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

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

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.

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.

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.

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. 

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

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.

@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

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

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…

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

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!!!!!

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″

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

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

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

@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

@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

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

Bit more.
http://www.grapheine.com/bombaytv/v2/play.php?id=147334

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

sorry try this.
http://www.grapheine.com/bombaytv/movie-en-cdc50acde539813563d62f61fae27ba6.html

I’ll make some for you… :)

I mean literally ;)

“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?

@ 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.

@ 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

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

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.

@ 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. 

@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

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.

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.

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.

“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.

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

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. :-]

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.

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

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.

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.

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.

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

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.

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

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

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

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

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://skepticbarista.wordpress.com/2010/10/24/subluxations-who-said-what/comment-page-2/#comment-851

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.

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

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

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

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.

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.

The spin has landed.

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

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).

@ 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?

There’s a contact address on the web site.

@Ex McStudent

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

@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?

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

@ 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?

@ 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.

” 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.

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

@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

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.

Andy

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

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

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.

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

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

@ 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

@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.

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.

@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.

@ 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.

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?

“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 ?

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.

@AL

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

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.

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.

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

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.

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?

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.

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?

@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!

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.

@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.

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?

@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.

@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!

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.

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?

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.

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?

@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.

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

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.

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?

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.”

@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?

@ 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
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.

@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.

@ 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.

Good article on evidence based dentistry.

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

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.

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

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.

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).

@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 ?

@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.

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

“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 …