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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.
“The evidence in the literature is quite clear: vertebral artery dissection (VAD), a type of stroke, is associated with chiropractic neck manipulation. It is not a common outcome, perhaps 1.5/100,000 manipulations, but it happens. What’s left is a somewhat subjective decision regarding the risks vs. benefits of the procedure…VAD is an uncommon type of stroke that affects the back of the brain. Rather than go into the details, I think we can all agree that strokes are a bad outcome, and that if a procedure carries that risk, it better have a lot of benefit…The best literature has failed to show a significant benefit of chiropractic neck manipulation vs. more conservative therapy for the treatment of neck pain. What we have here is an intervention that carries a small but real risk of a catastrophic complication, whose benefits are unclear at best.” Peter Lipson MD, Whitecoat Underground (30th September 2011)
Follow up: 2nd October 2011 Supporting the unsupportable
“…when it comes to risk, there is a small but definite association between chiropractic neck manipulation and the rare form of stroke known as vertebral artery dissection. This correlation is most clearly seen in young patients, those who would not normally suffer from strokes. Given the lack of superiority of chiropractic, and the small but real association with VAD, I stand by my advice that one should not allow a chiropractor near the neck.”
"Common sub-themes endorsed by surgeon's were diversity within the chiropractic profession as a barrier to increased interprofessional collaboration…criticism for treatment of non-musculoskeletal complaints, and concern over whether chiropractic care was evidence-based." Chiropractic &Manual Therapies (October 2011)
“Is chiropractic at RMIT [Royal Melbourne Institute of Technology] really worthy of government (read: tax-payer’s dollars) support?...RMIT has been publicly criticised for opening a Chiropractic Paediatric Clinic, along with a public call from Loretta Marron for this clinic to be shut down. You may think that this doesn’t sound like much to complain about, the reason is: There is zero scientific evidence that chiropractic is effective for any specific childhood condition …Chiropractic treatment is not without risks, thus children are being treated with chiropractic ‘therapy’, without any conclusive evidence that the treatment being performed is effective. From a totally objective, mathematical, non-emotional risk/benefit point of view, if there’s no benefit from treatment the child only gets the risks associated with the treatment.” Mal Vickers, Victoria Skeptics (29th September 2011)
Follow up: 3rd October 2011 RMIT (Not So) Open Day
“And so it was, I went along to RMIT’s Open Day on August 14, 2011, with my camera, voice recorder and some prepared questions. As any good skeptical researcher would do, I went searching for the evidence and for the experts that might help me find it. Surely, if there is any up-to-date science behind chiropractic the leaders of chiropractic teaching in Australia would know? Would I be the one to eat humble pie and change my mind if the science had come of age?...I found a quiet moment to approach Tom [Molyneux] and engage in polite conversation. I introduced myself as a blog writer from the Australian Skeptics and asked Tom if he’d be willing to be interviewed. Tom was polite but firm in his answer, which was ‘no’…”
“Someone had to document chiropractic claims, so I decided that it may as well be me…An intriguing finding from my research was that nearly every Australian chiropractic website makes similar claims. I concluded that the 19th century teachings of chiropractic in universities including the RMIT University in Melbourne, Macquarie University in Sydney and Murdoch University in Perth might be part of the problem…When I noticed that the RMIT ran a paediatric chiropractic clinic, I realised that it was probably promoting inappropriate and potentially harmful treatments. Armed with more evidence and additional research, I asked professors of medicine, psychology and science in Australia and the UK to support a report to Federal Health Minister Nicola Roxon, requesting that this clinic be shut down. From both sides of the planet, the response was overwhelming. As more letters continue to head for Canberra, and more support comes in from around the world, I can only hope that our transatlantic efforts will stop this blatant exploitation of our precious children.” Medical Journal of Australia (4th April 2011)
Highlights the problem of chiropractors’ fear of the consequences from negative results of good quality research. Journal of the Canadian Chiropractic Association (September 2011)
Our quick and somewhat informal review of the World Wide Web (www) pages of the NZCA [New Zealand Chiropractic Association] and the NZCC [New Zealand College of Chiropractic] suggests that those ideally placed to set an example by complying fully with the NZ chiropractor code of ethics are falling short, at least insofar as their compliance with Section 2.3. We therefore urge the NZCB to ensure that compliance with the code is effectively enforced, given its role in protecting both patient and practitioner. Andrew Gilbey, Jose Perezgonzalez, New Zealand Medical Journal (12th August 2011)
The September 2011 issue of Consumer Reports has inappropriately endorsed chiropractic treatment by reporting that subscribers who answered its annual survey said that chiropractic treatment had been more helpful to them than various other treatments for back and neck pain. The article acknowledges that the survey data might not represent the experiences of the general population and should not be compared to the results of clinical trials. However, it fails to place the survey's findings in proper perspective. In 1975 and 1994, Consumer Reports thoroughly debunked chiropractic's subluxation concept and warned very clearly about bad chiropractic advice and overselling. The September 2011 report provides no such warnings, shows a subluxation-based chiropractor giving an "adjustment," and recommends using the American Chiropractic Association to help find a chiropractor. The article gives similar uncritical advice about acupuncture and massage therapy.
Barrett, S., Chirobase (7th August 2011)
“"I see that our graduates have a more and more difficult time making a living because the third party payers continue to cut reimbursement to them. One way to increase reimbursement ethically is for the DC to have a broader scope...," says Winterstein; in effect, admitting the obvious fact that financial gain is an ultimate motivation for seeking prescriptive rights.” Chiropractic media report (3rd August 2011)
“A number of concerns around chiropractic practice have been raised recently. Another concern is the use of unproven diagnostic techniques which can produce false diagnoses for which patients are told that they require often lengthy courses of treatment. Such practices have been described recently by a former president of the Chiropractors Registration Board of Victoria (in Australia), who said that some chiropractors misuse equipment such as thermography, and "phrases such as ...'attract new patients' and 'keep your patients longer in care', are common enticements for chiropractors to attend technique and practice management seminars.”… this case describes the use of an unproven diagnostic technique, leading to an incorrect diagnosis of a musculoskeletal problem in an asymptomatic individual resulting in worry, unnecessary cost, and in all likelihood, unnecessary X-rays and a prolonged course of a treatment that is not only unnecessary but also could lead to life-threatening adverse effects. Patients rightly assume that any diagnoses made by healthcare professionals, particularly those who call themselves doctors, are accurate and that any recommended treatments are supported by clinical research evidence, have a positive benefit/risk profile, and are, above all, necessary. The motive behind this practice appears to be to generate clients from healthy individuals." Professor Shaun Holt, Adjunct Professor of Biological Sciences, Victoria University of Wellington, Journal of the New Zealand Medical Association, Vol 124 No 1339 (29th July 2011) [Subscription]
Reveals that chiropractic is used the most for disease prevention - without evidence of effectiveness. Hawk C, Ndetan H, Evans MW Jr. Prev Med. (13th July 2011)
"BMJ Clinical Evidence — an excellent organization that publishes EBM reviews (much like the World HQ for EBM, The Cochrane Collaboration) — updated their acute low back pain review recently. Here’s what they had to say about spinal manipulative therapy: One systematic review (149 people) and one subsequent RCT (101 people) added at this update. The review and RCT found no significant difference between spinal manipulation and placebo or usual care in pain. One further study added in harms which reports on adverse effects after spinal manipulation. Categorization of spinal manipulation changed from ‘Likely to be beneficial’ to ‘Unknown effectiveness’. This is nothing new to anyone who has actually been following the SMT evidence: scientific optimism about spinal manipulative therapy has been steadily eroding for a decade. There was never any evidence of serious efficacy (it always failed the “impress me” test), and larger and better experiments have conclusively shown that it is either completely ineffective, or so unreliable and trivially effective on average that it really just doesn’t deserve to be an expensive therapy with a good reputation any more. It just isn’t all it’s cracked up to be." Paul Ingraham, Skeptic North blogspot (11th July 2011)
"Despite the controversies and paucity of evidence the term subluxation is still found often within the chiropractic curricula of most North American chiropractic programs…The recent uproar about the U.S. Council on Chiropractic Education’s new accreditation standards and General Chiropractic Council of the UK’s position on the subluxation shows how much resistance there is to dropping the term.” Timothy A Mirtz and Stephen M Perle, Chiropractic & Manual Therapies (17th June 2011)
CONCLUSION: “This study suggests clinicians at this college are moderately open towards the chiropractic treatment of some *non-musculoskeletal disorders*.” Journal of the Canadian Chiropractic Association (June 2011).
“The future of chiropractic in Australia is at a crossroads. For the profession to move forward it must base its future on science and not ideological dogma. The push by some for it to become a unique and all encompassing alternative system of healthcare is both misguided and irrational.” John Reggars, DC, Chiropractic & Osteopathy, (21st May 2011)
“…in an unprecedented attack, John Reggars, a former president of the Chiropractors Registration Board of Victoria, said elements within the Chiropractors’ Association of Australia (CAA) had brought the profession to a crossroads, where it had to choose between science and pseudoscientific dogma...He claimed the CAA’s active promotion of so-called vertebral subluxation complex (VSC) — an unproven theory that spinal misalignments affect the “expression of innate intelligence”, resulting in ill health — was damaging the profession’s credibility… “Chiropractic trade publications and so-called educational seminar promotion material often abound with advertisements of how practitioners can effectively sell the vertebral subluxation complex to an ignorant public,” Mr Reggars said. “Phrases such as ‘double your income’, ‘attract new patients’ and ‘keep your patients longer in care’, are common enticements for chiropractors to attend technique and practice management seminars…Selling such concepts as lifetime chiropractic care, the use of contracts of care, the misuse of diagnostic equipment such as thermography and surface electromyography and the X-raying of every new patient, all contribute to our poor reputation, public distrust and official complaints.” “For the true believer, the naive practitioner or undergraduate chiropractic student who accepts in good faith the propaganda and pseudoscience peddled by the VSC teachers, mentors and professional organisations, the result is the same, a sense of belonging and an unshakable and unwavering faith in their ideology.” Mr Reggars said both the Chiropractic Board of Australia and the Australian Competition and Consumer Commission needed to take “clear and decisive action” against the promotion of VSC as a cause of ill health…He talks about some clinics churning through hundreds of patients a day, the package deals where patients pay up-front for fixed numbers of chiropractic sessions, the family deals where the kids are treated alongside mum and dad. None of this looks pretty. Paul Smith, Australian press (13th May 2011) [pdf]
“Traditionally chiropractic was almost entirely based on the notion that 'subluxations' of the spine need to be 'adjusted' by spinal manipulation – if not, illness would be the inevitable outcome. We all know this is not true, some might say ridiculous, yet the chiropractic profession has been slow to doubt this gospel…Why? The answer, in my view is simple. If you take the basic concept of 'subluxation' away from chiropractic, what remains? The answer, I fear, is not a lot!” Professor Edzard Ernst, Pulse (9th May 2011) [Free registration]
Video segment of James Winterstein, DC, President of National University of Health Sciences, in a speech given in Marco Island, Florida at the FCLB (Federation of Chiropractic Licensing Boards) during May 2011.
Alan Botnick, DC, criticises JC Smith's book The Medical War against Chiropractors: The Untold Story from Persecution to Vindication. (Amazon, 2011)
“A paper recently turned up in the journal Rheumatology by Majid Artus and his colleagues at Keele University. They performed a systematic review that aimed to assess not the effectiveness of interventions but instead the overall pattern of symptom development over time of back pain sufferers who take part in clinical trials and how it might vary between different types of intervention…It is interesting that the placebo treatment/waiting list control/no treatment group didn’t differ from the treatment groups.” Neil O’Connell, researcher in the Centre for Research in Rehabilitation, Brunel University. (Body In Mind blog, 22nd November 2010)