Chiropractic is crap

I’m aware that I’ve blogged rather a lot about homeopathy being crap because I just love the lunacy of it so much but today I thought I’d redress the balance a bit by writing an equally objective and unbiased post about why chiropractic is also crap. I didn’t have to look far for inspiration. Take a look at this:

What I like to do is live a life of health and vitality by eating well, exercising every day, making sure I receive Chiropractic every week, take no medications, not getting vaccinated, drinking pure water, taking wholefood supplements/fish oil/probiotics, no smoking or alcohol and making sure I treat my body with respect.

When a chronically ill skeptic tells me that my lifestyle is quackery, I only feel sorry for them being trapped in a belief system that suppresses their quality of life. It’s not my job to change that belief system.

I like the fact that it is a free world and I get to choose what I do with my body.

This very sad comment, by someone called Jeremy, appeared on my blog months ago but I ignored it and forgot about it. I was reminded of it only after seeing the same kind of nonsense posted on different websites recently. It’s not all nonsense, of course. Eating “well” (we assume he means a balanced, nutritious diet) and taking regular exercise together with not smoking or drinking heavily are indeed a good idea for anyone who wants to stay as well as possible and the NHS has a huge website which includes a wealth of information about healthy eating and exercise and much else besides.

The nonsense part is in the middle and starts with weekly chiropractic sessions and ends with probiotics. I can’t be bothered to deal with most of it at the moment. Obviously the guy’s living a great lifestyle and, as long as he manages to keep out of the way of any serious infectious diseases and any organic banana skins when he’s out exercising with his blinkers on, I’m sure he’ll be fine. In any event, the people who are most likely to die in epidemics are not healthy adults like him and if he wants to reject evidence-based medicine and spend his own money on unnecessary food supplements and probiotic yogurts or whatever, I’m sure nobody cares enough to try to stop him.

No, what I’d like to challenge here is the weekly chiropractic he “makes sure” he gets. Why, for fuck’s sake?  Time and time again I see this notion that we have to do something more than just eat, exercise and not smoke. To keep really, really well, it seems we have to regularly fork out extra money for some quack therapy or wonder foodstuff. Too often, the normal ups and downs of everyday life: tiredness, aches and pains, the odd tension headache, occasional insomnia or bowel problems, etc, are viewed as problems we need to not only treat as if they were potentially life-threatening medical conditions but that we should spend money on trying to prevent them happening at all.

Hmm…that maybe wouldn’t be such a bad thing if these therapies were effective but here’s the thing about chiropractic: having it regularly doesn’t make an iota of difference to your physical health and you may as well spend the money on talking about yourself to a counsellor or just having a nice evening out. Decide which leisure activity you can afford that is most likely to lift your spirits and go for it — but preferably choose one that doesn’t carry a risk of a vertebrobasilar artillery stroke.

Thanks to the British Chiropractic Association’s unutterably stupid decision to sue Simon Singh, which has forced the spine wizards into the spotlight, many of us know a lot more about chiropractic now than we did before. Indeed, there are many who didn’t realise that chiropractic isn’t part of mainstream medicine. But they realise it now, in spite of the best efforts of some quacks to continue to misrepresent the BCA v Singh case. (If you missed the storm kicked up by an idiotic homeopath called Lionel Milgrom wrongly stating that the BCA had won the libel case and been awarded substantial damages when it hasn’t even gone to trial yet, read about it here, here and here.)

And for those that have been on another planet for the last few months, the backlash against Mr Justice Eady’s decision at the preliminary hearing took the form of hundreds of complaints being made to the GCC and Trading Standards about the implausible claims made by hundreds of UK chiropractors. The message is clear: if there is a jot of scientific evidence for these claims, bring it forth or withdraw the claims. Don’t resort to legal muscle to shut us up.

Inevitably, a few pissed-off spine wizards dipped their toes into the shark-infested waters of internet forums where skeptics gather or left their droppings beneath the blog posts of the complainants. It was a “witch-hunt” said one. The complaints are “vexatious”, said another, who goes by the name of David and more of him in a moment .

I’ve always thought the term ‘witch-hunt’ quite an appropriate one to use about people who promote and practise pre-science therapies. As for ‘vexatious’, isn’t this adjective usually reserved for complaints that are intended to cause inconvenience but have no real grounds? The complaints against chiros do have good grounds: there are chiros making unsupported claims that they can treat things like asthma, which have nothing to do with the spine, chiros misrepresenting themselves as doctors and chiros claiming that having regular sessions will help maintain good health. That the complaints should cause inconvenience or annoyance is just an added bonus. Yes, it may be annoying and inconvenient for them to have to change their websites and leaflets but they shouldn’t have been making those claims in the first place. Those who call these complaints ‘vexatious’ presumably believe that chiropractic really can treat everything from asthma to bedwetting to sports injuries to colic. I wonder if they also believe it can cure deafness?

Because that’s how it all started that day in September 1895 when, so the story goes, a grocer called D.D. Palmer prodded and poked at a deaf man’s spine after which the man said he could hear again. There’s an excellent article by the SkepDoc, Harriet Hall, in the current issue of Skeptic magazine, which reminds us that a science develops over many decades but a pseudoscience can pretty much be thought up over breakfast. A pseudoscience like chiropractic is, in my opinion, more like a New Religion — otherwise known as a cult — than like science. D.D.Palmer and L.Ron Hubbard, founder of Scientology, seem to have a have been cut from the same cloth. Indeed, Harriet Hall tells us that Palmer “spoke of a God-given calling and seriously considered making chiropractic a religion”.

It’s reasonable to describe what Palmer invented as a pre-science therapy because he based it on an idea that we know now to be wrong: that all bodily functions are controlled by the nerves. He thought he could feel bones out of place in the spine and decided for no good reason that these “subluxations”, as he called them, were the cause of most cases of disease. Funnily enough, these chiropractic subluxations, didn’t show up in x-rays, an inconvenience chiropractors addressed by changing the definition of subluxation from the partial dislocation that Palmer imagined to

A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.

The World Health Organisation quoted by Wiki.

It may seem hard to believe that anyone still subscribes to the idea that disease prevention depends on keeping one’s spine ‘aligned’ but evidently many people do. Harriet Hall’s article includes a list of chiropractic insanity in her local community (somewhere in the US, I presume) and it includes this:

A chiropractor informed me that if germs caused disease we’d all be dead and insisted that you can’t become ill if your spine is properly aligned.

Presumably my commenter, Jeremy, who makes sure he gets his weekly preventative dose of chiroquackery believes the same thing, as does the chiro who helpfully commented beneath another of my previous posts thus:

Do you get regular check ups at the dentist to avoid tooth decay? Do you get your car serviced regularly to prevent major engine problems? Our bodies are constantly put under stresses of everyday living, therefore, some patients like to have problem areas worked on at regular intervals (every one-six months perhaps) to help prevent their problem returning…I do this by using spinal manipulation, massage, postural advice, exercises programs, dry needling (like accupuncture) etc.

I’m sure he gives a great massage and gives very good advice on how to sit up straight and what exercise to take. These, however, are not chiropractic. You can get equally good advice from a physio and you can get a massage in, um, other places.

It’s disagreement over what chiropractic actually is that seems to be vexing David  over on Zeno’s blog. He is one of those chiropractors who eschews the use of the term “subluxation” and argues that the practice of most British chiropractors is properly described by the Anglo-European College of Chiropractic and the Welsh Institute of Chiropractic i.e. they focus on what the latter calls the “diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the functions of the nervous system and general health”.

Well, it’s true that description doesn’t use the word ‘subluxation’. It does, however, allude to the effects of “mechanical disorders” of the musculoskeletal system on the nervous system and general health. It stops short of giving examples of these effects but it sound suspiciously like the idea that a back problem can be connected in some way to ailments that having nothing to do with the back, which is at the heart of why chiropractic is dismissed as quackery by so many. It’s also the reason why there are currently hundreds of complaints being investigated about chiros claiming on their websites that they can treat a variety of different complaints that have absolutely nothing to do with the back.

David asserts that “spinal manipulation does not equal chiropractic”, which we all knew anyway. “It’s the complete package that counts,” he tells us. “We have the whole range of techniques available to us”. What he does not tell us is this: If chiropractic is no longer the theory that mythical subluxations of the spine are the cause of most ailments, then what is it? I mean what is the theory behind chiropractic nowadays? What distinguishes these modern chiropractors who are focussing on “mechanical disorders” from other practitioners who use manual therapies?  David does not tell us and neither does the Anglo-European College or the Welsh Institute. Nor, in spite of David insisting that chiropractic treatment is scientifically supported, do any of these sources tell us where to find the scientific evidence that supports it.

Another claim he makes is that,

Interestingly, physiotherapists only really took to manipulation when they realised that chiropractors were getting so much better results in the treatment of back pain.

Actually, that’s not very interesting. At least, not as interesting as this systematic review, which reveals that spinal manipulation is no better than other therapies for treating lower back pain. And there is no evidence that it is effective in treating — or preventing — anything else. What’s more there is a “very small but very real risk”, as Hall puts it, of stroke with neck manipulation. In a previous post I gave the example of a young woman called Kristi Bedenbaugh who saw her chiropractor for sinus headaches. During a neck manipulation she suffered a brain stem stroke and she died three days later. Harriet Hall mentions 20-year-old Laurie Jean Matthiason,  who saw her chiropractor for lower back pain and had 186 neck manipulations over a six month period. The last one killed her.

The gullible fool who goes for a weekly chiro session in the belief that it maintains his good health, might be interested in the case of Sandy Nette, who used to believe the same thing until she suffered a severe stroke. Click on her name to see her website if you dare. It’s mostly still under construction but here’s a taster:

Due to Chiropractic Highest Neck Manipulation
I Am Now Trapped Inside An Immobile Body

I don’t mean to scaremonger…well, not very much anyway. I will happily concede that vertebrobasilar artillery stroke resulting from chiropractors performing their manipulations is extremely rare. In a nine year population-based study [Cassidy et al] conducted in Ontario, “only” 818 patients were hospitalised for VBA strokes after chiropractic manipulation. The best article I’m aware of on the dangers of chiropractic manipulation and which refers to the Ontario study is right here.

As the man, Jeremy, says, it’s a free world and we can choose what to do with our bodies, including subjecting them to costly, needless and potentially dangerous physical therapies. Just don’t make claims for those therapies unless you can point to evidence that your claims are true. That’s all.

49 thoughts on “Chiropractic is crap”

  1. well I see you did your homework on the “negative”.
    but you didnt on the “positive”.
    WHY ????
    because the positive outweighs the negative?

  2. “I’m aware that I’ve blogged rather a lot about homeopathy being crap because I just love the lunacy of it so much…”

    I rather love the lunacy of the anti-Homeopathists, such as yourself.

    With recent high dilution research, real scientists, rather than armchair sceptics, continue to experiment with discoveries such as that certain high dilutions prepared in a manner shockingly similar to Homeopathic remedies do in fact still cause biological effects even after all the molecules of the stimulant have been diluted away.

    If you like lunacy you’ll love things like trips to the moon, A-bombs, lasers and Quantum Mechanics. All of them are absolutely crazy, but, unfortunately by your criteria, the “lunacy” of them is quite real.

    Somehow, the positive double blinded tests about Homeopathy are ignored and a rather pathetic attempt to ascribe its obvious curative effects to “placebo” is made in belated acknowledgement that cures and improvements really are happening under its administration.

    But most astounding of all is how nearly two centuries worth of clinical reports, case histories and other data from perfectly competent MD’s and other health professionals published in their journals could be ignored or discounted in the light of the current insufficient theoretical scientific validation. And many of these report similar cures and properties from similar remedies for similar conditions despite the necessity for individualization.

    Either Homeopathy works or else you expect us to believe that some of the greatest medical minds of their day, doctors who have seen thousands of patients each, had somehow deluded themselves into a self induced hoax. I DON’T think so.

    Equally dangerous to the cause of science and scientific research itself is your attempt to utilize ridicule and your own supposedly “non” lunatic position as some sort of implied determinative factors, a priori insulting everyone who dares to think otherwise, instead of admitting that all you have is the same as everyone else – an opinion.

    Your comments on Chiropractic, though they do mention one important issue and possible danger, suffer from the same limitations.

    Scepticism is good – but unreasoning scepticism, that idea that one’s position is inviolate based on one’s own conception of the “obvious” or “common sense” is nothing more than a mental disorder, aptly characterized by Homeopath Laughingmysocksoff as “Scepticemia”.

    I do hope you will entertain this admonition which, in my opinion, mars your otherwise excellent comments and tends to get you associated with compulsive Quixotian crusaders against “woo” instead of a good logic minded sceptic, ready to admit the possibility that there are new discoveries and breakthroughs to be made, in Homeopathy, in Complementary and Alternative Medicine, and in all the Universe around us.

  3. Thanks for your comment, James. I’ll answer it in full:

    Paragraph 2: Yes, it’s a good idea to start your criticism with an insult. That really ensures you’ll be taken seriouly.

    P3: In a previous blog I linked to research at the University Toronto, which found that any molecular change in water round a solute lasts under 50 femtoseconds. Your claim that “certain high dilutions…cause biological effects even after all the molecules of the stimulant have been diluted away” is worthless unless you can similarly reference the relevant findings.

    P4: I’ve no idea what point you’re trying to make about A-bombs, etc. Sounds like another pointless insult.

    P5-6: Positive results for homeopathy are not ignored. The point defenders of homeoquackery like yourself can’t seem to grasp is that the totality of evidence needs to be considered. When considered as a whole the overwhelming evidence is that homeopathy works no better than placebo. This is indisputable.

    P7: You “DON’T think so”? I’m afraid an argument from personal incredulity is as worthless as an unsupported claim. In any event, your assertion about “some of the greatest medical minds of their day” is highly contentious. Even if it were true, the greatest medical minds of today recognise that homeopathy is crap because that’s what 21st century science tells us.

    P8-10: Sorry – did you not realise this is a personal blog? Of course I admit that what I write is my opinion – I could hardly make it any clearer. I do, however, support my arguments with relevant links and references. Unlike you. Nowhere have I ever made an appeal to “common sense”, so your putting it in quotes as if it’s something I’ve said is disingenuous. In my experience it’s the defenders of quackery who appeal to common sense by saying things like “it worked for me so of course it’s true.” Utter hogwash which thoroughly deserves to be ridiculed.

    Final para: Funnily enough, how this blog is perceived depends entirely on the perspective of the reader. As you can see from other comments, some think it is written by a logic-minded skeptic while others accuse me of being in the pay of Big Pharma. I couldn’t care less either way. What I will say is that you have no grounds whatsoever for suggesting I don’t have an open mind. When I started researching altmed, I had an open mind – and still do. I have done my research carefully, everything I write is supported by evidence, which I link to and I am happy to engage with any serious counter-arguments. Alas, the quacks who comment here never have any serious counter-arguments. They never engage with what I actually say, they simply resort to empty ad hominems and accuse me of being closed-minded, just as you have done.

    Pots and kettles spring to mind.

  4. You can say that chiropractic is crap if you don’t find the right clinic to be at. If experience the right way of having chiropractic you wouldn’t say that.

  5. Interesting point, ‘downtown chicago chiropractor’. How much do you think it’s reasonable to spend trying out different chiroquacks before one finds ‘Dr Right’, so to speak?

    No doubt you’d like readers to think that the Chicago clinic whose link I’ve removed from your post is the “right clinic” for them but I’m afraid I only accept ethical advertisers on this site. Anyway, as your IP address reveals your location to be the Phillipines, I don’t imagine you’re recommending them from personal experience.

  6. Dear Skepti,

    I got another one! Even after I posted a note calling attention to the advertising of chiros via Web spamming, another poster dropped a comment with a link to another chiro.

    Sigh. Thanks for keeping the banner of reason flying high.

  7. “but here’s the thing about chiropractic: having it regularly doesn’t make an iota of difference to your physical health and you may as well spend the money on talking about yourself to a counsellor or just having a nice evening out”

    where is your evidence that this statement is correct? Show me any “long term” studies that show no health benefit from regular chiropractic visits. Or is this just your opinion in your “equally objective and unbiased post about why chiropractic is also crap “

  8. Hi there!

    I sense you’re *fed up* with having to defend chiropractic and you’re not thinking clearly. 😉

    No, it isn’t my opinion. It is because there is no objective evidence that having regular chiropractic helps one “live a live of health and vitality”, as Jeremy claims, that I am able to make that assertion. If you are claiming that there is some general benefit to health by having regular sessions with a chiro, the onus is on you to provide the evidence.

    If I assert there are no health benefits to ear candling or cupping or reflexology, would you need to see long term studies before you believed it?

  9. Hello Skepticat, I’m afraid you couldn’t be more wrong about my tag. Beleive me, myself and all the other chiros in the UK don’t feel as if we have to defend chiropractic against ,what 10-12 bloggers, who are , mostly, wannabe scientists.
    You say there is no objective evidence.

    Medical evidence is ranked according to its value:[17]

    1a: Systematic reviews (with homogeneity ) of randomized controlled trials
    1a-: Systematic review of randomized trials displaying worrisome heterogeneity
    1b: Individual randomized controlled trials (with narrow confidence interval)
    1b-: Individual randomized controlled trials (with a wide confidence interval)
    1c: All or none randomized controlled trials
    2a: Systematic reviews (with homogeneity) of cohort studies
    2a-: Systematic reviews of cohort studies displaying worrisome heterogeneity
    2b: Individual cohort study or low quality randomized controlled trials (<80% follow-up)
    2b-: Individual cohort study or low quality randomized controlled trials (<80% follow-up / wide confidence interval)
    2c: 'Outcomes' Research; ecological studies
    3a: Systematic review (with homogeneity) of case-control studies
    3a-: Systematic review of case-control studies with worrisome heterogeneity
    3b: Individual case-control study
    4: Case-series (and poor quality cohort and case-control studies)
    5: Expert opinion without explicit critical appraisal, or based on physiology, bench research or 'first prin

    For over half of the evidence types above there is overwhelming evidence that chiropractic works, but because it doesn't fit with the types yoou would like to see you are blinkered into thinking there is none.

    Are you a research scientist? I happen to know and treat several and have asked their opinion on how chiropractors could run a gold standard double blind rct. And guess what in their opinion you can't. 3 research scientists have told me , a poor chiropractor, that they think it can't be done.

    back, no pun intended, to your defence statement. I see 1 or 2 new patients everyday and have done for some years. I'm not unusual, I have never in 20 years used the title doctor, never treated a child under the age of 8, except my own and I do not have the slightest urge to defend chiropracti

  10. Well, fed up, since you have no “urge to defend chiropractic”, I’m sure it’s very nice of you to give up your free time to come to my blog and defend it anyway. Thanks for staying true to type and including the ad hominems – it’s nice to have what I say about altmed practitioners confirmed. 🙂

    I’m aware of Sackett’s levels of evidence, thank you, and I’m not sure why you think your defence of chiropractic is helped by pointing out there is good evidence for it at the lower levels – that is what you are saying, isn’t it?

    You are, presumably, aware that this is a ranking system of evidence with the strongest evidence ranked at the top. The reason it is the strongest is because it is the most objective i.e. the most free from bias. As I said, there is no objective evidence that having regular chiropractic helps one “live a life of health and vitality”.

    I would agree with any of your friends who say it would be a waste of time to run an RCT on such a nebulous idea as whether having regular chiropractic helps one live a life of health and vitality. But if you think testimonials and case studies – with all the inherent biases that beset medical research – provide good evidence that a therapy is effective, then I’m afraid you are the one who is blinkered.

    I certainly wouldn’t agree that that a high quality RCT would be impossible to evaluate chiropractic for specific ailments. No, I’m not a research scientist but here is someone who is and – guess what? – he’s running an RCT for chiropractic even as we speak:

    http://clinicaltrials.gov/ct2/show/NCT00954759

    Whether that trial will ultimately meet the ‘gold standard’ remains to be seen but – apart from the fact that it’s been run and sponsored by people with a vested interest in the result rather than an independent body like a university – is there any reason why it shouldn’t?

  11. @fed up

    As you’re not a research scientist yourself, what makes you think you are qualified to evaluate evidence better than a sceptic blogger can?

  12. What I said was in response to your statement “having it regularly doesn’t make an iota of difference to your physical health” which is obviously not true as there is a lot of evidence, maybe not up to your standard, that shows it does improve your physical health.
    You cannot be serious when you say I’m blinkered if case studies and other lower levels of evidence are not good enough. To base all your opinions on only gold standard evidence is like looking down a tube. A very narrow tube.
    The study is interesting, if it proves positive how long do you think it will be before it’s pulled to pieces?
    “apart from the fact that it’s been run and sponsored by people with a vested interest in the result rather than an independent body like a university”
    Thats funny, do you really beleive research done at a university will be completeley independant and free from biase? Is any research done without vested interest?
    Autumn.
    I have spoken and questioned several phd research scientists over this matter, I know their opinion. I am a chiropractor and know the subject better than most. I have 20 years of evidence to show chiropractic is not crap.

  13. fed up, I asked you if you could see any reason why the RCT I linked to couldn’t meet the gold standard. You didn’t reply. Perhaps you need time to check it out with your research scientist friends, who said such a trial wasn’t possible?

    I’m sure if the result is significantly positive, it will indeed be “pulled to pieces”, as is right and proper according to the scientific method. If it turns out that the study wasn’t properly randomised or blinded, etc, or that the result isn’t satistically significant, the study will be dismissed. On the other hand, if it turns out to be a good quality trial, this will be objective evidence that chiropractic can treat infantile colic and will merit resources being invested in efforts to replicate the results. It would be wonderful if a safe, effective treatment for infantile colic could be found and I would hope that any good objective evidence would be considered grounds for further investigation.

    On the question of how independent research is, my point is simply that when tests are sponsored entirely by a party with a vested interest, there is some evidence that some bias in favourite of the vested interest creeps in, though often this is not hugely significant. I’m sure your scientist friends will have told you this.

  14. If the rct proves positive the complaints made by mr perry and zeno to the GCC will be null and void. Mr Singhs case will fail and all the mobilised skeptics will have to question why all the fuss was made. Anectodal evidence and case studies have shown positive outcomes with colic for years, but this hasn’t stopped the skeptic community overwhelmingly quack bashing chiro claims. I’m sure it will be positive but I’m also sure it won’t be good enough for some science writers. My reason for this is because there is no “fake” chiro treatment given in the study. This is also the reason given to me why a gold standard can’t be reached with chiro. You need to bring in placebo. No chiropractic, Chiropractic and fake chiropractic are needed in such a study, here lies the problem. I don’t know, and neither do the researchers I have questioned who have had chiropractic, how fake chiropractic adjustments can be given. Also in a gold standard double blind RCT the “adminstrator” is not supposed to know who gets the real treatment and who gets the placebo. In a chiro RCT the adminstrator would have to be a chiropractor who obviously would know if he/she were using real or fake adjustments. If a fake adjustment could be done.
    If the trial is positive maybe other claims are based on something and maybe Jeremy was right!

  15. If the rct proves positive the complaints made by mr perry and zeno to the GCC will be null and void. Mr Singhs case will fail and all the mobilised skeptics will have to question why all the fuss was made.

    Now THAT made me laugh. If this RCT shows positive results, this certainly won’t make Simon Singh “fail” as he could only comment on the evidence available at the time he wrote his column. (And wasn’t he also writing about asthma, sleeping problems and ear infection?)

  16. wow you have made a great point. People like you and other skeptics shout so loud that there IS NO EVIDENCE, when actually there is evidence just not to the level you deem acceptable. When other evidence does come to light, you then say it’s OK for me to have said those things because the evidence wasn’t available at the time. Its called short sighted. Or how to sell a book.

  17. LOL, people like me ^^
    I guess if “people like you” want to convince “people like me”, they have to provide evidence that IS EVIDENCE in “our” eyes. If you can’t you’ll have to accept that “we” tell “you” you don’t have evidence.

    I know what kind of evidence would be good enough to convince me that Chiropractic works – RCTs that replicably show significantly positive results (and YES, those would be necessary for every single or at least a lot of ailments Chiropractors say they can treat). If those tests were able to demonstrate that Chiropractic treatment does BETTER than standard treatment I’d use Chiropractic treatment.

    What evidence would be necessary for you to accept that Chiropractic doesn’t work?

  18. What would you do if all evidence showed chiropractic was the best method of treatment for all types of back pain, but it didn’t work for you?
    What do you think you would do if all the evidence showed it didn’t work but it helped you?
    I don’t feel the need to convince people like you. If it were up to me I wouldn’t bother even trying to set up a rct or any other form of evidence that would appease the scientific establishment. Do you think anybody I have seen today would be put off treatment by negative research? Do you think my database of several thousand patients have come along because of positive research they have seen?
    Do you think the physios that see me think chiro is better for them than “standard” treatment?
    This is why you, singh, ernst et al don’t matter to me and shouldn’t matter to all chiros. I really believe, hand on heart, you wouldn’t stop people coming for chiropractic treatment. I have been working for 20 years and the vast majority of new patients, over 90%, come from word of mouth. If I were to show everybody I’ve seen today, who have told me their symptoms have improved, negative research about chiropractic do you really think they would stop coming? If you do you obviously work with computers and not people.
    If you had experienced something for yourself but a research paper(based on evidence available at the time. sic) told you that what you had experienced was wrong or could not work, which would you beleive?

  19. That’s correct. It’s something I do everyday.
    Vicky and skepticat I have a question for you both. Have you ever had elective surgery? If you have did you search for any research or evidence before you had the procedure?
    If not see if you can find a gold standard double blind rct for any surgical procedure. I have 2 surgeons that come to see me and I asked 1 recently about the evidence base for operations he performs. No gold rct s for what he does. If you have had surgery and you obviously didn’t find the standard of research you require for chiropractic , why did you have the op? What evidence was enough for you to allow someone to cut you open?

  20. Vicky. Sorry I missed that last sentence. The only evidence I would need for me to not believe chiro works would be everybody telling me that they were not improving, my appointment book empty. Simple really.

  21. Sorry I’m late in returning here guys.

    fed up, your arguments are a wee bit muddled.

    The first one:

    ‘zeno and simon’s complaints will be null and void’ (if the trial I linked to gave a positive result).

    No, they won’t, because the complaints were not (just) about claims to treat infant colic. (Nor, as Vicky pointed out, were Mr Singh’s comments in the Guardian). zeno’s complaints were that the chiros’ websites contravened the GCCs own code of practice by including claims for which there is no scientific evidence. Every such claim is specified in the complaints and they cover all manner of ailments.

    “When other evidence does come to light, you then say it’s OK for me to have said those things because the evidence wasn’t available at the time. Its called short sighted.”

    No, it’s called rational. I can say with all confidence that feng shui (including all the stuff about good and bad spirits) is bollocks. If, somehow, feng shui – spirits and all – is proven beyond reasonable doubt, is it suddenly “not OK” for me to have called feng shui bollocks, even though all that was available at the time was anecdotal evidence and observation of individual devotees?

    If that analogy doesn’t grab you, try replacing ‘feng shui’ with ear candling or reflexology or cupping or any other biologically implausible idea because, at the heart of the matter is the theory on which chiropractic is based. The fact that chiros may now have in their armoury some useful skills and complementary therapies that help some people some of the time is not the issue. The issue is about ‘subluxations’, or whatever euphemism is preferred, and the idea that these are at the root of all kinds of diseases and conditions that have nothing to do with the spine. Yesterday I was examined by a chiropractic. Judging by him, this idea is still alive and well and being imparted to patients who don’t know any better.

    As for ‘Mr Singh’s case will fail’. I trust you are aware it isn’t his case but the BCA’s who objected to his comment that they happily promote bogus therapies. He said, “the British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence” I can see how one positive good quality RCT – a jot of evidence – for colic will change that statement but I’m afraid it wouldn’t nullify it altogether.

    In any event, with all this wonderful evidence for chiropractic you keep talking about, why do you suppose the BCA decided to sue Simon Singh instead of taking the offer of a 500 word response in the Guardian?

    Your point about RCTs:

    “… there is no “fake” chiro treatment given in the study. This is also the reason given to me why a gold standard can’t be reached with chiro. You need to bring in placebo. No chiropractic, Chiropractic and fake chiropractic are needed in such a study, here lies the problem.”

    Actually, it isn’t a problem when the subject of a study are young babies. Here’s how it works: You take the babies away from their parents; you do something or nothing to them; you bring them back to their parents. Neither their parents nor the medics who are measuring their development know which group each baby is in and the babies can’t tell them.

    Finally,

    “Have you ever had elective surgery? If you have did you search for any research or evidence before you had the procedure?”

    Yes and yes. I wouldn’t dream of having elective surgery without doing some research. I found out the stats for the operations, including the incidence, the risks and the success rate.

    “If you have had surgery and you obviously didn’t find the standard of research you require for chiropractic, why did you have the op? What evidence was enough for you to allow someone to cut you open?”

    See my previous answer. The operations I had were long established, routine and I could access the stats. If I were to be offered a surgical procedure that was still at an experimental state and not much evidence for or against was available, I would consider it in terms of all possible outcomes and weigh up whether to risk it or not.

    Hope that clarifies. 🙂

  22. I’ve just had another thought: If I were to have a surgical procedure that was still in the experimental stage, I would be told this was the case. In fact, it has already happened and I declined the procedure and decided to live with the problem which, I was told, was likely to clear up within a few years. If I’d been told that, without the operation, I’d be stuck with the problem for life, I may have decided to risk it. I don’t know.

    My point is that to tell patients the truth about the state of the evidence is to behave ethically. If chiros were to tell patients that there is no scientific evidence that chiropractic adjustments (or whatever you call them) cure colic but that many people observe an improvement in their babies afterwards, nobody could really object on ethical grounds.

    The chiro I saw yesterday looked me straight in the eye and told me chiropractic treats colic and ear problems effectively.

    To that, I object.

  23. This is what Skeptics want from chiropractic.
    “I know what kind of evidence would be good enough to convince me that Chiropractic works – RCTs that replicably show significantly positive results”
    But this is ok for surgery.
    “I found out the stats for the operations, including the incidence, the risks and the success rate”
    Don’t you think that is exactly why people see chiros. Risks success rates?
    “Actually, it isn’t a problem when the subject of a study are young babies. You take the babies away from their parents; you do something or nothing to them; you bring them back to their parents.”
    This is what we were talking about.
    “RCT I linked to couldn’t meet the gold standard.”
    I gave you a reason why it probably wouldn’t meet gold standard.
    “If chiros were to tell patients that there is no scientific evidence that chiropractic adjustments (or whatever you call them) cure colic but that many people observe an improvement in their babies afterwards, nobody could really object on ethical grounds.”

    FFS what do you think we do all day, stand there and say i can scientifically prove that I will cure you of this this and this!!!!
    The VAST majority of chiros convey to new patients their own “risks and the success rate”. I guarantee nothing. I will try to help using a technique that has proved very successfull with lots of problems.
    “My point is that to tell patients the truth about the state of the evidence is to behave ethically. If chiros were to tell patients that there is no scientific evidence that chiropractic adjustments (or whatever you call them) cure colic but that many people observe an improvement in their babies afterwards, nobody could really object on ethical grounds.”

    Again sorry to go back to this but this wasn’t good enough for most, it wasn’t good enough for you and “I guess if “people like you” want to convince “people like me”, they have to provide evidence that IS EVIDENCE in “our” eyes. If you can’t you’ll have to accept that “we” tell “you” you don’t have evidence.” Vicky

    “The chiro I saw yesterday looked me straight in the eye and told me chiropractic treats colic and ear problems effectively.”
    Did he say HE has helped children with colic and ear problems? or did he say there is scientific evidence to show it does? If he has seen positive outcomes following chiropractic for colic and he wasn’t stating there was a mass of evidence to prove it what is your problem? He has either experienced “many people observe an improvement in their babies afterwards” or he’s a liar.

  24. First of all I was only talking about what I want, not about sceptics in general (hence the quotes when I say “people like me”). I didn’t speak for Skepticat, so don’t quote me and do as if it was what Skepticat asks for.

    Second, you constantly talk about RCTs when in fact you mean double blind placebo controlled trials – there are other RCTs, you know? As you said it would be nearly impossible to conduct double blind placebo controlled trials of Chiropractic, but what about an observer blind trial?
    By the way: I didn’t even ask for placebo control, but for the results to be replicable by independent research.

    Third, anecdotes (a.k.a. “having seen positive outcomes”) aren’t evidence. When you quote Skepticat saying
    “The chiro I saw yesterday looked me straight in the eye and told me chiropractic treats colic and ear problems effectively.”
    and then ask her
    “Did he say HE has helped children with colic and ear problems? or did he say there is scientific evidence to show it does?”,
    I really have to ask myself if you read what you write before hitting the “submit” button. You quoted what he said – Chiropractic treats colic and ear problems effectively. If he says that with no evidence, then indeed he’s lying.

  25. Vicky, again no evidence to you is not the same as no evidence in medicine or the whole scientific community. There are levels of evidence and ,possibly, this chiro has seen improvements with these ailments in children. Skepticat said in her own post
    “If chiros were to tell patients that there is no scientific evidence that chiropractic adjustments (or whatever you call them) cure colic but that many people observe an improvement in their babies afterwards, nobody could really object on ethical grounds.”
    I was merely trying to establish if this was indeed what the chiro was saying.

    What I mean are gold standard trials.
    OK so you are just commenting on yourself and not the scientific or skeptic community. If thats the case what qualifications do you have that justifys
    “they have to provide evidence that IS EVIDENCE in “our” eyes. If you can’t you’ll have to accept that “we” tell “you” you don’t have evidence.” Who are you to tell me I don’t have evidence? What puts you in a position to make judgements on chiropractic evidence and wether or not chiropractic has any scientific basis? What qualifications do you hold that enables you to do that?

    And how about answering the question you neatly ducked. Have you had any elective surgery? and if you have did you, in your expert opinion, find gold standard RCT evidence before you went ahead?

  26. Skepticat, just to get back to the title. Which chiropractic in your opinion is the “crapist”
    Activator,Gonstead,Diversified,Logan,McTimoney,Drop-table,Wellness, toggle?

  27. And how about answering the question you neatly ducked. Have you had any elective surgery? and if you have did you, in your expert opinion, find gold standard RCT evidence before you went ahead?

    I didn’t “duck”. I have never had any surgery whatsoever.

    What I mean are gold standard trials.

    Unfortunately you didn’t give a definition of what you call “gold standard trial”. You say RCT, but that’s just a superordinate concept and when you talk about how there’s no placebo for Chiropractic treatment and that’s why there can be no “gold standard trial” of Chiropractic, I guess you do mean double blind placebo controlled trials.

    OK so you are just commenting on yourself and not the scientific or skeptic community. If thats the case what qualifications do you have that justifys
    “they have to provide evidence that IS EVIDENCE in “our” eyes. If you can’t you’ll have to accept that “we” tell “you” you don’t have evidence.”

    OK, I’ll repeat it: when I am saying “people like me” (or “we”, or “our”), I’m only giving my personal opinion, using plural only because you replied saying “people like you and other skeptics”. No qualification needed to have an opinion on a subject.
    But that wasn’t the quote you used to illustrate “what sceptics want” and then mixed with Skepticat’s answer: it was “I know what kind of evidence would be good enough to convince me that Chiropractic works […]” (bolded the important word), so it should have been OBVIOUS that I was talking about myself.

    Who are you to tell me I don’t have evidence? What puts you in a position to make judgements on chiropractic evidence and wether or not chiropractic has any scientific basis? What qualifications do you hold that enables you to do that?

    Well, seems like people don’t need to be scientists to have an opinion, do they? I didn’t comment on “Chiropractic evidence”, I commented on “scientific evidence”. I am a scientist (chemist, the “chemistry” kind, not a pharmacist), so I am capable of reading scientific literature (and understanding it) at least as good as you are.

  28. Fed up, I think you should change your nickname to ‘obtuse’. If I’m not mistaken, you are trying to argue that sceptics operate a double-standard and are demanding the highest level of evidence for chiro but are willing to accept a lower standard for surgery. Is that it?

    There is no double standard operating here. Bear in mind, firstly, that placebo only works on conditions that are placebo-responsive and, secondly, many conditions get better of their own accord. The reason why the quality of RCTs depend on their size, randomisation and blinding is to ensure that the results are statistically significant, that biases have been eliminated as far as possible and that the results can’t be explained by regression to mean.

    Conditions for which elective surgery is offered aren’t usually placebo-responsive and don’t usually get better of their own accord (there are exceptions to both).

    Let me try and make this as simple as possible using a specific example of elective surgery. Let’s say a man is thinking of having a vasectomy. He does some basic research: He finds out exactly what the procedure is and discovers that it’s a long-established, routine operation that thousands of men get every year and that it has an almost 100% success rate. He notes the incidence and nature of known side effects and, obviously, takes them into consideration.

    Given the quality of the data already available to him, would it be rational for him to decide against the operation on the grounds that there is no RCT showing that a genuine vasectomy was a more effective contraception than a placebo operation? Think about it.

    Let’s say the same man has a colicky infant. He looks for information and comes across chiropractors’ websites claiming that colic is effectively treated by chiropractic. He goes looking for the same kind of hard data that helped him make his vasectomy decision. What does he find? A statement from the General Chiropractic Council acknowledging that,

    “The available evidence of the efficacy of the chiropractic contribution to the management of some types of asthma, migraine headache and infant colic is inconclusive.”

    Not a great start then. I’d hazard a guess that if he’d read a statement like that about vasectomy, he’d drop the idea pretty quickly.

    Given the dearth of good objective evidence, he decides to talk to a chiropractor. What does the chiropractor tell him? Probably that chiropractic is very successful at treating infant colic before going on to tell him a about a number of successful cases that he personally treated and he can show you the written testimonials from the parents because they are held in a file that patients can browse through while in his waiting room.

    It may occur to the father to ask how the “adjustments” treat colic and how anyone knows whether the “successfully treated” infants improved because of the chiropractic, because of something else or whether they would just have got better anyway, seeing as colic invariably gets better eventually, regardless of what is done.

    Or he may simply be so tired and stressed by the screaming infant that he decides anything is worth a try. As the chiropractor calls himself “doctor”, the father quite reasonably assumes he is medically trained and knows what he’s talking about.

    It may be, fed up, that your emotional investment in chiropractic is such that you are unable to see why the man’s decision is not based on good objective evidence that chiropractic works, is not nearly as good as the evidence on which he bases his decision to have a vasectomy (or nose job cataract surgery or whatever) and that it is perfectly reasonable to demand that good objective evidence exists before allowing chiropractors to take credit for treating it successfully.

  29. This is what we were talking about.
    “RCT I linked to couldn’t meet the gold standard.”
    I gave you a reason why it probably wouldn’t meet gold standard.

    And I countered with a reason why it could. As young babies can’t talk, there is no need for the control group to undergo fake chiropractic. The control group could just get a nice cuddle. There could be another control group that’s just left in a cot. The aim is simply to see if those treated with chiropractic improve in a way that suggests it is significantly more effective than not having the chiropractic.

    A large carefully designed trial along those lines would give the best possible evidence. I’ve no idea whether the trial I linked to meets any of the gold standard criteria.

    FFS what do you think we do all day, stand there and say i can scientifically prove that I will cure you of this this and this!!!!

    Calm down. No, of course I don’t think you say that. But all three of the chiros I have seen now (from two different firms) have (1) given me biologically implausible and scientifically unsupported explanations for the causes of certain ailments and (2) made claims to my face about what chiropractic can treat but for which there is no good objective evidence. You don’t say why you think you speak for the “vast majority of chiropractors” but, regardless of what they say to new patients, judging by all the claims being made on the internet, I’ve good reason to suspect that the vast majority do the same as the three I’ve met i.e. make false claims.

  30. Skepticat, just to get back to the title. Which chiropractic in your opinion is the “crapist”
    Activator,Gonstead,Diversified,Logan,McTimoney,Drop-table,Wellness, toggle?

    I neither know, nor care, what the difference is.

    Don’t worry skepticat, your back muscles haven’t been pulled. See how you feel tomorrow.

    Now I know you’re a quack. You have no information about my physical state, about my back or what I was doing when I pulled a muscle, nor who made the diagnosis. Yet you confidently assert that diagnosis is wrong.

    Which of those schools of chiropractic you mention is the telepathic one that you subscribe to?

    (In case anyone reading is wondering where I said I pulled a muscle, it was on Twitter yesterday. “Having visited a chiro undercover yesterday, the chiro god has visited revenge on me with pulled muscle in my back.”)

    Subluxations are crap?

    *sigh* Don’t insult my intelligence. I know about medical subluxations. It couldn’t be any clearer that my comments are about chiropractic subluxations which are, indeed, crap.

    http://www.chiroandosteo.com/content/pdf/1746-1340-17-13.pdf

    http://www.chirobase.org/01General/chirosub.html

    http://www.sciencebasedmedicine.org/?p=3022

    Thank you for your contributions here, fed up. You have given me inspiration for a future blog.

  31. Skepticat, I don’t actually use the term subluxation but I have given evidence that they exsist and are written about in medical, radiological(?) and veternerian professions. You point me to chiro websites? What is the difference in chiro or medical sublux? and were is your evidence that chiro sublux is crap?

  32. @fed up

    That the term ‘subluxation’ is used in medicine isn’t in dispute.

    In my blog I explain the origin of the chiropractic subluxation as defined by D D Palmer, which turned out to be a figment of his imagination. The second link I provide in my last but one comment goes into more detail.

    In my blog I also quote the amended definition of the chiropractic subluxation that is provided by the World Health Organisation (WHO). The WHO distinguishes between chiropractic and medical subluxations, specifying that the latter is a “significant structural displacement” and therefore visible on X-rays.

    The problem with chiro subluxations is the theory that they affect neurological function which, in turn, cause all sorts of disorders that have nothing to do with the spine. There is no such theory behind subluxations in other medical specialties.

    You ask for my evidence that chiro subluxations are crap. That is why I provided the links. The first link is to a newly-published epidemiological study on the chiropractic subluxation. Three of the four-strong team of researchers are chiropractors, the fourth is an associate professor of physical education.

    From the conclusion:

    “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. The lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.”

    In other words, it’s crap.

    The third link is to Harriet Hall’s blog about the research and what it means for chiropractors.

    “Sigh, if only this poor fellow actually knew the evidence.”

    Indeed. He could have saved himself a fortune.

  33. Skepticat kindly made me aware of this rather interesting blog post based on a comment I left previously (not sure if it was this blog).

    I am actually quite flattered that my comment made such an impression!

    I am a bit concerned though, that Skepticat disputes the benefit of taking a fish oil supplement and drinking pure water. Taking fish oil reduces inflammation. Might help those aches and pains you talk about?

  34. i have never in my life seen a more narrow minded view of an entire profession than yours — there are bad home builders, bad cooks and certainly bad chiropractors…. but to completely “destroy” a profession over your view that its “crap” is uneducated — esp the stroke thing — u must be a drug rep or “medical” wannabe – there was a study done at a chiro “college” of all places over a 10 yr period to prove/disprove this myth over 100,000 manipulations were observed and evaluated and not one incident and that was performed on “student” chiros — this led to another eval that included 3 million manips and not one incident — which again is why u must be a med rep — you got one story and ran with it — from a neurosurgeon’s lips to my ears (and he even taught at a medical college) 20% of people improve w/ surgery, which is why the “pain injections” have become so popular b/c the med profession has realized less invasive is better — do some research b/f u make urself an expert — the medical profession has little to offer for pain anywhere — take this pill, see u in 2 weeks, that didnt work, lets take an x-ray, then physical therapy 3x a week for 4 weeks, oh that didnt work, now an mri, oh look “there’s the problem” you need injections — you will spend far more in co-pays and deductable than anything else — see a chiro 3 or 4x and you should be better if he knows what he is doing — how do u feel about plumbers

  35. Good grief, tb, if I were your English teacher, I’d give you a slap for turning in work like that. I might lose my job over it but it would be worth it if it knocked some sense into you.

    If you really want me to read your rant, I invite you to resubmit it with full stops (aka ‘periods’) in place. As it is, I got no further than the first line and I understand from it that you disagree with my opinion that chiropractic is crap. Well, as it happens, I have revised my opinion in the 15 months since writing the above article.

    I no longer think chiropractic is merely crap. I think it is utter crap, I think the so-called ‘profession’ has a high proportion of charlatans and every one I’ve engaged with online has been cerebrally challenged and a thoroughly nasty piece of work.

    I do hope you take the time to read some of my other posts ridiculing chiropractic. 🙂

  36. Have a look at the GCC’s website newsletter on the outcome of barista’s multi complaint onslaught on chiropractic, Just saw this post over on barista’s septic blog:

    Considering his hit rate here (see below) was 0.03% complaints actually referred to the PCC for a hearing I hope you can all swallow that monumental defeat with some kind of dignity.

    What a total waste of public funds, I think that the ASA and GCC should be able to present the charges of these obviously malicious complaints firmly at all of your doorsteps. Misuse of a public service, attempted libel I am sure there is a legal field day here and look forward to this coming together.

    OMNIBUS COMPLAINTS UPDATE FROM THE GENERAL CHIROPRACTIC COUNCIL

    “In 2009 we received complaints about 680 registrants from a handful of individuals, concerning advertising claims on websites. In 2010 we received another 38 complaints.
    Of those 718 complaints, 24 remain to be resolved at either Professional Conduct Committee meetings or hearings, which are expected to take place by the end of the year”

    Funny thing is we still don’t really have any patient complaints which is what the whole process has been set up to deal with!

    Is that weird, a complaints process to protect the public who don’t seem to need it!

  37. I said stop behaving like an arsehole, nobby. And that’s not an ad hominem – it’s just an insult, which you thoroughly deserve for your nasty, abusive, incoherent rants about another blogger. Flattered as I am that you should choose this blog to have your nervous breakdown on, if you expect me to do anything more than insult you when you behave like this, think again.

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