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Jonathan Hearsey, osteopath


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Richard Lanigan, chiropractor


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mt


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Bebo, chiropractor


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Stefaan Vossen, chiropractor


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James Pannozzi, homeopath


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pv


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AJP, homeopath


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Lifelinking


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Sarah Hamilton, homeopath


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Susan Elizabeth, homeopathist


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phayes


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Sarah Hamilton, homeopath


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crabsallover


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struck-off doctor, Rita Pal, 'NHS whistle-blower'


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AJP, homeopath


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JB, chiropractor


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AJP, homeopath


"The person writing all this negative press on homeopathy must be getting a big fat check from one of the pharmaceutical companies who would dearly love to push homeopathy off the map."
Erika Alisuag


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Tanya Marquette, homeopath


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JF Derry, self-publicist


"Oh shut up SK. You write hot air and spew rubbish as usual."
Rita Pal again.

What do you get if you visit a chiropractor?

This year sees the centenary celebration of D.D. Palmer’s great work entitled, The Science, Art and Philosophy of Chiropractic, in which he claimed that “A subluxated vertebra… is the cause of 95 percent of all diseases… The other five percent is caused by displaced joints other than those of the vertebral column”. Not that I’ve noticed any chiropractors celebrating.

A few months ago I visited a chiropractor just to see what would happen. I blogged the whole episode here but, in a nutshell, I told him I had come out of curiosity, taking advantage of a special offer £20 introductory appointment, which was being touted in a shopping centre on a busy Saturday. As a cover story I mentioned I had occasional lower backache but it wasn’t really a problem, I was just curious to see if he could explain it. He asked a lot of questions and wanted me to have a couple of x-rays. I declined. 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.

Here’s a letter I received from the Clinic Director.

I have recently reviewed your case records and it appears that you have discontinued your care programme. Of course I sincerely hope that you are doing well and will not suffer any setbacks.

We feel a responsibility to every patient that consults and I am therefore concerned that your symptoms may reappear or your condition may become chronic due to your not visiting the clinic for care. I would be happy to discuss your case with you if you so wish either by telephone or in person if you would prefer to pop into the clinic. If you choose the latter simply call the Front Desk to schedule some time. They will be happy to help you.

Whatever your decision I want you to know that we stand ready to be of assistance to you at any time in the future.

How caring and concerned they are! Introductory appointments at that place cost £95 a go. Subsequent appointments are likely to be cheaper and will no doubt seem like a bargain in comparison.

I toyed with the idea of ringing her up to ‘discuss my case’ just to see if she would continue to give me the hard sell or whether she’d do the decent thing and say, “Well, if you’re not suffering any symptoms or problems, there’s no need to come back” but I couldn’t be arsed. These are people who give up their Saturdays to harangue shoppers into submitting to having their spines “checked” (i.e. poked and prodded through several layers of clothing) and then do their damndest to get you to make an appointment at their clinic. If she’d actually read my case notes, she shouldn’t have sent the letter in the first place. The fact that she did is enough to persuade me that the primary concern here is not getting people well but getting them to part with their cash.

So I responded with an email:

“Thank you for your recent letter soliciting my further custom.

I was surprised to receive this given that I had only had one initial appointment, which I booked as a result of the special offer you had been promoting in Brent Cross shopping centre the previous week. I booked this appointment more out of curiosity than anything else and I had not started any ‘care programme’.

However, I welcome this opportunity to raise a couple of concerns with you.

When I visited your premises for an appointment with Jim, I noted a number of posters on the wall of his room containing what appeared to be misinformation about ‘subluxations’.

One of them said:

“A subluxation. The silent killer. Chiropractors correct subluxations.”

Another claimed:

“Subluxations were found to be the cause of several health problems, including tonsillitis, vomiting, hyperactivity, sleepiness, lower resistance to infections especially ear, nose and throat infections.

Subluxations: a serious interence with normal communication from the brain to the body. This interference may cause sickness and disease. No-one, especially a child, should have to live with subluxations. Have your family checked for subluxations frequently.

Refs: Hendricks, C.; Larkin-Thier, S Otitis Media in Young Children Chiro: The J of Chiro Res & Clin Invest 1989; 2 (1): 9–13 J Am Osteopath Assoc. 1966 May;65(9):964-72. Manipulative therapy of upper respiratory infections in children.”

Yet another claimed that, “Preventive chiropractic care can help with many types of health problem.”

Jim’s responses to my various questions were in keeping with the hypothesis that so-called subluxations can cause all manner of ailments.

However, the most recent research on the subject of subluxations concludes:

“No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.”

Ref: Mirtz et al, Chiropractic & Osteopathy 2009, 17:13doi:10.1186/1746-1340-17-13

http://www.chiroandosteo.com/content/17/1/13

As I’m sure you are aware, the General Chiropractic Council recently issued guidance to members:

>>GUIDANCE ON CLAIMS MADE FOR THE CHIROPRACTIC VERTEBRAL 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.

Chiropractors are reminded that

* they must make sure their own beliefs and values do not prejudice the patients’ care (GCC Code of Practice section A3)
* they must provide evidence based care, which is clinical practice that incorporates the best available evidence from research, the preferences of the patient and the expertise of practitioners, including the individual chiropractor her/himself (GCC Standard of Proficiency section A2.3 and the glossary)
* any advertised claims for chiropractic care must be based only on best research of the highest standard (GCC Guidance on Advertising issued March 2010)<<

In light of this guidance, I trust the posters will be binned.

Kind regards”

(Jim isn’t his real name).

The news that the subluxation was dead in the water emerged a few weeks ago in a correspondence between the GCC and Skeptic Barrista, who very helpfully blogged about it here. Zeno wrote a comprehensive obituary here.

D D Palmer, inventor of the original subluxation, was a snake oil salesman.  He based his invention 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 so-called misalignments — which he decided to call subluxations — 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.

Source: The World Health Organisation quoted by Wiki.

But that was a long time ago — well before the BCA’s libel action against Simon Singh forced the spotlight onto what chiroquacks have been getting away with and the subsequent campaign to get them to clean up their acts.

How are chiropractors responding to the news of the old subby’s demise? The answer is ‘predictably’. This is the response I got to my email:

Thank you for your email. We have indeed received the information from the GCC  regarding the use of the term subluxation until more research supports the concept. Of course we have already removed the posters, as I am sure many other clinics will be, to make sure we are in compliance of all GCC regulations.

Kind regards

I take this to mean that the chiros at this particular practice will stop using the word and quite right too. But I am not reassured that they won’t do what other chiropractors have been doing for a long time and use any number of synonyms: “joint misalignment, joint dysfunction, facet syndrome and articular derangement” are the examples helpfully provided by the GCC to mean pretty much the same thing, even though the correspondence from the GCC to Skeptic Barista makes it clear that there is no clinical research evidence to support the concept whatever it is called. Understandably, the writer of the email to me is ostenisbly optimistic that one day there will be evidence that supports the concept and maybe there will be. Give them time. They’ve only had 100 years so far.

88 Responses to What do you get if you visit a chiropractor?

  • Hi Skepticat,
    I read your post with interest, particularly when considering our past communications on Zeno’s blog.
    I must admit to be quite confused by your attitude to it all, as it seems to be quite natural for a practice to show care, and attention and quite cynical of you to find that source of derision. Also I think that their response to your email was quite constructive and not so “predictable”. But then, I don’t think there would be any response you would have found to be “admireable”. Tell me Skepticat, how many years did it take medicine to become scientifically validated, and what percentage of its practices have so far been validated by this method? Suddenly a century doesn’t seem that bad hey? Particularly in the light of the fact that medicine as is, is still struggling with back pain…
    Good critique of the marketing material though,… I think it is quite sh#t too.
    Finally, exchange “chiropractor” for “dentist” and “spine” for “teeth”, re-read your blog post and ask yourself the question: “is it really that strange to look at problems in the small to avoid them getting big?”
    Kind regards,
    Stefaan Vossen

  • I was interested in Stafaan Vossen’s comparison of your chiropractor with a dentist, since I was thinking of my dentist as I read that. He is an excellent dentist, but he does tend to send out letters at 6-month intervals getting increasingly insistent that I am neglecting my dental health each time if I have not been to see him in the meantime.

    Last time I went it was 2 years since my previous appointment (I don’t normally leave it quite that long) but because I’d been taking good care of my teeth he did about half as much cleaning as he normally does when I return after 6 months. That didn’t stop him from charging me 50% more than my previous appointment. He had insisted I have a major x-ray, and got rather shirty when I said I might not want to pay for that in future.

    The point is that private health professionals often tout for repeat business. The difference between a dentist and a chiropractor is that the dentist actually does something for your health that isn’t based on 19th century charlatanry.

  • @S.Vossen’s question: “is it really that strange to look at problems in the small to avoid them getting big?”

    Problem avoidance is second nature to people who look ahead, but may not occur in people who only respond to the situation.

    What difference does it make to substitute “dentist” and “teeth” in Skepticat’s post? Quite a bit in my opinion.

    The depth of science and knowledge in dentistry has grown significantly in 100 years. The same doesn’t seem to be the case for chiropractic. A dentist can reasonably predict what a course of treatment will entail, what it will achieve and when it will end. A dentist can also predict what will likely happen without treatment. For a given subluxation can a chiropractor provide such a prediction. There doesn’t seem to have been any advance in subluxation research and understanding in 100 years.

    Skepticat is not being cynical, she is being skeptical. Her skepticism of the value of a visit to the the chiropractor may simply be based on a possible lack of return on the financial investment.

    I have no direct knowledge or experience with chiropractic, but would personally rather go to a well qualified massage therapist. I haven’t managed to find anything about the advances in chiropractic science in my readings.

    While my permanent teeth grew in, I enjoyed sucking on mint candies. As a result I am well acquainted with the dramatic advances in dental science procedures and materials that have occurred over the last half century, having had a lot of first hand experience in its application.

    I think the substitution of “dentist” and “teeth” in Skepticat’s post is a fail.

  • The evidence regarding recall intervals for dental patients is mixed. NICE guidelines are probably the best. Similarly, the advice as regards the intervals between routine radiographic examinations varies.

    What is well-established is that regular dental care in the presence of active, ongoing disease processes is a good thing. If there is no disease, all the dentist is doing is patting you on the head and saying “jolly good”. I suspect that the same thing applies with spinal manipulation; if you’ve got problems, regular care would be a good idea. The problem arises as to what constitutes a problem. The unscrupulous dentist or spinal manipulator will see problems where none exist and seek to treat or prevent non-existant problems.

    The two can, of course, go hand-in-hand..
    http://www.cathedraldentalpractice.co.uk/holistic_treatment.html

    I’m a dentist, by the way.

  • I’d agree with Stefaan that “we have already removed the posters, as I am sure many other clinics will be, to make sure we are in compliance of all GCC regulations” is not the predictable response – the GCC’s message was ambiguous enough to leave wriggle room for true believers, so I’m glad they say they’ve removed them.

    I agree with Skepticat’s expectation that synonyms and other deceptive terms will continue – you can’t change people’s beliefs by regulation.

    The phrase “your condition may become chronic due to your not visiting the clinic for care” in their discontinued patient letter is a deceptive threat that is probably in breach of GCC and other regulations, especially since you did not have a “condition” to become chronic.

  • @JimR and @Lenny
    I would fully agree with you that the substitution of “spine” and “teeth”, “chiropractor” and “dentist” is not a good for the purpose of clinical comparison. I placed it rather badly within my post as a means to make anyone reading the post think about how we can all fall into the trap of prejudiced interpretation and post-rationalisation.
    I would say to JimR that, at least in my clinc, patients are after their assessment (and my patients tend to be chronic non-reponsive cases) presented with a clear outline of : cost, number and sequence of treatment visits and expected outcome. These are all required within the context of my money-back guarantee (in which I do not claim to “cure” every one, but rather x% improvement within the treatment protocol).
    Although I accept that this may be exception rather than rule, I do think that it is very well possible to offer that level of predictability and with the guarantee the return on investment is made clear at the onset. Should the return not be achieved a full refund of investment is made, thereby leaving really only the time invested as a lossmaker. This, I do feel is still an investment but fortunately the stats so-far are really good.

    Kind regards,
    Stefaan Vossen
    ps if your case were to be responsive to massage therapy, I would refer you to a good massage therapist, I know quite a few if you’d like. Point is that the field of cases I deal with are not. If they are, they’re not for me.

  • When I said they responded predictably, I was referring to the optimistic “until more research supports the concept”. There is no way chiropractors can admit that the whole premise on which their therapy is based is a nonsense even though there isn’t a jot of evidence to support it.

    Is Stefaan in kamikaze mode? Why would anyone draw attention to the advances in medicine made over the last century compared to the…ahem…advances in chiropractic?

  • @skepticat:
    Want an admission?
    The whole premise is based on something which hasn’t got much more than a minimal-sized jot of high-quality scientific evidence to support it. That it should be nonsense in consequence is rather short-sighted of you.
    Stefaan is always in kamikaze mode as he is not intimidated by people making non-sequeturs. I quite happily draw attention to the fact that there isn’t much advance in chiropractic research (other than the obvious stuff) because it is completely inconsequential to me and my patients. That it is consequential to you is examplary of your perceived decision-making process. Hence why I asked you to look into it and see whether your perceived decision-making process is actually all that coherent with reality…
    Kind regards,
    Stefaan Vossen

  • The reason you’re always in kamikaze mode, Stefaan, is because you are incapable of engaging with straightforward arguments in a straightforward manner but resort instead to misrepresentations, ad hominems and diversions, which fool nobody.

  • @skepticat
    You seem quite the sourpuss today skepticat…where is the ad hominem, the misrepresentation, the diversion?
    That’s quite the ad hominem attack, isn’t it? Just joking, it’s fine.
    Thing is though, I asked you a simple question, relevant to the topic of discussion. Called you short-sighted for decry something which hasn’t got much evidence to be “nonsense”.
    I don’t think that’s unfair? Is it?
    I did explain fairly clearly why in my opinion I seem “in kamikaze mode” to you, but if you know better…
    You employ logic to construct what seems to me (in my biased view) to be erroneous. I am employing logic to deconstruct your argument…and build another one, taking some of your arguments’ components with it, constructively assembling a view point, that’s all. Don’t take it personally, please.
    Stefaan

  • *sighs*

    I said that something for which there is not a jot of evidence is nonsense. This is a perfectly rational assertion to make.

    You twisted this into my decrying something to be nonsense even though “it hasn’t got much more than a minimal-sized jot of high-quality scientific evidence to support it.” Spot the difference? You then sanctimoniously accuse me of being ‘short-sighted’, which is an ad hominem. This is typical of your style of engagement, from what I’ve seen.

    If there was really a jot of ‘high-quality scientific evidence to support it’, it would indeed be short-sighted of me to dismiss it as nonsense (though it is still an ad hominem and this isn’t about me taking it personally, Stefaan, it’s about you using fallacious arguments). But I maintain that there isn’t a jot of high quality scientific evidence to support the premise on which chiropractic was developed as a therapy, that being that subluxations in the spine are the cause of all manner of ailments. That is my argument so if you are going to ‘deconstruct’ anything, please stick to what I actually write.

    I’ve re-read all your posts and I’m afraid I don’t see this “simple question, relevant to the topic of discussion”, you claim to have asked me.

  • @skepticat
    I did start that sentence by “want and admission?” the following sentence is my admission, the way I can personally agree to it, in riposte to your statement “chiropractors won’t admit to…” You said we wouldn’t, and I did. It was not me twisting your words, but rather me watching mine…

    This does seem like a question to me (from the first post):”Tell me Skepticat, how many years did it take medicine to become scientifically validated, and what percentage of its practices have so far been validated by this method?”

    Also an ad hominem, strictly speaking is an attempt to destroy one’s argument merely by making statements about their character or similar personal traits rather than addressing the nature of the argument. All I said was that it is short-sighted to call something nonsense just because it hasn’t got a jot of evidence. Evidence is great, evidence is wonderful, but it is not everything.

    Finally the premise that subluxations can cause all manner of ailments by itself is really not that thick. It just depends on what you understand a subluxation to be. As I posted in zeno’s blog it could mean “any underlying cause”. Ergo “any disease has an underlying cause”. Sounds right to me…
    If on the other hand you are assuming that “all subluxations are spinal” is part of the foundations of chiropractic then you are badly mistaken: this was a later addition by some very misguided people…

    That would undermine the argument quite fundamentally.

    Stefaan Vossen

  • There you go again..

    I said “There is no way chiropractors can admit that the whole premise on which their therapy is based is a nonsense even though there isn’t a jot of evidence to support it.”

    You didn’t admit that, you claimed something else – that there IS a jot of evidence and then used it as a reason to call me short-sighted, which is an ad hominem. Thanks for the definition, by the way, which fits what you did exactly.

    My point about your question is that it is neither simple nor relevant to the topic. Your point was that a century is a very short time in the history of medicine but that’s a moot point – unless you can explain how it addresses the point I made, which is that in the last century – the golden age of medicine thus far – no evidence has emerged to support the concept on which subluxation was based and developed.

  • @ Skepticat
    Instead of going on and on about chiropractors being this or that, why don’t you just let
    one treat you. You’re not going to die or be maimed. If you entrapped a couple of bad ones in
    the past, then get a reference from a friend,a satisfied patient or a medical doctor. And do tell
    them you’re skeptical,why not?
    It doesn’t matter what they believe in,either you feel better or you don’t. Either they solve your
    problem or they don’t. Same thing when you see a medical doctor.
    As a matter of fact, go see Stefaan, he;d treat you royally. If chiropractors are accused of doing studies that are too small to be clinically relevant, then you haven’t done enough research either.

  • @ Robin. Treat me for what? There’s nothing wrong with me. I haven’t said anywhere that I have a problem, have I?

  • @Skepticat.
    If there is absolutely nothing wrong with you then you don’t need anyone to work on you.
    So when you do, you might try going to a different chiropractor to be fair. Then you can truly
    judge the therapeutic effect.
    My post above was not necessarily specific to you personally.

  • Oh. So I don’t need the chiropractic ‘maintenance’ they push at us in order to avoid succumbing to the degenerative disease they keep trying to scare us with?

    (There’s a clue as to why I go “on and on about chiropractors being this or that”. As long as they do, I reserve the right to continue going on about them. Bloody charlatans.)

  • @Skepticat,
    Would you not agree that everyone should do some kind of maintenance to keep fit and
    attempt to allay the degenerative/aging/stiffening process? If you can do it yourself
    by stretching and strengthening,fine.
    No one should be pushy because no one likes to be pushed.

  • Thanks for another superb post, Skepticat.

    @ Robin
    When you say “Would you not agree that everyone should do some kind of maintenance to keep fit and attempt to allay the degenerative/aging/stiffening process”, I hope you aren’t implying that chiropractic maintenance/preventative care is a viable option, especially in view of the fact that a paper from 2008 concluded the following:

    Quote
    “…there is no evidence-based definition of maintenance care and the indications for and nature of its use remains to be clearly stated. The prevalence with which maintenance care is used has not been established. Efficacy and cost-effectiveness of maintenance care for various types of conditions are unknown. This conclusion is identical to that of a similar review published in 1996, namely that maintenance care is not well researched and that it needs to be investigated from several angles before the method is subjected to a multi-centre trial.
    http://www.chiroandosteo.com/content/16/1/3

    The fact remains that the only reasonably good evidence for chiropractic lies with spinal manipulation (which isn’t true chiropractic and can be administered by other manual therapists) for the relief of pain in a sub-group of low back pain sufferers – and even then there are equally effective conventional treatments available which are cheaper, safer, and not mired in quackery.

  • @Blue Wode,
    No I did not mean to imply specifically chiropractic maintenance. I meant that people
    should stretch and try to remain flexible and they should continue to challenge their
    muscles ( and other things like your brain) as well.
    A chiropractor certainly could and should educate patients to this end. Most practitioners
    of manual medicine have books and have studied techniques from other related disciplines.
    Sure, conventional treatments work for some if not many and are often the first thing people
    try. When they don’t work, there are alternatives.Chiropractic is one.
    I talked with my mother’s physiatrist the other day. She has a severe Thoracic kyphosis
    deformity due to Osteoporotic compression fractures. As you know I’m sure, a physiatrist is a
    proper doctor of physical medicine.
    He told me there was not much that could be done besides preventing further worsening.
    He then told me that” we need to emphasize PREVENTION of these problems in the first
    place with all our young people. Hmmm, sounds like something a chiropractor might say.

  • “He asked a lot of questions and wanted me to have a couple of x-rays.”

    God knows why it is even legal for them to do that but it seems to me your experience illustrates the importance of *avoiding* regular chiropractic care to prevent degenerative disease. ;-)

  • @phayes
    Because some chiropractors are licensed to take and read X-rays, request and read MRI scans. And that’s because they are trained to do so. That’s why. Remember that although skepticat stated she didn’t say there was anything wrong with her in more recent posts, in the original posts she clearly related to the chiropractor in question that she “occasionally got back ache, nothing much”. Now, let’s just for fun (devils advocate) consider the possibility that said chiropractor in one of “the many questions” asked whether she had pain at night, or found it difficult to reproduce the pain with movement and let’s consider that skepticat is (rather than the brunette 30-something vixen I imagine her to be) a lady of years with a troubled medical history including repeated use of streoids etc,… you may find at least two very good reasons to want to take an X-ray: cancer and osteoporosis (although the clinically more astute may argue that if visible on X-ray osteoporosis is well beyond redemption and would candidly argue bonedensity scanning to be more appropriate). Now, of course I personally would rather refer for it to be done on the NHS, but I could (albeit with swollen tongue in cheeck) see the sense in X-raying skepticat…I never bought any x-ray equipment as I have little use for it and it’s expensive, but that can be very inconvenient to patients so it depends on what your clinic is geared up to: convenience always comes at a price…
    @scepticpuss
    listen, I understand that you have been traumatised by your experience and that this is your way of coming to terms with the emotional scars and not just a bit of fun but I think you are getting a bit carried away with the generalisations…your sample-size is a tad small wouldn’t you agree?
    I would urge you to study and revise the meaning of ad hominem attack. You seem to like the term, but if the argument is being broken down by its own merit then that is not an ad hominem. It would be if I was trying to deconstruct another argument unrelated to your short-sightedness or otherwise put: claimed that ” your argument about biomechanical movement patterns is false because you have smelly armpits”. In this particular case the short-sightedness is within the argument i.e. “it is nonsense because it has no evidence to support it” is in my opinion a short-sighted argument comparable to “the earth is flat because as far as I can see it is flat”. If I were truly mischievious I would then add: “and I do not care about your stories of walking in a straight line and ending up at the same point…”
    Moving along swiftly I think that you’re mistaken in that accoding to your report this clinic is charging £95 per visit… a(nother) reporting mistake?
    Finally I conclude from your last post that chiropractors are (probably amongst others) charlatans because they push maintenance care… could you be more specific about what exactely it is that makes you feel that maintenance care is adding/contributing to the fact that this makes chiropractors charlatans?
    @Bluewode
    that’s right (for once) spinal manipulation is not “true chiropractic”, true chiropractic also looks at gait, malocclusion, life-style etc issues and manipulation, together with mobilisation, rehabilitation, myofascial theapy etc etc… thanks for the headsup and finally understanding what is so amazing about chiropracic management of the patient!
    Kind regards,
    Stefaan Vossen
    This is only the beginning

  • For drive-by readers of this comments section, the following piece, which was written by neurologist Steven Novella, should help you to understand why Stefaan is apparently so upset at the increasing widespread, public exposure of a major public health issue known as ‘chiropractic’:

    The Chiropractic Conundrum
    http://www.theness.com/neurologicablog/?p=1867

  • @bluewode
    lol, where you conclude I am “upset” from is exemplary of your analytical and deductive skills! I am having a giggle at the expense of the disingenous nature of much of this so-called skepticism, including yours! Steven Novella, much revered in skeptic land will certainly have much of use and value to contribute, but I hadn’t actually read this piece so sorry BW it has nothing to do with anything, idiots making ridiculous posts about stuff they don’t know much about on the other hand is very much source of entertainment to me.
    Take care anyway and I will have a quick read to see whether the Novella reference is yet another non-reference as you are want to produce on a habitual basis…
    Stefaan Vossen Doctor of Chiropractic

  • @BW had a quick look at Novella’s post and thought you might like my views:
    Novella uses terms like “legitimate”, “pseudoscientific”, “magical interventions” or phrasologies like “chiropractors tend to…” and “it is reasonable to presume…”
    Evidence-based is interchangeable with legitemate and scientifc, whereas non-evidence-based practices are interchanged with “magical”, pseudo-scientific” et al… and therein lies the problem: not evidence-based IS NOT evidence of non-effectiveness or as Ernst conceded after much badgering “absence of proof is not proof of absence”…
    Do I think all of the stuff chiropractors do is beyond scrutiny or likely to be anything more than placebo or possibly dangerous?; certainly not, but I do think that some people are being awfully naive by assuming that this is a “profession” they are talking about. They are talking about a number of individuals and they are talking about a field where there is not much else good going on. Some people are forgetting to think about the risks of the alternatives and the implications fo not doing anything…
    According to these definitions there are quacks in every profession, healthcare and otherwise. This does not excuse nor does this mean that the chiropractic profession hasn’t got its work cut out to move forwards. But I do not consider the cloak of hypocrisy habitually employed by so-called skeptics thick enough to cover the blatant bias that lies in these statements. These “evaluations” of the state of a “profession” are farcical with as many assumptions required to underpin a statistic as poles to a pole-house.
    Sorry, it’s a #fail
    Stefaan Vossen

  • Stefaan wrote: “Evidence-based is interchangeable with legitemate and scientifc, whereas non-evidence-based practices are interchanged with “magical”, pseudo-scientific” et al… and therein lies the problem: not evidence-based IS NOT evidence of non-effectiveness or as Ernst conceded after much badgering “absence of proof is not proof of absence”…”

    Stefaan, you are correct in saying that “absence of proof is not proof of absence”. However, I would venture that administering an unproven chiropractic treatment *as if* there were evidence in its favour is unethical, especially when that treatment is likely to have a lesser effect on patients, and a greater effect on the chiropractors (most of whom work in the private sector and have financial interests to protect).

    I think you have to remember that quite a few patients will be loathe to tell you that they aren’t satisfied with their treatment – in other words, demand characteristics are likely to see them telling you that they *feel* better (rather than *being* better) less they should embarrass you and have to admit to themselves that they’ve wasted their money. As for (asymptomatic) patients who return for chiropractic ‘maintenance care’, in many cases they will victims of a big fib delivered by a figure of authority – i.e. victims of a slick marketing tactic used by many chiropractors to ensure that their businesses continuously enjoy a healthy cash flow.

  • @Stefaan

    Your response is not really convincing or reassuring¹. Personally, I think chiropractors probably shouldn’t be allowed to take x-rays unless a GP authorises it or something. Furthermore, even the conventional docs may be overdoing the x-rays² and I was mildly unnerved recently when I was given two x-rays (after the first didn’t ‘come out right’ or something) for a condition which I and they already knew with high confidence was just a kidney stone. Next time I visit my GP I mean to ask if she knows that that happened since I’m not sure the hospital even bothered to record the fact that I had two x-rays instead of one.

    ¹ http://bjr.birjournals.org/cgi/reprint/71/843/249.pdf

    ² http://www.guardian.co.uk/world/feedarticle/9125810

  • @BW
    Who is is you say is administering an unproven treatment “as if” there were evidence in its favour? (and I am assuming that you refer to high quality RCT-based evidence here, right?). Is it the BCA with its “plethora”? The BCA is not a profession, they are an organisation who said and did things which were geared towards something else… Is it the majority of chiropractors out there? If so, I’d love to see what you base that on…I have no problem with sayng to any of my patients that there no evidence whatsoever to support anything I do…they couldn’t care less about the presence or absence of evidence in support of what I do, as long as it works for them. I have no problem telling them they might die from a stroke or be disabled for their entire life being maimed by the treatment. These are risks patients are willing to take and understand are part of the fact that as a clinician I am not god and do not know everything.
    My patients won’t be all that loathe to tell me if they’re not getting better as they wil get their money back if they didn’t get better to the degree I said they would.
    The problem is fundamentally that these discussions are not about what it is really about: the patient. As such they are missing the point rather broadly in the eyes of the clinician… Science is a great thing but it is not deterministic when absent and nor should it be, don’t you think? This is also why I asked @skepticat the big question in regards to how much of modern medicine thinks has been tried, tested and proven… you may find (is my hunch) the percentages to be similar in chiropractic management of the patient. It’s not ideal but neither is it what it is made out to be.
    Stefaan Vossen

  • @phayes,
    how is my answer not reassuring/related in any way to your reference to (yet another) Ernst article?
    Stefaan Vossen

  • Stefaan wrote:

    Listen, I understand that you have been traumatised by your experience and that this is your way of coming to terms with the emotional scars and not just a bit of fun but I think you are getting a bit carried away with the generalisations

    You’d be surprised how often quacks and evangelists resort to this kind of ‘observation’, which is yet another ad hominem and, since you seem to have trouble understanding the term, allow me to explain. Let’s first take a standard definition of ‘ad hominem‘.

    An ad hominem… is an attempt to persuade which links the validity of a premise to a characteristic or belief of the person advocating the premise…

    Ad hominem abusive usually involves insulting or belittling one’s opponent, but can also involve pointing out factual but ostensible character flaws or actions which are irrelevant to the opponent’s argument. This tactic is logically fallacious because insults and even true negative facts about the opponent’s personal character have nothing to do with the logical merits of the opponent’s arguments or assertions.

    In your first ad hom you deflected attention away from what I actually said: ‘there is not a jot of evidence…’ by coming up with something else: ‘there is a jot of good quality scienfific evidence’ but, rather than provide references for such evidence, you call me short-sighted for dismissing this. Well, I haven’t dismissed it. I maintain it doesn’t exist. However, let’s say it does exist. what does your calling me short-sighted bring to the discussion? How does it advance your argument and address mine? It doesn’t. At best (from your point of view) it diverts attention away from the important issue of whether or not there is even a jot of evidence. At worst (also from your point of view) it exposes you as someone who can’t support his argument and resorts to ad hominems to divert attention from them instead.

    As for your second example, often people who are so convinced of something that they are closed-minded to the possibility that they could be wrong, will persuade themselves that the judgement of anyone who disagrees is blighted by negative emotion as a result of some kind of bad experience. This can be a reasonable assessment if there is clear evidence that somebody has had a bad experience. If someone has been abused by priests or beaten up by police, it’s hardly surprising if they distrust all clergy or all police in general and that this clouds their judgment with regard to all such people forever after.

    Now you have decided that I have been “traumatised” by some experience or other and am “coming to terms with the emotional scars”. Fortunately for you, Stefaan, I am not someone who has suffered injury or trauma at the hands of a chiropractor, otherwise your comment would have come across as unbelievably crass and patronising. As it is, it’s just another empty attempt to belittle me and deflect attention away from the argument, to which it adds nothing.

    …your sample-size is a tad small wouldn’t you agree?

    Is that an argument? Let’s have a look:

    P1. Skepticat maintains there is no good quality evidence to support the premise on which chiropractic is based.
    P2. Skepticat only has personal experience of two chiropractors.
    C. Therefore Skepticat is wrong.

    OK, fine. I agree I have limited personal experience of chiropractors. But since I am not claiming my experience of these chiropractors in support of my assertion that there is no good quality evidence to the support the premise on which chiropractic is based, this observation is irrelevant. The reason I assert there is no good quality evidence to support the premise on which chiropractic is based is because I have looked for it and not found it.

    To be clear about what I understand to be the ‘premise on which chiropractic is based’ I am happy to go with the wiki definition.

    Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system...Traditional chiropractic assumes that a vertebral subluxation or spinal joint dysfunction interferes with the body’s function and its Innate Intelligence,

    (My bold).

    If you disagree with this description you are, of course, at liberty to edit the wiki article.

    Finally, both the chiropractors I saw quoted £95 as the price of an appointment at their respective clinics and neither of them mention fees on their websites. However, after considering your comment, I looked at a few other websites and realise that the price I was quoted was probably only for an introductory appointment, which would include the x-rays and that subsequent appointments would undoubtedly be cheaper. I apologise for this error and have amended my post. Thanks for the courteous way you pointed it out to me.

  • Stefaan wrote: “Who is it you say is administering an unproven treatment “as if” there were evidence in its favour? (and I am assuming that you refer to high quality RCT-based evidence here, right?)… Is it the majority of chiropractors out there? If so, I’d love to see what you base that on…”

    It’s based on the following:

    Quote
    “…89.8% of (USA) chiropractors feel that spinal manipulation should not be limited to musculoskeletal conditions…in the UK, the influence of those `vitalists’, who insist spinal manipulation is a panacea, is growing.”
    http://jrsm.rsmjournals.com/cgi/content/full/99/6/279

    Stefaan wrote: “I have no problem with sayng to any of my patients that there no evidence whatsoever to support anything I do…they couldn’t care less about the presence or absence of evidence in support of what I do, as long as it works for them. I have no problem telling them they might die from a stroke or be disabled for their entire life being maimed by the treatment. These are risks patients are willing to take and understand are part of the fact that as a clinician I am not god and do not know everything.

    You might not have a problem with that, but others clearly do:

    Consent: its practices and implications in United Kingdom and United States chiropractic practice
    CONCLUSION: Results from this survey suggest a patient’s autonomy and right to self-determination may be compromised when seeking chiropractic care. Difficulties and omissions in the implementation of valid consent processes appear common, particularly in relation to risk.
    http://tinyurl.com/6ajn5d

    Consent or submission? The practice of consent within UK chiropractic
    CONCLUSION: Results suggest that valid consent procedures are either poorly understood or selectively implemented by UK chiropractors.
    http://tinyurl.com/559ued

    It’s also interesting to note a revealing comment which was made at an inquest in Canada which involved a chiropractor who had allegedly caused a patient to suffer a stroke through neck manipulation. When pressed as to why he wasn’t telling his patients about the “potentially catastrophic injuries and death” which may result from neck manipulation, he said that if he were to tell patients that “I can kill you”, then “half of them would walk out”. (Use ‘Edit’ then ‘Find on This Page’ to locate quote.)
    http://www.chirowatch.com/Chiro-Lewis/oakley-closing.html

    Stefaan wrote: “My patients won’t be all that loathe to tell me if they’re not getting better as they will get their money back if they didn’t get better to the degree I said they would.”

    But what of other chiropractors?

  • @skepticat
    Did the chiropractor you saw tell you what area he wanted to X-ray?

  • Yes. The lower back, where I said I occasionally got an ache when I stood for a long time.

  • @ skepticat I now understand why you think there was an ad hominem attack: you think that the “jot of evidence” is relevant to me, or the discussion. As per my statement: “I quite happily draw attention to the fact that there isn’t much advance in chiropractic research (other than the obvious stuff) because it is completely inconsequential to me and my patients”. I thought that by making that statement quite loud and clear you would have understood that it means that the lack of research evidence is really not of any consequence to me or my patients.
    Like I said before and will say again: whether or not something has a jot of evidence to support an intervention is significant but not deterministic to deciding whether or not the action should or should not take place. If on the other hand there is evidence of it being ineffective it becomes a great deal more deterministic. There not being a jot of evidence is relatively important but not deterministic to most patients, and as my argument to you stands, most forms of healthcare interventions. As such scientific evidence to a clinician reinforces held beliefs, whilst lack of scientific evidence leaves questions. Learning to live with functioning in a world full of questions is the clinician’s plithe. Clinician’s of all healthcare professions.
    Kind regards,
    Stefaan Vossen

    ps there is a jot of evidence for chiropractic care. Even if it is only in assessing manipulative therapies (one of the chiropractor’s tools) for common, mundane chronic biomechanical back pain and similar. That’s why I couldn’t agree to your version of the required “admission” and it makes no sense that I should have to as it is completely misguided (as it implies there is none, even poor quality evidence, all factors which you unfortunately haven’t defined clearly). If you’re trying to “do a Simon” at least have the intellectual courtousy of adding into your statement a clear ramification (like for colic or asthma or something at least).
    pps there is a logical “wiki-loop”: the spinal subluxation might be one of many types of subluxations (some might be mental subluxation for example) and innate intelligence could be the ability to self-regulate and self-repair. Ergo: sources of interference on self-managemnet and self-repair mechanisms cause dysfunction and discomfort. Sounds logical to me, what do you reckon?

  • @Skepticat
    In your previous version of About Skepticat you stated that you were middle-aged. If you are around 50 or supplied some additional information to the chiropractor that you haven’t told
    us, there would be no breach of standards of care for taking an X-ray of your low back. Radiation
    exposure would be miniscule as well.
    This study may at least help you to see why some chiropractors think preventative manipulative
    treatment is worthwhile:
    http://www.ncbi.nlm.nih.gov/pubmed/15129196

  • Thanks for the link, Robin, it looks interesting. I am 53, btw.

  • The efficacy of manipulative therapies only establishes that treatment as a useful method, no matter what practitioner utilizes it; whether a chiropractor, masseuse, physical therapist, etc. It’s utility does not in and of itself establish the credibility of any of these occupations. For this treatment, I would tend to go for the lowest cost.

    Personally, the lack of evidence for the mainstay of chiropractic, subluxations, really scares me away from the profession. If I am the ideal rational consumer economists prat about, then I would choose a professional service that has a lower level of controversy and is least costly; not always a straight forward choice.

    A lot of medical treatments have questions attached to them and I would sort through the menu of options in that profession before consenting to a procedure.

    Word of mouth referrals, stories of wonderful experiences, hands on treatment, etc. induce a satisfied experience in many people. I believe that the recommended treatment for lower back pain, absent observable evidence for a direct causation, is to do nothing.

  • @JimR
    “I believe that the recommended treatment for lower back pain, absent observable evidence for a direct causation, is to do nothing.”
    I am assuming you mean “in the absence of observable…”
    There are two problems with this assertion as interpreted within the above context:
    1)the assumption that this strategry has not already been tested by the patient
    2)the confines and limitations to what you consider “observable”
    On 1) do you have any indications what the duration of symptoms prior to presentation is? I have no stats on this but my own clinic and most of my colleagues it seems to be prevalently chronic (as is entirely understandable considering we have a “free” NHS and most chiropractors work privately-drive to action therefore must be significant)
    On 2) what do you consider “observable”? Looking at things like gait dysfunction and maloclusion problems require skill and some expertise, but very easily observed to those who have that skill and expertise. I chose those two examples because a lot of the unresponsive low back pain I see is either directly or colaterally linked to these two problems either by themselves or linked to co-existing spinal dysfunction. Lots of people seem to consider those dysfunctions (subluxations if you wish) unobservable. As a chiropractor I look at the presence of such dysfunctions to make sure I only manipulate in those cases where the root-cause is indeed spinal, rather than waste patient’s time and money using (amongst others) manipulative strategies where in fact podiatry or orthodontic care would be more effective.
    Also nobody (I think) was saying that manipulative therapy is the sole remit of chiropractors, but neither is the chiropractic tool-bag restricted to manipulative therapies). The fact remains that it is a tool in the bag which happens to have been tested (badly, in my opinion), reason for which I could not agree to skepticat’s terms and conditions for her “admission”.
    Kind regards,
    Stefaan Vossen

  • Stefaan,you appear to have a compulsion to make things what they are not. I have made no ‘admission’ and there are no ‘terms and conditions’. I simply made an assertion that I believe to be true concerning the premise on which chiropractic is based and has been developed. However hard you try to make the communication between us about something else, nothing you have said has impinged on this assertion in any way and that’s fine by me. The fact that there may be a jot of evidence for chiropractic care in some instance or other is irrelevant – I’ve never said there wasn’t – and so is your protestation of the bleeding obvious i.e. that the lack of evidence is “completely inconsequential” to you and your patients. They wouldn’t be your patients and you wouldn’t be a chiropractor if any of you were bothered by a little thing like evidence.

    The only reason I responded to you in the first place is that I was fed up with the way you patronise people in your responses, the way you twist things people say and resort to ad hominems. I urge you take a serious look at your style of engagement because it totally sucks.

  • @skepticat
    Firstly please remember that this is a little light relief for me, and most of it is written with tongue firmly wedged between molars. I think it is pointless to refer back to quotes from you to argue to the contrary, as it is clear to me you have no ill-intentions but are rather trying to argue the finer points of something you know little about. The “I said-you said” argument currently ensuing seems to be confusing matters even more for you, so just in order to clarify: I did not say you made an admission, I on the other hand made one to you in accordance but not agreement to your “There is no way chiropractors can admit that the whole premise on which their therapy is based is a nonsense even though there isn’t a jot of evidence to support it” statement. I must admit I did not clearly understand you were not referring to therapy but to the original philosophical pinciples underpinning the therapy… I am foreign after all and English is not my mother tongue. It does however make mention in your statement of “the premise of their therapy”,… hence my confusion. Of course,… that combined to the salient question to how any person is supposed to provide evidence on a philosophical principle and how on earth it should be relevant or possible for a principle behind a therapy to over-shadow the fact that it works are what caught me out here, but never mind, I am probably getting a bit retentive now…
    Anyway, you seem, by means of the clarification in your last post, to be refining what it is there’s “not a jot of evidence for” in the context of your earlier statement: “There is no way chiropractors can admit that the whole premise on which their therapy is based is a nonsense even though there isn’t a jot of evidence to support it”. I now take it you here refered to the basis of whole premise of chiropractic philosophy, and not the therapy, as the therapy clearly does have a jot of evidence going for it, even if that is really not that significant (unless there was evidence going AGAINST, of course).
    So we are now at the crux of the matter, the principle(s) (the whole premise) of chiropractic philosophy…
    Two questions to you:
    1) does it matter?
    2) what do you believe them to be/what are your sources?
    Few thoughts I’d like to share with you on these topics:
    1)-What the original principles of anything say surely has little if any bearing on the validity of the profession as practiced today. If medicine were to be judged on its original principles it would carry much ridicule, ridicule I feel it really doesn’t deserve, not on its own merits and certainly not on its historical associations. Neither would it be able to provide much evidence at all, a lack of evidence which would not matter greatly at all, as long as patients get better.
    2)-I don’t think you can really seriously argue there is anything wrong with the chiropractic principles but some people have gone into the discussion with some denying it any value because of its Victorian-era, quasi religious expressionism (a posthumus ad hominem attack skepticat?) decrying it as a “religious cult” on the basis of denounciation of the principles of “Universal intelligence” and “innate intelligence”. Maybe they should have a look at the history of Asclepius or more contemporary to Palmer: remember that bearded fella Darwin who was mocked and ridiculed for inferring that we had “evolved” and were not created by God…that was not much before DD Palmer’s writings. And DD Palmer was not half as learned as Darwin, nor in quite as good academic circulation and company. Cut the guy some slack…he was living in hicksville for cris’sake.
    Also just as a quick aside: the basic principles never stated that “all disease is caused by spinal subluxations”… which is what I suspect you are alluding to in your statement “the whole premise on which their therapy is based”. Please let me know if this is wrong. Point is that defining that statement as even part of the “whole premise” is a misrepresentation often used by lots of pseudo-skeptics who never bothered to do their homework. In fact, even if it did say that (which it doesn’t) would that in any way be relevant today? Surely even somebody as deeply scarred as you can see that that could be construed by some to be nonsense, or even short-sighted? Although that does of course does not mean your argument is invalid in any way. Just one more time: subluxation can be interpreted (without sacrilege to any of the principles I think) to stand for “dysfunctional mechanism”. They can be emotional, physical or chemical. If the destructive force of the dysfunctional mechanism exceeds the coping mechanism (innate intelligence) then dysfunction of that system occurs. The different subsystems in the human body are interconnected and may declare symptoms in eachother (physical signs of emotional stress, chemical imbalances due to emotional stress, emotional dysfunctions due to physical diability etc etc) systems which have all evolved by natural selection , natural selection which is by-product of geological, metereological and biological interactions(Universal intelligence).
    Anyway enough fun been had now…
    A patient of mine, who is one of the UK’s leading epidemiologists came in today and we talked about blogs where people with little knowledge about a topic make grand conclusions based on little or no experience or knowledge. He concluded from your comments that “she does not seem to understand clinical reality”.
    I couldn’t have put it any more succinctly myself.
    Kind regards,
    Stefaan Vossen

  • This is slightly off subject as it is specifically about regional back pain.

    Dr. Nortin Hadler, authored “Stabbed in the Back: Confronting Back Pain in an Overtreated Society.” http://www.amazon.co.uk/Stabbed-Back-Confronting-Overtreated-Society/dp/0807833487/ref=sr_1_1?ie=UTF8&s=books&qid=1276620348&sr=1-1

    He was interviewed for a US radio show (62 min.) and the audio files are available till mid-July at:
    http : / / www. peoplespharmacy.com/2010/05/20/770-stabbed-in-the-back/ [URL disabled because of possible malware content]

    The first audio file is a two (hosts)-on-one interview with Dr. Hadler. Five interesting things that I have attempted to summarize my understanding from the interview are:
    1). If you go to your doctor about regional back pain (defined in the interview, but mainly not from a traumatic injury) and he looks at an x-ray and says here is a calcification on L-4 and that causes your pain; Dr. Hadler suggests you say, “Baloney.” The resolution of the common radiograph is too low to see such a thing.
    2). If you say you have gone for a year without back pain, then this is very unusual. Normal life conditions include recurrences of GI irritation, back ache, heart break, etc.; it is the normal human condition.
    3). Going to a chiropractor will nearly always result in the patient reporting that they feel better. The process of intervention is the important factor in the population that will seek out this type of treatment; although, there is no proof that any actual improvement was achieved.
    4). No one should ever have surgery for regional back ache.
    5). There are no drugs, relaxants, steroids, or anti-inflammatory drugs that directly help with the pain.

    The second audio file (60 min.) has a two (hosts)-on-three (guests) interview and starts with a summary of health news (7 min.) then goes to a shorter interview with Dr. Nortin Hadler apparently edited from the first audio file. The second guest is Dr. John Sarno, author of “Mind Over Back Pain”, starting about 30 min. into the interview. He says that most of the pain is from psychology causes: stress, etc. The pain is real, but acts as an avoidance mechanism to distract us from the emotions we are having. Madeline Guven, a patient of Dr. Sarno, joins at interview about 48 min. into the program. She believes that there is a strong mind-body connection and that discovering what is bothering you may alleviate the pain.

    Two nearly identical web pages on back pain:
    Acute: http://www.nlm.nih.gov/medlineplus/ency/article/007425.htm
    Chronic: http://www.nlm.nih.gov/medlineplus/ency/article/007422.htm

  • @Robin

    On 12th June you say, “A chiropractor certainly could and should educate patients to this end. Most practitioners
    of manual medicine have books and have studied techniques from other related disciplines.”

    To me this sounds like chiropractors are trying to find something they can do that is related to human health. That is, trying to find some sort of identity now that the subluxation has, err, ceased to exist. I’ve noticed chiropractic nutrition and brief smoking cessation counselling too.

    You also say that, “Most practioners have books and have studied other related disciplines”. Well I would hope that’s the case if they have completed something like 4000 hours of class room study.

    At the end of this all, I still can’t fathom out quite why chiropractic continues to exist.

    @Stefaan

    The ‘absence of evidence is not evidence of absence’ thing is a bit first-year. Moreover, if chiropractic is evidence-based, then isn’t there simply a bit of a chicken-and-egg thing going on?

  • Stefaan wrote

    Surely even somebody as deeply scarred as you can see that that could be construed by some to be nonsense, or even short-sighted?

    I’ve no idea why you feel the need to be so gratuitously offensive, Stefaan, but taken together with your claim that it’s just “a little light relief” for you, I can only conclude that you are a rather nasty piece of work, as well as a complete idiot and therefore not worth wasting another second of my time on.

  • Thanks, JimR. Very interesting.

  • @AndyGilbey.
    “At the end of this all, I still can’t fathom out quite why chiropractic continues to exist.”
    Why do we need psychologists when we have psychiatrists?
    Chiropractic exists because many people want an alternative to drugs and surgery.
    That’s it, chief. Medical doctors mainly prescribe drugs and do surgery. And when one
    drug causes another problem you get another drug. Haven’t you seen anyone or had family
    that was screwed up by some medical doctor experimenting on them? I see it everyday
    directly or indirectly.
    If you had actually read a little more than Trick or Treatment before you decided to call yourself an expert on chiropractic, you would know that there were disagreements in early chiropractic
    about theories, techniques, direction of the profession, and THERAPEUTIC SCOPE. Chiropractic split into factions almost as soon as it was founded because there was not uniformity in accepting that all you had to do was
    adjust vertebrae and you could cure everything. C’mon, a learned man like you calling himself an expert should have at least researched this a little more.
    As silly as you might think Palmer’s theories were, the alternatives ( medicine and surgery) AT THE TIME weren’t anything to brag about.
    So you have three basic factions in chiropractic. One that believes that all you need to do
    is find and correct subluxations and another that incorporates any type of natural therapy as treatment. Often, non-chiropractic is the only treatment.
    The third type lies somewhere in between and may not embrace the subluxation as
    a cure-all but knows and has seen experientially that we can influence the nervous system
    by our intervention even if the RCTs can’t prove it yet.
    It is possible to treat many conditions with natural methods and substances before loading up
    on drugs.
    And there is competition between chiropractors,osteopaths and physical ( physio)
    and massage therapists. That’s why we are taught THEIR techniques as well. Whatever works.
    The more you know the better. I can apply any therapy or remedy I choose according to my
    license as a drugless practitioner.
    There are plenty of MDs who will give you drugs or surgery when that is really needed.
    And you can walk in off the street and get a general physical examination as well as a medical
    doctor can do which at least puts us ahead of a PT( in theory) which generally requires a referral and possibly a lengthy wait.
    And I don’t care if you call me doctor. That’s an ego trip for anyone who insists they must be
    worshipped and respected more than the rest of us.
    Yeah,there are bad chiropractors. Don’t go to them. Do your homework. Don’t go to bad MDs
    either. That’s what needs change within the NHS.
    Read my post Andy, I’ve answered your questions.
    That is why we exist,why we’re not going away or becoming absorbed into physical therapy.
    Now can we respectfully work together for our public’s sake?

  • I asked my wife this morning:
    Q: “what do you call someone who attacks you, and then is surprised you defend yourself?”
    A: “an idiot”
    She did refine it further later on with “but don’t expect them to change their mind if they have gone to the lengths of setting up a blog about it”
    As is often the case, she is probably right

    This is only the beginning

  • Stefaan

    People might change their minds if provided with cogent, convincing evidence of a contrary position, preferably not surrounded with the unnecessary ‘baggage’ your contributions seem to come with.

    We’re still waiting.

    Perhaps your research project will be the clincher?

  • @Andrew Gilbey

    Chiropractic exists because chronic pain exists and people who are desperate will try anything. The same goes for GPs who’ve exhausted all other possibilities and don’t know how else to get rid of a patient. I’m sure a lot of GPs who refer to chiropractors do so without an iota of faith in the actual treatment but they’ve got nothing left to offer them.

    @Zeno

    I suggest not feeding the troll. Judging by his last comment, Stefaan does seem a particularly desperate example of one.

    @Stefaan

    As you are unable to challenge assertions and arguments without peppering your comments with snide digs or blatant insults you might like to consider signing up for a logic class and learning how to argue properly.

  • Dammit, I got diverted by Stefaan’s trolling and forgot what I meant to post in the first place, which was this:

    phayes said, “…God knows why it is even legal for them to do that..” (offer x-rays)

    to which SV responded:

    “Because some chiropractors are licensed to take and read X-rays, request and read MRI scans. And that’s because they are trained to do so. That’s why. Remember that although skepticat stated she didn’t say there was anything wrong with her in more recent posts, in the original posts she clearly related to the chiropractor in question that she “occasionally got back ache, nothing much.” .

    Don't put something in quotation marks unless it's really a quote, troll.

    What Skepticat actually said was “occasional lower backache when standing for a long time” .

    That some chiros be may licensed to take and read x-rays doesn’t answer why it is legal for them to do so at the slightest of a problem. It actually contravenes NICE guidelines to even offer x-rays for non-specific low back pain, let alone go for the hard sell, as the chiro in question did.

  • Hello. This has been a good hours entertainment.
    I’ve read a few blogs like this, most of them pick up on a couple of mis-phrased sentences and turn them into the argument. That’s what makes it entertaining I think. If everything here was evidence based it would be boring.
    I don’t know any chiropractors who practice using the original DD Palmer philosophy, I’ve never met one who claims to cure cancer or create world peace with one adjustment. The Chiro’s I know and have been treated by have always treated me based on a well respected work by Kolar, Janda etc. In a 20 minute appointment I’d spend maybe 30 seconds getting cracked, the rest would be spent receiving massage, stretching and strengthening techniques and learning about what I can do to stop any further imbalance between muscle groups, joints or whatever. NICE guidelines like manipulation and exercise for non-specific LBP.
    @JimR – Its quite easy to see changes on X-rays, have a look at a Radiology book and they have arrows pointing at ‘calcification’, although it might be termed sclerosis or osteophyte and other fun names, so I’m not sure what the guy on the radio studied.

    If chiropractic could get more funding for research, higher quality trials could be carried out. Until then we have to rely on case studies etc to learn and base their treatment.

    The GCC states: Chiropractic is concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal manipulation or adjustment (World Federation of Chiropractic, 1999).
    Dont use Wikipedia to get your definitions. Chiro in USA is different from over here from what i can deduce.

    I await peoples angry responses…

  • Phil Turner said, “Don’t put something in quotation marks unless it’s really a quote, troll”

    Amen. That is absolutely typical of Stefaan’s ‘debating style’ and why he is no longer welcome here.

  • Hi Cane

    The GCC states: Chiropractic is concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal manipulation or adjustment (World Federation of Chiropractic, 1999).
    Dont use Wikipedia to get your definitions.

    Wikipedia says:

    Chiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system.

    Is there a jot of difference?

    Well, yes. While wiki states in no uncertain terms that the hypothesis that mechanical disorders of the musculoskeletal affect general health via the nervous system is a hypothesis, the GCC treats it as a given.

    Which it isn’t.

  • However the wording of the GCC quote uses the word “and” not “on”, musculoskeletal disorders affect the nervous system AND general health. It doesnt say the musculoskeletal dysfunciton affecting the nervous system has a direct effect on general health e.g. causing cancer or diabetes.
    Chiropractors see a lot of people with nerve compression, not just around the spine but also things like carpal tunnel etc. If people have some relief from chronic pain this can improve their general health as they can then regain normal exercise regimes and their body isn’t being filled with things like tramadol.
    On the point of MDs etc, they do a good job a lot of the time but I have a large portion of patients who have been on meds from their GP for 4 months, if they’re lucky they’ve had a session with a physio (which consisted of no physical contact, just a sheet of exercises). Its understandable they go to a chiropractor, not everyone gets better but the majority do, and then feel frustrated they’ve put it off for 4 months.

  • Cane wrote: “The GCC states: Chiropractic is concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system and the effects of these disorders on the function of the nervous system and general health. There is an emphasis on manual treatments including spinal manipulation or adjustment (World Federation of Chiropractic, 1999).”

    FYI, it’s worth noting another one of the World Federation of Chiropractic’s definitions. This one was published in 2005:

    Quote
    On June 15, 2005, the World Federation of Chiropractic, at its 8th Biennial Congress26, unanimously agreed that chiropractors should be identified as “…spinal health care experts in the health care system…with emphasis on the relationship between the spine and the nervous system…” This definition fails to place proper limitations on chiropractors who use spinal adjustments to treat general health problems, plunging the profession deeper into pseudo-science and away from establishing an identity for chiropractors as back-pain specialists.”
    http://jmmtonline.com/documents/HomolaV14N2E.pdf

  • Cane wrote: “…if they’re lucky they’ve had a session with a physio (which consisted of no physical contact, just a sheet of exercises). Its understandable they go to a chiropractor, not everyone gets better but the majority do, and then feel frustrated they’ve put it off for 4 months.”

    Interesting. That’s very similar to Edzard Ernst’s conclusions about the results of the 2004 BEAM trial:

    Quote
    “…the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch. If this “devil’s advocate” view is correct, the effects have little to do with spinal manipulation itself.”
    http://www.bmj.com/cgi/content/extract/330/7492/673-c

  • “…the data are compatible with a non-specific effect caused by touch: exercise has a significantly positive effect on back pain which can be enhanced by touch. If this “devil’s advocate” view is correct, the effects have little to do with spinal manipulation itself.”

    – The nhs phyio’s should spend more time making contact then.

  • Cane wrote: ” – The nhs phyio’s should spend more time making contact then.”

    But they might think that would encourage patient dependency.

  • That sounds terrible! People getting better so they want to continue with care…gosh. Probably better that they stay in pain, you’re right.

  • Cane, Sorry I’m not sure which ‘and’ you mean and how you think it makes a difference. Who’s talking about cancer and diabetes? I’m not sure I’ve known a chiro claim to be able to treat these but I have met two chiros who claimed that digestive problems could be treated by making adjustments to the spine. When I asked the first one what the spine had to do with digestive problems she spoke vaguely about the nerves all being connected. (Blogged here). That sounds like a classic example of a traditional chiropractic explanation. I’ve also seen countless websites making claims about being able to treat infant colic, bedwetting, asthma and ear infections. I have to assume they would give the same explanation – otherwise what explanation is there for claiming that chiropractic can cure something like asthma?

  • I was using cancer and diabetes as examples as I’ve heard stories of some american evangelical style chiro’s claiming to cure these conditions in the past. These guys are hardcore DD 1920′s theory chiro’s and make up 0.01% of the profession (I dont think they practice now, but they would have been stopped advertising like that).
    Except for a mindless few who claim to cure asthma, Chiro’s might rarely offer to help treat (not cure) asthma. As an asthma sufferer myself, whenever I get a bad spell, things are made a lot easier when i get treated – when breathing is bad the secondary respiratory muscles become more active and tighten up and therefore cause restriction around the bones they insert into (ribs, spine, clavicle). It makes a big difference when i can take a full breath without working too hard to force my ribs to expand.
    As for the others, I have no idea. I know there’s been hundreds of cases of colic eased (not cured) through chiro treatment. Recent research on otitis media has been inconclusive with some evidence for, but not statistically relevent.
    The important word is treat, not cure. Anyone who advertises that they can cure the conditions is about as reliable as Ernst.
    I will put >>x<>and<< general health. There is an emphasis on manual treatments including spinal manipulation or adjustment (World Federation of Chiropractic, 1999)."
    The "and" makes a huge difference. I dont go to buy milk and bread, that would be a little moist if they were the same thing, i get them seperatly.
    "Well, yes. While wiki states in no uncertain terms that the hypothesis that mechanical disorders of the musculoskeletal affect general health via the nervous system is a hypothesis, the GCC treats it as a given." – given your love of evidence, its strange that you have made the assumption here that the GCC takes it as a given.
    By the way, I must compliment you on how you draw people into these debates.
    £95 for an initial assessment is disgusting – unless you live in central london perhaps. It's £35 where I go, X-rays are a tool to be used only when they are needed, not because Chiro's can.

  • @ Phil Turner
    I’ve signed up for your serious argument clinic. I hope it meets your approval:
    http://www.youtube.com/watch?v=kQFKtI6gn9Y

  • Cane said: “Except for a mindless few who claim to cure asthma, Chiro’s might rarely offer to help treat (not cure) asthma.”

    I found 19% of around 300 chiros making claims about asthma: what do you think the difference between ‘treat’ and ‘cure’ is?

  • @ Zeno
    Big diff between treating and cure. You treat or control Hypertension and diabetes.
    And usually the MD will use step-therapy. Let’s try this first and see how you do then if that
    doesn’t work we’ll try something different or add to that. A very scientific approach.
    Did you even read the responses to this post? (19% of around 300 chiros)

  • Yea, like Robin said. There is a huge difference.
    A cure is the end of a medical condition.
    Treating something is a way of reducing or controlling symptoms.

  • @ robin

    Brilliant link – thanks! :-)

  • Robin

    So ‘treat’ is a claim that chiro affects the condition and ameliorates it in some way or to some degree, but not actually eradicate it?

    I assume you’re not in the UK, but here, I don’t think the GCC would accept any claim that chiro cures or even treats asthma or diabetes. Such claims are just not supported by the evidence. In fact, the Bronfort Report says of hypertension that spinal manipulation is not effective. And by its omission, there is also no evidence for diabetes.

    Of course, it’s the non-statutory, marketing budget-funded, ‘voluntary’ Advertising Standards Authority who effectively control the claims made by chiros – they would not accept any such claims either and would consider – quite rightly – a claim to treat just as seriously as a claim to cure. Unless the chiro advertiser had robust scientific evidence to back up that claim, that is.

    You said: “Did you even read the responses to this post? (19% of around 300 chiros)”.

    Can you explain what you mean?

  • @Skepticat

    “…why he is no longer welcome here.”

    Please, please, please, do not ban Stefaan. Everyday I look forward to seeing what he’s going to write next. I strongly suspect, so does he!

  • He will no doubt continue with his interventions over at Zeno’s blog and elsewhere for you, Andrew. ;-)

  • @ Zeno
    I was suggesting that the responses to your post ( 19% of around 300 chiros) are more
    interesting and thought provoking than this usual “extracting the michael” from the chiroquactors
    ( as they are described).
    One cannot argue that the Brontifort report is what it is. If your only complaint is that chiropractors
    are publicly making claims for conditions not supported by the studies reviewed
    that time, I’ll buy that.
    There is a section in the Brontifort report that says:
    Chiropractors are reminded that

     they must provide evidence based care, which is clinical practice that incorporates the best
    available evidence from research,

    AND
    the preferences of the patient and the expertise of practitioners, including the individual chiropractor her/himself .

    What do take the second line to mean?

    Do you think possibly some chiropractors get the positive results for which they make (unsupported) claims in daily practice or do you only think they’re only trying to swindle the public?

    C.O. Watkins, D.C. urged decades ago, resolve to be bold in what we hypothesize but cautious and humble in what we claim.

    Is that OK with you?

  • The nervous system side of things is often overlooked as precursors to spinal dysfunction.
    Any loss of proprioception can lead to joints being pushed beyond their comfortable means leading to sprains strains excess forces etc. Retrain the proprioception and the joints will be more stable and less at risk of injury. How many chronic cases of low back pain could be stopped by some simple retraining?
    The obliquues capitus inferior muscle in the neck has 252 muscle spindles per gram of muscle (compared with 16 spindles per gram in the lumbricals of the hand). As we age our vestibular sensitivity declines, and if spinal motion decreases, the proprioceptive feedback from these spindals decreases placing a massive burden on the visual balance systems. Maintain this motion in the spine and the proprioception has a nice boost, which can help prevent falls etc in old age.
    A small nugget of an example i know, but lets not forget the importance of chiropractic and the nervous system. Dont confuse “straight” chiropractors with the new “mixed” chiropractors. The two professions are vastly different.

    “the preferences of the patient and the expertise of practitioners, including the individual chiropractor her/himself .” – Clinical experience is the way in which we get ideas for research and proof. If nobody treated anything without solid RCT evidence of effectiveness we’d still be in the medical dark ages. Give it more time. However, the profession must be more careful with advertising – something they have cracked down on recently. Its only serving to damage the profession from within due to blogs like this. Im sure when the unproven marketing is gone the bloggers will find something else to shout about.

  • and when i say “damage the profession from within due to blogs like this” – Ignore the “…due to blogs like this”. blogs like this just use it as a good excuse to bring the whole profession down, when it could be dealt with quietly through the GCC.
    Dont forget, chiropractors get into the profession to help people, not for money. Sure some stray to the dark side putting profits over professionalism but thats true in every industry (including journalists…), but if all they wanted was money they’d be working in another profession.

  • @Cane

    Do you have a reference for the information about proprioception? Particulary how this would be used by chirorpactors.

    Do chiropractic advertisments normally state whether they are for a straight or a mixer? I’ve looked at quite a few chiro ads over the last few years and can’t say I’ve seen this distinction being made.

  • Hi Skepticat,

    Good stuff. I’ve not read all the comments yet but have a feeling I’m guilty of being a member of the ‘overuse of single quotation marks’ society. Oh, well.

    Anyway, thought I’d share a link to my newest, favoritest, quack. He’s a chiropractor who not only says small-minded things about health, but people too. More specificially, children; even more specifically, children with autism. Here he is on Youtube using language like, “This kid was really messed up,” plus lots of other good ones. If you can tolerate watching, here you go…hand gestures and all:

    http://www.youtube.com/watch?v=3fYuW55VPiY

    Oh, poor Bill, Billy!

  • Thanks, B. After seeing that I feel like slashing my wrists.

  • @B HArris

    Well found! Cripes!

    That said ;-), I still reckon Drheatherosst, also on youtube, trumps your fellow as she does baby’s, neck cracks, facial activators the lot.

    Maybe we should have a game of chiropractic claims trumps.

    Now this would all be quite innocent fun, were it not for the fact that some people are taken in by it.

  • Forget that last post – this one has to be the best ever: http://www.youtube.com/watch?v=YaJ3ovzJsjE

    This guy seems to advocate chiropractic rather than conventional medicine for cancer!

  • Have any of you looked at the claims osteopaths make too? Quite similar if you have a trawl through the websites apparently, they must be purely money driven just like chiro’s, both professions can’t possibly see results with things like asthma and colic can they??? surely not… (sarcasm is the lowest form of wit, yet probably an applicable form for this forum).

    @andrew gilbey – exact references, not at hand – internet is my down time. But, try reading a neurology book or even anatomy books (at a long shot, wikipedia ‘muscle spindles’). You will see that in order for muscle spindles to provide proprioceptive feedback they must be stretched…if there’s limited movement in a joint then there is limited stretch in the muscle and therefore limited proprioceptive feedback.

    Its not law to identify yourself as a specific type of chiropractor. sadly. The straights could call themselves Chiroquaks or something maybe. But who am I to question their beliefs and philosophys?

    @skepticat – I like your comment on that video from B Harris.

    A note on the maintenance treatment thing, people feel the benefit or they wouldnt keep going. In my practice, maybe 20% of patients decide to come every few months and usually they’ve been having one or two problems in that time. The other 80% come with a problem, get the problem sorted and we discharge. The ones who come back often don’t want to do the exercises etc that will reduce the flare ups so they take an easy option that gets them out of discomfort, they’re happy with that, the others tend to have chronic complaints or disabilities which are eased with treatment, most of them have tried the NHS route and found very little help. If a patient ever felt hard done by for coming back, I would talk to them about it and tell them not to make another appointment unless they needed to. Im sure this is the same for a lot of chiro’s, it certainly is of the 6 or 7 that I know in the same town. We like to help people, not rip people off.

  • @andrew gilbey – that video is a terrible account…if a chiro were to delay proper cancer treatment they should be put away. If she is a real patient, i bet she was misdiagnosed with cancer and the follow up would have confirmed that.

  • @Cane

    “Have any of you looked at the claims osteopaths make too?”

    http://skepticbarista.wordpress.com/?s=osteopaths

  • Skepticat,

    Oh, did I need that laugh!

    Andrew Gilbey,

    Are you referring to this?:

    http://www.youtube.com/watch?v=HFqEXLcOWD0

    Though I had to think it over, I do think your video might have mine beat. At least Bill Billy could possibly possess the strength to take a swipe at the ‘Goodfellas’ looking thug who’s fraudulantly attempting to cure him of everything. The newborn baby, on the other hand, is completely defenseless against her thug. Actually, that would be thugs – the sickening chiropractor plus the mom!

    Look at the caption: “…his monthly wellness adjustment….” Monthly?! How many months could there possibly have been up to that point?

    I do hope that girl in Texas is fibbing and that she always had been and always will be okay.

  • @B Harris

    Yes, that’s the one – Sorry I should have added a link

    @Cane

    Where you say, “i bet she was misdiagnosed with cancer and the follow up would have confirmed that.” Very good point – I overlooked that possibilty.

  • I have read the ‘debates’ being carried out here and on Zenos blog, the latter I feel no need to revisit as I have said me piece.

    My concerns are why any of my colleagues would really wish to continue to post here.

    To our profession, our patients and the vast majority of the world (and it would seem that we can include the support of American President and his administration in this);

    1) Our in depth science based undergraduate education (not dissimilar to undergraduate medicine), is not in doubt.
    2) Our abilities to function as primary contact health care professionals with the ability to diagnose, manage and treat our patients to their satisfaction, is not in doubt.
    3) Our evidence, which is as good if not better as other manual medicine professionals to include osteopathy and physiotherapy, is not in doubt.
    4) Our varied treatment skills, safety record and approach to musculoskeletal medicine, is as good if not better as other manual medicine professionals to include osteopathy and physiotherapy, and is not in doubt.
    5) Our ability to function professionally, appreciating all professions have bad apples and Shipman and computer hackers spring to mind, and is not in doubt.
    6) Where as we state that we are Chiropractors, with all that that entails, there is not a jot of evidence to suggest that the more vocal people on this blog or in fact zenosblog are university educated, other health heath care professionals or have the education allowing them to be able to correctly assimilate the information offered and thus and debate the subject adequately, this is not in doubt.
    7) That a percentage of people who disagree with either Zeno or Skepticat or some of their entourage, or who offer information that they are unwilling or incapable of understanding are banned, this is not in doubt.

    In summery, we know our educational standards, we know what we do works, our patients know what we do works, we know, like many other manual professions , that we need more evidence but we know that we will survive, we know that we will continue to grow. We also know that we will be what we will be, in spite of people like Zeno or Skepticat, rather than because of them.

    Therefore trying to debate, talk sense, offer reasonable or rationale trains of thought and through an intellectual process, attempt to change minds, is wasted on people who are unwilling or incapable of reason and whose sole purpose in this debate seems to be to decry or destroy the chiropractic profession. ….so why give them the time of day.

    My advice to all my colleagues here is, please don’t post, it gives them a credence that they genuinelly don’t deserve.

    Lets leave them to their ‘party hats and ice cream’ and get on with what we do best, treating patients.

  • Finally got round to having a look at your blog. Loving your work, Sarah, all the articles I’ve read have been excellent. It was really nice meeting you and hope your workload is finally easing off a bit! Cheers ;-)

  • Anagram nonsense:

    Phatic* + Horror = Chiropractor

    *http://en.wikipedia.org/wiki/Phatic

  • Hello Skepticat, and all,

    Here’s another video I can share:

    http://www.youtube.com/watch?v=vyMBxDyvOcI

    While this guy is your typical lumphead chiropractor, within what he says is of note. And shows the way these kind of frauds really know how to skirt around the licensing laws.

    I know the video is torture to sit through… But at first there’s the innuendo that he is capable of making a medical diagnosis – in this case hypothyroidism (his focus on only that one aspect of thyroid disease is itself suspect). As the interview goes on it becomes clear that in order for someone to be “qualified” to be his patient, that person must first have been diagnosed and be on medication (courteous of a doctor with a more adequate license).

    So, his service is to help in some way with maintenance, right? Especially for those who are currently on medication that’s not working, right? But he doesn’t go into much detail on how he himself helps with that. He does, however, mention that of his approach: It takes a highly-motivated person; it’s for those interested in taking control; the miracle is really inside of you. Hmmm. Sounds like you’d better be on your toes and in tip-top shape before showing up to an appointment with this guy!

    One thing he’s says at the end is just absurdly wrong. He says there are seven different thyroid conditions but only one requires hormone medicine. Wrong! Plus that book he’s plugging is known even within the ‘fall for everything gang’ as useless.

    Between the misleading way this guy represents himself; the sexist remarks he makes about his wife; and the flaky host. Oh, dear! But my point is that everyone needs to be aware of marketers like this.

    Don’t care for thyroid disease, here he is talking about diabetes:

    http://www.youtube.com/watch?v=-g2yBFlEWuA&feature=related

  • @B Harris
    I watched the two videos and there is no indication he is DC anytime during the interviews. I guess that’s one way to fly under the radar. Pretty neat marketing hook to imply that you will not be taken unless qualified.
    Looking at the schedule for San Diego Living he is on twice this week. That’s a lot of air time. It implies he has a sufficient following to be an asset to the show. I cannot believe the San Diego area has a shortage of interesting talent.

  • How true! The show plugs this guy without a mention that he’s actually a chiropractor.

    Yeah, you’d think San Diego could do better(?). Especially since they’re relatively close to Hollywood. Or to a skeptic would that be Hollywoo?

    (Sorry, couldn’t resist that corny joke; it’s getting late…)

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