What alternative health

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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.


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Part of the “A Scientific Look at Alternative Medicine," course given by Thomas J. Wheeler, PhD, to students at the University of Louisville School of Medicine. Also includes a critical look at the anti-vaccination movement. [PDF]  Handout    Reading   [HTML] 

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"...it has [also] been shown that patients are very pleased and satisfied with chiropractic care whether they get better or not....Furthermore, it has been said that chiropractic's greatest contribution to health care has been the development of a solid doctor-patient relationship. So, let's not kid ourselves. It may not be what we say.....but simply the way in which we say it that stimulates some measurable change in patient's general health care status. Some studies support this view." Views of David Byfield, Susan King and Peter McCarthy, chiropractic staff members at the University of Glamorgan, UK.

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“We just came across a fancy patient information form that was given to a patient after an assessment by a clinician. The form just blew our minds (but not in a good way) because it seemed to be the perfect clinical tool for generating ongoing pain and disability, and all by the simple process of ramping up the fear. So, just for fun, we thought we’d take you through it…Page 2 “Your nervous system controls everything”… The terrifying consequences of subluxations…The “Spinal Decay Report” Oh my goodness my spine is crumbling!...What is wrong with giving patients detailed information? Absolutely nothing but ultimately information should be accurate and empower the patient to make good decisions. The problems here are legion.” Neil O’Connell, Body In Mind blogspot (19th August 2010)

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“Both anecdotal and quantitative studies have shown that chiropractors are very likely to order spine X rays. Given the inutility of these studies, and the radiation exposure, what reason could there be (aside from financial incentive) for chiropractors to order X rays?...X rays are a significant intervention. Anytime ionizing radiation is applied to a human being, there better be a good reason for it. If there is no evidence that the X ray will help in a meaningful way with diagnosis or treatment, then no X ray should be done. There is no clear reason any chiropractor should ever order an X ray.” PalMD, White Coat Underground blogspot (10th August 2010)

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The head of the Connecticut Chiropractic Council, a trade group, refuses to answer the question “What is neck manipulation” during testimony before the Connecticut State Board of Chiropractic Examiners on 19th January 2010. [3:32 mins video segment]

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“There is evidence to indicate that upper cervical manipulation can cause stroke by injuring vertebrobasilar arteries. Many chiropractors routinely manipulate the neck as part of a treatment regimen designed to improve health by adjusting ‘vertebral subluxations’. Physical therapy practitioners may occasionally use cervical spine manipulation in the treatment of a problem related to loss of mobility. Although stroke caused by neck manipulation is rare, it happens most often among chiropractic patients who may be subjected to unnecessary manipulation based upon untenable guidelines.” This review, written by a retired chiropractor, offers some insight into problems associated with chiropractic neck manipulation. Samuel Homola DC, The Scientific Review of Alternative Medicine (2007)

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“What does this ruling mean?

The Board’s declaration that there is no risk of cervical artery dissection and stroke following manipulation is a finding of fact and not binding on the courts. As is their ruling that informed consent does not require a warning. Under Connecticut law, whether a warning of risk is required is determined by the “reasonable patient” standard, that is, what would a reasonable patient consider important in making his decision whether to undergo a particular procedure. One of the very purposes of the reasonable patient standard is to prevent practitioners from setting low standards and then claiming they’ve abided by their profession’s standard of care. Imagine the chiropractor sued for failure to warn who erroneously thinks he’s been inoculated against malpractice claims by following the Board’s ruling. Surprise!

As a matter of fact, the hearing transcript and videotape are now in the hands of plaintiffs’ personal injury attorneys, who will mine it for useful information. A couple of years ago the American Justice Society (formerly known as the Association of Trial Lawyers of American) started a chiropractic interest group (that is, interest in suing chiropractors for personal injury). The section collects and distributes such information for AJS members.

The chiropractors may have won this battle, but they could be losing the war.”

Jann Bellamy, Science Based Medicine (2nd July 2010)

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“A few months ago I visited a chiropractor just to see what would happen…He gave me the hard sell on the importance of regular chiropractic care to prevent degenerative disease. I listened and nodded politely then left and that, as far as I was concerned, was the end of the matter. But there’s apparently an old adage I didn’t know about until it was mentioned by someone on the Bad Science forum. It goes like this: Q: What do you get if you visit a chiropractor? A: Another appointment. Like everyone else, chiropractors have a living to earn. Of course, most of us don’t try to make a living delivering an unnecessary and scientifically unsupported therapy to people who don’t need it. But I guess those who do aren’t going to let anyone who’s already set foot on their premises, had both feet through the door, get away without at least one more attempt to lure them back.” Skepticat blogspot (10th June 2010)

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The General Chiropractic Council, a UK-wide statutory body with regulatory powers, has just published a new position statement on the chiropractic subluxation complex:

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.

They remind chiropractors that they must make sure their own beliefs and values do not prejudice the patient’s care, and that they must provide evidence-based care. Unfortunately, they define evidence-based care as

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. [emphasis added]

This effectively allows “in my experience” and “the patient likes it” to be considered along with evidence, effectively negating the whole point of evidence-based medicine.

Harriet Hall MD, Science Based Medicine (29th May 2010) 

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“A popular therapy among chiropractors who treat pets is low level laser or “cold laser” treatment. It is an impressive bit of showmanship to pull out a complex-looking device and with a serious expression wave a beam of light over a patient, but the evidence to suggest it is anything more than showmanship is weak at best.” The SkeptVet (26th May 2010)

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“2010 is the 100th anniversary of the Flexner Report – essentially an expose on poor-scientific regulation of medical practices that led to a scientific revolution in mainstream medicine. Chiropractic is in major need of its own Flexner Report (an Ernst Report?). In my opinion they need to clean house if they want to become respected members of the evidence-based mainstream medical community. They are trying to achieve this through legislation, lobbying, and advertising rather than genuine quality control, and that is a shame. As Ernst writes – their failure to do so constitutes an ethical and public health issue.” Steven Novella MD, NeuroLogica blog (10th April 2010)

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“Conclusions The majority of chiropractors and their associations in the English-speaking world seem to make therapeutic claims that are not supported by sound evidence, whilst only 28% of chiropractor websites promote lower back pain, which is supported by some evidence. We suggest the ubiquity of the unsubstantiated claims constitutes an ethical and public health issue.” Edzard Ernst, Andrew Gilbey, Journal of the New Zealand Medical Association (9th April 2010) [pdf]

NOTE: In 2003, 69% of all UK chiropractors felt confident to treat visceral/organic conditions, currently this figure stands at 74%. In the US,“nearly 80% of chiropractors teach a relationship between subluxation and internal health”, 88% believe that subluxation contributes to over 60 % of all visceral ailments, and 90% feel that chiropractic treatments should not be limited to musculoskeletal conditions.

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The founder of Victims of Chiropractic Abuse, Inc. - a survivor of chiropractic stroke - testifies before the Connecticut State Board of Chiropractic Examiners on the need for Informed Consent prior to neck manipulation. Chiropractors in the audience heckled her during the presentation sparking an emotional response. (19th January 2010) [2:25 min video segment]

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"I’ve had friends who complained of various ailments and bothers, some of whom swear that after visiting a chiropractor they felt 100% better…for awhile at least. I’ve always been of the opinion that everyone feels 100% better after a massage, a stretch and what passes for professional attention. The thing about chiropracty is that, when you look at the evidence, it’s really no better than sugar pills and rest…and in some ways it’s very much worse. Chiropractors are dangerous, make outrageous and unsubstantiated claims about the effectiveness of their “treatment”, and now one group of these charlatans wants permission to NOT advise their patients that cervical manipulation might cause a stroke." Cousinavi blog (9th January 2010)

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“The Canadian Broadcasting Company (CBC) show “Marketplace” does a scathing exposé of so-called nonsurgical spinal decompression treatment with machines like the DRX 9000 and of some of the unscrupulous practitioners who offer it. Between the hidden camera footage and the weasel words of the chiropractor they interview, it’s quite entertaining.” Harriet Hall, MD, Science Based Medicine (28th March 2010)

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“By a 4-1 vote, the board turned back a request for a "declaratory ruling" that would have mandated the state's chiropractors to warn patients that cervical manipulation of the spine can be dangerous. Medical doctors know this warning as "informed consent." I called board Chairman (and chiropractor) Matthew W. Scott to ask about the decision, which was made at a public meeting Tuesday morning. "I'm not allowed to talk about it," Scott said. There is one board member who isn't a chiropractor. She voted for requiring informed consent and was happy to talk." They see no risk of stroke from cervical manipulation," said Jean Rexford, the executive director of the Connecticut Center for Patient Safety. "They relied on one study. It's time to really take a close look at how all these boards are being run. We have way too many foxes watching the henhouse." Many chiropractors have been irate about the proposal, saying that evidence of a risk doesn't exist and that they are being singled out. Stroke victims, an increasingly outspoken group, say all they want is for patients to learn about the danger. The legislature, which passed the issue to the chiropractic examiners, might now take up the issue again. "It makes me wonder why we have a board at all," said Norm Pattis, lawyer for the stroke victims. "If the board won't do it and legislators won't, then we will go to the courts."” Rick Green, Hartford Courant (18th March 2010)

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“I spent 43 years in private practice as a “science-based” chiropractor and a critic of the chiropractic vertebral subluxation theory…If I had it to do over again, however, I would study physical therapy rather than chiropractic. Considering the controversy that continues to surround the practice of chiropractic, I would not recommend that anyone spend the time, effort, and money required to earn a degree in chiropractic. Physical therapy, which is now beginning to include spinal manipulation in its treatment armamentarium, may offer better opportunity for those interested in manual therapy. Properly-limited, science-based chiropractors are now essentially competing with physical therapists who use manual therapy. Unfortunately, only a few chiropractors have renounced the vertebral subluxation theory, making it difficult to find a “good chiropractor.” I consider physical therapy to be more progressive and more evidence based. For this reason, I generally recommend the manipulative services of a physical therapist rather than a chiropractor. There are some science-based chiropractors who use manipulation appropriately, but until the chiropractic profession abandons the implausible vertebral subluxation theory and is defined according to standards dictated by anatomy, physiology, and neurology, I would not describe it as a science-based profession.” Samuel Homola DC, Science Based Medicine (4th March 2010)

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“Until a few years ago I assumed, when I heard the words ‘Dr X, a chiropractor’, that they referred to a doctor of medicine who specialised in a fully recognised branch of medicine…The alarm bells only rang when I saw one of their stalls in a shopping centre one day, complete with chiros touting for business. I surely can’t be the only person who finds it utterly weird that people claiming to represent a serious health discipline behave so evangelically and hang around public places hustling, (though, come to think of it, D.D. Palmer did say something about possibly making chiropractic a religion). What I didn’t know until recently was how chiropractics use ‘bait and switch’ to gain respectability. At these public promotional events, they focus plausibly on muscular-skeletal conditions and give the impression they are something to do with physiotherapy. Given their low cost introductory offers, why wouldn’t anyone with a chronic ache or pain give them a go? Once they’ve lured people into the surgery they start talking nonsense about subluxations and how these cause all manner of conditions that have nothing to do with the spine. I didn’t give chiropractic another thought until the BCA took the momentously stupid decision to sue Simon Singh, thereby exposing the dearth of scientific evidence for claims blithely made by its members and inspiring thousands of open-minded and concerned people like myself to do some serious research.” SkepticatUK blogspot (3rd March 2010)