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What you should know about chiropractic

This article was originally published in The New Scientist

Edzard Ernst and Simon SinghFor many people, chiropractic appears almost mainstream. Some chiropractors even call themselves “doctor”. In the UK, chiropractors are regulated by statute, and in the US they like to be seen as primary care physicians. It is therefore understandable if people hardly ever question the evidential basis on which this profession rests. 

The origins of chiropractic are surprising and rather spectacular. On 18 September 1895 Daniel Palmer, a “magnetic healer” practising in the American Midwest, manipulated the spine of Harvey Lillard, a janitor who had been partially deaf since feeling “something give in his back”. The manipulation apparently cured Lillard of his deafness. Palmer’s second patient suffered from heart disease, and again spinal manipulation is said to have effected a cure. Within a year or so, Palmer had opened a school, the first of many, and the term he coined, “chiropractic”, was well on its way to becoming a household name.

The only true cure

Palmer convinced himself he had discovered something fundamental about human illness and its treatment. According to Palmer, a vital force – he called it the “Innate” – enables our body to heal itself. If our vertebrae are not perfectly aligned, the flow of the Innate is blocked and we fall ill. Chiropractors speak of these misalignments as “subluxations” (in conventional medicine, a subluxation means merely a partial dislocation). The only true cure is to realign the vertebrae by manipulating the spine, and in the logic of chiropractic it follows that all human illness must be treated with spinal manipulations. Many chiropractors also assert that we need regular “maintenance care” even when we are not ill so that subluxations can be realigned before they cause a disease. In the words of Palmer “95 per cent of all diseases are caused by displaced vertebrae, the remainder by luxations of other joints”.

All diseases are caused by ‘subluxations’ blocking the flow of the ‘Innate’

This bit of history is important because it explains why many chiropractors treat all sorts of conditions, not just back pain. In fact, in the early days, back pain was not an issue for chiropractors at all. Today they are divided into roughly three camps. One adheres religiously to Palmer’s gospel – indeed, at one stage Palmer considered establishing chiropractic as a religion. Another has moved on and now employs a range of non-drug treatments in addition to manipulations, mainly for treating back pain. The third group is situated somewhere in between these two extremes and, at least occasionally, treats many conditions other than back pain.

If you find this hard to believe, here is the evidence. A 2004 survey by the UK General Chiropractic Council revealed that most chiropractors believe they can treat asthma (57 per cent), digestive disorders (54 per cent), infant colic (63 per cent), menstrual pains (63 per cent), sport injuries (90 per cent), tension headaches (97 per cent) and migraine (91 per cent). According to a 2007 survey, 69 per cent of all UK chiropractors see themselves as more than just back specialists, and 76 per cent consider Palmer’s original concepts to be “an important and integral part of chiropractic”.

Pre-scientific

So, are they right? Palmer’s concepts of the Innate and subluxation are pre-scientific and wacky, but that in itself needn’t mean that the treatment is not helpful. We therefore need to ask, how good is chiropractic spinal manipulation in treating anything?

The answer is not clear-cut. For back pain, there is some encouraging evidence. Chiropractic manipulations have been shown in several clinical trials to be as effective as standard treatments. One needs to know, however, that standard care is not very effective for bad backs, and studies that adequately control for placebo effects tend to arrive at less positive conclusions. When my team in Exeter reviewed data from these more rigorous trials we concluded that “spinal manipulation is not associated with clinically relevant specific therapeutic effects” (Journal of Pain and Symptom Management, vol 22, p 879).

For virtually all the other conditions which chiropractors treat, where rigorous trials have been done, the evidence is weaker. In some cases, the most reliable studies have found that spinal manipulation is ineffective.

Not justified

Chiropractors and many of their professional associations often claim otherwise, but a few do acknowledge this problem. In 2001, one team of chiropractors looked at this issue, and their conclusion was blunt: “The largest professional associations… make claims for the art of chiropractic that are not currently justified by available scientific evidence”. Since then, several investigators have come to similar conclusions.

The issue is not just whether chiropractic treatments work. There is also the question of the safety of chiropractic spinal manipulation, a matter that few people seem to be aware of. Several big studies have shown that a large proportion of patients experience side effects after receiving chiropractic spinal manipulation. Luckily these complaints – mostly pain – are not normally very severe and are usually gone after a day or two.

There have, however, been several hundred cases of potentially very serious complications associated with this treatment. Extreme chiropractic manipulation of the neck can damage one of the two vertebral arteries that run roughly parallel to the upper spine and supply part of the brain. The consequence of such a “vascular accident” can be a stroke, and several deaths are on record. Such disastrous events are, of course, rare; this is one reason why it is difficult to investigate this phenomenon systematically and not all studies show the same result.

Warning

In the book I co-wrote with Simon Singh, Trick or Treatment? Alternative medicine on trial, we dedicate a chapter to chiropractic. After weighing all the evidence, our conclusions were not flattering: “Warning: this treatment carries the risk of stroke and death if spinal manipulation is applied to the neck. Elsewhere on the spine, therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions chiropractic therapy is ineffective except that it might act as a placebo.”

Simon later wrote an article in The Guardian newspaper about chiropractic. In it, he quoted from the website of the British Chiropractic Association which, at the time, made fairly clear claims that chiropractors can effectively treat a whole range of childhood diseases, including asthma. The evidence for treatment of this condition is less than weak: no fewer than three controlled trials have found that chiropractic spinal manipulation has no beneficial effect. The best of these studies, published in The New England Journal of Medicine, concluded that “the addition of chiropractic spinal manipulation to usual medical care provided no benefit”.

Not supported

For alerting the public to all of this, and possibly preventing harm to unsuspecting children, Simon deserves much credit. Instead, he is being sued for libel by the British Chiropractic Association. I think this is a serious issue that raises two crucial questions. Is it acceptable that scientists and journalists are restricted in their criticism by the legal muscle of those who are being criticised? And is it acceptable that professional bodies, such as the British Chiropractic Association – or indeed any other organisation – are able to make therapeutic claims that are not supported by scientific data? I leave it to the reader to decide.

Profile

Edzard Ernst is professor of complementary medicine at the Peninsula Medical School in Exeter, UK. In his investigations of alternative therapies, he has found only about 5 per cent are supported by scientific evidence; the rest are either ineffective or have not been tested properly.

See also: McTimoney Chiropractors told to take down their web sites.

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56 responses to “What you should know about chiropractic

  1. Megan Oltman June 12, 2009 at 12:44 am

    Making therapeutic claims unsupported by evidence is certainly suspect, but seeking to stifle genuine investigation is even more so, it seems to me.

    As for chiropractic itself, I can only give anecdotal testimony. I feel I have been aided considerably in recovery from several accidents by chiropractic treatment. However, as a chronic migraine sufferer, I have become more skeptical. At my chiropractor’s urging I have received treatments during an active migraine on a number of occasions. There was never any noticeable improvement or speeding up the resolution of the migraine attack. I have also noticed no difference to the number or severity of migraines I get during periods when I am getting regular chiropractic versus periods when I am not.

  2. beatis June 12, 2009 at 7:57 am

    @ Megan Oltman,

    I am very sorry to read that you are suffering from migraine. I had migraines myself for many years and know how debilitating it can be, it drove me into despair at times. I wish you all the best.

  3. Marcus Ettinger DC June 12, 2009 at 8:05 pm

    This is just my opinion and not a complete critique of the above article.

    There will always be lovers and haters, of just about everything imaginable. These lovers and haters may base their opinions on a wide-range of things such as: faith, clinical trials, schooling, up-bringing, prejudice, class, guessing, friends, family…. Whether or not chiropractic has been put through a double-blind, cross-over, placebo study and validated by the AMA and big pharma, makes it no less effective for those who receive it. A patient just wants to be out of pain, and whether the adjustment created a placebo effect or if it was real, is not on the patients mind when he thanks the doctor because he’s out of pain.

    For the past 5,000 years validation of medicine, in all of its forms, has been empirical (based on observation). To me, I will choose observation, with its 5,000 years of successful use over big pharma’s scientific model. It’s like having the fox watch the hen house. Just look at Vioxx (27,785 deaths total), Celebrex, NSAID’s (8,000 deaths/yr) Raptiva…. In the United States alone, deaths due to properly prescribed medications range from 30,000 – 100,000 per year (depending on source).

    All I can do is speak for myself. In 20 years of being a chiropractor I have delivered over 30,000 cervical adjustments, without one complaint. My malpractice is lower than both my automobile and home-owners insurance policies. That, in and of itself says a lot about the safety of chiropractic.

    I appreciate the passion of the authors, but wish they would have focused on areas that may have changed our world for the better, rather than create more friction, negativity, prejudice and division. We have too much of that as it is.

    Marcus Ettinger DC

  4. evenarsenicisnatural June 12, 2009 at 8:25 pm

    Marcus:

    Way to go by misdirecting the subject – typical quackademic tactic.

    Bullshit-o-meter overload.

  5. anaxymperator June 12, 2009 at 8:43 pm

    I’ve just had a look at your website. You make quite a number of claims, about chiropractic being able to cure or significantly improve a number of serious diseases. Can you back these up at all, other than with testimonials? I don’t necessarily mean double blind trials, but have any reliable long-term studies been done into the effect of chiropractic on for example ADHD, diabetes, IBS, etc?

  6. Michele June 12, 2009 at 8:45 pm

    Chiropractic care does help asthma, at least in my son’s case. I have also noticed that since my son has stopped his chiropractic care that his Autism has become more severe. How or why? I don’t care. It worked for him and that is what I care about.
    As for myself it helped relieve my severe Vertigo, sciatic pain and lessened my anxiety disorder. Again, how or why? I don’t care. They helped me and they didn’t try to sell me anything nor did they fill my hands with prescriptions to mask anything. Nowadays all my doctors do is prescribe me with meds I really do not want to take. It’s a personal choice based on personal results. There isn’t anything “Quack-like” about that. Like everything YOU choose. I am just thankful we have the option.

  7. beatis June 12, 2009 at 8:58 pm

    A collegue of mine has a son with autism. They have taken a dog and every day they take a long walk with their son and the dog. This has turned out to be very beneficial for the boy and has helped him enormously in interacting with people. The added bonus is that he gets plenty of fresh air, it’s completely free of charge and doesn’t create any treatment dependency.

  8. anaxymperator June 12, 2009 at 9:29 pm

    @ Marcus Ettinger,

    All diseases are caused by ’subluxations’ blocking the flow of the ‘Innate’

    You don’t believe this, do you?

  9. Marcus Ettinger June 13, 2009 at 3:27 pm

    @ anaxymperator,

    I actually DON’T believe that ALL diseases are caused by ’subluxations’ blocking the flow of the ‘Innate’.

    @ evenarsenicisnatural,

    My first sentence stated, “This is just my opinion and not a complete critique of the above article.”

    If I would have actually debated the post or critiqued it completely, I would admit that you were correct in your comment, but that was not my intention. My post just adds my thoughts to their opinions and is no way trying to deflect. I merely believe that chiropractic is far safer than pharmaceutical medications.
    Chiropractic is not a substitute for a medication and a medication is not a substitute for Chiropractic.

    @ Michele – Great testimonial!!!

    @ Beatis – Great testimonial as well!!!

  10. Marcus Ettinger June 13, 2009 at 3:28 pm

    @ anaxymperator,

    I have to go for the rest of the weekend, but when I get back I want to respond to your questions relating to my site. Have a great weekend.

  11. Bram Hengeveld June 13, 2009 at 3:59 pm

    @ Marcus
    Isn’t it absurd to split medicine into ‘observational’ and ‘the other part’ (of which you give no explanation)? Did it ever occur to you that science based medicine has firm ground in observations? Theories and hypotheses need to be proven (or perhaps ‘not falsified’) But what do you think scientists need for the evidence?

    I believe it to be very distracting from the main point when you stress the death-rate of certain drugs. But nevertheless it quite clearly explains the point I’m trying to make: how did the number of deaths came into existence? The observations needed to generate them are part of the system: HRT seemed quite promising, but it turned out to be a disaster, to add another one.

    And then there is the other part of your ‘observations’. 30.000 observations in 20 years to be precise.
    Why, in God’s name, aren’t those recorded properly? You could go all science based medicine with your own set of patients. Why not prove your methods work? Why not settle the question properly?

    At present there’s just records showing certain ‘chiropractical-ish’ treatments to have fatal side-effects, but no, or very little positive effects.

    That’s the other distinguishing fault (I assume) you’ve made: science is just a tool, it’s not a goal. A tool which, if applied correctly can offer more insight than saying ‘30.000 treatments and not a single side-effect’ . Like for instance it could, when analysed correctly: look, I treated those patients and it worked well: most of them saw positive outcomes.
    Only saying you haven’t encountered one problem in 30,000 cases is not saying anything about how well it works (also a point your missing when comparing to certain drugs: there are drugs that work very well, but we don’t know that about chiro) . And it would also prove you’re quite a superhuman: 30.000 cases without a mistake.

    In short: If I were as prone to distrust new tools (as opposed to 5,000 year old ones) I wonder whether I’d be typing this… Or writing for that matter.

    And for crying out loud: saying ‘Big Pharma’s scientific model’ (in contrast with 5,000 yo observational medicine) is, well, eh… flabbergasting.
    What about checklists? There is worldwide evidence that checklists (like, a piece of paper, that says: did you do X or Y before, during and after surgery?) can increase patient safety. The research put into certain conversational techniques, which can be used by nurses at rehabclinics? The evidence that says that, to prevent bedsores you should turn patients every 4 hours. (even patient that just underwent thoracic surgery and are recovering on an ICU) I have absolute no idea on the total amount of drugs and other medical equipment that could be saved by just turning patients to prevent bedsores. But it’s a very big number (billions of dollars). That would mean that Big Pharma would really, really miss out on a lot of sold goodies.
    And what about research into patient records and personal drug reviews, which very often actually cuts druguse in the elderly?

    There is more to science than ‘Big Pharma’.

  12. Bram Hengeveld June 14, 2009 at 8:22 am

    “In over 18 years of helping people Dr. Ettinger has personally witnessed many miracles; miracles unexplained by traditional medicine. Dr. Ettinger has seen cancer, HIV, gallstones, high cholesterol, diabetes, weight, ADD/ADHD, arthritis and autoimmune conditions vanish.”

    (source: http://www.advancedhealing.com/index.php?option=com_content&view=article&id=2&Itemid=7)

    Tell us more! Vanishing HIV and cancer; don’t let the rest of the world out on this, it would be inhumane. It took ‘em a long time, but Big Pharma is now giving away AZT @ non-absurd prices; with your cures, even when modest (like curing about 5%) you would save thousands of lives.

    “At just 43 years of age Dr. Ettinger has accomplished much to help his fellow man and there is no sign of him slowing down.”

    Like I said: thousands of lives.

  13. beatis June 14, 2009 at 8:32 am

    Hi Bram,

    “In over 18 years of helping people Dr. Ettinger has personally witnessed many miracles; miracles unexplained by traditional medicine. Dr. Ettinger has seen cancer, HIV, gallstones, high cholesterol, diabetes, weight, ADD/ADHD, arthritis and autoimmune conditions vanish.”

    You are quite right, the question is of course: what precisely is the contribution of chiropractic in these “miracles?” I sincerely hope dr Ettinger has scrupulously and meticulously recorded all the relevant factors over the years, so as to help the advance of knowledge and science.

  14. evenarsenicisnatural June 14, 2009 at 8:50 am

    Legitimate medical records to back up these claims??

    Bah, who needs legitimacy when you have TESTIMONIES?

    I sense lots of ‘marketing’ and little else…hmmm, maybe some Sterling or Mastertech…?

  15. anaximperator June 14, 2009 at 12:36 pm

    Testimonials: the “evidence” of the scientifically poor…

  16. Marcus Ettinger June 14, 2009 at 6:50 pm

    I am back!!! WOW, I love all the attention.

    Everyone: I am a chiropractor who happens to have a holistic medicine practice. A chiropractic adjustment is just one of the modalities at my disposal and is not what got any of those conditions listed above better. So, lets put the treating disease w/chiropractic adjustments to rest. I don’t claim that or do that.

    I do standard medical work-ups on all new patients (blood tests, MRI’s CT’s…) I have pre and post diagnostic tests validating my claims and I have many MD’s and DO’s who refer me clients and vice versa . Ex: There is no one thing that makes a person go from HIV + to HIV -. There were MANY separate components that contributed to the reversal, one of the being my input. I doubt that it would ever be able to be replicated in a group setting, but individually I think I could do it again if patient compliance was 100% in.

    I DO have a pre and post blood tests to prove my statements. I responded back because I KNOW what I have done, I am proud of it, my patients appreciate my help and knowledge in the areas of nutrition, diet, exercise, diagnosis….

    I will leave you with this to ponder (I will not be responding back). Hypothetically speaking, you the reader had been diagnosed w/cancer. After surgery, chemo and radiation the cancer came back. The oncologist told you that all treatment options were exhausted and that it would be best to get you affairs in order.

    What would you do? Give up because all so-called medical options failed and there were no more available? Or try an alternative, unproven treatment in hopes that it might work?

    I appreciate your passion.

    Marcus

  17. beatis June 14, 2009 at 7:03 pm

    I’m very sorry you have decided to go while leaving all our questions unanswered. Not exactly what I would call convincing.

    Or try an alternative, unproven treatment in hopes that it might work?

    That’s what you would have me do. But it’s definitely not what I would do.

  18. anaximperator June 14, 2009 at 7:16 pm

    Mr Ettinger delivered his tale just as expected: all sound and fury, signifying nothing.

  19. Marcus Ettinger June 14, 2009 at 7:24 pm

    All right I’ll stay for a bit longer. My wife doesn’t like that I am on the computer all the time.

    Let’s make this easier for all concerned. What is the question?

  20. beatis June 14, 2009 at 7:36 pm

    “In over 18 years of helping people Dr. Ettinger has personally witnessed many miracles; miracles unexplained by traditional medicine. Dr. Ettinger has seen cancer, HIV, gallstones, high cholesterol, diabetes, weight, ADD/ADHD, arthritis and autoimmune conditions vanish.”

    Question: what precisely is the contribution of chiropractic in these “miracles?” I sincerely hope you have scrupulously and meticulously recorded all the relevant factors over the years, so as to help the advance of knowledge and science.

    And Anaximperator said:

    I’ve just had a look at your website. You make quite a number of claims, about chiropractic being able to cure or significantly improve a number of serious diseases. Can you back these up at all, other than with testimonials? I don’t necessarily mean double blind trials, but have any reliable long-term studies been done into the effect of chiropractic on for example ADHD, diabetes, IBS, etc?

  21. beatis June 14, 2009 at 7:41 pm

    In this comment 2009/06/13 at 3:59pm Bram had a number of questions for you as well:

    Isn’t it absurd to split medicine into ‘observational’ and ‘the other part’ (of which you give no explanation)? Did it ever occur to you that science based medicine has firm ground in observations? Theories and hypotheses need to be proven (or perhaps ‘not falsified’) But what do you think scientists need for the evidence?

    I believe it to be very distracting from the main point when you stress the death-rate of certain drugs. But nevertheless it quite clearly explains the point I’m trying to make: how did the number of deaths came into existence? The observations needed to generate them are part of the system: HRT seemed quite promising, but it turned out to be a disaster, to add another one.

    And then there is the other part of your ‘observations’. 30.000 observations in 20 years to be precise.
    Why, in God’s name, aren’t those recorded properly? You could go all science based medicine with your own set of patients. Why not prove your methods work? Why not settle the question properly?

    At present there’s just records showing certain ‘chiropractical-ish’ treatments to have fatal side-effects, but no, or very little positive effects.

    That’s the other distinguishing fault (I assume) you’ve made: science is just a tool, it’s not a goal. A tool which, if applied correctly can offer more insight than saying ‘30.000 treatments and not a single side-effect’ . Like for instance it could, when analysed correctly: look, I treated those patients and it worked well: most of them saw positive outcomes.
    Only saying you haven’t encountered one problem in 30,000 cases is not saying anything about how well it works (also a point your missing when comparing to certain drugs: there are drugs that work very well, but we don’t know that about chiro) . And it would also prove you’re quite a superhuman: 30.000 cases without a mistake.

    In short: If I were as prone to distrust new tools (as opposed to 5,000 year old ones) I wonder whether I’d be typing this… Or writing for that matter.

    And for crying out loud: saying ‘Big Pharma’s scientific model’ (in contrast with 5,000 yo observational medicine) is, well, eh… flabbergasting.
    What about checklists? There is worldwide evidence that checklists (like, a piece of paper, that says: did you do X or Y before, during and after surgery?) can increase patient safety. The research put into certain conversational techniques, which can be used by nurses at rehabclinics? The evidence that says that, to prevent bedsores you should turn patients every 4 hours. (even patient that just underwent thoracic surgery and are recovering on an ICU) I have absolute no idea on the total amount of drugs and other medical equipment that could be saved by just turning patients to prevent bedsores. But it’s a very big number (billions of dollars). That would mean that Big Pharma would really, really miss out on a lot of sold goodies.
    And what about research into patient records and personal drug reviews, which very often actually cuts druguse in the elderly?
    There is more to science than ‘Big Pharma’.

  22. Marcus Ettinger June 14, 2009 at 10:30 pm

    Betis, Bram and others, I am with 100% certainty, sure you will have something to say about this, but it is what it is. After contemplating writing a book to answer all of your questions and then thinking (based on the tone and content of your blog theme, blog posts and comments to commentors) You are just going to prejudicialy rip it all apart anyway. I have decided to go enjoy the rest of a beautiful, sunny SoCal day. Come Monday I will be back doing what I love, helping people.

    If you want to evaluate or invalidate my way of helping, that’s perfectly fine by me.

    I have no ill feeling toward anyone on this forum. You guys are passionate and I too love lively debate.

  23. evenarsenicisnatural June 15, 2009 at 12:27 am

    Yep, the same-old pathologic blaming others for the lack of medical knowlege/training, ignoring facts, the continuous deception – err, ‘marketing’ – to not provide full disclosure, rattling off the same tired (and blatently false) quackademic rhetoric, and being an obvious fucktard.

    Buh bye, don’t bust the screen door on your way out.

  24. Michele June 15, 2009 at 12:50 am

    Wow. The depth of judgement here is frightening considering it seems that no one here KNOWS Dr. Marcus Ettinger. I understand opinions on chiropractic care. They will vary relating to people’s personal experiences and the experiences of those they know but to attack his integrity in such a manner is just ridiculous.
    I do know Marcus. I have known him since we were in high school and even then he was a very kind, serious, old beyond his years young man. He is filled with integrity and the fact that he only wants to help heal people and continues to be courteous and respectful of you all just proves to me I am not wrong in offering my support. He has never been my caregiver. I am speaking of his integrity as a human being which does support his integrity as a Chiropractor. At least I believe so. I prefer to have someone who has passion for what he does help in my care than to have someone who just goes through the motions. Maybe it’s just me. I am glad he is out there because I know he is kind and truly has his patients best interests in his mind and heart.
    I wish this could be more eloquent but writing is not my greatest strength. I just want to offer my support and maybe question why you all seem so angry. YOU GET TO CHOOSE WHO YOU HAVE CARE FOR YOU. So, why be angry if someone chooses other than what or whom you might choose? It is their choice as it is yours for yourself.
    Have a lovely week!

  25. evenarsenicisnatural June 15, 2009 at 2:24 am

    Damn, forgot to set the countdown timer for the posse to show up…

  26. beatis June 15, 2009 at 4:41 am

    @ Michele,

    On his web site, mr Ettinger is making claims as to the efficacy of chiropractic in curing autism, hiv and cancer. It’s only normal that we asked him to give some evidence for these claims and it’s not our fault that he doesn’t. But when you have no way of backing up these statements, you shouldn’t make them.

  27. anaximperator June 15, 2009 at 7:34 am

    @ Marcus Ettinger,

    You just said:

    I too love lively debate

    Somehow it doesn’t seem like that to me at all.

  28. Bram Hengeveld June 15, 2009 at 8:58 am

    @Beatis:

    mr. Ettinger already stated chiropractic didn’t cure any of the ‘listed above’.

    He seems only able to state what chiropractic doesn’t do. It doesn’t seem to harm (30,000 without a single problem) nor does it cure HIV+ people, gallstones, etc.

    @mr. Ettinger: Are you now suggesting you were thinking of writing a book to answer our questions mr. Ettinger? Why? Just tell us what chiropractic does. Or how it could/should be researched.

    And by the way: my comment was (for a large part) not on chiropractics itself, but on your rather weird claims about (big pharma’s) scientific model.
    Well, at least they look weird to me. But, I’m just a nursing student and you are a ‘dr’ and a BSc, so perhaps you could explain me what I missed. Beatis quoted my reply above. (so you know which one I’m talking about; it’s the observational-medicine-vs.-BP’s-scientific-model-thing.

    So there’s no ripping apart chiropractic, I’m just really, really, really curious about your views on science and it’s role in medicine, since, from my point of view, you’ve said really, really, really weird things about it. I might even say absurd things.

  29. beatis June 15, 2009 at 9:33 am

    Mr Ettinger, you say:

    A chiropractic adjustment is just one of the modalities at my disposal and is not what got any of those conditions listed above better.

    ” What I would like to know then is what exactly is the contribution of chiropractics. The same thing with the “miracles” you said to have witnessed. And if chiropractic played no part at all in what got these conditions better, then I think you shouldn’t imply that they did on your web site.

    No one wants to rip apart chiropractic. But it’s you who suggest and imply that chiropractic plays an important part in curing all kinds of serious conditions and it’s you who are making outlandish statements on the nature of conventional science. We just would like you to back this up. What is wrong with that?

  30. Marcus Ettinger June 19, 2009 at 4:20 am

    I thought you might like this, since you are so in to “evidence based” medicine. Dr. Eddy coined the term and I doubt you will be able to find fault in him and if you do please write him and tell him how wrong he is.

    The “scientific” argument is largely a red herring and the sign of a double standard. Medical economist David Eddy, MD, Ph.D., observes that only 15% of medical procedures have ever been scientifically verified, and the other 85% of common medical procedures have no “scientific basis!”

    Scroll to the bottom of this link to read his entire interview. Enjoy. http://www.pbs.org/healthcarecrisis/experts.htm

    What is “evidence-based” medicine?

    Evidence-based medicine is in fact a very simple, common sense concept. It says when we have a treatment where we know it’s effects and it has benefit, we should do it. We should give patients those treatments. When we have evidence that something is not beneficial or is harmful, we should not do it. And when we don’t know what the effects of a treatment are, when we don’t know whether giving a treatment to a patient will make them come out ahead or come out behind, we should be conservative. Conservative means if it has any significant harms or very high cost, we probably should discourage it. Unfortunately, we just don’t have good control trial evidence about the effects of a lot of treatments. And if we required that there be X amount of evidence for treatment, a lot of treatments that are commonly done would not pass that test. So we don’t want evidence-based medicine to be interpreted as you can’t do something or it won’t be paid for unless there’s perfect evidence.

    One might wonder why we have to actually look at evidence, why we can’t just ask experts, for example, to tell us whether or not a treatment works. The unfortunate fact is that it’s extremely difficult for experts to really know what the effect of a treatment is. And it’s very easy for us to be fooled. The history of medicine, both in the past and very, very recently, is filled with examples where experts were dead sure that a treatment was effective, but when we finally got around to doing the studies, we found out the treatment wasn’t effective, or pmight even be harmful. We’ve had experts testify under oath in trials that treatments were effective and beneficial. Then when we finally get the research results, we find out that they were dead wrong. The fact is that the practice of medicine, the biology of the disease, human variation is way too complicated for the human mind, even the mind of a medical expert. And when we try and do it in our heads alone, we make mistakes.

  31. beatis June 19, 2009 at 6:18 am

    @ Marcus Ettinger,

    I have been wanting to write a post about this subject, but it seems you’ve cut the ground from under my feet just now.

    In reading your comment and the interview with dr Eddy, I take it you are referring to (double blinded) randomized controlled trials or RCTs when you talk of ‘evidence based medicine’. This way of gathering evidence is condisered the ‘golden standard’ when it comes to scientific research.

    However, in a lot of situations, RCTs are just not possible and of course this limits their applicability.

    This doesn’t mean that there are no other ways of gathering scientific knowledge. A very important way of gathering evidence is observational research. Observational research can be done in the form of cohort studies or patient control studies. It was observational research that showed that eating fish twice a week is beneficial to our health.

    A way of observational research is to select two groups. The first group consits of of patients with a specific complaint or illness. Next to each patient a healthy person is selected with the same age, the same sex and other essential identical characteristics regarding lifestyle, eating habits, condition etc. These people comprise the second group. The health developments in both groups regarding the essential identical characteristics over a long period of time are being observed and meticulously recorded. It is exactly this kind of observational research that showed indisputably that smokers develop lung cancer much more often than non-smokers.

    A great number of scientists have been arguing to give back to observational research its rightful place next to RCTs, like Professor Sir Michael Rawlins, Chair of the National Institute for Health and Clinical Excellence for example, and no longer consider it ‘second rate.’

    Observational research would be excellently suitable as a scientific method I think for disciplines such as chiropractic.

  32. beatis June 19, 2009 at 7:11 am

    @ Marcus Ettinger,

    The unfortunate fact is that it’s extremely difficult for experts to really know what the effect of a treatment is.

    Do you consider this a reason for not even trying?

  33. cryptocheilus June 19, 2009 at 8:32 am

    Yeah, instead of addressing his own profession for the complete lack of any evidence, Ettinger addresses ‘the other group’ for not being able to support ‘all’ evidence.

    Figures.

  34. Marcus Ettinger June 19, 2009 at 10:29 am

    @Beatis, On the contrary, I 100% believe in “Observational” Research. The statement Dr. Eddy makes, “The unfortunate fact is that it’s extremely difficult for experts to really know what the effect of a treatment is.” is so true. Vioxx looked great on paper but when given to hundreds of thousands of patients, only then did the “observational” portion come into play and it was found to hurt people. I believe that “observation” research is important in recommending a treatment just as I do in discontinuing one. I am glad to see we are in agreement on something.

    @cryptocheilus I wouldn’t quite go so far as to say that there is, “complete lack of any evidence.” All that proves is that you haven’t spent any time doing your own research into chiropractic research. I picked three entries that are not the be-all-end-all on chiro. research, but I like them.

    Is Chiropractic Evidence Based? A Pilot Study http://www.chiro.org/ChiroZine/ABSTRACTS/Is_Chiropractic_Evidence_Based.shtml

    A review of research and Observation on “Chiropractic Neck Treatments Increase Risk of Stroke” In a nutshell, the risk is quite low. http://www.webmd.com/news/20010521/chiropractic-neck-treatments-increase-risk-of-stroke

    Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care http://chiroandosteo.com/content/14/1/18
    “Evidence-based practitioners are the future leaders of chiropractic, because they possess the ability to apply research and are likely to deliver more effective and less costly interventions.”

    I can’t leave without giving something to talk about, so here goes. I do not advertise, never have. I have been in practice exactly 20 years, in am 44. I have a website which is the only outside source that a prospective client would know I am there. I get maybe 1-2 clients a year from my website. 99% of all of my new clients come from patient referrals and that has been the case since day one. If what I did didn’t produce a positive result, statistically speaking, after 20 years, with only referrals as new patients, I would have been out of business a long time ago. Observationally speaking, what I do must have some effectiveness. If anyone here wants to design a study for me to apply in my practice to help validate what I have just said, I will willingly accept that task.

  35. beatis June 19, 2009 at 10:52 am

    I’m not sure everything went as it should just now… I approved one of your comments and it just disappeared. :-(

  36. Marcus Ettinger June 19, 2009 at 10:59 am

    Just a thought: I bet if we could meet in person and discuss this over a pint and some good food, we would most likely share a lot of common ground.

    It’s interesting how a one dimensional medium such as this can facilitate such divisiveness, not to mention that writing is so black and white and talking things-out adds so much more to a topic.

  37. Marcus Ettinger June 19, 2009 at 11:00 am

    It’s all there now.

  38. jennyj0 June 19, 2009 at 11:07 am

    That would mean quite a journey on both our parts, for we live in Europe and you live in the USA. :-)

  39. beatis June 19, 2009 at 11:11 am

    It’s interesting how a one dimensional medium such as this can facilitate such divisiveness, not to mention that writing is so black and white and talking things-out adds so much more to a topic.

    This makes it all the more vital to be extra careful in expressing one’s thoughts and ideas.

    We are very international here: Dutch, Danish and Italian.

  40. Marcus Ettinger June 19, 2009 at 11:13 am

    Point taken!!!

  41. evenarsenicisnatural June 19, 2009 at 3:25 pm

    …and the bluster n bullshit show continues.

    P. T. Barnum was so right.

  42. jennyj0 June 19, 2009 at 3:34 pm

    There’s a sucker born every minute and there’s a crook born every hour to take care of 60 suckers…

  43. beatis June 19, 2009 at 3:38 pm

    If anyone here wants to design a study for me to apply in my practice to help validate what I have just said, I will willingly accept that task.

    No offence meant, but don’t you think you might want to do this yourself? Design a study that is.

  44. Marcus Ettinger June 19, 2009 at 4:05 pm

    @ beatis – People come in for pain and the observational conclusion to whether or not a chiropractic adjustment was successful or not would be if the client stated he or she was out of pain or still in pain.

    Other factors that would be hard to test would be range of motion. If the client was in pain the their ROM would most likely be reduced. When out of pain the ROM would be back to normal (so that’s not a good indicator).

    Blood pressure: A client is in pain so their BP may be elevated, out of pain reduced PB (still not a good indicator because it’s the absence of pain not the adjustment that did it)

    I hope you see my point here. What in this forums mind would they need to see to justify the existence and application of chiropractic and who should be responsible for paying for the testing?

    @ evenarsenicisnatural – Please drop by my office if you are ever in Southern California, I would love to give you a free cervical adjustment.

  45. evenarsenicisnatural June 19, 2009 at 4:48 pm

    My cervical scoliosis wouldn’t benefit at all by an ‘adjustment’. I’m rather fond of having normal nerve function.

  46. beatis June 19, 2009 at 5:10 pm

    Let’s just, for the sake of argument, assume it is impossible to test chiropractic, in whatever way, either by means of CRT or by means of observational research. I just think you shouldn’t make any claims then as to the efficacy of chiropractic.

  47. Marcus Ettinger June 19, 2009 at 9:00 pm

    @ Beatis,

    I don’t quite duplicate what you are mean by “shouldn’t make claims about chiropractic.”

    If I have 100 patients who are experiencing low back pain and they receive a chiropractic adjustment and get out of pain, isn’t that exactly the same as saying I have 100 people with headaches and they took aspirin and there headache went away, or 100 people w/a sore throat who took antibiotics and their sore throat went away?

    They have X and take or receive Y and X is gone. What name do you give that? If one of the people who received Y and got rid of X, claimed that Y was effective, would they be wrong?

    I am just trying to find out what you would call the claim made by the person receiving Y and if they are wrong for making it.

  48. beatis June 20, 2009 at 8:29 am

    Really Marcus,

    I can hardly believe you are being serious; are you sure you’re not just trolling…?

    The fact is that your examples don’t mean anything, as long as we don’t know what happened to a control group who received a fake treatment and as long as we don’t know what other things the subjects have been doing, just to mention a few things.

    You might want to read a good book on how to design a decent RCT first. For example Snake Oil Science by R. Barker Bausell. Here’s another review of the book: http://www.nytimes.com/2007/12/25/health/25book.html. Bausell’s book is written in a way that makes it understandable and educating for everyone, including people who have no experience with conducting scientific trials themselves.

    Good luck!

  49. Marcus Ettinger June 20, 2009 at 1:50 pm

    @ Beatis – I understand your point and I am aware of comparing an aspirin to a placebo to determine the % of headaches relieved by both.

    Until I have time to conduct a study, I was trying to find out if twenty years of getting people out of pain was all placebo, and am I lying when I say that there must be some effectiveness in what I do.

    I am totally serious here. I just want to know what I should call twenty years of delivering chiropractic adjustments and getting people out of pain? Effective, a miracle, twenty years of good luck, the greatest placebo ever known to man….?

    Effective: adequate to accomplish a purpose; producing the “intended” or expected result. Based on this definition I would have to say, EFFECTIVE.

  50. beatis June 20, 2009 at 2:13 pm

    It could be placebo. Placebo is a very strong mechanism and I don’t mean anything derogatory with it. It’s just that one would want to know if there is any effect beyond placebo, because the placebo effect is always there, in each and every research without fail.

    But all science starts with observation of all relevant factors. Factors like weight maintenance, age, sex, life style, eating habits, occupation, the treatment that you are giving them, other treatments they follow, medication they use, etc., and the meticulous recording thereof. If you do this over time, you may come up with valuable information. This is how they used to do it in the early days of medicine, and it often has yielded valuable scientific information.

  51. Bram Hengeveld June 20, 2009 at 3:03 pm

    mr. Ettinger said:
    “They have X and take or receive Y and X is gone. What name do you give that? If one of the people who received Y and got rid of X, claimed that Y was effective, would they be wrong?”

    yes, it’s a (very basic) logic fallacy known as ‘post hoc ergo propter hoc’.

  52. Marcus Ettinger June 20, 2009 at 4:31 pm

    Bram, Thank you for that. I am also familiar with “post hoc.”

    Personally, I love “coincidental correlations.” It seems, so does the rest of the world. 99.9% of the worlds population base their daily decisions on “coincidental correlations.” How illogical of them. Earth is not planet Vulcan and Spock is just a one-off TV character.

  53. Bram Hengeveld June 20, 2009 at 9:00 pm

    Perhaps you’d care to comment on the fact that it still is a logic fallacy:

    If one of the people who received Y and got rid of X, claimed that Y was effective, would they be wrong?

    I don’t care about captain Spock. You gave a logical fallacy, which has nothing to do with captain Spock. Actually you’ve now made two. 1. the above mentioned
    2. first you state the logical fallacy and now you dispose of it, by stating we should abandon rational thinking. What’s the plan?

    You seem to like using letters:

    p. post hoc ergo propter hoc is a logical fallacy
    q. chiropractic works
    you stated: not-p (by implying the person is right) then: q. But ofcourse post hoc ergo propter hoc IS a logical fallacy, so your reasoning needs a bit of work.

    Next thing you do (implicitly):
    r: Logical fallacies don’t matter (because of our emotions)
    q: chiropractic works
    you state if r -> q,
    but ofcourse logical fallacies do matter and the reasoning is way off there to begin with. ‘Spock’ and the effectiveness of chiro aren’t related.

    Make up your mind first: do you wan’t to follow the rules of logic, or are you going for ‘non-spock’ reasoning?
    Then make your point, because right now I believe it to be a very empty can.

  54. Marcus Ettinger June 20, 2009 at 10:10 pm

    Bram,

    If everything and everyone in the world followed strict logic, than I, as everyone else would apply strict logic in making their decisions. Since the world as we know it doesn’t follow the rule of strict logic, I choose to discuss things in a manner in which any lay person can relate. If we were in a laboratory than I would discuss (whatever) in the manner that would be most suitable for that environment, most likely – strict logic.

    I wish logic WAS the rule of the day; America’s financial markets would still be intact. Politicians would actually do what they were elected to do….

    In a debate, logic is a great, but it doesn’t translate absolutely into real world, everyday, mundane living.

    I understand you want a logical answer to chiropractic, alternative medicine, acupuncture, etc. and effectiveness or validity or claims made. I got that. Here is where we differ and I don’t feel I am wrong in thinking this way: At the end of the day does it work? As far as I am concerned, and the majority of the world, “The proof is in the pudding.” If I get a haircut and I am satisfied, I am happy. If I have a headache and I take Ibuprofen and it goes away, I am happy. Logical or illogical, I am just looking for results.

    We just see things differently. Neither of us are wrong, we just have different opinions. You seem to want absolute proof of things, I on the other hand value testimonials, recommendations, expert opinions, observations, empirical data, as well as peer reviewed research, when choosing things or determining their effectiveness.

    P.S. I think we have reached an impasse on this topic and we are now just going in circles. Thank you for being intellectual and mature in your comments. There were a couple of commenter’s that seem to lack that. Good luck with school and your career.

  55. beatis June 21, 2009 at 7:43 am

    I on the other hand value testimonials, recommendations, expert opinions, observations, empirical data, as well as peer reviewed research,

    In my opinion, testimonials only have any value when they can be validated. But that is practically never the case. Without that, they are worthless. You say you value expert opinions, observations, empirical data, as well as peer reviewed research. All these things have scientific value, but I see none of it on your website and you don’t seem to have any inclination of providing these things. I seems you’re only paying lip service but have no real intention of ever delivering. I’m quite disppointed at that and I think it proves prof. Ernst’s point Edit added: and Bram’s point (Submitted on 2009/06/21 at 11:49am) exactly.

  56. Bram Hengeveld June 21, 2009 at 11:49 am

    @ mr Ettinger

    No, we haven’t met an impasse. You are failing to see the wrong claims and argumentations you make.

    Why apply logic in your arguments and when the going gets tough abandon it? (as far as that is possible: faulty logic is faulty logic, even when you don’t care about logic. Just like a sign that says: ‘roadblock ahead’. You can ignore it, but when traveling at 60mph I advice you to use logic)
    First you gave a form of logical reasoning, which I showed was wrong. Right after that, you say: well, logic is of little use in everyday life.
    But given the examples you have noted (i.e. financial crisis) I think you are really making a big point for actually using logic, which is, indeed, great in a debate. Like the one we are in now!

    And yes, one of us is wrong. You are. (everyone is entitled to his own opinion, but not to his own facts) At least, you remain so if you don’t step up to a more rigorous view on your job and a more mature view on ‘the way things work’. You are trying to place yourself outside the realm of reality. Newsflash: you are not. If chiro has an effect, it can be measured. (as such, your questions on ‘how to do this research’ is flabbergasting) Ofcourse your opinion can be such that you don’t care, or don’t want to measure the effect chiro has.

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