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"…we surely stick out like a sore thumb among professions which claim to be scientifically based by our unrelenting commitment to vitalism. So long as we propound the 'one cause, one cure' rhetoric of Innate, we should expect to be met by ridicule from the wider health science community. Chiropractors can't have it both ways. Our theories cannot be both dogmatically held vitalistic constructs and be scientific at the same time."
Joseph Keating Jr, 'The Meanings of Innate', Journal of the Canadian Chiropractic Association, 46,1 (2002), p.10.
"Considering that the vast majority of serious complications after spinal manipulation has occurred with chiropractors, it would seem that chiropractors are the profession with the worst track record regarding manipulation for back pain." Professor Edzard Ernst (15th November 2013)
"In view of the cost of chiropractic spinal manipulation and the uncertainty about its safety, I would probably not rate this approach as the treatment of choice but would consider the current Cochrane review which concludes that "high quality evidence suggests that there is no clinically relevant difference between spinal manipulation and other interventions for reducing pain and improving function in patients with chronic low-back pain" Personally, I think it is more prudent to recommend exercise, back school, massage or perhaps even yoga to cLBP-sufferers." Professor Edzard Ernst (12th November 2013)
"The Australian Spinal Research Foundation (ASRF) has just released their Annual Report detailing financial activity for 2012-2013. Net revenue for this period was $1,697,097. The amount of money spent or allocated to research grants was $52,029. This amounts to 3.07% of all monies generated...Conversely, $605,956 was spent on salaries or wages during this same period. This seems somewhat disproportionate. So, in this post The Rogue Chiropractor will look deep into the history of ASRF revenue and research grant expenditure...perhaps the ASRF needs a name change – Australian Subluxation Marketing Fund, so that chiropractors who have moved on from the vertebral subluxation complex can easily identify that this might not be where they want to direct their donations and those that want to contribute to VSC research can do so." The Rogue Chiropractor blogspot (9th October 2013)
"Today, in The Australian newspaper, it was revealed that "Central Queensland University [CQU] will next year offer [chiropractic] courses in Brisbane and Sydney alongside its Mackay courses". The Chiropractors' Association of Australia [CAA] has been working hard since Macquarie University decided to dump its chiropractic course due, diplomatically, to its status of, shall we say, research unencumbrance... [According to] the CAA 2012 President's report, some expenses are for the employment of a political lobbyist, and the employment of a public relations firm. Evidence? No way, chirostars. It's all about protecting the public image from questions regarding evidence. It's not about providing evidence. It's about holding back-slapping conferences of mutual admiration, selling each others' wares, and promoting each others' beliefs. It's about attacking and denigrating people who ask for evidence. It's about not being crystal clear about your anti-vaccinationism, and your belief in the invisible. It's about avoiding public scrutiny, so you can privately affect the health choices of others, without having pesky regulations and codes of ethics intrude upon your love-circle. Then it's about demanding respect in the public sphere, whilst threatening legal action against those who would ask legitimate questions. Then you claim it's about the research..." Reasonable Hank blogspot (6th August 2013)
"...the excellent [Australian] science program Catalyst covered [here] the growing problem of non-evidence-based chiropractic. It is a good thing that the fly-boys of the Chiropractors' Association of Australia are getting more exposure to the light." Reasonable Hank blogspot (12 July 2013)
"...if DD Palmer was able to cure deafness in 1895, then modern chiropractors should be able to do this as well...According to my checks, there is little evidence that this trick hasn't been performed since. Why not? DD Palmer did it, so why aren't chiropractors curing deaf people world wide? Surely that should be the first therapy taught to young chiropractors! If you want [another] reason to doubt the concept, then what about high quadriplegics, like Christopher Reeve, who had perfect hearing, but a non-functioning spinal cord. Not malaligned or subluxed – not functioning at all. So when you hear someone tell you this story, just remember that you're hearing it without using your spinal cord. Some chiropractors insist that adjusting the spine can, indeed, fix your hearing, your diabetes, your child's autism and asthma, and "enhance" your immune system. They invented the concept of "innate intelligence" to explain it, which is some sort of life force that cannot be seen, does not follow nerve pathways, yet can somehow be manipulated and adjusted by cracking a person's neck or back. How is it that something, that cannot be seen or touched or imaged, be "adjusted"? How can you know that the supposed "adjustment" is being performed correctly, healing the "innate", when it cannot even be measured? You'll need to ask a chiropractor that. It's a convenient and intuitive concept, but completely without evidence. None. And much evidence to the contrary. It's a fairy tale, designed to make people believe...Let's be honest, if your chiropractor mentions the words innate or subluxation, or attempts to provide you treatment that isn't directly related to spinal complaints, then you're dealing with a non-evidence based practitioner." John Cunningham, MD - Spinal orthopaedic surgeon specialising in cervical and lumbar spinal degeneration and trauma (10th July 2013)
"While spinal manipulation is an acceptable modality in the treatment of back pain, it is used inappropriately by some chiropractors who use manipulation as a treatment for disease by 'adjusting vertebral subluxations.' Defined by the subluxation theory that gave it birth, the core of the chiropractic profession continues to cling to a modified version of the theory, despite rejection by the scientific community. Philosophical differences between the various factions in chiropractic, ranging from some who have renounced subluxation theory to those who are subluxation-based, keep the profession divided and marginal." Samuel Homola DC, Focus on Alternative and Complementary Therapies [FACT] (June 2013)
"We are not picking on chiropractors as much as we are holding them to the same standards we would expect of any health profession." Michael Vagg, Clinical Senior Lecturer at Deakin University School of Medicine (Australia), and Pain Specialist, The Conversation, (12th March 2013)
"...what does this tiny investigation suggest? Not a lot, I have to admit, but I think it supports the hypothesis that research into chiropractic is not very active, nor high quality, nor does it address the most urgent questions." Edzard Ernst (1st February 2013)
Chiropractors are trying to rebrand themselves as primary care physicians...they are seeking the expansion of their scope of practice, via the magic of legislative alchemy, to include the prescription and administration of drugs. Not drugs that any self-respecting M.D. would use, but drugs nonetheless. That effort succeeded to an extent in New Mexico. Recently Colorado got into the act. Other states have followed suit. One of the main obstacles in their way is the lack of authority to prescribe drugs. Colorado chiropractors recently attempted an end run around the time-consuming and expensive process of lobbying the state legislature and getting their practice act amended to include prescription privileges. Perhaps they were aware of certain snafus (which we'll get to soon) bedeviling New Mexico chiropractors in their quest for practice expansion. The Colorado Board of Chiropractic Examiners' solution was to bypass the legislature altogether by simply passing a rule giving chiropractors the authority to administer and prescribe certain drugs. Never mind the fact that this was totally beyond the authority the Colorado Legislature gave the Board...Meanwhile, in New Mexico, the battle over chiropractic prescribing continues. As reported in a previous post, the legislature amended the chiropractic practice act to create a new iteration of chiropractor, an "advanced practice" version, which takes all of 90 hours of additional training plus passing a test. The New Mexico Chiropractic Association describes part of this training on its website [capitalization and punctuation as in original]: Routes of administration [for 'naturally derived' substances], of course, are oral, topical and rectal, which we may already do but new to us here are intravenous (IV) and intramuscular (IM) administration. Doctors completing the certification will be prepared to do: IM injections (B12, homeopathic, magnesium, trigger point, etc.), neural therapy injections Intravenous procedures (meyer's cocktails, H2O2, chelation, ascorbates, amino acids, minerals, etc.), emergency procedures Laboratory testing and diagnosis. In other words, a veritable pantry full of quack remedies, now conveniently available via an IV...The Arizona Association of Chiropractic has filed an application with the state legislature for an expansion of chiropractic scope of practice to include the use of natural substances, homeopathic medication and orthomolecular therapy as an opportunity to enhance care for their patients. According to the petition, these "services" are currently available to chiropractic patients in Oklahoma, Utah, Alaska, Oregon and Idaho, as well as New Mexico and Colorado. Ten other states are in the process of considering legislation. We'll return to these unfortunate developments in a future post." Jann Bellamy, Science Based Medicine (24th January 2012)
"All things considered, with the status and the future of chiropractic in doubt, I would not think that any well informed person following the guidelines of science today would choose to be a Doctor of Chiropractic rather than a Doctor of Physical Therapy." Samuel Homola, DC, Science Based Medicine (26th October 2012)
“In conclusion, while uncontrolled case studies have shown that the Activator maybe effective at reducing back pain without any firm proof (such as a well designed RCT study), I would agree with Prof Ernst’s view that this type of intervention has no sound scientific bases and is “at best, an expensive placebo”.” Prof Richard Appleyard, Australian School of Advanced Medicine, Macquarie University. Friends of Science in Medicine (October 2012) [pdf]
A critical review of J.C. Smith’s book, The Medical War Against Chiropractors: The Untold Story from Persecution to Vindication: “Nowhere does he mention chiropractors like Sam Homola, who have criticized chiropractic from within. Nowhere does he mention that half of chiropractors are still undermining public health by discouraging immunizations. Nowhere does he acknowledge or respond to the arguments against chiropractic, for instance the wealth of material on Quackwatch’s Chirobase, Homola’s numerous books and articles, and magazine and blog articles by me, Steven Novella, David Gorski, and many others. Nowhere does he acknowledge the critiques of the Cassidy stroke study and the other studies he cites, [and] throughout, he confuses chiropractic with spinal manipulation.” Harriet Hall MD, Science Based Medicine (23rd October 2012)
“There is a disturbing effort afoot to rebrand chiropractors as primary care physicians… Part of this effort includes convincing state legislatures to grant prescription privileges to chiropractors, an effort that succeeded in New Mexico…The attempt to rebrand chiropractors as primary care physicians is bad enough, but giving them the legal authority to prescribe is beyond the pale. New Mexico’s ill-conceived legislation has turned into a debacle, with the pharmacy and medical boards having to haul the chiropractic board into court to comply with the law. And once they got limited privileges, chiropractors lobbied for increasing privileges to the point of wanting to prescribe controlled substances and dangerous drugs without any oversight and the right to practice surgery to boot. If you think this can’t happen in your state, think again. Remember that chiropractors got all 50 state legislatures to grant them the privilege of “detecting” and “correcting” the imaginary “subluxation.”” Jann Bellamy, Science Based Medicine (6th September 2012)
“…the only convincing evidence that has emerged to support chiropractic treatment is in the care of humans with lower back pain, in which chiropractic is about as effective as conventional care. This does not justify the application of chiropractic for any other medical condition or the use of chiropractic in non-human animals without appropriate research to justify this.” The Skeptvet (19th August 2012)
“One of the most disturbing complaints I hear comes from chiropractic patients who have paid thousands of dollars in advance for a course of treatment lasting several months─after succumbing to a high-pressure sales pitch involving scare tactics. These patients have usually opted to discontinue treatment because symptoms have either worsened or disappeared. Most have signed a contract, however, that does not allow a refund, even if the treatment regimen was not completed. Some have used a chiropractic ‘health care credit card’ to borrow the advance payment from a loan company, leaving the patient legally bound to repay the loan. It’s never a good idea to pay for chiropractic services in advance. Treatment should be discontinued if symptoms have worsened after one week of treatment or have not improved after two to four weeks of treatment. In many cases of neck or back pain, symptoms will often resolve after a few weeks, eliminating the need for further treatment. Patients who have signed a contract for discounted long-term treatment that involves correction of vertebral subluxations, however, may be told that subluxation-detection instruments indicate that they still have subluxations that need to be corrected to prevent a recurrence of symptoms. Treatment may then be continued as a preventive-maintenance measure, even in the absence of symptoms ─ all in keeping with subluxation theory which proposes that correction of vertebral subluxations will ‘restore and maintain health’. Such unnecessary treatment is a needless expense, and it poses a risk that outweighs benefit, especially in the case of neck manipulation which is potentially dangerous. It is generally considered to be unethical to ask for contracted payment in advance for long-term treatment of a health problem, since such an agreement is tantamount to a guarantee that the treatment will be effective. There is no way to determine if chiropractic treatment might be effective or how many treatments might be needed. I generally advise chiropractic patients to pay for treatment per visit on an as-needed basis and only for treatment of mechanical-type back pain and related problems. A ‘free exam’ or a request for payment in advance should raise a red flag. Few consumers are aware that a diagnosis of ‘subluxations’ in a chiropractor’s office is in itself a red flag.” Samuel Homola DC, Science Based Medicine (17 August 2012)
“Provocative testing before cervical manipulation is widely recommended in the chiropractic literature. The validity of such testing is questionable, and at any rate the HVLA maneuver is not part of the provocative test and it is the likely culprit. Regardless of the magnitude of risk, the existence of a risk is undeniable and patients should know there is a risk before they agree to treatment. The Association of Chiropractic Colleges suggests informed consent but does not mandate it...any degree of risk is unacceptable when there is no benefit. A Cochrane systematic review has shown that HVLA manipulations are no more effective for neck pain than gentle mobilization and that neither is effective unless used in conjunction with an exercise program. And there is even less evidence for benefit in non-neck-related conditions. NUCCA practitioners and other chiropractors who manipulate necks for almost any complaint are clearly out of line.” Harriet Hall, MD, Science Based Medicine (14th August 2012)