) who believed in the supreme importance of the pelvis. Earlier chiropractors and osteopaths believed that all health problems were the result of spinal “subluxations” or “osteopathic lesions”, interfering with the flow of “energy” from the brain to the internal organs: simple and satisfying. Once we practice manipulative techniques, however, we sooner or later find that the changes we diagnose (mainly by manual methods) are not just haphazard, but follow certain rules. Very frequently when we treat the craniocervical junction we observe response throughout the motor system, which seem to follow a certain pattern. More importantly, the response are by no ways limited to a particular segment of the spinal column, an accepted tenet of neurology. No less frequently, and quite regularly, we see responses at all levels of the motor system. We thus learned to distinguish “key regions” of the spinal column where treatments was particularly effective in producing such reactions. For a long time these observations were limited to the spinal column, ignoring the feet, hands and the orofacial system, putting the emphasis on joints and under-rating muscles and soft tissues.
    It is therefore seemed important to find out whether there is a rule governing these “repercussions” involving the motor system as a whole.”

  • http://spinaljoint.com Richard Lanigan

    @SB “they say chiropractic does not work” let me take you back to the points I made on your blog, which dont seem to be there any more http://skepticbarista.wordpress.com/2010/10/17/subluxations-still-no-evidence/#comments An adjustment stimulates receptors in the joint which connect to the central nervous system. All Chiropractors agree with that statement

    You keep repeating chiropractic does not work and trials prove it?? Is that like saying an adjutment has no effect on a joint or spinal dysfunction has no effect on nerve receptors in the joint and these nerves do not connect to the central nervous system and the nervous system or pain can not affect a persons wellbeing.

    What I find amazing is that skeptics believe an adjustment does nothing to the joint and nervous system, yet with the same mouthfull of drivel you can claim it is so powerfull that it kills lots of our patients. I can only conclude you dont know what you are talking about, and I have to give up. Like I said we will have to agree to disagree.

  • CDC

    @SB
    I do not really think you are “slow in your head” even though you at times appear so, but when you use phrases like “spine crack” I know you are not objective in your criticism. You just have a different agenda then the true skeptics. True skeptics deserve respect, as they can change their mind. I can change my mind, but I need good research, you might say. I ask you then what kind of research is acceptable?

  • http://skepticbarista.wordpress.com/ Skeptic Barista

    Richard,

    Depending on the nature of the treatment being tested, describing the content of the placebo could indeed be classed as relevant and in that case there is a valid argument for disclosing the contents (even if just sugar). But this doesn’t apply to all treatments. Sham manipulations or sham acupuncture doesn’t involve administering sugar pills.

    Contrary to the view held by many chiropractors that there is ‘no evidence’, so they can fall back on their own judgement. RCT’s and Systematic Reviews of chiropractic treatments DO exist and they say chiropractic does not work, or is no better that a placebo.

    If the ‘Placebo’ is just ‘sugar’ or ‘olive oil’ and this produces the same (or better) effect as chiropractic, then that is indeed a damning criticism of chiropractic …. If the placebo in the colic trial had a benefit meant it was indistinguishable from chiropractic …….. why pay excessive fees for a spine crack when a sugar pill does the same job!

    Systematic reviews of RCTS’s remain the ‘gold standard’ of evidence. They DO exist for a range of conditions claimed to benefit from chiropractic and the ALL conclude that chiropractic does not work. Chiropractors who reject RCT’s simply becuase they don’t give the results you want and in effect rejecting Sackett’s advice on EBP.

    I wonder if the AUKC’s 120 page dossier of evidence, presented to the GCC to support the VSC contained a single RCT!

  • http://spinaljoint.com Richard Lanigan

    I like this article by Mike Adams; this is the point i was trying to make to Skeptic Barista. The placebo in the study that skeptics claim shows chiropractic is not an effective treatment for colic was not a placebo because it was like;y to have an effect on the child.

    “Placebo fraud rocks the very foundation of modern medical science; thousands of clinical trials invalidated”

    You know all those thousands of clinical trials conducted over the last few decades comparing pharmaceuticals to placebo pills? Well, it turns out all those studies must now be completely thrown out as utterly non-scientific. And why? Because the placebos used in the studies weren’t really placebos at all, rendering the studies scientifically invalid.

    This is the conclusion from researchers at the University of California who published their findings in the October issue of the Annals of Internal Medicine. They reviewed 167 placebo-controlled trials published in peer-reviewed medical journals in 2008 and 2009 and found that 92 percent of those trials never even described the ingredients of their placebo pills.

    Why is this important? Because placebo pills are supposed to be inert. But nothing is inert, it turns out. Even so-called “sugar pills” contain sugar, obviously. And sugar isn’t inert. If you’re running a clinical trial on diabetics, testing the effectiveness of a diabetes drug versus a placebo then obviously your clinical trial is going to make the diabetes drug look better than placebo if you use sugar pills as your placebo……read rest of article http://www.naturalnews.com/030209_placebo_medical_fraud.html

  • Garland Glenn

    You didn’t answer my question. What kind of doctor are you? And yes Dr. Glenn does know certain things. Would you really want to go to a doctor that didn’t know what he/she was doing? Research has show that doctor confidence can be as much as 30% of a positive response.

  • David

    @ Andy Lewis

    Like I said, it’s evident that you have solidified your opinion of chiropractic and chiropractors but, unfortunately your beliefs are as invalid as the ones you choose to ascribe to chiropractors.

    What your postings demonstrate is that you have no interest in learning about chiropractic, only to denigrate. That defines you not as a sceptic, as the naysayers like to describe themselves, but as a heckler. And for that reason, in the immortal words of Duncan Bannatyne, “I’m out!”

  • Andy Lewis

    Frequently when discussing alternative medicine I get told ‘I am not up to speed’ or that because I have not spent 4 years studying homeopathy (say) I am unqualified to comment on it. However, as is commonly said, you do not need a PhD in invisible imperial textiles to say the emperor has no clothes on.

    As for chiropractic, I have learned of its origins, studied its claims, appraised the evidence and come to a conclusion that it is (mostly) superstitious nonsense. My position may be uncompromising (to you) but it is not ill informed.

    Nor is my position fixed. My mind could be changed by evidence. I wonder what it would take to change the minds of a practising chiropactor? I wonder if you could adequately describe the objective evidence that would shift you views about the nature of what you do? After all Dr Glenn KNOWS!

    And I also have some direct experience with chiropractors. In particular, a student at the local college is a family friend and has lodged with us during studies. Despite what the college principles would like the GCC to think, chats down the pub reveal a pretty vitalistic and anti-science pedagogy there.

    I also have direct experience with bad back pain. I know that it can be crippling, but also go away quite of its own accord – without 10 years of maintenance adjustments.

    I do not expect the chiropractors to be too self-reflective. You are no different from homeopaths in that respect. But you have sought to be statutorily regulated and so you should be held to account as such. I don’t agree that you should be regulated – but as you are, then it would be a huge deception not to be judged according to the standards you have chosen for yourselves.

  • Garland Glenn

    Andy
    If you’re going to quote me, please do me the courtesy of not taking it out of context. The quote is this:

    Research is only important, to me as a clinician, if it helps me to understand better what I already know works(NOT BELIEVE) OR if it leads me to discover new conditions, or ways of treating conditions I already treat, better. Because as an ethical clinician, I only treat those things I’m successful in treating. (emphasis added)

    You are not at liberty to take my statement out of its context. The reverse of this is, I don’t treat things I’m not successful in treating (regardless of what the research says.

    You don’t know me well enough to know what my prejudices are. The only thing you know about me is though what I have written here. Do not presume to know anything else about me. You know nothing of my prejudices. I said know because I KNOW. If you maintain your cuastic nature, I will not repond to you again.

  • Garland Glenn

    Dr. Lewis
    I have never, nor do I know of any chiropractor, claimed “medical qualification”. I guess we need to define words before we are able to use them. There are two common uses for the word doctor: someone with a doctorate degree and or someone who doctors. To my knowledge neither God nor anyone else for that matter has decreed that doctor is exclusive to those who even without doctorate degrees practice medicine.
    Secondarily, you obviously have some very deep issues with chiropractic. I won’t speculate as to what those might be. To enter into an intelligent forum you must either be “up to speed” on the topic or teachable. You are obviously neither. To make the statement you do regarding chiropractic you either have been under a rock for the last 30 years or don’t care what the research shows. Research is, in this case, a two edged sword. You can’t evoke to argue with chiropractors successfully do and at the same time ignore the overwhelmingly conclusive evidence that chiropractic is not only effective but is significantly more effective than anything medicine has to offer for the majority of back problems which chiropractors treat. I would also conclude from your comments about back pain that you either aren’t a doctor or you field and or experience is FAR removed from the treatment of back pain.
    To use the rhetoric you do, I could only arrive at the most unimpressed conclusions about the nature and quality of your “doctor training”. Ie. You really have no idea of what you’re talking about. Take the weekend and read. Come up to speed and then enter intelligently into the conversation.

    By the way what kind of doctor are you? I’ve opened myself up, do the same.

  • Andy Lewis

    @David let me remind you what Dr Glenn said “Research is only important, to me as a clinician, if it helps me to understand better what I already know works”

    Glenn just ‘knows’ – the evidence is only there to reinforce his prejudices. As for your point about RCTs “not provid[ing] all the evidence necessary for the care of patients in any healthcare field, let alone neuromuscuolskeletal care” , it is not EBM to go about scraping levels of evidence to defend implausible treatments such as chiropractic. If there is no good evidence for the faith beliefs of chiro then you really ought not to be making claims to your customers.

    @CDC Treating a customer for 10+ years is everything that is wrong with chiro in a nutshell. What evidence do you have that this ‘package of care’ is beneficial for a customer? You are locked into a mutual dependency and kidding both yourselves.

  • CDC

    Andy, what is wrong with you? Are you one of those bitter ones who flunked out of “chiropractic school”? :)

    I often find comfort in knowing that people like you never get to know the true possibilities of chiropractic. Every once in a while when a patient I have been treating regularly for 10+ years spontaneously burst out “man, I feel great” or a 70 year old say “I feel like I was 25″ I ask them to imagine never having another adjustment again and how they would feel about that. All my colleagues that have asked the same kind of questions to their patients know the answer, but you Andy – you do not. You are too ignorant and that is your punishment in life.

  • David

    @ Andy Lewis

    It seems from what you say that your opinion of chiropractors and chiropractic is settled, so it’s unlikely that facts will alter it. However, the reality is different from your opinion.

    Chiropractors are not all of the belief that their knowledge is superior to RCT evidence. Unfortunately though, RCTs do not provide all the evidence necessary for the care of patients in any healthcare field, let alone neuromuscuolskeletal care. Clinical experience has a place in the evidence base and best practice will inevitably be a combination of what experience shows to be effective, with the results of good research. This is evidence-based care.

    Your comment about a chiropractor making a lot more money by practising outside the constraints of best evidence is completely without foundation. For over twenty years I have practised by incorporating best evidence into my, primarily musculoskeletal, work and I see as many patients in every week as I wish. In fact, according to my wife I work far too many hours, but it’s hard to say no to people in need.

  • fed up

    I like this bit. You know what they say, “those that can do, those—

    “Discussions on the field of dentistry in general are mainly dominated by the gap between academics and general dentists working in the field. General dentists in our sample shared the impression that EBD is typically targeted at academics. Many of them also said they found it impossible to work with new developments, without cost and time limits.”

  • fed up

    Good article on evidence based dentistry.

    http://www.jdentaled.org/cgi/content/full/72/6/736

  • fed up

    “A chiropractor who practices within the constraints of best evidence will make far less money than one who allows their own beliefs to dictate their scope of practice.”

    Again I think this shows your lack of knowledge as far as chiropractic goes.

    Best evidence, maybe not GOLD RCT, but best evidence shows chiropractic works for back pain, which is exactly what most chiropractors do for a very high proportion of their day. Infact it’s all I’ve seen all week. Back pain. It’s what most chiros do all week. Back pain. I enjoy helping people with back pain, the best evidence shows back pain can be improved with chiropractic, what do you think we do?

    As for the money side I usually see at least 1 person a day and don’t charge,I’ve done it for years. When was the last time you worked for free Mr Lewis?

  • Andy Lewis

    Dear Dr Glenn. (It is Dr Lewis, by the way, if we are to insist on titles).

    Having a doctorate is not the same as ‘being a doctor’. And being trained in chiropractic is not the same as having a medical qualification. I say that, because chiropractic cannot demonstrate itself to have specific medical effects (beyond minor and temporary back pain relief). What has become quite clear over the past few years to many people is that chiropractic aren’t specialist doctors but but a pseudo-medical cult that has grown out of the particular superstitious beliefs of Victorian fair ground bone crackers.

    You may have adorned yourself with titles and courses and even state recognition, but none of that alters the basic fact that cracking peoples’ bones is not some mystical panacea or even a particularly good treatment for back pain.

    The reason is obvious. Chiropractic was founded on the false belief that subluxations were a major cause of ill health and that with special manipulation these subluxations could be corrected. This has now quite conclusively been shown to be false. Whatever beneficial effects you might have are essentially coincidental. As such, trying to create a medical speciality from this false belief is misleading.

    You believe you are effective though for the same reasons that homeopaths, acupuncturists and other supersititious medical practitioners also believe they are effective – the post hoc fallacy. Bad backs are chronic but variable in their symptoms. People have heir bones crunched, their symptoms inevitably improve (eventually) and chiropractors assume it was their intervention that was central to this natural process. This is what you call your ‘gold standard’ of evidence – and the very reasons RCTs are seen as more reliable.

  • Garland Glenn

    The bit about the VISA cards deserves further response. Patients freely chose to see chiropractors. They freely chose to spend their money there. Unless I’m mistaken or uniformed, patients are not being forced at gun point to see chiropractors or any other “alternative” practitioners. Most chiropractors that I know have practices that are driven by internal referral. If chiropractic was the “rip off” certain people would like to paint it to be, why do patients enthusiastically refer their families and friends? Patients refer because they received good care at good value. And yes money is an issue. I, at the end of the day, have to make a profit to keep my clinic open. Just like any other business, if I provide substandard care ( or ineffective care) at an unreasonable cost, my business will close. I don’t have the luxury of having the government forcing people to support me through involuntary taxation.

    Why is it that people criticizing chiropractic fail to realize that the only reason it has survived 100+ years is because patients like what they get for their money. If they didn’t, the market place would have done what the AMA failed to do. That is, make it go away. You can try all you want but the patient will, in the end, vote whether or not chiropractic survives. That’s how it should be. Patients will determine whether or not chiropractors treat for colic not some self appointed watch dog. Yes, patients vote with their feet and their VISA gold card. They vote to keep me open and practicing. They do so with their referrals and their money.

  • Garland Glenn

    Mr. Lewis, while I cannot speak for others that might be posting here, I do in fact have two doctorate degrees recognized by the Midwest Council on University and College Accreditation which is the same organization that accredits all Colleges and Universities (including medical schools) in the Midwest portion of the USA. I also have a PhD in Physics and Electrical Engineering . So unlike many, including the GPs in the UK, I have two real Doctorate degrees. I am a doctor by vocation and degree. Stephen Hawking is a doctor by degree and not by vocation while you local GP is a doctor by vocation and NOT by degree. Why do we have to keep going down this road? Being a doctor is only peripherally related to medicine. Your comments about the VISA gold card would be unfair to all those I treat for purely altruistic reasons. You still fail to grasp that the welfare of the patient is the paramount factor here. Since you don’t know me from Adam, your comment can only be seen as childish, deliberately inflammatory and designed to shut down discourse rather than to promote it.

    You can fix ignoance with information and discourse but you can’t fix stupid.

  • Andy Lewis

    Let me be clear. I am quite happy to accept that most chiropractors are sincere in what they do and what they believe. But that their attitude to evidence is aligned with their best financial interests too. Now, that does not mean that they are necessarily corrupt. As I have said, I see chiropractic like a cult – and its beliefs and practices have evolved to ensure that it survives and prospers. In that sense, the beliefs that their personal authority is a better judge of efficacy that more objective evidence, such as RCTs, is explained because this idea has better ‘survival value’. A chiropractor who practices within the constraints of best evidence will make far less money than one who allows their own beliefs to dictate their scope of practice.

    This problem exists within all types of health care – and that is why robust regulation is there to try to keep practitioners on the straight and narrow. Chiropractors are not liking that now as robust regulation is crashing headlong with very deep seated and cult-like beliefs.

  • David

    @ Andy Lewis

    A word of caution. If you and your fellow Nightingale evangelists wish to be taken seriously, then I would advise against making unsupportable, and frankly libelous, remarks about the motives and character of chiropractors.

  • fed up

    Yawn.
    “Of course, he is not putting the patient first – he is putting his own beliefs and his own self-interest first.”

    I do love it when a skeptic makes such sweeping statements about chiropractors motives. It shows total ignorance.

    I suppose all physios, dentists, surgeons, nurses infact anybody in healthcare that actually gets paid, actually takes money for their services are only putting themself first.

  • Andy Lewis

    I do love it when chiropractors ask “are you a doctor?” to their critics, because the irony, of course, is that they are not. They like to think they are. But they are not. “Cultish bone cracking masseur” does not sound such a grand title.

    You can see the cultishness in Glenn’s response where he flatly rejects RCTs and claims the only gold standard is the patient in front of him. I would suggest that he needs to go a little further and state that the only gold standard is the gold visa card in the patient’s wallet in front of him. Ensuring that the chiropractor gets the best patient response by the extraction of the credit card is paramount.

    Of course, he is not putting the patient first – he is putting his own beliefs and his own self-interest first. A gold standard indeed. Those that dare put forward research are called ‘Bozo’s’

    And that is why I am happy to be part of the Nightingale Collaboration. I do not want to see chiropractors shut down, but I would like to see patients properly informed about what the best evidence says about the treatment, what the risks are and what alternatives exist. If chiropractors mislead patients about what they can expect then I am happy to see their regulators act. I imagine we will get bored eventually, but I also image the scope of practice of chiropractic to change quite considerably too. And when I do get bored, there are plenty more people who also feel strongly that people should not be systematically misled by people who claim to be health professionals (if not doctors).

  • Garland Glenn

    Skeptic Barista are you a doctor? (of any kind) Do you actually have any clinical experience in treating patients? Let’s understand few things from the perspective of a clinician. RTCs are not the “Gold Standard” for a clinician. How the patient in front of me in my treatment room responds to what I do for him/her is the “Gold Standard”. And, it’s the only standard the patient cares about. The only thing that is important here is the patient. Research is only important, to me as a clinician, if it helps me to understand better what I already know works OR if it leads me to discover new conditions, or ways of treating conditions I already treat, better. Because as an ehtical clinician, I only treat those things I’m successful in treating.

    There is a factor (that continually overlooked) that has to be figured into most chiropractors’ perception of research done on chiropractic applications. Richard has previously, in his diplomatic way, alluded to this. For a chiropractic adjustment/treatment to have any possibility of being effective, it must be delivered by an accomplished practitioner. The only accomplished practitioners I’ve ever meet are very busy in practice. I’ve been doing this for 25+ years and I’ve yet to meet an accomplished chiropractor who had time to do research. We’re too busy taking care of patients. This is why we became chiropractors. I have been adjusted by the leading researchers in the UK and I can unfortunately say that, without exception, they where incompetent at best. Those of us in practice achieving great results are understandably resistant to letting a bunch of Bozo’s who aren’t any good at what they do, dictate to those of who are accomplished, what we can and can’t treat. It is well appreciated that most of the chiropractors involved in research and teaching weren’t able to make it as practitioners. It’s unfortunate but true. Now you want me to let someone who isn’t any good at what I do tell me what I can do. That isn’t in the best interest of the patient. How the patient in my treatment room responds is the “Gold Standard”.

    As a side note: Some research is done in the colleges by students. This is just as abysmal. It takes years of adjusting to become accomplished. I look at the research findings that say chiropractic type treatment for XYZ isn’t effective and think who are the clowns doing the research because I’m getting fantastic results for XYZ. Ex migraine headaches.

    This is the wonderful thing about the free market…..Patients vote with their feet. (to borrow a line). The problem here is regulators are trying to tell patients what they can and cannot have. If a patient wants to pay Richard to treat her baby for Colic and Richard feels that his treatment (based on his years of clinical experience AND his integrity as a practitioner) has a good possibility of helping the baby, it’s the patients decision what treatment she wants and where she wants to spend her money. It’s not your decision and it’s not your money. However if the government is providing the care (NHS), than it becomes the governments decision what care she can have and what Richard gets paid for it.

    Regulate the integrity of the practitioner and let the market decide if the treatment is effective.

    If you really want to do something worthwhile, direct this energy into closing down all the McDonalds hamburger joints in the country. Now that really is a health threat.

  • http://spinaljoint.com Richard Lanigan

    SB;somewhere on the blog there is a diagram of what you are looking for from a lecture Edzard Ernst gave to the GCC in 2005.

    You asked for the anatomical explanation for subluxation, I gave you it. You asked for the physiological basis for subluxation theory I explained it. You could not understand why chiropractors would refer to the WHO definition of chiropractic I explained it. You said chiropractors cant agree on anything they do, you were also wrong on that one. You assumed I would disagree with the WHO on taking x-rays I didnt.

    Not once have I ever said to you there is research that proves anything about chiropractic and now you seem to be suggesting I would exclude good quality research and present a case study as proof, that is bullshit you would have to ask the Danish government why they decided to fund chiropractic treatment for colic.

    Most of the evidence supporting chiropractic is at the bottom end of the scale, case studies, yes they are weakest form of evidence. That evidence with the practitioners experience is enough to justify the intervention if not to advertise it as a treatment for said condition, and you know what if an adjustment helps one person and ten others tried it without success they would all agree it was worth trying, if nothing else had worked.

    Absence of evidence is not evidence that something does not work or will not work. You gave an example of a small study that showed chiropractic was not more effective than a placebo, the mother. I do hope people do more research into the effect of spinal joint dysfunction on these conditions because I know what I see in practice every day, you dont.

    You are perfectly entitled to campaign for more evidence for chiropractic and it would be great if skeptics could help raise money for high quality research, rather than just trying to be awkward. I would support the Nightingale people on that.

  • http://skepticbarista.wordpress.com/ Skeptic Barista

    Any chiropractor care to list Sackett’s heirachy of evidence in order, starting with the highest quality ‘gold standard’ working down to the lowest levels of evidence.

    Then care to comment at what level you believe the best evidence for chiropractic treatment falls into this heirachy.

    Remember Sackett called for the integration of the highest quality with the lower quality, not the exclusion of the best to justify the worst!

  • http://spinaljoint.com Richard Lanigan

    I asked you what is the best evidence and you refer me a study that states chiropractic was no better than placebo. The placebo in the study I believe you are referring to was a mother holding their child and I have questioned the diagnosis of Colic in that study. Trust me there are not hundreds of Babies with colic waiting to be put into a study and sometimes researchers cut a few corners to get their subjects.
    There is evidence out there (not great ) evidence nevertheless on the basis of which the Danish government funds chiropractic treatment of colic. NHS direct takes a different view and so what opinions are like noses we all have one.

    There is also evidence that chiropractic can help back pain. How does this happen? As I have said on your blog it is to do with the relationship between receptors in spinal joints and the CNS. The Low back is 5 vertebra are you saying manipulation has no effect on the other 19 vertebra. You are saying you dont know because there is a lack of evidence or you dont believe what I see on a regular basis in practice. I dont have a problem with that you have made clear you would only have treatment that there is conclusive evidence its effectiveness.

    Take skeptic Blue Wodes advice, the pain will go away by itself, then ask your self what causes the wear and tear associated with arthritis. Why dont all the joints wear and tear symmetrically? Does it matter if joints stiffen up and other joints have to compensate. That is your choice and I would choose chiropractic care before drugs Vioxx.

    We will just have to agree to disagree about spinal joint dysfunction and its effect on well being.

  • Fed up

    Sb. How do u weed out a trial if all trials have some bias or financial gain for the company or researcher paid to do it?

  • http://skepticbarista.wordpress.com/ Skeptic Barista

    @Richard:
    On the subject of colic.
    You say “There is a hierarchy of evidence and if you dont have an RCT you use the “best available evidence” which in the case of Colic the best evidence out there would appear to be chiropractic”

    Your are mistaken on two points.
    1. There are RCT’s available that have looked at chiropractic for colic, they show that chiropractic is NOT an effective treatment.

    2. The best evidence out there would NOT appear to be chiropratic.

    I would hope that anybody reading this who may be considering chiropractic treatment will take time to visit NHS Direct to see thier view on the evidence:

    http://www.nhs.uk/Conditions/chiropractic/Pages/Evidence.aspx

    “There is some evidence that chiropractic is not an effective treatment for”

    “This means that scientific trials found that chiropractic had no beneficial effect when used to treat these conditions”

    “There is a lack of good-quality evidence on the effectiveness of chiropractic for other conditions for which it is used by some practitioners.”

    ….. And in the interests of fairness
    “There is good evidence that chiropractic is an effective treatment for: persistent lower back pain”

    But lower back pain is all they offer any support for!

    Unless you consider that the NHS don’t understand EBM/EMP ?

  • http://spinaljoint.com Richard Lanigan

    Neither does he say you should not try something because of a lack of evidence. I wrote an article on colic and I asked you what is the best evidence?

    what did clinicians do before they had evidence they tried things based on thier experience. You seem to forget there are laws in this country you can not use patients as gunea pigs to experiment on.

  • http://skepticbarista.wordpress.com/ Skeptic Barista

    @Fed up:
    That’s why Systematic trials are the so vital, they help to weed out any bias that could be associated with a single trial.

    I think Sackett sums it up by saying:
    “It is when asking questions about therapy that we should try to avoid the non-experimental approaches, since these routinely lead to false-positive conclusions about efficacy.”

    He then goes on to comment that the Systematic Review and the RCT should be considered the ‘gold standard’. His heirachy of evidence places both RCT’s and Systematic reviews above clinical experience and patient case studies, yet this is what chiropractors routinely rely on!

    If the volume of RCT evidence shows a specific condition (colic) is not helped by a particular treatment (manipulative therapies) then it does not mean the practicioner can simply look lower down the heirachial list until he finds a level of evidence that he can use to justify treatment.

    For example: Colic & chiropractic.
    Systematic Reviews of the evidence all show that chiropractic is NOT an effective treatment for colic. This does not mean chiropractors can ignore these findings and just fall back on their own ‘clinical experience’.

    Sackett promotes integration of evidence from both sources, not the exclusion of RCT’s simply becuase you don’t like their findings!

    I don’t think anything he says can give justification for disregarding the ‘gold standard’ evidence and just accepting evidence of a lower quality.

  • Fed up

    Then you say…SB@ This gets even more complicated when the issue of bias comes into the equation. Chiropractors charge for these treatments, this is how they earn there living and it is totally in their own interest to say it works and to have that view accepted…

    Is there any treatment, drug or procedure that doesn’t have some bias? Drug companies need to sell their drugs. Researches need to gain funding. I would like to see an rct that isn’t associated to some form of financial gain.

  • http://spinaljoint.com Richard Lanigan

    Hi Skeptic Barista, last week I spent some time answering your questions on subluxations http://skepticbarista.wordpress.com/2010/10/17/subluxations-still-no-evidence/ . I always try to answer genuine questions however Skeptics rarely answer my questions. I would much prefer to debate these issues in a public forum and see how much skeptics do know about chiropractic without Google to help them. You said I would not give a straight answer on x-rays I did http://skepticbarista.wordpress.com/2010/10/24/subluxations-who-said-what/#comments

    Now you say I “seem very selective in your view of Sackett’s message on EBM”.

    You say ….SB@ If you are going to question others on their understanding of Sackett’s message, you really should acknowledge his full message. On ‘Evidence based medicine what it is and what it isn’t’ – Sackett said:
    “Because the randomised trial, and especially the systematic review of several randomised trials, is so much more likely to inform us and so much less likely to mislead us, it has become the “gold standard” for judging whether a treatment does more good than harm. However, some questions about therapy do not require randomised trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be conducted. And if no randomised trial has been carried out for our patient’s predicament, we must follow the trail to the next best external evidence and work from there…Sackett’s view on EBM is the integration of clinical expertise alongside external evidence and properly conducted trials. Neither on on it’s own is good enough …..”

    I dont know what you think I think about evidence but having done a masters in health promotion at Brunel University and understanding of EBM is a requirment to write a dissertation and I have no problem with anything you have quoted from Sackett. The quote I used is from Sacketts introduction and would be his definition and there is not room to cover everything he said. This quote has two parts which state “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough”

    There is a hierarchy of evidence and if you dont have an RCT you use the “best available evidence” which in the case of Colic the best evidence out there would appear to be chiropractic http://www.chiropracticlive.com/?p=50 not conclusive proof of guarenteed sucess, however enough evidence to say it is worth trying in my opinion and the Danish Governments. The Skeptics demands for RCTs and dismissal of a practitoners knowledge and experience shows a lack of understanding of EBM because “without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.” My quote presents both sides of best evidence. Perhaps thats why I have many doctors as patients for my experience, this is what one wrote about me in an article. http://www.parkclinic.info/ourPatients.htm

    You then say …SB@“I think there are valid reasons to listen to what individual chiropractors see in their clinics, but in listening to their views is not the same as accepting them over high quality, properly conducted trials”.

    I would not disagree with that either, so what do you think is the best available evidence for children with colic

    You then say….SB@”it should be remembered that chiropractors struggle to agree with each other on what chiropractic is (subluxations, prescribing rights etc). If chiros can’t agree on fundamental issues of chiroractic practice then it is difficult if not impossible to just accept their views of what works and what doesn’t”……

    All chiropractors agree with the principle that there is a relationship between the function of the spinal joints and the nervous system, all chiropractors agree chiropractic can restore motion to stiff joints. All chiropractors agree that chiropractic helps people in pain and pain can have a detrimental effect on people health. All chiropractors would agree that chiropractic is a much safer intervention than pharmaceuticals. There is a lot more chiropractors have in common than they disagree about.

    Then you say…SB@ This gets even more complicated when the issue of bias comes into the equation. Chiropractors charge for these treatments, this is how they earn there living and it is totally in their own interest to say it works and to have that view accepted…

    Well you dont accept it,Simon Sing, Ernst has been a poster boy for CAM skepticism for 12 years, so I think its fair to say chiropractors have to do a bit more than stand at the door making promises they cant keep. Anyone who provides a service has an element of self interest its when that self interest is at someone else’s expense it become a problem.

    Bearing in mind how keen the GCC is to bring cases against chiropractors very few complaints have been brought by patients claiming to have been ripped off. You would think with all the complaints Zeno has put into the system he would have a few patient who had been ripped up supporting him, if your assertion is correct.

    You then say SB@….If RCT’s are discounted, all we are left with is the word of the individual chiropractor and whatever chiropractic philosophy that individual subscribes to.Disregarding RCT’s simply becuase you can’t reach the standard is most certainly NOT what Sackett means by EBM!….

    Who is discounting RCTs? Chiropractic like Surgery is dependent on the skill of the practitioner which increase the variables which can make RCTs less reliable. This begs the question is quantitive research models the best way to asses skill based interventions, qulaitive research may be better. RCTs work very well on drugs because the intervention is exactly the same each time, you can not say that about an adjustment. I am not an expert in research methodology and think researchers would be better equiped to debate the pros and cons od different methodologies, than me and the skeptic movement.

    When I was younger I was a very good footballer and would get picked for teams because of my leadership qualities and technique and would not have been happy if researchers decided the best players were 25, right footed and 5.10″ and choose them for them to play. I am certain my technique is better than the average chiropractor or say a new graduate and I would be concerned if the effectiveness of my adjusting technique was measured using the average or a new graduates…
    RCTs assume there is an average person who responds in an average way.

    There are two ways to judge an intervention a trial or a patients response. I am happy to be judged either way.

    You finish up with your put down by saying….. SB@ “I will avoid the temptaion to state that Sackett referred to the clinical evidence of ‘Good Doctors’ and it is far from accepted that chiropractors are Doctors, especially when Sackett talks of Evidence Based MEDICINE”.

    It is generally accepted that chiropractors use the courtesy title “doctor” of chiropractic just as medical doctors use it. You may not like it, but some things you guys will have to get used to.

    I guarentee you ten years from now most of the Nightingale Collaboration will have got bored slagging off CAM and the vast majority of chiropractors will be still be in practice.

  • CDC

    I would think that letting the public have accurate information about healthcare
    so they can make informed choices would be good for chiropractic and not so good for say … drug companies.

    If the agenda is to find out what is best for the public I really cannot see any chiropractor objecting to this. However if the agenda is to intimidate, bully and harass chiropractors working in small businesses individually I think lawyers are going to make a lot of money within the next couple of years.

    You can always find certain individuals in any profession trying to cut corners or bending some rules, but as far as I understand of the surveys being performed most chiropractors worldwide (90%+ of 100 000) agree upon subluxation, how to practice, adjusting having a positive effect on general health, not treating symptoms or disease, not wanting prescription rights etc.

  • http://skepticbarista.wordpress.com/ Skeptic Barista

    Richard,

    I would have been totally shocked if you had fully welcomed the formation of the Nightingale Collaboration, so your comments are understandable.

    On the subject of EBM

    You seem very selective in your view of Sackett’s message on EBM.
    If you are going to question others on their understanding of Sackett’s message, you really should acknowledge his full message.

    On ‘Evidence based medicine what it is and what it isn’t’ – Sackett said:

    “Because the randomised trial, and especially the systematic review of several randomised trials, is so much more likely to inform us and so much less likely to mislead us, it has become the “gold standard” for judging whether a treatment does more good than harm. However, some questions about therapy do not require randomised trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be conducted. And if no randomised trial has been carried out for our patient’s predicament, we must follow the trail to the next best external evidence and work from there.”

    Sackett’s view on EBM is the integration of clinical expertise alongside external evidence and properly conducted trials. Neither on on it’s own is good enough ….. this is something I would agree with – with some caveats.

    Where I would disagree with most chiropractors is that they want their own, individual clinical expertise to be accepted as equally as valid as high quality systematic reviews. It should be acknowledged that Sackett states that the RCT and systematic review are far less likely to mislead. Systematic reviews of RCT’s are less prone to bias and less prone to one poorly conducted trial distorting the truth.

    I think there are valid reasons to listen to what individual chiropractors see in their clinics, but in listening to their views is not the same as accepting them over high quality, properly conducted trials.

    It should be remembered that chiropractors struggle to agree with each other on what chiropractic is (subluxations, prescribing rights etc). If chiros can’t agree on fundamental issues of chiroractic practice then it is difficult if not impossible to just accept their views of what works and what doesn’t.

    This gets even more complicated when the issue of bias comes into the equasion. Chiropractors charge for these treatments, this is how they earn thier living and it is totally in their own interest to say it works and to have that view accepted.

    Add this to the fact that many chiropractors openly state that RCT’s are not an appropriate method of judging chiropractic treatments. Indeed there are chiropractic associations in the UK who are actively lobbying the ASA to have the required standard for evidence (RCT) lowered, so that their clinical expertise is all that is required.

    If RCT’s are discounted, all we are left with is the word of the individual chiropractor and whatever chiropractic philosophy that individual subscribes to.

    Disregarding RCT’s simply becuase you can’t reach the standard is most certainly NOT what Sackett means by EBM!

    I will avoid the temptaion to state that Sackett referred to the clinical evidence of ‘Good Doctors’ and it is far from accepted that chiropractors are Doctors, especially when Sackett talks of Evidence Based MEDICINE.

    Regards

  • Garland Glenn

    The evidence is this: iatrogenic death is now the second leading cause of death in the US (I don’t know what it is in the UK), accounting for approx. 300,000 deaths per year. So…medicine is killing almost 1000 people per day in the US or more deaths per hour than can be attributed to chiropractic in over 100 years. You know some people strain on knats and swallow camels.

    Also the comment is made:”It is particularly important that the public have accurate information about healthcare so they can make informed choices.”
    How many patients know enough biochemistry to know whether or not they should be taking a particular drug? I would venture < 1%. I know I rarely see a patient who knows enough anatomy and physiology to make an informed choice. That’s why you have to TRUST your doctor.

  • John

    “Unfortunately Simon was unable to attend the official launch, but they presented a very small women who had been told by a chiropractor she would grow if she was adjusted every week for a year.

    Having treated the lady for a year the chiropractor presented the lady with six inch second hand platform shoes. The chiropractor claimed the shoes were worth the £2,000 she paid as Elton John was the previous owner.”

    I reckon this is manure …

  • fed up

    “Nightingale’s lasting legacy on the profession of nursing is widely known. What is not as well known is her use of aromatherapy in the nursing profession.”

    And in the mail this article.

    http://www.mailonsunday.co.uk/news/article-479792/Letters-reveal-nurse-Florence-Nightingale-maybe-sinner-saint.html

    These bits seem to sum up the founders of this collaboration.

    “Yet the unpublished letters of one her contemporaries paints an altogether different portrait of a woman as domineering, bossy, bloody-minded and self-promoting as she was previously thought to have been sweetnatured and altruistic.”

    “To Hall, she was nakedly ambitious, serving not her country but her meddling ego.”

    “As to whether she was a virtuous woman following a natural vocation or scheming egotist who abused her prominence, history must still decide.”

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