text:
In Memoriam
Following on from Skeptic Barista's tenacious questioning of the GCC over the lack of evidence for the chiropractic subluxation, and my obituary of it, the GCC have announced that it is no more than 'an historical concept' to be consigned to the rubbish bin of a bygone, pre-scientific, evidence-free history.
The final nail in the coffin for the subluxation is their guidance (cached) for chiropractors, issued today:
The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.
Chiropractors are reminded that
- they must make sure their own beliefs and values do not prejudice the patients' care (GCC Code of Practice section A3)
- they must provide evidence based care, which is clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners, including the individual chiropractor her/himself (GCC Standard of Proficiency section A2.3 and the glossary)
- any advertised claims for chiropractic care must be based only on best research of the highest standard (GCC Guidance on Advertising issued March 2010)
This is interesting because of their statement about beliefs. They clearly see a chiropractor's belief in subluxations as unfounded and irrelevant and indeed possibly prejudicial to the best interests of their customers.
However, it's not so much a 'theoretical model' of anything: it's never been any more than an hypotheses and one that has never had any evidence base. It was a notion that the quack D D Palmer invented to 'explain' to the unsuspecting why he was charging them money to crack their backs. As I've said before, there has never been any good evidence for either the subluxation nor its supposed effects on nerves.
The way they've phrased their second sentence is also interesting:
It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.
It seems to me that this was carefully written so that it included all conditions — anything at all that might be considered a 'health concern' is covered whether that is some actual condition such as back pain, or some more esoteric chiropractic condition like 'feeding problems'. This should prevent them claiming that anything at all is caused by the mythical subluxation and stop them blinding their customers with sciency-sounding words.
All change again
This is a good time to be a web designer. Just think of all those websites that will need to be changed — again — to remove yet more misleading claims.
Of course, it might not be that simple. As Blue Wode has pointed out, there are a plethora of terms used by chiropractors instead of the bogus S word. The GCC's guidance doesn't say anything about any of these, and I suspect that some website changes may amount to no more than substituting a few new words. The GCC will need to keep on its toes if they really want to protect the public from misleading claims.
Applying appropriate care
The second bullet point in the guidance cites part of clause A2.3 of the GCC's Standard of Proficiency. Although in the same document as the Code of Practice, it's not really been relevant to my complaints, so I've not mentioned it before.
However, in full, the clause is:
A2.3 Applying appropriate care
Chiropractors must be knowledgeable about the underlying theories of the care they provide and be competent to apply that form of care in practice. Chiropractors' provision of care must be evidence-based and appropriate to the patient's health and health needs. The patient must have consented to the form of care. Chiropractors must care for patients in a way that minimises risk to that patient.
With the 'theory' of subluxations finally declared a mere historical artefact, what 'underlying theories' of chiropractic are left?
How are they going to explain to a customer why they think a good back crack will make any difference to their cervicogenic dizziness, their migraines or their chronic back pain?
How are they going to explain to a customer that they need to keep coming back for 'wellness' or 'maintenance' care to stop those nasty subluxations from causing you future health problems?
How indeed.
So whilst this new guidance by the GCC is a welcome step in the direction of evidence-based chiropractic (whatever that is), they may find some abiding by the letter of the guidance but not the spirit. Not dissimilar to the lip-service many have paid to the ASA guidance they are mandated to abide by.
Inspired by the atheist bus campaign and this bus advert that Skeptic Barista happened across:
146 Responses to In Memoriam
Another beautifully researched post, Zeno.
I still find it very puzzling that the GCC has declared that the 'Vertebral Subluxation Complex' isn't supported by clinical research evidence when, in 2004, Margaret Coats, CEO of the GCC, claimed that there was "scientific evidence" for the *many* interpretations of the word 'subluxation'. See point 4 here:
One has to wonder what happened to that scientific evidence when the chiropractic subluxation was discussed at the GCC's 12th May 2010 meeting.
For those interested, the above link is lifted from the June 2004 correspondence which the group, Action for Victims of Chiropractic, conducted with the GCC. See here:
It's also worthwhile reminding readers of the following comments which were made in the GCC's Fitness to Practice Report 2007 (p.13 of the original document) regarding a complaint it received against one of its registrants:
"The GCC's expert witness advised that the discovery of subluxations (areas of vertebral restriction in the spinal joints) is commonplace to the point of universality in patients."
Surely that expert witness should now be investigated by the GCC for misleading its disciplinary panel.
I would also point out that in the Minutes of its 1st May 2007 Council meeting the GCC reported:
"Members discussed the strong views expressed by a registrant about the content of the GCC's answer to the question 'What is subluxation and is it dangerous?' Council AGREED that it was content with the current wording."
Yet, in an email to Skeptic Barista last month, the GCC clearly stated that it had "never considered the research evidence for the chiropractic vertebral subluxation complex":
I don't see how it could be possible for the GCC profess to being "content with the current wording" for its definition of a subluxation if it hadn't discussed the evidence on which it was based.
Interestingly, former chiropractor, Richard Lanigan, mentions in his latest blog post that the GCC "has avoiding defining them" [subluxations] because "to do so undermines the principles of spinal care and chiropractic and they would have to comment on the WHO understanding of chiropractic".
Well, let's not forget that serving on the panel that developed the WHO's "understanding of chiropractic" (i.e. its Guidelines on Basic Training and Safety in Chiropractic) were Margaret Coats, Chief Executive & Registrar of the GCC, and Anthony Metcalfe, former president of both the BCA and the World Federation of Chiropractic. (pp. 35-36 in the link below):
Anyone else confused?
Another nice post & thanks for the mention & link.
Whilst it's true that the GCC's guidance only mentions 'subluxations' and chiropractors use a range if different terminology to refer to the same thing, it is perhaps worth mentioning what the GCC said in response to one of my questions:
4. What is a subluxation and can it do me harm? ( This is the question removed from the GCC's FAQ)
4. On your fourth question, the word 'subluxation' is a synonym for terms such as joint misalignment, joint dysfunction, facet syndrome and articular derangement.
Not that I believe for one moment that it will stop chiropractors from using some other 'fuzzy' medical sounding terminology to refer to what is essentially a subluxation, but if chiropractors literature is to stay on the good side of the ASA then they need to be careful on the wording they use and ensure it's not something that could be seen as a synonym for that historical, unproven concept …. the subluxation.
Oh and I love that bus banner. Can you imagine the uproar from chiropractors if that was seen driving around UK towns & cities!
Yes, it's also worth remembering the following which is lifted from one of Skeptic Barista's excellent blog posts:
"Importantly, the GCC acknowledge (answer 4) that terms such as joint misalignment or dysfunction have the same meaning as subluxation. Simply using different terminology is not a get out clause!"
A subluxation never should have been interpreted as a clinical entity and this is where the chiropractic profession in its ill-faited attempts to medicalisation sold its spirit and principles. Unfortunately this has also caused much confusion amongst the so-called sceptics who come up with "subluxations don't exist" banners which are only directed to the address of the subluxation concept as per GCC and BCA interpretations who enacted these attempts to medicalisation. Once and for all: a subluxation is not a spinal event. It is a group name given to any systematic dysfunction in any arena of the healthcare spectrum which is causing a challenge to the ability to cope and which, when its intensity exceeds the ability to cope causes a reduction in well-being (subluxation is casue of all dis-ease).
Subluxations can be identified in the biomechanical, biochemical and psycho-social arena. Lots of people treat subluxations and chiropractors tend to primarily treat biomechanical subluxations. Some poeple who treat subluxations in the other arena's are amongst many others cogitive behavioural therapist and clinical nutritionists.
When a subluxation has caused so much damage that there is no therapeutic point to reversing the subluxation in order to achieve an improvement to the condition then surgery and palliative care are the only appropriate pathway. If the injury or trauma is not caused by a subluxation but blunt trauma, cancer, retro-virus or other similar pathological process then there is no need for the removal of a subluxation as there is none. When there is a subluxation (e.g.nutritional deficiency) accompanying such injury ,then removing the subluxation will facilitate recovery by virtue of non-interference (i.e. the person is recovering without further challenges to their ability to cope).
Chiropractic is bigger than most chiropractors, because they aren't too well equipped to deal with subluxations of non-biomechanical origin. Some chiropractors are not that well equipped to deal with these either and should rethink their claim in the health-care market. Some common biomechanical subluxations include gait dysfunction (pes planus/cavus), anatomical leg length discrepancies, orthognastic subluxations (bite/occlusal dysfunction) and spinal subluxations. They don't usually exist in isolation in the presenting patient due to the fact that the presenting patient is a symptomatic patient (in most cases) which will either require a high-intensity subluxation, a chronically present subluxation or a multitude of low-level subluxations. The potentially cumulative capacity of subluxations has some people confused as they see changes or improvements in one arena (say the biomechanical) when subluxation is removed in another arena (say the psychological) which then swiftly and simplistically leads them to presume they treat these biomechanical conditions.
Some chiropractors are as confused about this as some sceptics, and understandably so.
Simon Singh and Edzard Ernst et al aren't wrong in saying there is no research evidence to back up certain claims, but they are grossly mistaken in assuming that there is any research out there assessing the chiropractic model. Often they refer to poor or weak evidence on back pain, my point is that considering the research treats back pain as an entity makes it invalid as a whole. Back pain, back pain and back pain can be three different things. Some can be caused by flat-footedness, some can be caused by spinal dysfunction some can be caused by orthognastic dysfunction, some can be caused by any combination of the three. Considering these are only three of a myriad of potential sources of subluxation I would go so far that research that looks at exercise vs manipulation vs medication is completely impotent and find it surprising that under those circumstances it was yielding weak or even poor evidence levels at all.
It isn't easy, but then rarely is anything worthwhile easy.
Kind regards,
Stefaan Vossen
This is only the beginning
@ Stefaan Vossen
In other words,
Remember, that each subluxation-based chirodigm exists more or less independently of the others, and is a self-referencing diagnostic-treatment loop which always, by its own definition "works". For the consumer and third-party payer (that's insurance) this presents a dilemma that borders on a nightmare. In short, there is no standard of care in the profession. As Forest Gump might say, "A chiropractic office is like a box of chocolates: YOU NEVER KNOW WHAT YOU'RE GOING TO GET!"
John Badanes, DC
typical blue-wode non-sense. please open your mind a tiny bit and understand that all healthcare models are in essence sollipsistic. The point and clinical challenge is to identify which sun needs to be turned around on which occasion. I would also refer in relation to your Badanes quote that
a) "you never know what you gonna get" because your back pain may very well be caused by something or a combination of things which is different to the previous patient. The other unfortunate fact is that some people are better at certain things than others and will prefer certain approaches to others in consequence. If you struggle with that then it is clear to me that this is all too intellectually challenging to you and expect you not to have spent much time with patients in your life-time
b)that chiropractic care as practiced in this way is the first and only healthcare approach which is assured to deliver the results and only "works" if the patients decides that is has done
c) Badanes does well to be critical of his own profession and you would would do well to reference context to quotes rather than trying to make things look like you have support for your views. That my dear is not science or scepticism, in fact it is self-delusion, something you accuse a lot of people of.
Stefaan, I can only assume that you've never heard of 'The Blue Dot Cure'. It has similarities to 'the self-referencing diagnostic-treatment loop'. Scroll down here:
talk of a self-referencing diagnostic treatment loop! lol that is very much what your brand of scepticism seems to be my dear Blue Wode. How about you stop pratting around and actually respond to what is being put in front of you, express your objections, your thoughts so that we can do something constructive rather than this circular nonsense?
ps "blue dot cure"? you are severly deluded if you think that we have the choice between the patient worsening/improving/staying the same.
Firstly: whether you like it or not patients only refer to you when they are happy with what you did for them. My practice does not advertise.
Secondly I operate an insurance-based money-back guarantee (it's me who's covered, so the patient does not opt in or out-I only take on the battles I can win)on treatment outcomes and only had one refund due in the last 250 cases. This patient didn't even want his money back because it did help, just not as much as I initially stated it would do.
Finally my practice primarily treats chronic conditions (average 7.2 years, lowest 2.3 years, highest 36 years) so you can keep your self-limiting nonsense for where it is appropriate.
Seems like you're quite a few steps behind BW
This is only the beginning
@ Stefaan Vossen:
You clearly have stong beliefs about what a subluxation is and what the effects of one are, I assume this is based on some good clinical research evidence and not just opinion!
Have you thought about contacting the GCC on this subject …. I did and found their replies very interesting 😉
How do you keep so up to date with the world of chiropractic?
Excellent picture! If I'd seen that bus I'd have laughed so much I'd have probably given myself a subluxation!
You cynic. Give them some credit! 😉 Surely, the GCC should be commended for showing they understand at least one aspect of the scientific process; that is, science is self-correcting. What once was believed to be true, they now admit was utter twaddle (i.e., not supported by a jot of evidence.)
@ Stefaan
If you have been treating some patients with chronic conditions for 36 years, might it not now be time to conclude your treatments don't work very well?
Also, you say you don't advertise, but I'm certain the website I found at http://www.chiropractorswarwick.co.uk/ is an advertisement. (Assuming it's yours. Doctor)
Lastly, I wonder if anyone who has had a 'subluxation' treated by a chiropractor in the past would have a case for demanding their money back? For example, if, on inspecting my car's service bill, I found the garage mechanic had done some panel beating to correct an engine misfire, I'd demand some money back (based upon my vague understanding of how cars work). Especially as the misfire is still there! (No doubt he'd tell me that there's part of the electrical loom under the panel he was beating and that it was being squeezed by one of the many dents so the electronic signal's to the ignition system weren't quite getting through…Bet he'd try to get me to bring the car in for a regular service too. No wonder I don't trust back street mechanics!)
Andrew Gilbey wrote: "I wonder if anyone who has had a 'subluxation' treated by a chiropractor in the past would have a case for demanding their money back?"
Excellent question.
I also wonder why it's taken the GCC so long to understand the scientific process. There wasn't any evidence* for the existence of chiropractic subluxations when statutory regulation came into force in the UK nearly 10 years ago, yet, with reference to my first post above, in 2004, Margaret Coats, Chief Executive and Registrar of the GCC, claimed that there was "scientific evidence" for the *many* interpretations of the word 'subluxation'.
You have to wonder what's happened to that scientific evidence.
[*Ref. Crelin ES,Ph.D. "A Scientific Test of Chiropractic's Subluxation Theory -The first experimental study of the basis of the theory demonstrates that it is erroneous." Chirobase.]
@skepticbarista I do have strong beliefs and intimate understanding of what they are. As per my post they can be a wide range of things. They can be leg length discrepancies (give heel raise), they can be gait dysfunctions (refer to good podiatrist or give off the shelf orthotics), they can be post-traumatic anomalous spinal movement patterns (I have a job), they can be orthognastic dysfunctions (refer to a good dentist or orthodontist) (and that is just talking about biomechanical subluxations so let's not ignore the others). As a person I am limited in the width of the arena I can comprehend and influence with my skill-set so I made the decision to only take on patients who have primarily biomechanical entities at the root of their complaints. I can identify when this is the case, it really isn't that difficult. Speak to a good podiatrist or orthodontist, they will know what I am on about. I am of the opinion that the GCC has people on its board who do not actually understand these discrepancies and in their befuddledness have decided it wise to "kill of the subluxation" and am enquiring as to how it is within their remit to define chiropractic. I have found the BCA's attempts to further disembowel the value of the chiropractic philosophy disturbing and will be addressing this issue shortly. I believe that should a patient benefit of medication (which is often the case even if it is just to facilitate joint stability by means of reduction of inflammation or return to normality by reduction in pain) that the patient can and should be advised so. The low-end stuff is available over the counter, the high-end stuff is best dealt with by the central partner in the patient's care; the GP.
@andrew gilbey I have a website and you can call me doctor if you like, I have earned it. As per my post I have treated and look after people who have suffered for 30 years and more prior to presentation, I am not so lucky to have been in practice for quite as long. Average time to recovery is 2 months. Money-back guarantee is based on their evaluation whether the treatment has worked for them. Not whether the subluxation is gone or not as I feel that my responsibility to the patient requires me to only offer care if I believe that the patient will benefit in their own experience, i.e. whether or not it has been worth their while. If that has not been the case, they get their money back. Simpels! You will also find that my website is largely information-based, something you don't seem to comment much on. I also have a sign above my door and business cards with my name on, do you feel that this really significantly deters from the observation that 90% of the presenting new patients have been referred by patients, GP's and consultants? I don't understand your car analogy as in case the misfire is still there you would get your money back and if I dented your bonnet you can sue me…
Regular service… mmm maybe you should have a little look at the scientific basis on which you go to your dentist for dental checks… let me know what you find, won't you?
Finally, I only charge when I need to adjust and that is based on an economical decision that if by doing that three, four, six times a year I am reducing the overall cost and suffering. As a physician I have to be judge, jury and executioner and that is a tall order sometimes. One for which I receive respect and appreciation and that makes me feel fully justified in my endeavours.
@BW I hope this has answered your "excellent question" (although I have to say it was put fairly clearly in previous posts, but never mind)
Kind regards,
Interesting comment from ex-chiropractor, Richard Lanigan, as to why the GCC took so long to produce guidance on the mythical chiropractic subluxation:
"…the political circumstances were not right to give the GCC/BCA alliance the opportunity to speak against it."
not ex-chiropractor- one of a few real chiropractors, just not what the GCC recognises/understand a chiropractor to be
@ Stefaan Vossen
Yes, ex-chiropractor, Richard Lanigan.
"It's a criminal offence for anyone to call themselves a chiropractor if they're not registered with us…"
Richard Lanigan, as you well know, is not registered with the GCC.
@Blue Wode
clearly the phrasology is beyond you. As I said: "just not what the GCC recognises/understand a chiropractor to be".
Sorry to be too witty for you, maybe you should start by reading people's posts and not just randomly spout. I could then also start to take you much more seriously and maybe even get the impression that you are actually interested in making things better rather than make sequences of statements. in case you are not interested in making things better, then I must question your motives for taking part in the discussion
@ Stefaan Vossen
Richard Lanigan, as far as I am aware, works in the UK.
In the UK, a *real* chiropractor is one who is recognised by the GCC.
Therefore Richard Lanigan is not a real chiropractor.
Whatever you think a real chiropractor is, or should be, is entirely irrelevant.
Entertaining as your view may be, it is inaccurate on a number of facets (I could still call myself a chiropractor if I was registered in Belgium but not on the GCC register) and minimalist. Also, to avoid future disappointment I was all along referring to the spirit of what it should be and always has been, but if you fancy feeling like you're winning battles by changing thread (which is something you are very adept at) then please do so with a little more acumen. The GCC and the BCA are changing the spirit of chiropractic to suit people like you who believe that unless evidence is available it can't be true. As I have said to you before and you have equally ignored: the model is complex and hard to evaluate. it can be evaluated but hasn't been done yet. So far patients are individually deciding whether it is something they wish to put their time and money towards. I would like the model to be tested rigorously. That takes time. In the meanwhile there is no need to change the model to suit you but the BCA/GCC feels there is. No-one in Europe agrees with them (have a peek at the ECU), but because they make the rules they can change overnight in England what I or Richard or anyone else is supposed to be seen to be doing. Surely even you sees that this is nonsense? Thankfully the patients, GP's and consultants know it doesn't matter, maybe one day you will do too. Ergo what the GCC says chiropractic is, is by and large irrelevant and so is your point (in numerous ways). Problem is that a lot of practising chiropractors think it is but thankfully it as such represents only a virtual dictatorship.
Stefaan Vossen Doctor of Chiropractic
One last post on this topic:
Zeno concludes from the statement:
"The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns"
that "it is an historical concept to be consigned to the rubbish bin of a bygone, pre-scientific, evidence-free history".
Jumping the gun a tad aren't you really?
I read that statement to be more like: It is an historical model which hasn't been tested yet. As such, for good scientific form and human decency, it shouldn't have any claims attached to it as of yet. Fair cop I say, obituary, not quite.
This is only the beginning
Stefaan Vossen wrote: "Entertaining as your view may be, it is inaccurate on a number of facets (I could still call myself a chiropractor if I was registered in Belgium but not on the GCC register) and minimalist."
Yes, that might be true of Belgium, but whilst you practice in the UK, by law you cannot call yourself a chiropractor unless you are registered with the GCC.
Stefaan Vossen wrote: Also, to avoid future disappointment I was all along referring to the spirit of what it should be and always has been…"
I understood that, but the fact remains that *real* chiropractors in the UK are registered with the GCC. However, I will concede that many of them still practice *real chiropractic* and, as such, will need to be brought up to speed with the evidence or weeded out.
Stefaan Vossen wrote: "The GCC and the BCA are changing the spirit of chiropractic to suit people like you who believe that unless evidence is available it can't be true."
Yes, hopefully the GCC and the BCA are finally following what the science tells us.
Stefaan Vossen wrote: As I have said to you before and you have equally ignored: the model is complex and hard to evaluate. it can be evaluated but hasn't been done yet."
The model has been evaluated several times and found to be erroneous.
Stefaan Vossen wrote: "So far patients are individually deciding whether it is something they wish to put their time and money towards."
That statement is meaningless in the context of evidence based medicine. People put their time and money towards all sorts of things that are ultimately of little value.
Stefaan Vossen wrote: "I would like the model to be tested rigorously. That takes time."
So 100+ years hasn't been enough time?
Stefaan Vossen wrote: "In the meanwhile there is no need to change the model to suit you but the BCA/GCC feels there is. No-one in Europe agrees with them (have a peek at the ECU), but because they make the rules they can change overnight in England what I or Richard or anyone else is supposed to be seen to be doing. Surely even you sees that this is nonsense?"
What I see is that some in the UK chiropractic trade are finally coming to their senses and realising that the day of scientific reckoning can't be put off forever.
Stefaan Vossen wrote: "Thankfully the patients, GP's and consultants know it doesn't matter, maybe one day you will do too."
As someone once said of medics who refer to chiropractors, it could be that they unload intractable, self-limiting cases on chirpractors for placebo 'treatments'. In that case, it's not really an endorsement of chiropractic as much as an acknowledgment that they are repositories for people who really need no treatment (with the hope they will not harm).
Stefaan Vossen wrote @ Zeno re the GCC's guidance on the Vertebral Subluxation Complex: "I read that statement to be more like: It is an historical model which hasn't been tested yet. As such, for good scientific form and human decency, it shouldn't have any claims attached to it as of yet. Fair cop I say, obituary, not quite.
Sadly, there may be a kernel of truth in what you say, but not quite for the reasons you give:
"I am afraid that the recent notifications from the GCC means nothing will really change. In short, they may only have to adhere more closely to ASA requirements, they are free to ply quackery as long as they are less overt.
The subluxation remains a "theoretical" model (by which they intend the lay-meaning of that word, as in "notional"). Chiros can continue to talk about the notion (and use other, sometimes descriptive, terms), as long as they don't advertise it as real.
They may not make "unscientific" claims; but they may make "evidence-based" claims (a far weaker standard). If I say "I adjusted the spines of five people with multiple sclerosis and they got better," that is "evidence;" and if I don't advertise it, it is not an ASA violation.
We have a saying that a difference only matters if it makes a difference, and I don't think their "concession" will make any difference."
In essence, it looks like we may still be looking at a fairly toothless chiropractic regulator in the UK.
@blue wode,
the model has never been properly and fully tested, show me where and I will show you you're wrong and so are your conclusions.
no, 100+ years was not enough, that's how far ahead it was.
your desire for scientific standards is laudable, the denial ensuing from it is not.
funny you claim to know that the meaning of "theoretical" was meant to be "notional"… funny indeed…
Stefaan, you know, and I know, that you are clutching at straws – otherwise you would have to face up to the following reality:
"Unsupported by science, chiropractors must either fall back on Palmer's pantheistic views or admit that the "subluxation" theory is erroneous. Without this theory, chiropractors are reduced to spinal manipulators whose primary treatment modality is shared by osteopaths, physiatrists, sports trainers, physical therapists, and others. Without subluxation theory, chiropractic's claim that it is a unique and comprehensive "alternative" to standard medicine is lost."
National Council Against Health Fraud's fact sheet on Chiropractic
I think you claim to know things you know nothing about a little too often. You have formed an ill-informed opinion on what the subluxation theory is and base your spoutings on what you think you know to be facts. When it doesn't suit you you change tack, when it does suit you you refer to quotes either grabbed out of context or placed into wrong context. You make assumptions on what the basis is for my views but do not ask questions… just make statements. I can see quite easily how one becomes ill-informed and self-referring (I know a famous scientist who does that too!) that way. As I stated before ("That my dear is not science or scepticism, in fact it is self-delusion, something you accuse a lot of people of"), talk of solipsism!
Take care anyway, and no, I am not clutching at straws, I think you very much are on the other hand. You clearly have the drive to make a contribution, shame it is not a constructive one (and yes in my view you proving that subluxation theory is false would be a positive contribution, please do! ps. can you forward me those pieces of research you claim have proven that it isn't? if you haven't, could you please stop making these false comments, that would be kind and decent, let alone scientific! Think a little about the value of your contribution whilst you're at it…
Stefaan Vossen wrote: "…in my view you proving that subluxation theory is false would be a positive contribution, please do!"
The burden is on you, and the rest of the chiropractic industry, to prove that it is valid. Until you do so, you should not be acting as if it were legitimate and charging patients a fee to fix something that might not be broken in the first place.
So that is your contribution? Place the burden of proof on me? How do you know I charge a fee for something that isn't broken? Are you assuming that chiropractors say to perfectly healthy people "you have a subluxation and I will take it away for you" and run a business on that premise? My patients first attend because they are in pain (chronic mostly so spare me the self-limiting argument) and pay me because I put in place changes which improve matters. Then they come to me to maintain a high-quality status quo (as I stated before not dissimilar to your checkup visits at the dentist, which I suspect you haven't questioned the scientific basis of, or you have bad teeth by now) That, I say is a fair exchange. As such it is a perfectly legitimate industry to be in, which incidentally (just to completely deflate your bias) has as much scientific support as most medical procedures (i.e. very little). That my dear is clinical life, and sometimes it's scary. My father has been a GP for 38 years, seen it all. Ebola virus when we lived in Congo, surgery with razorblades, obs&gynea, death in the office… this man's ONLY reason for retiring next year is that he is afraid to make a mistake. Think about that. And then wonder whether I take anything you are saying about clinical and scientific certainty seriously. Life and clinical life are not conducted through stats and creating this alternative reality where it has to fit the box or it is immoral is what got people burnt and persecuted. The need for scientific evidence is your dogma and bible, your "opium for the people". I look forward to adding a page to it so you can sleep better and take on the challenge of contributing as much as I can (I am a bit shit with stats though).
@ Stefaan
I can only conclude that you are unable to provide any scientific evidence for chiropractic 'subluxations'.
Please do provide me with the proof that you stated showed it did not exist. If you can't, please retract your statement. I never stated I could provide you with proof that it does.
This is like our own little 140+ character twitter account! Thanks zeno!
For the benefit of readers who wish to know what Stefaan Vossen is arguing about, this explains it all:
"And then wonder whether I take anything you are saying about clinical and scientific certainty seriously."
Sadly for your customers, high quality clinical & scientific evidence in support of treatments are not high on your agenda.
"The need for scientific evidence is your dogma and bible, your "opium for the people"."
Your willingess to practice on patients without reliable scientific evidence is your profession's weakness, it's shame and will in the end be its undoing.
You are right that "this is only the beginning" The quack elements of chiropractic are being peeled away layer by layer.
Colic, asthma, allergies, subluxations, all challenged – all gone ……. One really has to wonder what will be left of chiropractic when we get to the end!
I've just read all through this thread and I would like to commend Blue Wode for (yet again) keeping it real and not responding in kind to (yet another) patronising and obnoxious chiroquack who, as you say, is clutching at straws and who is also, evidently, a liar. If that site isn't an advert then what is it?
Stefan said, "Are you assuming that chiropractors say to perfectly healthy people "you have a subluxation and I will take it away for you" and run a business on that premise? "
Indeed, that is exactly what chiropractors do. I know this from personal experience.
I feel another blog post coming on….
You are right, Richard Lannigan certainly appears to have a practice in Kingston on Thames, UK. The last time I checked, it also appeared to mention chiropractic.
With regard to the peeling away layer by layer, I think you're absolutely right. I guess this is why a lot of chiropractors are expanidning into other areas, such as smoking cessation and nutirition and 'wellness'.
Now for some fun:
For any of you night owls, here are three links to videos put on youtube by the Yost family chiropractic centre. When you watch the first one, please try to ensure you are not eating – I wouldn't want anyone to choke when they see the poor patient's head being stapled toward the end (also note how the centre section of the chiropractic bench collapses under the poor patients hip when the 'subluxation' is 'corrected' – the noise reminded me of Penn and Teller's classic 'chiropractic cat sketch, which is also available on YouTube):
Is it just me, or does anyone else feel uneasy about real patients being shown on YouTube? And 'medical' services being advertised?
Just in case they vanish, I have downloaded copies for future reference.
Regarding the first link in the post above – see how the poor patient gets 4 sets of 3 staples in her forehead (left to right), but 6 sets of 2 staples in her cheeks right to left). No doubt this pattern of stapling is supported by some sound research. 😉
Clinical and scientific assertions are of great interest and import to me. The problem is that I know the research isn't there to allow me to make claims in regards to colic, otitis media etc, in fact it's not really there for me to make strong claims regarding back pain either. So I don't. Simon Perry made a claim against a website on which I was featured, but which I did not control. In fact I go out of my way to explain to patients that changes in any other field other than the biomechanical are purely coincidental… The research isn't there, full stop. That is primarily because the research does not reference to the mehodology used. I asked Blue Wode to provide me with the evidence he is claiming statements by (i.e. "there is proof it isn't true), and he won't provide it. Scepticism,… really?
My patients come to me because they are in pain. My method seems to get them out of pain. Coincidental or not. They are happy to pay for that. Maybe I am no better than a faith-healer, maybe it is all placebo. But I am a clinician and a phycisian first and foremost and my duty lies with my patients. Not with satisfying your thirst for evidence. I am making no claims other than nearly all the patients i take on as patients get better and are happy to pay for that service and are happy to refer to me.
Entering into a scientific debate requires research to be done. It hasn't been done. All that has been tested is the value of manipulation to back pain. And that is not what we are talking about as chiropractors. It seems to be what you think we do, and that is where your notions are fundamentally misguided, I am sorry to say.
the claims are gone because they should never have been made in the first place, but the subluxation concept is certainly not. I think you are referring to the notion of "spinal subluxation causing all disease". that is dead, and should never have been born. Do not claim too loudly that it is the sceptic's doing,… we were on it for the last decade but noone had the balls to make statements.
@sceptikat, I am truly deeply sorry you had such an experience and cannot tell you how cross that makes me. It shouldn't have been the case but that is due to a chiropractor, not chiropractic.
Kind regards,
@blue wode
ps the article you reference as "what I (Stefaan Vossen) am talking about" is not what I am talking about. If you bothered to read the post you would know what I am talking about. You would then also know you haven't a leg to stand on. Please start answering the questions, I am curious as to your "evidence". Your reluctance makes me feel like you haven't really got anything at all and are clutching at very dry straws on a dusty thursday morning.
Stefaan Vossen
This is only the beginning
Stefaan, you are correct. I don't know what you're talking about, and I get the impression that you don't know what you're talking about either.
@BW, thank you for that.
Many of your impressions have been incorrect. I suspect this one is too.
Now could you please reference or retract?
This is only the beginning
Stefaan Vossen stated:
My practice does not advertise.
That's pretty clear.
In response to this claim, Andrew Gilbey replied:
Also, you say you don't advertise, but I'm certain the website I found at http://www.chiropractorswarwick.co.uk/ is an advertisement. (Assuming it's yours. Doctor)
Clearly that is Stefaan Vossen's website and the GCC certainly considers websites to be advertising. Vossen never responded to this.
Is there more?
Well, yes.
There is The Chiropractic Network Limited. This is a company of which Stefaan Vossen is a director. This can be checked at Companies House. The website for The Chiropractic Network (www.tcpn.co.uk) redirects to Chiropractors Warwick.
By the way, Stefaan, your annual return to Companies House appears to be two weeks overdue.
So, is there any other advertising for Chiropractors Warwick or The Chiropractic Network Limited?
Searching for a chiropractor in Warwick advertising on yell.com returns The Chiropractic Network Ltd with the address of Chiropractors Warwick.
Unfortunately, the website for this entry is http://www.ccpn.co.uk, which is the website of the Covenant Christian Praying Network. Maybe the link to a religious website was a mistake. Or maybe not.
It's not entirely clear to me whether this is a free or paid for entry. But it is still advertising for Chiropractors Warwick.
There are also adverts for The Chiropractic Network Limited or Chiropractors Warwick on:
And then there is Warwickshire Life magazine. In the June 2009 edition, all of page 103 is devoted to The Chiropractic Network Limited.
Be warned: this is one of those horrible virtual magazines that try to make your screen look like a paper copy and you need to register to read it, but the relevant page is here.
The top half is an advertisement feature about the Network. The bottom half is an advert for his clinic.
Note that he titles himself 'Dr Stefaan Vossen' at the bottom of the advert without making it clear that he is just a doctor of chiropractic, not a registered medical practitioner.
What was it you said, Stefaan?
My practice does not advertise.
Excellent investigative work, Zeno.
@ Stefaan Vossen
My main impression of you appears to be spot on.
What a beautifully poor ad hominem attack
Also, you missed one. I am also in local faces (little local edition, like a small, local yellow pages if you want) and the only point of reference for chirolocator (as I am the only clinician to have MedicalAssure policy).
I am a doctor, you and anyone else can call me that, I earned it
So does the NHS advertise? Because they have a website too you know? I think you are just being a little silly there aren't you?
Thanks for letting me know I will have words with my accountant
The christian prayer group will have a bit of a shocker when reading my entry on evolution, I don't know why there is a link there, also I don't think I have anything to do with the other websites you refer to. You do know they self-generate content, don't you?
I opened my clinic in June 2009 and announced it in a local magazine, boohoo.
I was in the yellow pages in 2008-2009 too.
So all that argument thrown away because you found an old advert and a website? Seriously what brand of scepticism is this?
Is this the best you can do to get your way out of a discussion?
90% of patient are referred
Still no news from Blue Wode
This isn't scepticism.
Shame on you
This is only the beginning
and what would your main impression be Mr. Wode? Mr. Wode hiding behind a pseudonym? Not replying to crucial question which undermine his argument?
How about Zeno's comments and "excellent investigative work"? Do you conclude anything from that?
This is turning into comedy central
Stefaan Vossen
You made a claim that you didn't advertise. That just wasn't a passing comment, but made as some kind of anecdotal evidence of the success of your business and/or the success of chiropractic.
I provided very good evidence that you have and do advertise and that proves your claim about not advertising to be false.
You have been caught out.
You try to squirm out of it with various straw men:
What people call you and whether you are entitled to use the prefix Doctor is irrelevant. What matters is whether it is used in contravention of the GCC CoP and ASA guidance.
Whether the NHS advertises or not is irrelevant. They haven't claimed they don't advertise: you claimed you don't advertise.
As far as I'm aware, Thomson Local do not generate content from elsewhere – you have to ask for an advert to be placed in their directories.
However, I'm glad to see that you now do admit to advertising, despite your previous assertion to the contrary.
One last point: providing evidence to demolish an assertion is not an ad hominen. I suggest you look at some of the guidance I've provided. This also might raise the standard of many of your other 'arguments'.
Blue wode claimed he has evidence that demolishes the subluxation concept. Please be seen to be consequential on his statements too…
The statements you made, as it refers to my person,my finances, my integrity is the very definition of an ad hominem (def: is an attempt to persuade which links the validity of a premise to a characteristic or belief of the person advocating the premise).
Your persuit of my "not advertising statement" is ludicrous and is your litlle strawhalm, hold onto it if you wish. 90% of new patients attending are still referred (if you thought about it from the start it logically follows that 10% weren't,… how did you think they came to know of me? It is in that context that stated "I do not advertise".
I have no idea why I am on Thomson Local, but I take your word for it and assume that I put content on there. So is this really how you are going to win this argument?
I thought this discussion was about the demise of the subluxation concept?
Stefaan Vossen Doctor of Chiropractic P.I.R.
This is only the beginning
@ Stefaan Vossen
Haven't you read this study that I referenced?
Crelin ES,Ph.D. "A Scientific Test of Chiropractic's Subluxation Theory -The first experimental study of the basis of the theory demonstrates that it is erroneous."
And this recent article by Harriet Hall, MD, that I linked to?
The End Of Chiropractic
@Blue Wode:
As per my very first post on 25/05/2010 (10 am):
"A subluxation never should have been interpreted as a clinical entity and this is where the chiropractic profession in its ill-faited attempts to medicalisation sold its spirit and principles. Unfortunately this has also caused much confusion amongst the so-called sceptics who come up with "subluxations don't exist" banners which are only directed to the address of the subluxation concept as per GCC and BCA interpretations who enacted these attempts to medicalisation. Once and for all: a subluxation is not a spinal event. It is a group name given to any systematic dysfunction in any arena of the healthcare spectrum which is causing a challenge to the ability to cope and which, when its intensity exceeds the ability to cope causes a reduction in well-being (subluxation is cause of all dis-ease)."
Your references do not test the hypothesis set out herein which is what I challenged you to do. I can only assume you missed this point, but it's OK, I have had fun, I hope you did too.
This is only the beginning
@Stefaan Vossen
"It is a group name given to any systematic dysfunction in any arena of the healthcare spectrum which is causing a challenge to the ability to cope and which, when its intensity exceeds the ability to cope causes a reduction in well-being (subluxation is cause of all dis-ease)."
What bits of your definition are testable?
Thank you IainD. I will post on this topic as I am in the process of proposing for a research project.
Kind regards
ps will take til tomorrow
The problem here seems to be that Blue Wode (and other commenters) are using the word 'subluxation' to mean what chiropractors traditionally use it to mean. This is an extremely foolish thing to do and everyone who does it deserves to be patronised and sneered at by Stefaan, as does that idiotic team of researchers who concluded that there is no evidence for the chiropractic subluxation being associated with any disease, etc. Obviously what everyone should do is abandon the traditional definition and adopt the one Stefaan has made up which, if you think about it, is a far more convenient definition covering just about every possible cause of every ailment under the sun.
Perhaps contrbutors could bear in mind that Stefaan's definition is the only one that matters here – why, he's even in the process of proposing a research project. This is only the beginning, as he says.
@ Stefaan
Welcome to the lions den.
I admire your passion and respect your knowledge and expertise. You and I both know that chiropractors in the UK are well educated, knowledgeable, skilled professionals working to do the best that can be done for their patients. They incorporate the available evidence into their practice and use their expertise and experience to deliver a service that patients value very highly. It is the high quality treatment and results which encourage our patients to refer new patients to us and allow us to thrive. If we didn't get good results, we wouldn't have a business.
Unfortunately, every barrel has the odd bad apple and the practitioners who aim to build their practices by unethical means deserve to be dealt with strongly. That is the job of the regulator, not a completely unaccountable internet blog.
This site is the mouthpiece of a "sceptic". However, Zeno lets his true character and intentions show when he makes posts such as his ugly, highly personal slur against your character earlier in this string. It's sad that his motives seem a lot less to do with scepticism than a vendetta against chiropractors. He wishes to paint all chiropractors as charlatans whose purpose in practice is simply to fleece their patients. For one who regularly complains about contributors making ad hominem remarks, it is extraordinary to make such an insulting insinuation.
As you have pointed out, the anonymous "Blue Wode", without disclosing his credentials, seems uninterested in discussion. It is quite obvious that his desire is not to see an improvement in the services offered to members of the public suffering with musculoskeletal problems, it is to see the ruination of chiropractors and chiropractic. It's telling how he chooses to refer to chiropractic as a "trade" and an "industry". He stubbornly refuses to recognise it as a profession. If he were to come out into the open and let us know what authority he has to occupy his apparently self-appointed high-moral position, I might be more inclined to listen.
"Skepticat" has apparently has bad experiences of chiropractic, which is regrettable. I'm interested to know when she consulted these chiropractors and how she chose the ones she consulted? She has been vehemently negative about chiropractors and the methods she believes they employ for some time. So, why did she consult two of them? I've asked her before where these chiropractors trained but she didn't respond.
"Skeptic Barista" seems to be more of a genuine sceptic, at least in his comments on osteopaths where he is prepared to acknowledge that not all practitioners have the same beliefs and philosophies. I would like to see him acknowledge that the same is true of chiropractors.
If there's anybody left reading this thread, other than the usual chirobashing suspects, I should comment on the "death of the subluxation" I've stated before that I'm happy to see the back of the term subluxation, because I believe it to be the wrong term to describe the lesions that chiropractors treat. The difficulty is that there is no easy way to describe, or single term one can use, that encapsulates the whole gamut of problems that we treat. It is therefore a mistake to try to use ANY single word to do this.
I have been a supporter of regulation in chiropractic and the setting up of the GCC. However, I do feel that they have gone too far in allowing outside, uninformed destructive influences to affect their direction. I have no desire to protect the "vertebral subluxation complex" concept, but I do object to the GCC folding to external pressure in this way. There will be protests from the "sceptics" that the GCC is simply reflecting the "evidence", but given that the VSC is simply a theoretical model, there was no need to deny it.
David said: "However, Zeno lets his true character and intentions show when he makes posts such as his ugly, highly personal slur against your character earlier in this string."
And what 'ugly, highly personal slur' was that? The one where I provided robust evidence that Vossen's assertion that he hasn't advertised was false?
Do you think the evidence doesn't prove Vossen's assertion (and if so, why) or do you believe Vossen, despite the evidence presented, has never advertised. Or perhaps you think I miraculously made up those adverts for his business? Which is it?
BTW, you still have absolutely no idea of my intentions nor character. But keep guessing.
I have blogged about my experiences with chiropractors and, on more than one occasion, have provided you with a link to these blogs but you have declined to click on these, preferring instead to respond with the petulance and gratuitous nastiness that are the hallmark of your interventions here. However, I am generous enough to overlook your past unpleasantness and provide answers so you don't even have to go and look at my "sad little blog" as you once called it.
When and how did I choose the chiropractors I consulted? I didn't choose them exactly. They were outside Sainsbury's touting for business like the two-bit hustlers they are. I saw the first one last year and the second one (from a different practice) in January.
Why did I consult two of them? Why not? They were offering something for next to nothing and I'm open-minded and keen to try new experiences. The fact that the first one talked utter crap, thereby confirming everything I'd been led to believe about chiropractors, didn't mean the next one would do the same. Unfortunately he did.
I don't know where the first one trained but the second one trained at the Palmer College of Chiropractic in Iowa.
I have no reason to believe from anything you or any other chiro has said on here that the two I've seen were any different from any other chiropractor. They both talked nonsense about problems in the spine causing all kinds of problems that have nothing whatever to do with the spine and they both try to scare people who are perfectly well into having unnecessary 'preventive treatment'. Total charlatans and the sooner people like that go out of business, the better it will be for their gullible victims. I'm not denying that there are people who've been helped by something or other that a chiropractor has done. It so happens that I've never met any of these people, while I know several who've regretted wasting their time and money on chiropractic treatment.
By the way, I see that you, as usual, have peppered your post with nasty little comments, impugning the motives of skeptic campaigners. You and Stefaan seem to be two of a kind. The two of you should get a room.
consider it by the by, I am not really bothered about the digressioins, please also note that much of the trouble with blogs and other similar media is that the tonality and facial expressions are easily lost or reinterpreted. Most of this stuff I say with humour and good will and I grant you the same.
I appreciate scepticism very much and am a thorn in the side of some people within my profession as a consequence. I don't need you to appreciate it but I am not here to convince you, just to add my tuppence to teh debate. many chiropractors agree with my interpretation of the subluxation theory (and I, like David do not like the word, but this is, I feel no time for semantics). i was merely proposing it and wanted yout rhoughts on it. i don't need you to agree with it, just would have liked your feedback so I can improve it.
Knd regards
This is only the beginning
Zeno wrote:
"BTW, you still have absolutely no idea of my intentions nor character. But keep guessing."
I am an open-minded person. I draw conclusions only from the evidence I see. Why do I need to keep guessing what your intentions are, why don't you just tell us?
@ Skepticat
I'm truly sorry you have been left with such a negative impression of chiropractors from your very limited experience. However, from your postings and your associations with other naysayers over the last years, it seems very unlikely that you approached the contact you had with these chiropractors with an open mind. And, I have to say, if I was going to try and gain an informed opinion on a profession, I wouldn't base it on what was presented to me at a marketing stall outside Sainbury's.
Believe me, it is very few chiropractors that recourse to this style of marketing, and those who do tend to have come to this country having acquired their philosophy and promotional techniques from abroad. As I have said before, if you take a look at the courses offered by the two major training institutions for chiropractic in the UK (the Anglo-European College of Chiropractic and the Welsh Institute of Chiropractic), you will see that the material taught is highly ethical and well researched. Having studied in the mid eighties in the UK, I can tell you that your impression of chiropractic is not representative of the profession generally.
As for your assertion that chiropractors try to scare perfectly well people into having unnecessary preventive treatment, what evidence do you have of that? Chiropractors are excellently placed to give patients advice on posture, lifestyle, ergonomics, and exercise to help them maintain a healthy future. They can also offer treatment for problems that have yet to become symptomatic but are detectable to the trained examiner.
This is no different from the approach taken by dentists who also critically examine their patients and give whatever advice and/or treatment is best for the current and future health of the patient.
@ David
Edward Rothman, current Clinic Director, Anglo European College of Chiropractic, in 2004:
"…can we start a small international reformist group that will be vocal without turning off people who want to reform the profession? Is this all a pipe dream or is there anyway we can take a stagnant profession that relies on unethical and immoral practice building schemes, unscientific technique gurus, and national associations without vision or intestinal fortitude and drag it into the twenty-first century?"
"…in the four years I have been in England, I have seen a change come over the profession there as more and more
people take on American practice building methods and are attracted to irrational, illogical techniques and treatment pursuits, e.g., "occipito-sacral decompression in chiropractic paediatrics" (don't even try to understand that one). Some of us can ban together and discuss these issues but will chiropractic/chiropractors ever change? What hope do we have of making the radical changes to the profession that is needed to attract rational scientific people into the field, considering the general state of the profession and the historical and current stance of the ACA?"
Lovely to make you acquaintance. Thank you for following this thread and your support and understanding. Please do stay in touch.
Stefaan Vossen
This is only the beginning
@ Blue Wode
My point illustrated precisely, thank you!
Although I think that Ed Rothamn was exaggerating the issue in order to emphasise the point, he was right. We have been invaded by a number of unprincipled practitioners from abroad who have damaged the reputation of chiropractic in the UK. Of course that quote does come from four years ago and as you say, Ed is now the Clinic Director at AECC and you can rest assured that the teaching there remains of the highest academic and ethical quality.
Readers should be careful not to confuse Dr Rothman's reference to the ACA (the American Chiropractic Association) with the BCA.
@ David
Surely you mean you *hope* that Edward Rothman was exaggerating the issue?
BTW, you are incorrect about the quote. It comes from *six* years ago.
Do you have any evidence that chiropractic ethics in the UK improved during those years?
@ Blue Wode,
I have had many discussions and many arguements with Dr Rothman (Chiropractor). He is a brave man who is trying to solve a conondrum. But there are many ways of solving this problem. The one he has been going down is expressed in those views. There are other options which do not require redefining chiropractic philosophy.
Kind regards,
@BW ps I think they really have improved and that is primarily thanks to massive cock-ups state-side, a bit like the obesity epidemic really.
@ Blue Wode
No, I don't mean that I *hope* Dr Rothman was exaggerating.
I have plenty of evidence that chiropractors in the UK practice ethically and responsibly, particularly those who have been trained here at the AECC or WIOC.
It is the so-called sceptics who promulgate the negative publicity for chiropractors. You really don't have to dig very far to see that chiropractic is a great deal better and healthier than you would portray it. But you knew that already.
David wrote: "I have plenty of evidence that chiropractors in the UK practice ethically and responsibly…"
And I have plenty of evidence that many of them don't:
The ethics of chiropractic
"I googled 'Chiropractic Clinics UK' (31/7/2008) and evaluated the contents of the first 10 websites of individual chiropractic clinics listed. My aim was to find out whether chiropractors adhered to their own ethical code… [The findings] suggest that many chiropractors violate their own ethical code."
Professor Edzard Ernst, New Zealand Medical Journal (5th September 2008)
Regulated but unruly
"Since 1994 chiropractic has been regulated by statute in the UK. Despite this air of respectability, a range of important problems continue to bedevil this profession. Professional organisations of chiropractic and their members make numerous claims which are not supported by sound evidence. Many chiropractors adhere to concepts which fly in the face of science and most seem to regularly violate important principles of ethical behaviour. The advice chiropractors give to their clients is often dangerously misleading. If chiropractic in the UK is to grow into an established health care profession, the General Chiropractic Council and its members should comply with the accepted standards of today's health care."
Journal of Health Services Research & Policy (3rd July 2009)
The University of Wales is Responsible for Enabling Bogus* Chiropractic Claims to be Made
And this Edzard Ernst article in The Times is also interesting…
"Since 1993, British chiropractic has been regulated by statute. This means that chiropractors have a similar standing as doctors or nurses. It also means that hardly anybody asks about the plausibility of their weird concepts and few people dare to question their therapeutic claims. Those who do might get intimidated or threatened. I know because I have had my fair share of chiropractic harassment."
Distrust me, I'm a chiropractor
Pretty damning stuff, IMO.
This is getting wearisome. David, I didn't base my opinion on what was presented to me at a marketing stall outside Sainsburys and there is nothing in my last post to suggest that I had. For the last time, I base my opinion on having read widely from a variety of sources, including your comments on this forum and on having had two spinal checks and one full examination at a chiropractors surgery.
My evidence that chiropractors try to scare people into having unnecessary treatment is, again, based on what the two chiropractors I have seen said to me, on what numerous other chiropractors have said on the internet and on the scaremongering posters that were on the walls of the chiro shop I visited. (But I suppose these were brought here from abroad, right?)
@ Blue Wode
Here we go again. You know as well as I do that all those quotes (each from good-old Edzard Ernst, is he a relative of yours?) constitute nothing more than opinion. The opinion of someone who has made it his mission to always be negative sbout chiropractic.
@ Skepticat
I'm sorry to say that I'm not convinced you have approached your contact with chiropractors with an open mind. Given your attitude towards chiropractors and chiropractic, I think it highly unlikely that you could ever see an encounter with a chiropractor as a positive event. Unfortunately, this also means that you can never be considered as a reliable source of comment.
For any readers who have managed to stay with the comments section this far, the following classic essay by the late Barry Beyerstein,'Social and Judgmental Biases That Seem to Make Inert Treatments Work' is well worth a read. It is a thorough analysis of alternative medicine and common errors of reasoning. and should help readers who are trying to understand Stefaan and David's views:
For those readers who are tempted to follow Blue Wode's propoganda and the link he has provided above, it should be noted that, whatever the merits or otherwise of Barry Beyerstein's article, it doesn't even mention chiropractic.
Chiropractic and its solid, evidence-based approach to musculo-skeletal healthcare, is a million miles away for the like of ear-candling, homeopathy and iridology etc.
Don't be fooled by this attempt to distract from the truth.
David said: "Here we go again. You know as well as I do that all those quotes (each from good-old Edzard Ernst, is he a relative of yours?) constitute nothing more than opinion. The opinion of someone who has made it his mission to always be negative sbout chiropractic."
Here we go again.
Have you any evidence that Ernst 'has made it his mission to always be negative about chiropractic', or is that just your opinion?
@ David
Are chiropractic students in the UK informed of the following prior to investing time and effort in training?
"WARNING: This treatment carries the risk of stroke or death if spinal manipulation is applied to the neck. Elsewhere on the spine, chiropractic therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo."
The above quote is lifted from p.285 of the book, 'Trick or Treatment? Alternative Medicine on Trial', by Simon Singh and Professor Edzard Ernst. After taking a thorough look at all the available evidence on chiropractic in 2007, it's what they propose that all chiropractors be compelled by law to disclose to their patients prior to treatment.
@ David,
Osteopath Vs Chiropractor (beliefs and philosophies):
For me the key difference in the beliefs & philosophies between osteopathy and chiropractic is the williness of each profession to practice and promote the elements of that profession that lie within the realms of quackery!
In general terms, osteopaths are either in one camp or the other, the cranial osteopaths being firmly in the quackery department. There are (and always will be) exceptions, but there seem to be quite clear boundries in what they believe.
Within chiropractic the demarcation lines between evidence and quackery are far less clear.
For example most of those defending the subluxation and crying out for it to remain central to chiropractic come from outside the BCA, it could also be said that these same chiropractors are (mostly) not exactly fans of the GCC!
Then we hear cries that the BCA are 'in bed' with the GCC and seeking the medicalisation of chiropractic. It would seem to be a farily clear divide, however it's not quite that simple.
Whilst the GCC and BCA seem content to do away with subluxations, the BCA were fully supportive of the now totally discredited claims for the treatment of colic, asthma and allergies etc. That put a good number of their membership into the quackery department, just because they can no longer advertise it doesn't mean they changed their fundamental beliefs & philosophies overnight.
We should all remember this when they start asking for permission to prescribe drugs!!
Then we have the pro-subluxation chiropractors, a good number of those not only made the same colic claims, but many want us to accept their view that this mythical subluxation is a 'cause all' and therefore 'cure all' lesion.
Furthermore they want people to accept this without any good evidence (AND GOD KNOWS, I'VE ASKED FOR SOME).
Many chiropractors can't even agree on what a subluxation is, let alone test it! I've seen a number of differing descriptions, some (like Stephaan's) very detailed stating exactly what 'they' believe a sublxuation is and its effects, however ask for evidence to support their particular version and we get the same result! No actual evidence.
Now here's something you may be able to help me with …..
Who is/was teaching chiropractors that they could treat these non-musculoskeletal conditions.
> Did the AECC include this as part of its curriculum?
Who is/was teaching chiropractors what a subluxation is – – there are so many differing views, which teaching college is right.
> Did/does the AECC teach that a subluxation is a causal factor in many healthcare issues and that treating it will cure these conditons?
If the colleges are/were teaching this, then they should have access to the evidence to support it. However, if the quackery elements of chiropractic are not taught at the colleges, then where and when in a chiropractors training / CPD do they start believing it!
David said: "Given your attitude towards chiropractors and chiropractic, I think it highly unlikely that you could ever see an encounter with a chiropractor as a positive event. Unfortunately, this also means that you can never be considered as a reliable source of comment."
You dismiss Skepticat's opinion because you think that, because of her attitude to chiropractic, she can't be independent?
Can we then dismiss a chiropractor's opinion for the same reason?
Do you have any evidence that Prof Ernst HASN'T made it his mission to always be negative about chiropractic?
David said: "Do you have any evidence that Prof Ernst HASN'T made it his mission to always be negative about chiropractic?"
YOU made the assertion, YOU show us your evidence.
David said: "Given your attitude towards chiropractors and chiropractic, I think it highly unlikely that you could ever see an encounter with a chiropractor as a positive event. Unfortunately, this also means that you can never be considered as a reliable source of comment."
Correct. However, my attitude towards chiropractors is a consequence of what I have discovered as a result of my research into them. I knew nothing whatever about chiropractic 18 months ago. But I'm sure it is comforting to you to believe that I have some kind congenital predisposition to dislike chiropractors so you go right on believing that if it makes you feel better. As for whether I'm a reliable source of comment, I have read enough of your posts to know that the only people you consider to be reliable sources of comment are people who agree with you. Your mind is resolutely and permanently closed to the possibility that the truth lies somewhere other than where you believe it to be and you have turned the rather lamentable failing of ignoring any questions or evidence that you don't like into a fine art.
Well done you! 🙂
@ Zeno
Do I have any evidence that Prof Ernst has made it his mission to always be negative about chiropractic?
Whether you would call it a mission, or simply a habit, there is no doubt that he is unremittingly negative about chiropractic and takes every opportunity he can to be so.
The "sceptics" will cry that he only makes negative comments because that's the way that he sees the evidence. However, a perfect illustration of Ernst's approach to chiroprctic is Blue Wode's favourite comedy quote above, from his favourite joke book, where Ernst and Singh choose to make a typically dramatic, scare-mongering statement about chiropractic.
As we have established before, given the evidence available to them, they could just as easily have come up with a statement along the lines of:
"Chiropractic is a tried and tested treatment for which there is good evidence, especially in the management of neck pain, back pain and headaches. Its effectiveness compares favourably with other treatments and although concerns have been raised about the safety of manipulation of the neck, the risks of serious side effects have been shown to be somewhere in the region of 1 in 2,000,000."
However, that wouldn't suit their agenda or sit well with the tone and intent of their book.
@ Skepticat
You wrote: "….my attitude towards chiropractors is a consequence of what I have discovered as a result of my research into them. I knew nothing whatever about chiropractic 18 months ago."
Please don't take offence to this, but what it means is that you haven't completed your research.
Despite what you say, my mind is not closed and you have no evidence that it is and I am not being confronted here with anything that challenges my beliefs, knowledge or mode of practice.
I am not an adherent to the "subluxation theory" and I loathe and despise the members of my profession who try to persuade people that they can offer them all the help they need to stay healthy by adjusting their spines. My point to you is that not all chiropractors practice in the manner that you have described but your response has been that you don't believe it. It's not my mind that is closed.
David wrote (@ Zeno): "Do I have any evidence that Prof Ernst has made it his mission to always be negative about chiropractic? Whether you would call it a mission, or simply a habit, there is no doubt that he is unremittingly negative about chiropractic and takes every opportunity he can to be so."
That is entirely untrue. As I already pointed out to you in my post at 18.34hrs on 1st April 2010, see here –
in The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach (2006, 2nd edn., Ernst E, Pittler MH and Wider B, eds.), in the concluding part of the chiropractic section, which focuses on giving a risk-benefit assessment, it says:
"Chiropractic treatment might be helpful for low back pain, but the evidence is not convincing. In view of the lack of truly effective conventional treatment for this indication, chiropractic might therefore be worth considering for such patients. For all other indications the evidence is even less compelling. Severe adverse events may be infrequent but mild transient complaints are common."
How that be can be reconciled with your assertions about Ernst's alleged bias is beyond me.
David wrote: "As we have established before, given the evidence available to them [Singh and Ernst], they could just as easily have come up with a statement along the lines of:
"Chiropractic is a tried and tested treatment for which there is good evidence, especially in the management of neck pain, back pain and headaches. Its effectiveness compares favourably with other treatments and although concerns have been raised about the safety of manipulation of the neck, the risks of serious side effects have been shown to be somewhere in the region of 1 in 2,000,000."
But you know, and I know, that such information would be unethical in that it would be failing to tell (mainly paying) customers that the evidence is slim, that many of the other treatments are cheaper and more convenient – and aren't associated with quackery – and that the risks of serious side effects are currently *unknown*, although several hundred are on record.
Wouldn't that be more professional, i.e. it puts patients first?
Amidst all this heated and interesting debate, I've forgotten why does chiropractic still exist? I guess this is an Emperor's New Clothes kind of question! So, can anyone (e.g., David or Stefaan) give me a logical reason. (Please can this 'reason' take into account that anything chiropractors say they can do can also done by another group of professionals, often much better.)
No sarcastic answers please (e.g., because it's a job or they can't get into med school). Just a straight-forward logical answer will suffice. We know why their trade once existed, but I'm unclear why it still exists.
Let me help you here and make it simple: you have two basic problems that you have to overcome.
You said: "Prof Ernst has made it his mission to always be negative about chiropractic".
This are two assertions that you are conflating:
1. Ernst is always negative about chiropractic
2. Ernst has made it his mission to always be negative about chiropractic.
Let me clarify them for you:
1. Ernst is sometimes negative about chiropractic, but he is not always negative. For example, in Trick or Treatment he says:
In short, the scientific evidence suggests that it is only worth seeing a chiropractor if you have a back problem.
So he is not always negative. That may not be the ringing endorsement you might like to see him give nor the praise you yourself might give it, but that's irrelevant.
2. You impugn motives for his reticence to endorse chiropractic; motives you have been unable to supply any evidence for. Perhaps you need to think about how on earth you would have gained that knowledge of his motives? Does he know what your motives are? Why should he, and why should you know why his motives are? Has he said anything anywhere about his motives? If not, what makes your guess about his motives any more right than anyone else's guess? Do have a special insight into his motives?
However, given that the first part of your assertion is false, the second is redundant. But what you are doing is assuming he is always negative – a stance you don't happen to like – and somehow coming to the conclusion that his frequent criticism is because he (for some unknown reason) wants to be always negative.
Dear sceptics,
You are concerned. You are wondering about the state of the world. A world where it is possible for quacks to ply their trade, corrupt the gullible and dishonestly acquire hard-earned money, let alone tax-payer's money or possibly threaten lives and risk injury. You are the knights (and a very few dames) of good reason and protecting the public against their own simple-mindedness. Some of you call them "morons". You'll look after your disabled, feeble little brethren and sisters, protect them from themselves. You are good. You are kind.
There aren't that many of you and this reinforces the fact that not only must you persist against the evils of quackery and idiocy you must also make sure you are heard and work relentlessly. You populate blogs and twitter, you campaign and lobby. You make sure that everyone who does not agree with you knows that you think they are idiots. And you are quite clever. You know things like "ad hominem" and "solipsistic". You really are quite clever.
Amongst others you think chiropractors are quacks. Some of you refine it further by use of prefixes; "some" chiropractors are quacks. Those chiropractors who aren't are those chiropractors who use something you call "Evidence Based Medicine". Those chiropractors who use EBM think you like them. They feel good because you have singled them out to be "some of the good ones". You have helped the world be a better place by singling out "the good ones". You are good. Funnily enough you have never produced a list or endorsed them.
Those chiropractors who still believe in the "woo" of subluxation theory are evil. They are meanie, horrid people who are only after one thing; getting rich on the back of the gullible, the moronic that you are failing to protect. You feel you are failing them this makes you unhappy but you take strength in your resolve. You are good.
You look at the statistics and you now know that you are right in your assertions; back pain is the only thing for which there is evidence that chiropractors can do anything (and you know that chiropractic care is quite expensive, because those meanie subluxation quacks make you come back loads of times and drive expensive cars and all live in mansions somewhere in Hertfordshire) and there are better and cheaper ways of getting same results from physios or exercise and they are free or on the NHS. It's obviously a rip-off. The stats say so. It must be true "coz stats it's scientific like, innit". You are so witty, you are good. And the ASA agrees with you and chiropractors can't call themselves "doctor" because they aren't proper doctors you know, they are "only" doctors of chiropractic. That's nothing compared to a "doctor of medicine". Nothing at all. Ah no, not quite. They are both doctors because they sat similar amounts of time on seats at schools called universities and studied clever stuff like anatomy and pathology and they can both talk to one-another in a language no one else understands. And it might be true that chiropractors in fact sat down for a bit longer on those seats, particularly for certain subjects. This should make them really very clever in those subjects, but you know better. They of course had to sit down for longer because they are a bit dim. And anyway real doctors come from proper universities and the quack ones don't and in case they do happen to have come from a proper university after all it must be that they have sold out or are run by idiots.
You have looked at the stats and they say so. And only people who failed to get into medical school would want to become chiropractors anyway. Surely.
I think you know where I am going with this. And no, I don't think you are entirely wrong. Sometimes, in certain areas and in ways that allow you to feel that you're right. You use logic to construct your arguments and you are a sceptic so any argument that does not align with yours must be false or emotional at best. You have been told so many times you are good you are slowly becoming god. You Know. You have Insight. You are the Light. You can find quotes to back up anything you say. You are Righteousness incarnate. The Google Book will show you what you want to see, and you know you are right because the stats say so.
Here's a shocker: the stats say that when you compare manipulation to exercise, to pills, to doing nothing they all kinda come out looking much of a muchness vis-à-vis back pain, but: chiropractors are not manipulators. Nor, for those quick-witted ones amongst you are they just "adjustors". The process which one must enact in order to be considered a chiropractor, the behaviour they must display (like wearing a stethoscope around the neck clearly (according to some of you) is the making of a medical doctor). First they decide whether the patient falls within their remit (the average ones will be able to pick up those that are too bad for them and the good (technically and ethically speaking) ones even tell those who are not bad enough to bugger off too). The chiropractic scope of practice defined itself at its inception by two simple but intricate theoretical conceptual questions: is there enough "Innate" and is there a (ny number of) "Subluxation(s)". Hair in the back of the neck rising rapidly. Let's rephrase: is there enough ability to cope and is there a systematic dysfunction. Breathe. E.g. Cancer=not enough ability to cope. Severe osteoarthritis=not enough ability to cope. Kidney failure= not enough ability to cope. Not enough ability to cope=refer, i.e. not for me. Put another way:
Q: What would happen if I did nothing?
A: a) nothing much but if there is a stressor and it's taken away that would be better
b) Some bad stuff the person rather not have but if the stressor is taken away they will still be able to improve on it.
c) Very bad things
If A=c) then not chiropractic patient. Simpels.
Secondly: if there is enough ability to cope, is there systematic dysfunction? No-Possibly-Probably-Yes.
If the answer to the second question is either probably or yes then the fun really only begins.
The patient in front of you is now deemed a potential chiropractic patient. But not quite just yet to this particular chiropractor. Confused? Many chiropractors with you, you are in good company.
What is the systematic dysfunction? Please bear in mind we are not talking of the pain or the symptom-those may be in the same or a different area and even in a different system (this is where the famed "I don't care about the diagnosis-show me the subluxation" comes from). Is it biomechanical, is it chemical/nutritional, or is it psycho-emotional? Is there more than one? Which one is the more/most important one? Say it is not biomechanical; then the patient in front of you is not a biomechanical chiropractic patient. If there is a biomechanical one but there are more important emotional ones, then the patient needs to see a psycho-emotional chiropractor (a good CB-therapist would easily fall in that category) then maybe a biomechanical chiropractor at the same time or afterwards. The biomechanical chiropractor now must decide whether the subluxation/systematic dysfunction is spinal, gait-based, orthognastic, or congenital (or something else, I am sure I haven't thought of all of them), then refer to the appropriate therapist. An orthognastic chiropractor would for example be an (in this new world and in this context considered a sub-speciality of biomechanical chiropractic) orthodontist or a good dentist. A good biomechanical podiatrist would be a good example of a gait-chiropractor, equally a sub-specialism of biomechanical chiropractic. In the search of a good spinal therapist, the biomechanical chiropractor may refer to her/himself or maybe an osteopath or a PT.
In this context and view, the chiropractor of today is a sub-specialist of biomechanical chiropractic which in turn is a sub-specialism of Chiropractic.
So why is the systematic dysfunction/subluxation important? Because it is the cause of the abnormal behaviour (chemical, biomechanical or psychological behaviour). It in itself can be of chemical, biomechanical or psychological nature and it can affect behaviour outside its own arena (lack of confidence causing abnormal postural behaviour). Why is the abnormal behaviour important? Because it is a cause of systematic and consistent stress. Biomechanical, psychological or chemical stress. And when that stress exceeds the ability to cope in a given arena, that arena will either be prone to injury or insidious trauma or will be unable to heal/recover. It results in suffering and unhappiness. That is why we care.
So, no, not all diseases are caused by subluxations, but subluxations cause dis-ease (un-ease, non-optimal being-this notion that chiropractors say that all diseases are caused by subluxations, was not part of the work of the Palmers, but rather an addition of simple minds afterwards). And no, not all subluxations are spinal (ditto). For certain dis-eases, removing subluxations will allow the patient to heal. For other dis-eases only palliative, surgical approaches will do (i.e. the ability to cope is compromised beyond reasonable expectation for natural recovery).
Of course this is only my interpretation of chiropractic and its meaning but it has a lot of agreement in what I have read, understood and seen, and it is testable…
I strive with humility to become, whilst knowing I will never be, a Chiropractor. I try to acquire the wisdom and the knowledge to detect subluxations, measure innate intelligence and only adjust when I have to and help the healing to come from within. I respect other healing arts for I may one day need them when my Innate is weakened or my subluxation is immovable, but I want to be a Chiropractor.
Does the poetry make a little more sense now?
Kind regards,
Stefaan Vossen
This is only the beginning
Oh dear.
@ Stefaan,
Although I think you are wrong, you are well within your rights to believe that subluxations cause dis-ease or anything else you want to imagine. Just don't use it in your advertising, unless you have the evidence.
@ Skeptic Barista
I'm not in a position to comment on osteopathy so I shall restrict myself to chiropractic.
I agree that there are cranks in the chiropractic profession and I loathe and despise those who aim to take advantage of people by exaggerating their problems and\or coercing them into unnecessary or unnecessarily prolonged treatment. There are also misguided individuals who hold some quite extraordinary beliefs about their ability to treat the whole health of a patient. I suspect that this category compares with the one you describe and dislike in osteopathy.
However, the rest of your classification of chiropractors is too simplistic. When it comes to the "subluxation", it isn't as simple as those who use the term being quacks and the rest not.
The subluxation means different things to different people and I personally never use the term. It has a very specific meaning in orthopaedics and to apply it to spinal dysfunction is, I believe, a mistake.
But, that does not mean that everyone who refers to subluxations is a quack. There are many chiropractors who use the term to try and encapsulate the concept of dysfunction in a spinal motion segment (that is, two vertebra, the separating intervertebral disc, the posterior facet joints, the muscles, ligaments and nerves associated with it.) In this context, to describe the subluxation as a mythical or fictitious entity, is to deny that spinal problems exist. The effects of dysfunction or injury within the spinal motion unit can be many and varied and are certainly not restricted to pain.
However, if any chiropractor is diagnosing dysfunction, exaggerating its consequences, coercing people into unnecessary treatment or claiming that they can effect cures for ailments for which there is no evidence, then they are contravening their code of practice and deserve to be disciplined.
If, on the other hand, a chiropractor is using simple terms to explain a patient's problem to them during the process of helping them understand their condition and how it can best be managed, then that is good practice. If they happen to use the term subluxation to describe an area of dysfunction, then I don't have any real difficulty with that, although I would rather not. I see it as being akin to someone being told they have a "trapped nerve" or "slipped disc", both of which are just as erroneous.
To condemn the whole profession because some of its practitioners use the term subluxation is nonsensical.
In answer to your questions:
1) "Who is/was teaching chiropractors that they could treat these non-musculoskeletal conditions.
> Did the AECC include this as part of its curriculum?"
When I trained at the AECC I do not recall there being any mention of treating non-musculoskeletal conditions in the curriculum, other than as part of the history of chiropractic. Every patient I saw as an intern in the college clinic was being treated for musculoskeletal problems.
2) "Who is/was teaching chiropractors what a subluxation is – – there are so many differing views, which teaching college is right.
> Did/does the AECC teach that a subluxation is a causal factor in many healthcare issues and that treating it will cure these conditons?"
Absolutely not in my experience.
You asked: "If the colleges are/were teaching this, then they should have access to the evidence to support it. However, if the quackery elements of chiropractic are not taught at the colleges, then where and when in a chiropractors training / CPD do they start believing it!"
In my experience, those chiropractors who have held these beliefs as a result of their undergraduate training have largely been trained at the "straight" colleges, mostly in the USA although some are Australian. UK graduates who hold these beliefs tend to have trained at the McTimoney College of Chiropractic, a college not accredited by the European Council on Chiropractic Education.
Sadly, there are those who, despite having been given a good grounding in the evidence-based approach to musculo-skeletal care at AECC or WIOC, have still gone over to the dark-side. I'm afraid that I'm not in a position to explain why they have done so but it's interesting how the gurus that they follow are never British trained.
I'll happily try to answer any other questions you have but it may be a few days before I can get back to you.
Any progress on your research project?
not sure what that means but sounds like a cop-out
my AECC experience is entirely in line with yours (2003 graduate). My thoughts on the time when one acquires wings of quackery is when a doctor is having to deal with the realisation that:
a)he/she doesn't know everything
b)can't fix everything
c)is trying to make a living/pay off a loan
GP's go through a similar process, but shoving pills for free on the NHS is less controversial to some of the sceptics. Chances are they will interpret this statement as "a chiropractor being controversially anti-medicine". My dad, 38 years into practice, deplores the state of medicine on a quasi-daily basis.
in full swing. Thought it'd be helpful to set the scene first, give the theory some context. Particularly as it is an interpretation of the subluxation theory most sceptics are not familiar with.
Kind regards,
Stefaan Vossen
ps is there someone out there who would be able to come up with a nice short term meaning "source of dysfunctional mechanism"? It has to be applicable to biomechanical, chemico-nutritional and psycho-emotional mechanisms.
@ David,
Thanks for your reply.
Some of your comments actually highlight Where I think there is a huge problem with chiropractic (and other therapies).
> "There are also misguided individuals who hold some quite extraordinary beliefs about their ability to treat the whole health of a patient"
> "The subluxation means different things to different people"
> "But, that does not mean that everyone who refers to subluxations is a quack."
You are correct in thinking that these are the practicioners whose claims I have the biggest problems with. This 'Holistic' apporach of treating the 'whole health' of a patient is common amongst CAM practicioners and usually involves large amounts of quackery or psudo-science to try justify it. But I would also question those who are unable to provide reliable evidence to back their particular views.
Here's why………..
By your own admission, different chiropractors describe subluxations in a different way, many using different terminology to describe what a subluxation is or isn't, some of those meanings definately fall in to the realm of quackery.
Add this to the potential for coercion, exaggerated and misleading claims or practices and you have a situation where the public are unable to tell who is right or wrong and therefore can have no confidence in any of the claims being made. Unless you can come up with a reliable way of distinguishing the good guys from the bad!
Or worse still, they misguidedly place their confidence in those who least deserve it!
This gets even worse when the profession itself teaches fundamentaly different philosophies and approaches to treatments, different schools of thought argue publically against each other and also against their appointed regulator.
McTimoney are still a recognised training provider within the UK, even if not accredited elsewhere.
Do you think the public knows where a particular chiropractor was trained or how that training is viewed with the wider chiropractic profession?
The final blow to chiropractics credibility is when they are asked to provide good quality evidence to support their claims. At this point the whole profession (quack element or otherwise) fail to produce any credible evidence.
The Bronfort report could only find a single condition that could be catagorised as supported by 'High' quality evidence, the rest were no better than 'moderate' – That's one conditon, one treatment, from within a whole profession!
Chiropractors often claim that RCT's are not a suitable method by which to judge the effectiveness of their treamtments, of course they will reserve the right to quote in a very positive way, any RCT that shows even a minor benefit – It seems only negative RCT's are unsuitable. A very biased approach.
Within itself the Chiropractic profession is mixed up, divided and heading towards meltdown, publically it makes claims it cannot defend or justify when questioned.
This is this divided profession that people like yourself and Stefaan are attempting to defend.
Arguments based along the lines of: The 'quack subluxation' isn't the same as 'my subluxation' & my subluxation is correct becuause I know it is! Just don't work at any level.
I appreciate how busy you must be, but could you attempt to answer this question: Why, in a world where there is traditional medicine, do chiropractors need to exist?
On your practice website, you provide a paper on MALOCCLUSION AND POSTURE, to which someone then adds (THIS IS QUITE A TECHNICAL PAPER!). Is it a peer-reviewed published paper? Because if it is not, then I think it's seriously misleading. My gut feeling is that it is not.
Here's a link to the 'paper' for anyone who want to see if they can make sense of it (I can't, although I'm not a chiropractor): http://www.chiropractorswarwick.co.uk/Malocclusion-and-posture.pdf
I've just checked the other 'research' links on your chiropractic website advert: I suspect we understand the term 'research' in quite different ways!
Ref to: http://www.chiropractorswarwick.co.uk/index.php/research/temporo-mandibular-joint-dysfunction/
@Andrew Gilbey
can you define for me what you understand "traditional medicine" to be?
TMJ article was translated from Italian by the authors. Most work in this field is recently being done at Milan university and across Italy. one of the most important drivers behind this work in the last 30 years is Dr. Jean-Pierre Meersseman, chiropractor. He is the medical director at AC Milan. Don't worry if you don't understand it, many people struggle with this but it is quite amazing when you see it at work. you're welcome to come over to the clinic and I'll show you. it's on there for the benefit of some of my colleagues who are trying to work out why I am able to offer a money-back guarantee and they aren't. This is part of the reason why. The key point is that you're looking at the world as a neural network and not a leavers and pulleys. (this is where chiropractors sometimes get all "this is the Einstein over your Newton -man" (smoky hash-induced voice added for effect).
TMJ-dysfunction piece: this is some work the people at Aqualizer did. It's a widely-used, very cheap way to temporarily disengage the TMJ to evaluate the value of the TMJ dysfunction in the clinical presentation. (e.g. without it, I have headaches, with it I don't. Headaches are the reason for my attending this clinic. Rather than put money into any other treatment modality I now know that wearing an acrylic splint or having corrective orthodontic care will be where I need to put my money.)I don't really understand what your point is. Would you be so kind as to elaborate?
Research has to start somewhere and putting a harmonious model forwards (I haven't forgotten you IainD) would be a good place to start. Very little debate seems to still be ongoing about the "subluxation" model (with recent obituaries itself. If you would like to open another thread on any of these topics i would be very happy to follow the link, but it is getting quite besides the point lately. Also all very good for people to say "there is no research" but please do not equate that to "there is research showing no value". This point has already been conceded by Ernst on another discussion I had with him some time ago (and to be honest it is so flippantly obvious that it is hard not to). All I am saying here is that the subluxation model as I propose it here (in no way claiming originality by the way) still needs researching (yes even after more than 100 years in existence). If the sceptics don't care enough to critique the model in its different interpretations (and I am only putting one forward) then it does seem easy to conclude that all they are after is being right and supporting their own prejudiced conclusions.
I agree with some comments: some chiropractors are crooks, some interpretations of the subluxation model are erroneous and misleading etc etc but does that then mean that "chiropractic is dead"? Really? There is so much value to this model (I believe) and it transcends into many professions and makes sense of their collaboration and some of their unexpected outcomes. It complements by working on other sections of the healthcare spectrum, will probably reduce cost (gutfeeling I know has you reeling but this can be tested and I am not expecting you or anyone to agree or disagree until it has been and it elicited the results one way or the other.
kind regards,
You have said;
"If the sceptics don't care enough to critique the model in its different interpretations (and I am only putting one forward) then it does seem easy to conclude that all they are after is being right and supporting their own prejudiced conclusions."
"I agree with some comments: some chiropractors are crooks, some interpretations of the subluxation model are erroneous and misleading etc etc "
It is totally ridiculous for you to claim the onus is on the 'sceptics' to prove each individual version wrong …. rather than you prove a single version right!
The unavoidable conclusion is that all YOU are after is being right and supporting YOUR own prejudiced conclusions.
However, I do agree with you when you say "Research has to start somewhere" What a shame that as a profession, starting the research is so much further down the list of priorities than starting the treatment!
@sceptic barista
I am not claiming the onus is on the sceptics to prove each individual version wrong, I am just letting you know that this is I think a reason why some people feel that way about the sceptics. The onus is COMPLETELY on me and those who agree with the view to prove this version accurate (or shall I say more accurate?). Later on there will have to be some sort of discussion whether it is still chiropractic or whether I will need to call it something else.
I am just keen to hear some feedback on this particular view, you see, I look at blogs like these as discussion forums where an idea can be put forward for critique. I am a positive minded fella.
Kind regards
@skeptic Barista:
However, I do agree with you when you say "Research has to start somewhere" What a shame that as a profession, starting the research is so much further down the list of priorities than starting the treatment!
I don't think starting the research is so much further down the list of priorities to the chiropractic profession. I just think that like with most healthcare professions (and I guess this is true for most sciences) the treatment came out of the arch-theory and the refinement of the theory came later in consequence to the incompatibility of the arch-theory to the findings of the treatment, resulting in the refinement of the practice and the theory. Chiropractic has done a few such cycles, but by no means enough. This is where much whingeing of the profession comes in relation to testing and funding and big pharma etc. as it would bring us up to speed a little more rapidly if we had more funds available. It's ok, we'll get there, eventually.
Stefaan Vossen
This is only the beginning
The is a portion of a chapter from a book, which i think describes how difficult it is to treat musculo-skeletal conditions and maybe why research is so complicated in this area. Enjoy reading and any feedback would be great!
"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"."
@A N Other
That seems to have killed this discussion off.
What I have found very interesting is that very few people who are clinically active join the ranks of the "sceptics" (or at least this strange brand of it we can occasionally find on these forums). I think that has a lot to do with the acceptance that "shit happens" and that "sometimes weird shit happens". That doesn't excuse inappropriate drawing of conclusions but it does create a certain open-mindedness.
The subluxation is dead, long live the subluxation!
Stefaan Vossen
This is only the beginning
@ AN Other
I'm not aware that anybody is claimin that certain musculoskeletal conditions are difficult to treat, or even correctly diagnose, only that those who claim to have the answer should be prepared to prove it and not simply expect people to accept their word.
Interesting that the text you have chosen makes no reference to vertebral subluxation complex, it's not clear that it even refers to chiropractic (osteopathy perhaps?).
It may be helpful if you could post the title & author of the book.
The text is in reference to manual therapies (Chiropractic, Osteopathy, Physiotherapy etc.) The point of the text is that RCT are very good for distinct structural pathologies. However in the case of musculoskeletal complaints, RCT provide some guidance, but clinical skill remains decisive.
@ A N Other,
So more of a general commentary on the fact that diagnosing musculoskeletal conditions can be difficult – OK I can accept that, but it doesn't show that any of those manual therapies are actually correct!
Especially as those therapies often have widely differing philosophies towards cause/cure, as we have seen these differences can be quite pronounced even with a particular therapy, let alone between competing therapies.
"but clinical skill remains decisive" ….. or to finnish the quote from the book "This, however, is considered "SUBJECTIVE"."
It is the 'subjective' element of clinical practice that supports the need to have non-subjective, unbiased research results.
I have no problem with accepting that there is value in clinical skills, only in the assumption (by some) that clinical experience can over ride the necessity for good quality evidence.
And especially by those who feel that clinical skills take precedence over the results of high quality research that report unfavourable results for the therapy.
If the evidence is difficult to come by …. that doesn't mean it's not needed. Arguably, there is actuall more of a requirement for good evidence to be found in those areas where the evidence is difficult to acquire.
Also, it is worth remembering that clinical experience is not the preserve of CAM therapists …. it apples equally to real doctors in their surgeries.
@skeptic barista,
please don't be so condescending and remember that chiropractors are real doctors. You might not feel that way but they are doctors of chiropractic like medical doctors are doctors of medicine. they deserve that title, worked hard for it and I would appreciate that you respect that fact.
In regards to non-mentioning of sublux-concept in the AN Other's chapter: "what's in a name?…" I used another term like "dysfunctional mechanism" to replace the term. I think it has been reiterated numerous time now that "subluxation" is not a particularly good term. The point you're making here is widely besides the point and if you're going to pin your arguement on a tired point of discussion as case in point I will be saddned. Here you have it: osteopaths remove subluxations, they just call it something else and they "believe" they exist in different ways. Same principle tho. You can do a lot better than that.
@ Skeptic Barista
Are you saying no one should do manual therapies then?
You seem to agree with me that RCT are important but in musculoskeletal care, how can an RCT be done for a complaint such as low back pain that can have multiple causes on presentation. Thats why so many different manual therapies have had RCT done for low back pain and they all come out the same as each other (equally effective)
@stefaan Vossen
You say "chiropractors are real doctors", but you have a vested interest in saying that. A conflict of interests, if you will.
Now I have no problem whatseover with people being 'car doctors', 'garage door doctors', 'shower doctors, 'etc, but I do personally have a big problem with chiropractors calling themselves doctor. And that is becuase they work in the area of health. Calling oneself a doctor in a health setting affects how they are perceived on a number of dimensions.
I'm not alone in this feeling: As far as I am aware, the UK trading standards also feel that chiropractors are not really doctors! One of the funniest headlines I've read in a long while was the one you can read here: http://www.telegraph.co.uk/news/uknews/1332118/Advertising-watchdog-cuts-chiropractor-down-to-size.html
So what is a real doctor? My feeling is that it's absolutely only someone with a doctoral degree (PhD or D.Phil) awarded by a proper university, or a person with a medical degree such as MbChB. For heavens sake, man, you're a chiropractor! Why not just call yourself that. If what you do is worthwhile, surely you don't need to inflate your status with the title doctor.
This discussion could clearly run for ever, I'm going simply going to refer to the research I quoted to the GCC.
This is from Chiropractic & Osteopathy a peer-reviewed online journal that aims to provide chiropractors, osteopaths and related health professionals with clinically relevant, evidence-based information.
(You'll notice it talks about CLINICAL RELEVANCE – something you are all very keen on)
An epidemiological examination of the subluxation construct using Hill's criteria of causation
Hill's criteria are the most commonly used epidemiologic model for suggesting a causal link for any diagnostic or treatment approach.
There is a significant lack of evidence in the literature to fulfill Hill's criteria of causation with regards to the chiropractic subluxation.
No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention.
Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation.
This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.
(You'll also notice the report concludes that subluxations have no valid CLINICAL application)
You see even when viewed from the point of clinical practice – subluxations fail!
@Andrew Gilbey
Thank god what you think is really ever only going to be what you think. Chiropractors are highly skilled, highly trained, MA-degree graduates from UK Universities with specialist education in the healthcare field (I can't even begin to explain you my disagreement to the inclusion of others into the UK's definition of the chiropractic profession…) These people are respected by GP's, consultants and patients.
The ASA is right to make sure that there cannot be any abuse of trust or implication of medical philosophy. Why a chiropractor would want to do that is quite frankly beyond me, but I would have to look into the history of this non-sense. I suspect it has something to do with the inclusion of some who would see benefit in making out that they are medical doctors. Funny that there is a reported history of a GP calling themselves "chiropractor" (not followed up by the GCC (lol)
Doctor Stefaan Vossen, Chiropractor
@skeptic barista
the argument set in your reference falls apart as soon as you include a need for analysis of polycausality (which is so obvious it hurts). Therefore its (and those of other pieces of research done so far in this field) conclusions are invalid. The best and most accurate thing you can say is "there is no research available".
Sorry Ernst and co.
Quote by David Colquhoun:
"A. Gilbey finds that the abuse of the title doctor is widespread and that chiropractors are the main culprits. An amazing 82% of 146 chiropractics used the title Doctor, andL most of them used the title to imply falsely that they were registered medical practitioners."
I ask of @ Andrew Gilbey, how does one know that chiropractors use the title to falsely imply that they were registered medical practitioners? Or is the feeling such that it is "thought" to be such as it infers, in one's own view greater importance?
Doctor Stefaan Vossen, Chiropractor
Stefaan Vossen
Whilst checking up on a few chiropractor websites, I found this information on the Yost Family Chirorpactic centre's website: One in Four Parents Link Autism to Vaccines. The actual study appears to have been a survey, but on Yost's website I feel it is being used in the context of vaccines cause autism! (Not least becuase BArbara Loe Fisher gets a mention.) Given the recent news regarding Wakefield,this really is quite staggering. Yost, by the way, has some amazing videos of herself at work on YOUTUBE (search for the username of drheatheryost) (http://www.yostfamilychiropractic.com/templates20/article/1987.html)
I love your line: "Thank god what you think is really ever only going to be what you think." 😉
@ Andrew Gilbey,
somewhere, someone said something which you feel it is being used in the context of….? Man you're good at this stuff. Is that how the New Zealand research was done?
I would love to know how the conclusion in regards to "chiropractors using teh title Dr. to imply medical status" came about, really I would LOVE to know. Or was it a BOGUS claim based not on evidence but prejudice and derogation?
(giggle in clenched fist)
Kind regards,
Stefaan Vossen
Doctor of Chiropractic
This is only the beginning
I think you're being deliberately obtuse, Stefaan. As you well know, the title 'Doctor' is commonly understood to mean one of two things: either that the title holder has a PhD or that s/he has qualified as a doctor of medicine. It is completely understandable that Joe Public should believe anyone claiming to be able to treat medical conditions and who uses the title of 'doctor' is a doctor of medicine. Other highly trained professionals like nurses, midwives, physiotherapists and dieticians don't seem to feel the need to pretend they are anything other than what they are but (some)chiropractors do and I note that those who do make a huge issue out of it and use the title at every opportunity – something even real doctors don't do. What possible reason can there be for you to call yourself 'doctor' other than that you wish to give the impression that you are qualified doctors of medicine?
This isn't a 'bogus claim based on prejudice' but a reasonable assumption based on the evidence available to us. What you don't seem to realise is that by pretending to be something you are not, you are shooting yourself in the foot and making it easier to dismiss you as dishonest quacks.
Thank you for recognising my obtusiveness is deliberate.
Stefaan Vossen
Thanks for that excellent explanation!
I recently carried out a little experiment (double-blind, although we only claimed single-blind) looking at CAM practitioners use of the title doctor (Gilbey & Perezgonzalez, 2010). It seems that potential clients are significantly swayed by the title of doctor: chiropractors using the title of 'Dr' were perceived as more expert, more scientific, and more likely to help than chiropractors using just their given and surnames. They were also perceived as more expensive.
In New Zealand, there is a report known as the Royal Commission into Chiropractic (1979). It makes interesting reading for any sceptics! It's very often cherry-picked by chiropractics – perhaps because it concludes that chiropractic probably does little or no harm. One part chiropractors almost entirely overlook is the recommendation that chiropractors should not use the title of doctor.
@stefaan Vossen is there any reasonable quality research to support the existence and clinical relevance of your "dysfunctional mechanism" ? If it lacks research behind it, how does it differ from being a personal re-interpretation of subluxation ?
@Skepticat, I don't think chiropractor so much want to pretend to be medical practitioners as to claim equal status with them in the patient's mind. That's consistent with Stefaan's request for respect and with Andrew Gilbey's observation that " chiropractors using the title of 'Dr' were perceived as more expert, more scientific, and more likely to help than chiropractors using just their given and surnames." In the U.S. they seem to often claim the role of a "primary care practitioner" too.
@Andrew Gilbey
"it seems that potential clients are significantly swayed…"
"Chiropractors using the title doctor were perceived to be more expert and more scientific…"
Seriously? It took a piece of "research" ("experiment" = a survey?) for you to figure that out?
Out of 100 people asked what they expect to see when they are told to expect a "dog", people are signiifcantly swayed into expecting to see an animal with 4 legs…possibly furry with a serious expectation of a tail…
Come on Andrew, how you come to conclude from any of this work that chiropractors are using the title to falsly imply medical status is beyond me.
You imply and refer so much to this nonsense that you seem to believe your own bovine doodoo.
I know what I do when it comes to spinal biomechanics, I get results for my patients (oh, delivery of predicted best self-reported outcome by the way: 98% of the time, or is that too unbelievably high a statistic for you?) and 90% of my new patients are referred to me by existing patients. My patients are chronic pain sufferers and the average cost of delivering results is £288.
If anything I am too cheap, come to think of it, but I am a bit of a socialist at heart so I want to make my prices affordable.
What exactely is your beef? Coz' it sure as hell ain't science! (or cricket)
Stefaan Vossen
Chiropractor, Human Being and Master of my Universe (yes I am being funny now and challenging your self-serving prophecies in relation to this mental mantra you and some of your compadres/madres seem to have that chiropractors are creepy, esoterical quacks-admittedly my wife has pointed out that something is only funny when it makes people laugh, so I will leave that to the readership).
is that a serious question? Or are you being as ridiculous as me (at times)?
Cr Stefaan,
It's funny you should say that "chiropractors are creepy". When my children are messing about at night, I tell them the chiropractor will come out from underneath their beds and crack their spines for them! It sure scares them to sleep! I bet you do the same with your kids, but use 'GP' for 'bogey-man and say he's going to prick them with a vaccine'?
More seriously, you say, "I know what I do when it comes to spinal biomechanics, I get results for my patients". What makes you so sure that isn't simple placebo?
So basically, the "skeptics" cry foul of a profession which in the UK by and large looks after chronic back pain which more often than not has been looked at by GP's and physiotherapists, is not ellegible for surgery and is causing lots of time off work and human suffering. They "critique" the subluxation concept whilst not actually understanding it and rather deride it for its historical origins. They say it is potentially dangerous whilst not making an accurate assessment of risks and benefits and discarding the evidence that is available (Breen report, amongst others). They say it might all be down to the placebo effect, and because a very complex and expensive clinical trial which would put this ridiculous debate to bed has not beend done yet they feel chiropractors have no place in the healthcare market (lack of evidence). Despite the fact that they are highly trained and on topics of relevance to the arena they function in score significantly better than most practitioners they shouldn't be allowed to call themselves "Dr.", a courtousy title they have earned and deserve, just so no-one is confused whether they are medical doctors or not… Really? I refer you back to an earlier post about being misguided: This is only about one thing for me: the patient.
Stefaan Vossen
You say that, "This is only about one thing for me: the patient"
Then I suggest you stop using the title of doctor, as clearly that is about you.
I hope you're NOT a doctor! Please look up the definition in your choice of dictionary
and tell us what the word means.
@Andrew Gilbey,
1) I would love you to answer the questions I have put before you some time ago now in regards to how you cam to the conclusion that doctors of chiropractic use the title doctor to imply medical "status"
2) would you also like me to stop wearing ties because god forbid they might imply status too (albeit sartorial in nature) or charge a fee for my work? That's about me too…
3) your argumentation is so weak and sollipsistic that even you must see that you are very much clutching at straws. I think you are only doing so by virtue of having failed to identify your real beef. Maybe you think that the provision of care for the patients I treat and help in the UK is adequate and think chiropractors redundant? Just so you know: it's not the case. Far from it.
4) can you please elucidate the thinking behind your position that a chiropractor should not use the title doctor "because it is not abut the patient but about them"? I think you will find that this is true for any academic or professional title, so I find it difficult to take your position seriously.
Kind regards,
Stefaan Vossen
This is only the beginning
Any progress on your research yet? Do you have a proposal? Even an outline might be interesting.
will post a link to my blog, so we can have a bit of a topic-specific discussion. Link published here tomorrow or Thursday.
@Stefaan, it was a serious question, but carefully re-reading your comments I think I had mis-interpreted you, and by "dysfunctional mechanism" you just mean that there is some component of the body or behaviour causing the problem. I am coming to think this is the case.
On Tuesday 25 May 2010 at 10:00 you referred to "any systematic dysfunction in any arena of the healthcare spectrum which is causing a challenge to the ability to cope"
On Saturday 29 May 2010 at 14:04 you said, in discussing diagnosis, "What is the systematic dysfunction? … Is it biomechanical, is it chemical/nutritional, or is it psycho-emotional? "
On the other hand, your language is somewhere in the postmodern / poetic / symbolic realm. Whe you use them it seems
"subluxation" = "underlying cause, of any kind"
"Chiropractor" = something special, perhaps 'true healer?'- "I strive with humility to become, whilst knowing I will never be, a Chiropractor"
You also said Sunday 30 May 2010 at 17:35 "is there someone out there who would be able to come up with a nice short term meaning "source of dysfunctional mechanism"? It has to be applicable to biomechanical, chemico-nutritional and psycho-emotional mechanisms." I think the term is "underlying cause."
Giving it a special name like "subluxation" creates a misleading apparent grouping a disparate set of causes. You have already recognised that the causes can be biomechanical, chemical/nutritional, or psycho-emotional (presumable not an exhaustive list) and restricted modern chiropractors to addressing a subset of biomechanical causes. Incorrectly grouped names cause errors in thinking by researchers, practioners and the public/patients.
I wonder what the GCC would have to say about this series subluxation-based lectures about to be held in the UK:
@ Blue Wode
"I wonder what the GCC would have to say about this series subluxation-based lectures about to be held in the UK:"
Why don't you ask them?
I think they may be a litte busy at the moment! PLease refer to Zeno's next post
Official: Chiropractic built on sand.
(Free registration)
Folks, it has been interesting reading this discussion. Some proponents of chiropractic have been extremely eloquent and I will never be able to match them on that front however eloquence does not imply in the smallest sense rationalism. As an example consider the world's religions, there are many, many religions, every single one is promoted by extremely eloquent adherents, and every one (more or less anyway) claims to be the only true religion, all the others being bogus religions.
Since they are often, usually or always contradictory, nearly all of them, all of them except one, or exactly all of them are misguided, bogus and wrong.
Until the Singh episode I had no clue what a chiropractic or indeed chiropractic might be. I did not even know of the exact word "chiropractic", using instead chiropractor/chiropractise (although I had never needed to try to spell them). "Chiropractic" smarts of ostentatiously mangled grammar to me.
Now, it is my honest opinion that it is a trade that cares much more for appearance than for facts, that worries about "reputation" rather than evidence, that is concerned with exotic, confusing, undefined words more than for customer's (including children's) health, that cares for the confusing use of titles and not a jot about reliable evidence. It is now thoroughly discredited subsequent to recent events in the Courts and the exposure of dodgy advertising and other claims and apparent misuse of titles by hundreds and hundreds of such traders. Del-boy looks like some kind of saint in comparison.
It seems that the whole concept was dreamed up by a snake oil salesman over 100 years ago. After reading a little about the history of this now scurrilous trade, I have wondered if perhaps he was a bit hard up and couldn't afford to stock up with snake oil, bottles, labels and stoppers. He therefore invented oil-less, bottle-less, stopper-less, label-less, snake-less snake oil. No more tedious sessions over the cauldron, plugging the bottles, licking the labels, loading the wagon.
Simply get the punters into the wagon and wave the tongue over them, an ostentatious wee rub on the back and poof! instant pecuniary relief without prior investment and of course instant pecuniary and perhaps other pains for the punter.
Charlatanics – is the word that springs first to my mind. (Please excuse the exotic mangled grammar, it seems strangely apposite:-)
Jim Smith
It has only just begun
@ Jim Smith
It's a terrible shame that you have come to the opinion you have about chiropractic. It just goes to show what a calamity the ill-judged decision to sue Simon Singh was.
The truth about chiropractic, as I have known it for the last quarter century, is that it is an honourable, caring profession helping a great many people to a better life.
If one was to form an opinion based on the information available on sites such as this, it is inevitable that you're going to come to a negative conclusion. Don't be swayed by the origins of the profession; if you were to judge "medicine" by its origins, you would believe that to be populated by barbaric, blood-letting charlatans.
I'm not going to defend every chiropractor out there, as I'm sorry to say that there are some whose philosophies and ideals are quite bizarre. However, don't dismiss the whole profession as a result of that or you should probably dismiss the whole dental profession for the views of some on the dangers of amalgam fillings. See for example this character who holds strong views on amalgam http://dentalwellness4u.com/index.html There again he calls himself "Dr", so presumably he must be a charlatan…………
Similarly, you would dismiss the whole medical profession for the views of some on homeopathy, for example this chap http://www.doctortwrobinson.com/homepage.html
Or, all veterinary surgeons because some hold that homeopathy can be effecetive, for example this lot: http://www.holisticvet.co.uk/
Quote: "Now, it is my honest opinion that it is a trade that cares much more for appearance than for facts, that worries about "reputation" rather than evidence, that is concerned with exotic, confusing, undefined words more than for customer's (including children's) health, that cares for the confusing use of titles and not a jot about reliable evidence. It is now thoroughly discredited subsequent to recent events in the Courts and the exposure of dodgy advertising and other claims and apparent misuse of titles by hundreds and hundreds of such traders. Del-boy looks like some kind of saint in comparison"
Honest or dishonest opinion is hardly relevant here, what is, is that it is founded on the same quicksand of the subluxation as-cause-of-all-disease interpretation… I am sorry but you really are barking up the wrong tree, but understandably so… seeing where you get your information from.
ps. the profession was not quite discredited in court action, the BCA's attempt to sue Simon Singh for libel (rightly, in my opinion) was.
pps. chiropractors don't misuse the title doctor, they are entitled to use it if they so wish
ppps. exotic confusing words are there to name exotic confusing things. these things being exotic is one thing, them being confusing yet another and a profession's concern with them only expresses the fact that there seems to be (for whatever reason) some intrest in it. It may be that there is a kernel of truth to it and that they are finding it difficult to discern that kernel.
That surely can only be a good thing..
Stefaan Vossen
@ Jim Smith
Most chiropractors become chiropractors because of a personal healing experience or seeing someone else helped when conventional medicine didn't. Do medical doctors choose their occupation
the same way or is because they'll have tremendous status, make extremely good livings and have a
great career? No one becomes a chiropractor because they can't wait to start dodging punches!
And chiropractic which literally means practical hands ,is a better descriptive name than osteopathy
( look up the definition of pathy and osteo). And ask Andrew Gilbey to tell you and us the definition of doctor.
"Honest or dishonest opinion is hardly relevant here…"
That statement was either stunningly stupid or stunningly arrogant! – The whole of your last post was nothing more than your opinion! Do you consider your opinion more relevant that that of others?
You offer your opinions on subluxations, whilst dismissing the opinion of some other chiropractos that that subluxations are a cause-all, cure-all condition.
Given your view that Opinions, honest or otherwise, are not relevant here, why should anybody accept your opinion as fact!
Perhaps they you would prefer to stick to proven facts, that is those supported by research evidence, although this is an area usually avoided by chiropractors!
@Skeptic Barista
given the choice of the two, I'd rather it be "stunningly arrogant". A little like your misquoting, or rather taking out of context of the quote;
1) it is simply not relevant whether it is honest or dishonest opinion, what on the other hand is relevant is that it is opinion fullstop, and not as you misread from my post that "opinion is irrelevant".
2) as very clearly (in my opinion) explained within the syntax of my post, the opinion is ill-informed and ill-construed. This is further demonstrated by means of the entries at the end of that post.
3) opinion is a wonderful thing and there to be added to, subtracted from, strengthened and changed alltogether and rhetotic is a powerful way to do so.
4) I would love to stick to proven fact supported by research evidence, but there isn't much of it. I already stated this to you in the past. The fact that something hasn't been researched does however not mean that it is ineffectual, a fact you seem to struggle with. Maybe you should spend a day in clinical practice, medical or otherwise to find out for yourself the difficulties entailed in a world of knowledge interlaced with gut-instinct and lashings of experience. But then you probably think that medical practice is an exact science, which is where I would seriously encourage you to speak to a few GP's about that topic. My dad is one, 38 years in practice, my mum is a nurse, 34 years in practice, and they have both told me that medicine is an art, rooted in knowledge, required for the reduction of unpredictability, predictability tested by science.
I just cannot help to feel like you are really missing the crux of this matter: clinical life (which is what most chiropractors are concerned with) is not the lab-version of reality you seem to be so fond of. I wish we could have tested models a bit better and a bit more by now. And no, in my opinion there is no science to back up that spinal subluxations cause colic and asthma, but then that is why I don't claim to treat these things. The problem is that there isn't even that much evidence to claim anything at all, so I don't claim much, other than that which I have experience of that I can predictably change in the patient in front of me. They are quite happy to buy into my service on that basis and the insurance company which provided me with the money-back guarantee was happy to provide me with the policy to claim that after having looked at my results. In the meanwhile I am working on developing the science…
Kind regards,
Stefaan Vossen
This is only the beginning
@Stefaan said: "will post a link to my blog, so we can have a bit of a topic-specific discussion. Link published here tomorrow or Thursday."
Any progress???
thank you for revisiting the posts I made in order to answer your question. I appreciate that response. I also fully concur that there is something very confusing abuot grouping things together like that but I think there is some merit in conceptualising the principle.
Kind regards,
Stefaan Vossen
some progress, unfortunately not enough. Talk soon
@Jim Smith
You say, "Some proponents of chiropractic have been extremely eloquent and I will never be able to match them on that front…".
I disagree on both counts 😉
@Jim Smith
I would agree with you: eloquence does indeed not imply rationalism 😉
Imitation is the most sincere form of flattery
I appreciate these things take time to polish – if you have a first draft, perhaps you could publish that?
Hi IainD:
the underlying premises of the study and its relevance to the practice of chiropractic care are the following:
1)dysfunctional mechanisms (the term used to replace an archaic and unhelpful "subluxation" exist in three general subgroups:
2)when the potency and intensity of the dysfunctional mechanism exceeds the subsystem's ability to cope destructive function results.
3)when destructive function occurs there is an increased likelihood of injury, inability to recover from injury or symptomatic display.
-not all symptomatic displays are consequence of intrinsic destructive function, but can also be due to excessive external impact
-certain intrinsic dysfunctions are secondary or predisposed to genetic function or secondary or predisposed to by cultural conditioning
the general outline of the study is as follows:
chiropractors today do not practice the full remit of the chiropractic philosophy as proposed herein. Chiropractors today practice primarily in the functional/structural field and provide primarily treatment for spinal dysfunction.
The first step in the study is to ascertain whether or not there is any validity to the notion that removing the underlying/predisposing biomechanical dysfunctional mechanism is likely to result in recovery or reduction in likelihood to biomechanical injury.
Due to the overwhelming interest and expertise in the back pain field held by most chiropractors in the UK, this first preliminary study will further narrow down to assessing the validity of this notion in the assessment of dysfunctional mechanisms pertinent to low back pain.
The study will prescribe assessment protocols for:
-gait dysfunction
-orthognathic malocclusion
-spinal dysfunction
The study is a prospective cohort study, where chiropractors using the protocol are compared to chiropractors who do not.
Further subdivision can be achieved by comparing results of patients who tested positive in one area but did not receive treatment in that area compared to patients who tested positive and did receive treatment.
Data acquisition tools and frequency are under discussion.
Assessment and treatment are provided by chiropractors in private setting. Podiatrist selected from a panel. Malocclusion will be managed by using soft dental splints. Chiropractors will use the manipulative technique of their choice, excluding traction techniques. Treatment protocols will be prescribed in three categories according to extent of tissue injury and tissue involved:
1)Muscular ++ Skeletal 0(or+)
2)Muscular ++ Skeletal ++
3)Muscular + (or ++) Skeletal + (or ++) Neurological +
Presence of neurological symptomatology requires identification of mechanism of injury (pathological/annular tear/discal bulge/discal hernia/IVF hernia). Only groups 2, 3 and 4 are eligible for the study, others must be referred for further evaluation).
This would then provide a number of criteria:
-class of injury (1, 2 or 3 as above)
-class of dysfunctional mechanism (gait, bite, spinal, gait-spinal, gait-bite, bite-spinal and gait-bite-spinal, totalling 7 subgroups)
-treated vs not treated
-reported progress
I hope it makes sense.
The real stumbling block is the control group and the placebo, but my thoughts on that are that it might be possible to cross-reference to other studies like the Mead study. It would also be possible to follow up with patients who were assessed and found to have any of the 7 classes of dysfunctional mechanisms but did not receive treatment and those who did not have any of the 7 classes of dysfunctional mechanisms and did not receive treatment.
there are lots of gaps within the text above as I am sure you will understand, but please do let me know your thoughts.
kind regards,
I thought you were going to publish it on your own blog?
G'day Stefaan,
Cohort comparison from different practices is a very weak study design because the populations are not comparable, and the equivalence of initial conditions and treatment results is unreliable.
To do the comparison reliably I think you need to:
– Have a common intake assessment of patients for suitability for treatment for orthognathic malocclusion or gait dysfunction
– The person doing the intake assessment must not prejudice the patients as to what treatment is appropriate.
– After assessing the patient, request that they enter the trial. If they agree they get randomly assigned to one of two treatments.
– Treatments to be provided by a different person from the person providing the intake assessment.
– Half the patients get treatment for the orthognathic malocclusion or podiatric treatment for gait dysfunction.
– The other half get the best 'conventional' spinal chiropractic treatment for their condition, in the opinion of the treating chiropractor.
– After a suitable time, the patients' condition is assessed by a person who is not aware of the treatment given, and who takes care not to find out. Someone not committed to the new protocol is probably best for this, so they do not unconsciously look for the signs used in the initial diagnosis.
Important points this achieves are:
– Randomised treatment, blinded assessment
– Control group with a control treatment with similar size placebo-effect
– No significant difference in patient experience between groups (all groups experience a change of practitioner between assessment and treatment)
– Minimisation of unconscious prejudice effects
"Imitation is the most sincere form of flattery" or insult.
problem with some of the criteria required to improve the validity is that they are not feasible in a private setting and that almost all chiropractors work in a private setting and would loose income over taking time off to work on a trial. Another problem is that the patients will want to be treated at the best of current knowledge. I haven't checked yet but am pretty sure there might be an ethics committee issue in this. I also think that even if the design is flawed in this way it will enhance or reduce the plausibility of the theory. Either way we will know a bit more and I am a firm believer that somewhere someone far smarter than me will be able to progress on from this. I think though that much value would lie in vast numbers. If this assessment protocol were to be held by a substantial number of chiropractors and held up for a number of years, it might overcome some of the concerns of population variability.
Kind regards
Blue Wode if your ego did not obstruct you so fiercely, your contribution to openly discuss possibilities or experiences would not be suffocated.
Searching is the first step. Right or wrong, both must exist in order to provide opportunities. We all hit walls and until then, we have not moved forward.
I suffer from "subluxation" or any title in which you care to name. I suffer from my vertebrae, ribs and other variations of fixated skeletal issues. At the moment, I have not found any other relief other than a chiropractic neurologist.
I was hoping to find some mature debates and conversation from other practitioners or patient experiences, but the nonconstructive negativity has drowned the objective.
Thank you Stefaan for seeking new probabilities. I am sure you would be the first one to admit when wrong and I am certain you crossed this road many times over in your life.
Wisdom has no ego.
@ Andrew John
Thank you for the ad hom attack.
Whilst I'm glad that you feel that you're experiencing relief from your musculoskeletal problems by visiting a chiropractic neurologist*, I suspect that you are failing to factor in other reasons for the benefits you perceive:
* Chiropractic neurology is an excellent example of exactly why we need science-based practices. Without a grounding in objective evidence there does not appear to be any limit to the degree that beliefs systems can be led astray. Any treatment can deceptively seem to work, and humans are very good at backfilling in justifications and explanations for phenomena that do not even exist. Left to our own devices we will tend to develop elaborate, but entirely fictitious, belief systems.
We figured our centuries ago, however, that systematic methods of controlling variables, controlling for bias, and rigorous statistical analysis can compensate for such human foibles. Until chiropractic neurology (and similar practices) avail themselves of such methods there is no reason to take their claims seriously.