Chiropractic under attack and fighting back

[jhunter1163]

http://www.worldchiropracticalliance.org/news/busads2.htm

I'm conflicted about this. I know the guy who runs the World Chiropractic Alliance, and he's the woo-est of the woo as far as chiropractic is concerned. Even a lot of mainstream chiropractors disavow this guy. And, for the record, let me state that I've worked in chiropractic offices in my past life quite a bit and I do believe that chiropractic is beneficial to SOME people, with certain specific conditions. However, it isn't the panacea that a lot of them say it is. I'd estimate that 60 percent of chiros are either woo or shysters (or both), and I've been around them long enough to know of what I speak.

That being said, I don't believe that trying to capitalize on public distrust of chiropractors is ethical. I don't know who's behind the "Chiropractic Stroke Victims Awareness Group", but if I had to guess I'd say that attorneys are involved. And if that's the case, it's just flagrant trolling for business. Any comments?

<edit> Link to CSVAG: www.neck911usa.com

 

[gumboot]

According to their about page:

Services Provided
MEDICAL
A review of the diagnosis and the extent of the neurological damage. Neck911 will offer an opinion as to any other tests that may be necessary.

LEGAL
Without cost Neck911 will review legal documents including a Statment of Caim. Your Attorney can contact neck911 directly. Information is distributed on a need to know basis to a wide variety of consultants. Attorneys from across North America are available.

EDUCATIONAL INFORMATION
Speakers are available for medical meetings, seminars, conferences as well as for individuals.

-Andrew

 

[stup_id]

1 comment, if you accept all the chiropractic therapy but not the woo.. why wouldn't you just use fisioterapy?

Fisioterapists are quite certified, have more medical background and possibly won't commit the same mistakes some chiropractors have done which made them elligible for lawsuits

 

[George]

http://www.worldchiropracticalliance.org/news/busads2.htm

does Mr. Randi agree or disagree with this hypothesis?

<edit> Link to CSVAG: www.neck911usa.com

What hypothesis?

 

[brodski]

http://www.worldchiropracticalliance.org/news/busads2.htm

I'm conflicted about this. I know the guy who runs the World Chiropractic Alliance, and he's the woo-est of the woo as far as chiropractic is concerned. Even a lot of mainstream chiropractors disavow this guy. And, for the record, let me state that I've worked in chiropractic offices in my past life quite a bit and I do believe that chiropractic is beneficial to SOME people, with certain specific conditions. However, it isn't the panacea that a lot of them say it is. I'd estimate that 60 percent of chiros are either woo or shysters (or both), and I've been around them long enough to know of what I speak.

That being said, I don't believe that trying to capitalize on public distrust of chiropractors is ethical. I don't know who's behind the "Chiropractic Stroke Victims Awareness Group", but if I had to guess I'd say that attorneys are involved. And if that's the case, it's just flagrant trolling for business. Any comments?

<edit> Link to CSVAG: www.neck911usa.com

Well, as the WCA seem to be fighting some imaginary daemons they call "allopathic skinheads" they seem wooed up to the eyeballs. They also seem to think that the appropriate response against criticisms of their "beloved" system of medicine is vandalism, as well as threatening pointless legal action (there is no way that they will win a libel case in the US based on those ads). There is some evidence of some benefit for chiropractic methods in some instance of back complaints, however all the evidence indicates that more evidence based practices, such as physiotherapy are much more effective, and safe. I don't see what is wrong with using lawsuits to try and force a little regulation onto chiropractors, they seem totally unwilling to try and regulate themselves, possible because the whole basis of their practise is a thoroughly debunked and discredited medical philosophy.

 

[Blue Wode]

I don't know who's behind the "Chiropractic Stroke Victims Awareness Group", but if I had to guess I'd say that attorneys are involved. And if that's the case, it's just flagrant trolling for business. Any comments?

Here's some background:

Because the ad points to the Neck911 Web site, many chiropractors assume the Chiropractic Stroke Victims Awareness Group owns the site. That is not true, however. Neck911 is a network of professionals who provide consultations on complications due to neck manipulation [2]. Its Web site is operated by John W. Kinsinger, M.D., an anesthesiologist who has investigated many chiropractors [3]. Dr. Kinsinger told me that neither he nor Neck911 had anything to do with the content or placing of the ads.

http://www.chirobase.org/08Legal/bus_ad.html

You can read more of Dr William Kinsinger’s views on chiropractic here:
http://quackfiles.blogspot.com/2005/12/kinsinger-letter-chiropractic-at.html

And here’s a video link to a presentation that Dr Kinsinger gave called “Chiropractic neck manipulation can cause death or injury”:
http://quackfiles.blogspot.com/2005/12/chiropractic-neck-manipulation-can.html

Stup_id

1 comment, if you accept all the chiropractic therapy but not the woo.. why wouldn't you just use fisioterapy?

This seems to be what the whole chiropractic issue boils down to.

 

[jon]

Well, as the WCA seem to be fighting some imaginary daemons they call "allopathic skinheads" they seem wooed up to the eyeballs. They also seem to think that the appropriate response against criticisms of their "beloved" system of medicine is vandalism, as well as threatening pointless legal action (there is no way that they will win a libel case in the US based on those ads). There is some evidence of some benefit for chiropractic methods in some instance of back complaints, however all the evidence indicates that more evidence based practices, such as physiotherapy are much more effective, and safe. I don't see what is wrong with using lawsuits to try and force a little regulation onto chiropractors, they seem totally unwilling to try and regulate themselves, possible because the whole basis of their practise is a thoroughly debunked and discredited medical philosophy.

Yeah, these allopathic skinheads sound good, but how do I tell them apart from homoeopathic ones

As lobby groups go, the neck911 site seems comparatively measured. They argue that:

The real concern should not focus on the frequency of this occurence but rather on risk/benefit ratio. No matter how infreqent the complication, if there is little or no benefit to the procedure, then a complication as severe as death can not be risked. This is the case with regard to chiropractic manipulation of the highest part of the neck. It is a procedure that is used to treat everything from ear infections in babies to high blood pressure and epilepsy in adults. There is no evidence of any benefit for the majority of the ailments that this procedure is utilized for.

Seems fair enough - just asking that some risk/return analysis be applied to chiropractic treatment. Even the case studies part of the site isn't 'evil chiropractors ruined my life stories', but starts with a search of the published literature. Compared to the BS some chiropractors spew about 'allopathy', seems like a very measured account of chiropracty.

 

[arthwollipot]

I've had some good results from chiropractors treating a limited range of neck and back problems. I certainly don't agree with those chiropractors who claim that it can cure everything from cancer to haemorrhoids.

Come to think of it, this is also what P&T said in their "Alternative Medicine" episode of Bull$h1t.

 

[Mojo]

Seems fair enough - just asking that some risk/return analysis be applied to chiropractic treatment.

But it's well known that this sort of analysis is unfair to therapies that don't have demonstrable benefits.

 

[jhunter1163]

The WCA is NOT representative of the mainstream of chiropractic, as much as it has a mainstream. Terry Rondberg is nuttier than my Christmas fruitcake. He's always ranting on about the evils of the subluxation, when there's no definition of what a subluxation is. If you read the news on his website you'll get the idea. He's even at war with the ACA (American Chiropractic Association) because, I suppose, he doesn't think they're woo enough.

Consumer-protection tip #1-if a chiro tells you that his practice is "subluxation-centered", run, don't walk away.

Consumer-protection tip #2-if a chiro tells you that you need daily adjustments for any reason, see #1 for action steps.

 

[brodski]

The WCA is NOT representative of the mainstream of chiropractic, as much as it has a mainstream. Terry Rondberg is nuttier than my Christmas fruitcake. He's always ranting on about the evils of the subluxation, when there's no definition of what a subluxation is. If you read the news on his website you'll get the idea. He's even at war with the ACA (American Chiropractic Association) because, I suppose, he doesn't think they're woo enough.

Consumer-protection tip #1-if a chiro tells you that his practice is "subluxation-centered", run, don't walk away.

Consumer-protection tip #2-if a chiro tells you that you need daily adjustments for any reason, see #1 for action steps.

But the point is chiropractic medicine offers unique and useful medical benefits, unfortunately what is unique isn't really beneficial, and what is beneficial isn’t unique. Chiropractic medicine started out fully woo, based on the idea that ALL illnesses where essentially mechanical in nature, slowly a group of more rational chiropractors have tried to steer the practice towards the areas where there is evidence of efficacy, unfortunately, as I said before, once you strip of the woo you are pretty much left with a subset of physiotherapy, calling this practise "chiropractic" is misleading.
It would be like homeopaths using non homeopathic preparations of quinine to treat malaria, claiming that they where using "evidence based homeopathy", when in fact they would be just using a treatment which had already been proven effective, and has nothing to do with homeopathy.

 

[jhunter1163]

My contention is that distortion of the facts is just as wrong when applied to a woo-practitioner as it is when the woo is the one doing the distorting. Chiropractic manipulation of the spine is safe and effective for low back and neck pain. It is true that there is a risk of stroke from manipulative therapy; however, the risk is very low. The chiropractor I worked for had performed upwards of 100,000 cervical spine adjustments by the time I left his employ; he had had one patient suffer a transient ischemic attack (not a stroke) and this patient had insisted on an adjustment after he examined her and initially refused to adjust her on the grounds that she was showing neurological signs that warranted an MD visit. So in my experience, the risk is 1 in 100,000. That's considerably better than the risks of side effects of most medications.

If anyone has hard numbers on the actual risk of stroke following chiropractic adjustment, let's put them out there.

 

[Blue Wode]

The chiropractor I worked for had performed upwards of 100,000 cervical spine adjustments by the time I left his employ; he had had one patient suffer a transient ischemic attack (not a stroke) and this patient had insisted on an adjustment after he examined her and initially refused to adjust her on the grounds that she was showing neurological signs that warranted an MD visit. So in my experience, the risk is 1 in 100,000.

But what about the patients who don’t stroke out in chiropractors’ offices?

…one must consider underreporting: if a patient suffers a serious complication after spinal manipulation, her chiropractor is unlikely to see her again, and the physicians who do might not think of a link between manipulation and the adverse effect. And even if they consider an association, are they likely to publish this as a case report? Moreover, none of the prospective studies available to date have enough power to detect events that occur less frequently than 1 in approximately 500 patients.

Life-threatening complications of spinal manipulation
Ernst E, Stroke, 2001 Mar;32(3):809-10
http://stroke.ahajournals.org/cgi/content/full/32/3/809?ijkey=B1cBViHFXxaTk

As for your claim that the risk of stroke from manipulative therapy “is very low”, the fact is that the true risks are currently not known:

It is concluded that serious cerebrovascular complications of spinal manipulation continue to be reported. Their incidence is unknown. Large and rigorous prospective studies are necessary in order to define the risks of spinal manipulation accurately.

Cerebrovascular Complications Associated with Spinal Manipulation
Ernst E., Physical Therapy Reviews, Volume 9, Number 1, March 2004, pp. 5-15(11)
http://www.ingentaconnect.com/content/maney/ptr/2004/00000009/00000001/art00002

What’s more, evidence is beginning to emerge that neck manipulation is not a recommendable treatment:

Our results suggest that adverse reactions to chiropractic care for neck pain are common and that despite somewhat imprecise estimation, adverse reactions appear more likely to follow cervical spine manipulation than mobilization. Given the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain.

Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study
Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM, Spine. 2005 Jul 1;30(13):1477-84.
http://www.ncbi.nlm.nih.gov/entrez/...uids=15990659&query_hl=23&itool=pubmed_docsum

Spinal manipulation for neck pain is a treatment with unknown benefits and unknown harm. Because of this and the fact that serious risks are on record, a responsible risk–benefit assessment cannot ignore the risks and cannot come out in favour of spinal manipulation. Remember the supreme law in medicine: first do no harm. Other therapies for neck pain exist, e.g. exercise, which are supported by at least as good evidence for benefit and which are at the same time free of significant risks. The inescapable recommendation based on the best evidence available today is to use exercise rather than spinal manipulation as a treatment for neck pain.

Spinal manipulation for neck pain – more good than harm?
Ernst E, Focus Altern Complement Ther 2004; 9: 107–10
http://journals.medicinescomplete.com/journals/fact/current/fact0902a06d01.htm

 

[jhunter1163]

There are figures re: documented CVAs associated with chiropractic manipulation here:

http://www.theelementsofhealth.com/uploads/Chiropractic Care Risks.pdf

I'm not disputing that the risk is there, nor should it be minimized. But, by the same token, it should not be exaggerated. The paper above puts the risk of death from complications due to ulcers related to long-term NSAID use at 1 in 2,500. You sure don't see THAT number trumpeted on buses.

I don't want to give the impresson here that I'm some pro-chiro woo. There is so much hucksterism and outright deception in that industry that I left utterly disillusioned. There are responsible chiros who practice sound medicine, but they are a minority. My purpose here is to try to give a fair hearing to the chiros, nothing more. I'm not out to win converts.

 

[Blue Wode]

I'm not disputing that the risk is there, nor should it be minimized. But, by the same token, it should not be exaggerated. The paper above puts the risk of death from complications due to ulcers related to long-term NSAID use at 1 in 2,500. You sure don't see THAT number trumpeted on buses.

…this has not been studied scientifically, and a true comparison would have to take many factors into account:

No prospective randomized trial conclusively demonstrates that chiropractic management reduces the incidence of serious NSAID complications, such as fatal gastrointestinal bleeding. NSAIDs taken at recommended doses for a short time are generally very low-risk for appropriately selected patients -- particularly the relatively young not on corticosteriods, anticoagulants, alcohol or tobacco and without a history of ulcers or severe comorbid illness.

Many patients continue to take NSAIDs while undergoing spinal manipulation. Moreover, spinal manipulation can frequently cause an exacerbation of pain, which might cause some patients to increase or initiate NSAID therapy. [Ernst E. Prospective investigations into the safety of spinal manipulation. Journal of Pain and Symptom Management, 21(3): 238-242, March 2001].

Herbal recommendations seem to be common among DCs; some remedies have actions similar to NSAIDs, while others directly affect bleeding per se. A recent set of reports by the North American Spine Society includes an 18-page reference chart listing approximately 70 herbs with their uses, potential side effects, and (known) potential interactions.

While side effects of low-back manipulation appear to be very uncommon, some chiropractic back-pain patients also receive neck manipulation, which entails additional risks.

Manipulation is much more expensive thatn NSAID treatment. So if both are equally effective, manipulation would be much less cost-effective.

http://www.chirobase.org/18CND/03/03-03.html

It’s also worth remembering that NSAIDs/OTC medicines contain Patient Information Leaflets which give warnings about potential serious side-effects – something which, as a matter of informed consent, all licensed health professionals are required to give their patients prior to treatment in order that patients can make fully informed choices. Now, if the following study is anything to go by, such informed consent is being largely ignored by chiropractors here in the UK:

Ninety-three percent said they always discuss minor risk with their patients but only 23% report always discussing serious risk… Results suggest that valid consent procedures are either poorly understood or selectively implemented by UK chiropractors.

Consent or submission? The practice of consent within UK chiropractic
Langworth JM, le Fleming C, J. Manipulative Physiol Ther., 2005 Jan;28(1):15-24
http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=15726031&dopt=Abstract

 

[RSLancastr]

And, for the record, let me state that I've worked in chiropractic offices in my past life quite a bit {snip}

Was it in ancient Egypt? In the court of Charlemagne?

 

[jhunter1163]

The point is that taking NSAIDs over the long term elevates the risk of complication and death. The paper I linked to places the risk of stroke from chiropractic at between 1 and 3 per million adjustments. Perhaps the LONG-term risk of death from complications of NSAID use is lower than 1 in 2,500 but I bet it's higher than 3 in 1,000,000.

And again, I'm speaking as a disillusioned supporter of chiropractic. There are any number of reasons why. Singer, Parker, Schofield, Rondberg.. their message is all the same.. "you can and should make LOTS of money by treating patients for this nebulous concept called "vertebral subluxation" on a frequent basis that isn't supported by their actual medical condition."

Apologies to the good chiros out there, and I know there are some, but even they have to be nodding their heads at what I say. Everyone sees the mailings, everyone has been to the seminars, the question is do you drink the Kool-Aid...

 

[Blue Wode]

Apologies to the good chiros out there, and I know there are some, but even they have to be nodding their heads at what I say.

But, unfortunately, the regulators aren’t likely to be nodding their heads. For example, part of the remit of the chiropractic regulatory body in the UK, the General Chiropractic Council, is to protect patients and set standards yet it doesn’t regulate chiropractic treatment approaches (which means that subluxation based chiropractic practices are allowed to flourish), and it has repeatedly denied that there is any evidence that neck manipulation causes stroke.

To me, this seems to bear all the hallmarks of a self-interest group.

 

[jhunter1163]

Blue:

I agree with you on this. To deny the KNOWN risks of any therapy is irresponsible to say the least. And there is conclusive evidence that there IS a risk of stroke with chiropractic. We can argue all day about what the risk is, but it exists and therefore ethically MUST be disclosed.

If the woos have gotten control of the GCC in the UK it's a sad day for chiropractic. I am foursquare against this "subluxation-based" chiropractic. It's just a sham to justify extended treatment protocols. You can ALWAYS find a subluxation somewhere in the spine. It's a natural consequence of being human (walking, lifting, bending, sitting, basically doing anything). There's no clinical significance to a subluxation per se. It's whether or not there's nerve irritation or impingement that's the issue.

 

[Blue Wode]

To deny the KNOWN risks of any therapy is irresponsible to say the least. And there is conclusive evidence that there IS a risk of stroke with chiropractic. We can argue all day about what the risk is, but it exists and therefore ethically MUST be disclosed.

If the woos have gotten control of the GCC in the UK it's a sad day for chiropractic. I am foursquare against this "subluxation-based" chiropractic. It's just a sham to justify extended treatment protocols. You can ALWAYS find a subluxation somewhere in the spine. It's a natural consequence of being human (walking, lifting, bending, sitting, basically doing anything). There's no clinical significance to a subluxation per se. It's whether or not there's nerve irritation or impingement that's the issue.

I agree. It also looks like exercise therapy is winning the day here.

Since we know that there is no evidence that spinal manipulative therapy is superior to other standard treatments (including exercise) for patients with acute or chronic low back pain:
http://www.update-software.com/abstracts/AB000447.htm

…and we know that the inescapable recommendation based on the best evidence available today is to use exercise rather than spinal manipulation as a treatment for neck pain:
http://journals.medicinescomplete.com/journals/fact/current/fact0902a06d01.htm

…you have to wonder what purpose chiropractic really serves.


Further reading:

The value of chiropractic by Edzard Ernst
http://journals.medicinescomplete.com/journals/fact/current/fact1002a02t01.htm

Chiropractic by John Jackson (UK Skeptics)
http://www.skeptics.org.uk/article.php?dir=articles&article=chiropractic.php