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Chiropractic in the News

Three recent news items about chiropractic have particularly irritated me.
(1) U.S. Army Brigadier General Becky Halstead (Retired) Speaks Out for Chiropractic Care
(2) Chiropractic Helps Child with Brain Disorder
(3) Swine Flu Chiropractor’s Handout

(1) General Halstead has become a spokesperson for The Foundation for Chiropractic Progress, a nonprofit organization dedicated to increasing public awareness of chiropractic. Her quoted comments boil down to

  • I like the personal attention and caring I get from my chiropractor.
  • Chiropractic advice about healthy lifestyle is essential
  • Chiropractic care prevents more serious health concerns
  • Chiropractic is essential for assisting in recovery from minor injuries.
  • Chiropractors don’t mask the problem with drugs and all their side effects.
  • Chiropractors are holistic and involve the patient in her own care.
  • “Listening appears to be a major tool.”

This is nothing but opinion based on personal experience and scientific ignorance. She offers no evidence that chiropractic theory is true, that chiropractic adjustments are effective, or that a chiropractor has any advantage over a science-based medical doctor who also spends time listening to patients, is interested in the whole patient, advises about healthy lifestyle, and avoids unnecessary use of drugs. Caring clinicians can be found in chiropractic, in homeopathy, in every kind of quackery, and in scientific medicine, with the advantage that the scientific clinician can also provide effective evidence-based treatments.

As a woman and a retired Air Force colonel, I am doubly ashamed that this high-ranking military woman has prostituted herself by becoming a spokesperson for pseudoscience. I hope they are paying her well.

(2) The “research,” reported in the Journal of Pediatric, Maternal & Family Health – Chiropractic, is not really what I would call research. It describes a case of a child with cerebellar ataxia whose problems completely resolved following four chiropractic adjustments. The report speculates that

the increase in the diagnosis of such disorders as ADHD, pervasive developmental disorder, Tourette’s Syndrome, obsessive compulsive disorder and other neurodevelopmental disorders, have their root in abnormal spinal development. Children’s nervous systems need the constant stimulation of movement in order to develop and function properly. Abnormal position or movement of the spinal vertebra can develop and this can lead to nerve interference. It is this interference, called vertebral subluxations, that chiropractors correct.

Maybe, but these subluxations have never been shown to exist outside the imagination of chiropractors, and the alleged nerve interference has never been demonstrated.

I couldn’t access the entire article without paying $50, but the abstract raised a lot of questions. A seven year old girl “presented for chiropractic care and cerebellar ataxia was noted.” Was this an incidental observation by the chiropractor, or had the child been previously diagnosed with documented ataxia? The chiropractor’s exam “isolated the location of trans-neuronal dysfunction to the right cerebellum.” How? What does “trans-neuronal dysfunction” even mean? Even the grammar is faulty: “Chiropractic analysis of static and motion palpation were used to examine the spine for subluxations.” The wording makes it unclear what the treatment was: adjustments were given “in either the cervical, thoracic, lumbar and/or pelvic region as needed. Neuro-rehabilitative exercises were given either at home and/or during the office visit.” “Within four visits there was marked improvement of gait patterns and resolution of the ataxia.” Really? Or did the chiropractor and parents simply convince themselves they saw improvement? Was cerebellar ataxia really there in the first place? Did a medical doctor confirm the diagnosis? Was there any long-term followup?

The abstract’s conclusion is propaganda, not a conclusion based on the study. It consists of speculation that is in no way justified by the data.

Understanding and applying foundational neurological principles via a patient specific, individually tailored, chiropractic management plan is essential. Assessing and optimizing asymmetrical neurological indicators should be part of screening and management procedures. In this case, addressing the dysfunction concerning the central integrative state of the cerebellum was necessary for optimum functioning of this seven-year-old female.

This is a case report, little more than a testimonial. I hope the body of the article clarifies some of the questions the abstract raises, but I have seen many, many similar chiropractic case reports that are poorly documented, that mix treatments so it is impossible to determine what caused the improvement, and that are eminently unconvincing. The value of case reports is that they can help guide future research. This seldom happens in chiropractic; there is no progress over time, and reports like this do not build into a coherent body of knowledge.

The author, Nicoleta Borcean, has no articles listed either on PubMed or in the Index to Chiropractic Literature. The journal this article was published in is a brand-new one, and I question both its concept and its editorial board. Why do we need a journal of “Pediatric, Maternal & Family Health- Chiropractic”? There is no evidence that chiropractic has any role in pediatric or maternal health, and the attempt of some chiropractors to become “family doctors” is misguided. The editor in chief is a professor at Life University, a scandal-ridden school that was denied recertification in 2002 because it offered substandard education. One editorial board member is Barbara Loe Fisher, Co-Founder & President of the National Vaccine Information Center – an anti-vaccine organization. Other board members are associated with the Academy of Chiropractic Family Practice and the International Chiropractic Pediatric Association, organizations whose raison d’être is questionable.

I’m not making an ad hominem argument. I’m not saying these individuals couldn’t produce a high-quality journal. But in this case, they haven’t; and their background helps explain why. The abstracts in the current issue are all case reports similar to the ataxia one. “I treated a patient and he got better” is meaningless unless you can show that you’re not making a post hoc ergo propter hoc error. The journal appears to be more interested in finding evidence to support chiropractic claims than in doing good science to test whether chiropractic claims are true. Pseudoscience tries to show “that” a treatment works; real science asks “if” it really works.

(3) Chiropractors were among the first alternative providers to jump on the Swine Flu bandwagon. I already wrote about this for the JREF’s Swift, but I’ll repeat it here. Their handout boils down to 6 recommendations:

  1. Build your immune system by getting adjusted.
  2. Limit the amount of sugar in your diet because sugar depresses the immune system.
  3. Avoid alcohol and white flour products.
  4. Drink more water
  5. Wash your hands frequently.
  6. Disinfect your rooms by spraying them with a solution of essential oils (4 drops to one cup of water).

Hey! One out of six isn’t bad. Handwashing is a good idea. The rest of this advice is useless for preventing infection.

They tell us “Studies show that being adjusted twice a week can increase your immune system function by up to 400%.” No they don’t. I couldn’t find even one such study. I did find a reference to “preliminary research” – apparently not published – that allegedly showed that patients who had received long term chiropractic care had 200% greater immune competence than patients who had not received chiropractic care and 400% greater than those who had cancer. This is uninterpretable because we are not told how the data were collected nor how “immune competence” was measured. Maybe sicker people are already seeing MDs and are less likely to see chiropractors. Besides which, the damage from flu is due to the immune response, and it’s conceivable that increasing immune competence might be harmful.

There is NO credible evidence that chiropractic adjustments decrease the risk of catching ANYTHING. Ditto sugar, white flour and alcohol (unless perhaps indirectly due to secondary effects of overindulgence). Drinking more water? No evidence. And spraying dilute essential oils is probably as effective as having a witch doctor wave a bone and chant.

Chiropractic may help some people with musculoskeletal pain, but reading news items like these doesn’t help my blood pressure!

Posted in: Chiropractic, Science and the Media

Leave a Comment (308) ↓

308 thoughts on “Chiropractic in the News

  1. Dr Benway says:

    The chiros simply want to associate the memes “family practice” and “chiropractic.” Frequent association over time becomes social reality.

    In marketing a novel idea to the public, there’s a tipping point once most people develop a belief about what most people believe.

    A belief about what “most people” think often influences behavior more than anyone’s personal opinion. People are tentative and uncertain about many issues and will defer to the wisdom of the crowd, as they perceive it.

    So the goal isn’t, “Yes, I’d see a chiropractor for my primary care,” but rather, “I’m not big on chiropractic myself. But lots of people see chiropractors for their primary care.”

    Eisenberg’s claim that 40% of Americans use CAM probably did more for CAM than anything else. I often hear, “I’m not big on CAM myself, but…” as a justification for further Federal funding of CAM pseudo-research, licensure, and professional development.

    Beliefs about what everyone else believes are easy to manipulate via marketing campaigns. Civil societies that value free speech haven’t yet figured out a means to check coordinated misinformation strategies.

    Once an incorrect “everyone thinks” notion is established, it seems to take a generation or more to undo.

  2. It seems like a form of shifting the overton window.
    By having people express the opinion that chiro is normal primary care, or better care, they incrementally shift opinion in that direction.
    Even if it’s by virtue of making people who say “chiro might not be completly crazy ” not seem as far out of the mainstream as they really are

  3. fergie34711 says:

    I have bit of question. Should I assume the Chrios and DO’s are not completely the same thing? Because as I understand it DOs essentially learn the same things in med school as MDs here in America but they have additional ‘chriopractic’ or really osteopathic methods taught to them.

    DOs are allowed to practice medicine and one is my family doctor and I have never got the impression that he believes that merely messing around with spinal adjustments will cure anything and everything under the sun.

    In fact you know when he did some adjustments to my back and neck? He did them when I complained that I always had spasms and yatta, yatta, blah, etc, etc… Well, he and other doctors had already scanned the hell out of my body and nothing was out of place. So he adjusted my back a little and it felt a lot better afterwards; he gave me some flexeril to help when my spasms got really bad. They never really did except once or twice every 6 months.

    Also my DO was the one to say I needed surgery when another doctor, an MD, thought he could fix me without surgery. Short answer: DO was right; I really needed surgery. He took one look at my cyst and said: “You need surgery now. I’m not going to do anything for you on this. I simply do not have the skill required.”

    Well, what I’m asking is are DOs ‘bad’ doctors? (for lack of a better word I use bad)

  4. Harriet Hall says:

    Osteopathy and Chiropractic had similar origins: They both did the same kind of treatments but osteopaths thought they were restoring blood flow and chiropractors thought they were restoring nerve flow. Osteopathy accepted scientific medicine and grew up; chiropractic remained a pre-scientific cult. Today, DOs pass the same licensing exams as MDs; they take the same internships and residencies. They are equivalent to MDs and also trained in spinal manipulation. In practice, many DOs stop doing manipulation or use it only in selected cases; chiropractors use manipulation for every patient because that is all they do. Note: I am speaking of DOs in the U.S. only; it is my understanding that DOs trained in other countries are not equivalent to MDs.

  5. Versus says:

    Dr. Hall: good post, with one small correction. “Chiropractic” does not help with back pain. Spinal manipulation, a manual therapy used by physical therapists, osteopaths, physiatrists and chiropractors to increase range of motion and reduce joint inflammation, is effective for low back pain, but no more effective than other conservative therapies, such as NSAIDs.
    “Chiropractic” is, among other things, the use of various forms of spinal manipulation (also called, when used in this manner and for this purpose, the “spinal adjustment”) to reduce the non-existent subluxation. It is very confusing and chiropractors seem to like it that way. Several years ago, when RAND came out with a study showing spinal manipulation was effective for some forms of back pain, chiropractors kept touting the study as an endorsement of chiropractic. One of the study’s authors, Paul Shekelle, MD, had to tell them to stop it. In fact, as I recall, the spinal manipulation in the study was done by physical therapists, not chiropractors. Spinal manipulation for back pain done by chiropractors has not been shown to be more effective than spinal manipulation for that purpose done by other manual therapists. That’s why I cringe when I hear of MDs referring people to chiropractors for back pain — the patients could go to PTs for the same therapy without all of the woo.

  6. Harriet Hall says:

    Versus,
    I agree completely and have said the same myself. The only thing about chiropractic that works is SMT, and when you get relief from a chiropractor it is not because of anything “chiropractic” but because they have used the same effective treatments that physical therapists and others also use. My language was imprecise; I should have said “Chiropractors may help some patients with musculoskeletal pain.” Thanks for the clarification.

  7. Harry says:

    @ fergie34711 Well, what I’m asking is are DOs ‘bad’ doctors?

    DOs are not bad doctors. At least I hope not, as I am a first year DO student right now. Our course work is almost identical to the MD’s, except we have a 1 hour lecture on Osteopathic Manipulation and a 2 hour lab where we practice manipulation on each other. Other than that, we do all the ‘allopathic’ medical course work as the MDs.

    @ Harriet Hall Note: I am speaking of DOs in the U.S. only; it is my understanding that DOs trained in other countries are not equivalent to MDs.

    Dr. Hall, you are correct. The DO schools in the US trains Osteopathic Physicians whereas outside of the US DO schools train Osteopaths. Osteopaths are similar to Chiropractors in scope of practice.

  8. fergie34711 says:

    Thanks guys for the info. My back pain was exactly low back pain and that’s the only time my DO used any spinal manipulation on me. I could have gone to a physical therapy session too but I got the same results for cheaper with my family doctor. (At least with my insurance that is…) Maybe that’s why MDs send patients to chrios for spinal manipulation for minor low back issues? Perhaps its cheaper than physical therapy? I don’t know if it is. I’m just wondering if that’s why.

    Not one of my doctors, DO or MD ever, ever suggested to use any alt med things. Although one MD (a neurologist) did suggest some B-12 vitamins to help with some unexplained nerve pain issues but vitamin supplements are not completely altie craziness. Anyway another doctor found a much better solution: Lyrica.

  9. Sivi Volk says:

    I pretty well stopped listening to anything connected to chiropracty. When my sister was born, my mother took her to her chiropractor for adjustment.

    The chiropractor claimed her could ‘fix’ my sister’s Down’s Syndrome. So, yeah. Hard to take it seriously.

  10. pec says:

    “the alleged nerve interference has never been demonstrated.”

    Subluxations are real, and the basic theory behind chiropractic is valid. It happens to be similar to the theory behind hatha yoga — but of course you will say that’s nothing but coincidence. It doesn’t matter how many people have experienced something directly, you will deny it if it hasn’t been recognized by a majority of the mainstream medical authorities.

    Just because the mainstream has not yet focused intently on subluxations (mostly for political reasons), you reject the idea completely.

    R Fern and P J Harrison. “The effects of compression upon conduction in myelinated axons of the isolated frog sciatic nerve.” J Physiol. 1991 January; 432: 111–122.

    “”Animal models suggest that vertebral displacements and putative vertebral subluxations may modulate activity in group I to IV afferent nerves.”

    Bolton P (2000). “Reflex effects of vertebral subluxations: the peripheral nervous system. An update.”. J Manipulative Physiol Ther 23 (2): 101–3. doi:10.1016/S0161-4754(00)90075-7. PMID 10714535.

    “Researchers at the Department of Physiology, University College London studied the effects of compression upon conduction in myelinated axons. Using pneumatic pressure of varying degrees on the sciatic nerves of frog specimens, the study supported the idea of nerve conduction failure as a result of compression.”

  11. Harry says:

    In a family practice setting what is nice about a DO vs an MD is that the DO (should) know how to do the Osteopathic Manipulative Therapy (OMT) which I think overlaps with physical therapy. So whereas an MD may have to refer a patient out for physical therapy a DO can do it in house.

    This of course presumes that OMT is efficacious… We are taught some stuff that is outright bullshit like “Osteopathy in the Cranial Field” but we are also taught some muscle energy treatments that I think /could/ work. I wish I had some better resources that would help me to understand what manipulative treatments have evidence and which do not. I usually just assume that most of what I learn isn’t valid while at the same time having my back popped from time to time helps if I have mild acute back pain. Like right now I’m hunched over my computer in a lecture hall and my back is a little sore in the lower thoracic vertebra. If I can talk a professor into popping my back, the pain disappears immediately and I feel better. There is just so little creditable research on OMT and it’s hidden within giant piles of bad research. The best research usually says that manipulation isn’t valid, but what about physical therapy techniques that we use but just don’t know it? Wow, I’m rambling…. sorry.

  12. Harry says:

    Pec,

    No one is contesting that it sucks to have a pinched nerve, so Fern and Harrison paper doesn’t matter.

    There is also a difference in the meaning of the word “Subluxation”. Copypasta from http://en.wikipedia.org/wiki/Vertebral_subluxationWikipediaOfficially, the WHO definition of the chiropractic vertebral subluxation is: “A lesion or dysfunction in a joint or motion segment in which alignment, movement integrity and/or physiological function are altered, although contact between joint surfaces remains intact. It is essentially a functional entity, which may influence biomechanical and neural integrity.” The degree of structural displacement is not necessarily “visible on static imaging studies.”[1] This is in contrast to the medical definition of spinal subluxation which, according to the WHO, is a “significant structural displacement, and therefore visible on static imaging studies.”

    Medical spinal subluxation, like spondylothesis, covers all the ‘real’ subluxations that are visible. Chiropractors take subluxation further to include subluxations that can’t be seen or measures but can be paplated. How can something be felt but not visualized on MRI or CT?

    I don’t have access to the Bolton paper but the conclusion from the abstract says CONCLUSION: Animal models suggest that vertebral displacements and putative vertebral subluxations may modulate activity in group I to IV afferent nerves. However, it is not clear whether these afferent nerves are modulated during normal day-to-day activities of living and, if so, what segmental or whole-body reflex effects they may have.

    So again, they are saying that having a pinched nerve sucks.

  13. megancatgirl says:

    I recently went to a physician who was a DO and I have been wondering how much quack is behind osteopathy. I noticed a few big differences between osteopathy and chiropractic (which I have used in the past). First, osteopathic adjustment isn’t about popping bones, but more like stretching muscles. It’s probably similar to physical therapy but more convenient. I wouldn’t know to compare because I’ve never had physical therapy.

    What impressed me is that the doctor used the osteopathic adjustment almost as an afterthought, and didn’t claim or believe that it would cure all my symptoms. He ordered standard urine and blood tests, and we talked about my medication without him telling me I don’t really need them. Then I said that my neck was sore, and he stretched it and showed me how to do the stretches myself. He only used it to treat the neck pain and nothing else. I feel much more comfortable having a physician touch my neck than a chiropractor. And he didn’t try to talk me into coming back twice a week for adjustments.

    Ever since then I have been debating with myself whether I should continue seeing this doctor. I read up on osteopathy and there is a lot of woo, but this doctor doesn’t seem to buy into the woo parts of it. He didn’t tell me to change my diet or that the adjustments will strengthen my immune system.

    I welcome any input about this, especially from other physicians.

  14. Calli Arcale says:

    Regarding whether a DO is a good doctor or not, it’s kind of the same question as whether an MD is a good doctor or not. They come in all kinds, and the process doesn’t weed out all the bad ones. But they can get all the same qualifications, which is the important part for this question.

    My husband’s PCP is a DO. I was seen by a DO opthamologist once (though as he lacked surgical qualifications, he was unable to do the procedure that I needed, and referred me to one of his MD partners). And most recently, my second child was delivered by a c-section performed by a DO obstetrician-gynecologist. She did an excellent job, particularly considering that there were a few complications not known before the procedure began, forcing her to do a vertical incision on the uterus rather than the preferred transverse incision.

    As with any medical professional, you might run into one that’s not very good. Keep your critical thinking hat on, and make sure to ask questions if you feel uncomfortable about anything. But otherwise, DOs in America are generally as good as comparably-qualified MDs.

  15. Mojo says:

    @Harry:

    Chiropractors take subluxation further to include subluxations that can’t be seen or measures but can be paplated.

    Or perhaps not:

    http://www.sciencebasedmedicine.org/?p=165

  16. Harry says:

    @ megancatgirl

    Where or not you want to continue seeing a physician is your decision alone. There are plenty of quacks with D.O. after their name just as there are plenty of quacks with M.D. after their name. After all, Dr. Atwood has been writing about Harvard’s own issues.

    I am not a physician, but I am a student physician… You want to have a good professional relationship with your physician and you should ‘interview’ your doctor to see if that’s possible. If you want, you can ask him directly what he thinks about alternative medicine and include things like Osteopathy in the Cranial Field, Homeopathy and Acupuncture. My own experience has been that the majority of the DO quacks are either OMT specialists or in Family Practice. I have found DO’s who use homeopathy, another who was big on herbs and supplements, another who said that DO’s are a bridge between Eastern and Western Medicine. By far, most have been on the good and level and have rejected the Osteopathic Quackery.

    My free advice, and you get what you paid for!

    -Harry

  17. Harry says:

    @ Mojoon,

    I have the hardest time in Osteopathic Practices and Principles class is when professors talk about palpating the rhythmic motion of the cranial suture’s moving. It’s so bad it makes baby jesus cry.

  18. hatch_xanadu says:

    The chiropractor “isolated the location of trans-neuronal dysfunction to the right cerebellum”.

    Wow. I would like to see that demonstrated on functional MRI. Surely that shouldn’t be a problem, no?

  19. Harriet Hall says:

    pec,

    THERE ARE NO vertebral displacements with chiropractic subluxations. Real subluxations are vertebral displacements and they show up on x-ray, as in spondylolisthesis. Chiropractors thought they were fixing real displacements until x-rays proved them wrong. Then they changed their definition of subluxation to a vague wishy-washy statement that essentially allows them to call anything they want to manipulate a subluxation.

    Sure, real subluxations and real nerve interference can cause symptoms. The problem is, chiropractors can’t show that what they are treating involves real subluxations or real nerve interference. Rational chiropractors like those in the NACM have rejected the whole subluxation concept.

  20. pec says:

    Chiropractic subluxations are real. Of course you think millions of people are hallucinating — that’s your explanation for everything the mainstream authorities don’t acknowledge. Mainstream medicine has fought a political war against chiropractic for many decades, and that would explain it if you don’t see a lot of research on chiropractic subluxations in mainstream journals. The nerve interference is related to the myelin coverings, not the actual nerve fiber. Displacements don’t have to be severe to cause this.

    “The problem is, chiropractors can’t show that what they are treating involves real subluxations or real nerve interference.”

    I bet there are tons of research, just not in mainstream journals. I will see what I can find.

    And I know from extensive personal experience with hatha yoga that the chiropractic concept of subluxations is very real, and very important, and fighting against it is a terrible disservice to the public.

  21. Harriet Hall says:

    pec “knows from personal experience” that something that doesn’t show up on x-ray is real. She trusts subjective experience above objective scientific evidence. What is she doing reading this blog?

  22. pec says:

    ” She trusts subjective experience above objective scientific evidence.”

    No Harriet. I explained that millions of people experience this, not just me, and also that there are tons of scientific evidence for chiropractic subluxations. Also, I said that if there is a lack of evidence in mainstream journals it could be because of the political war MDs have waged against chiropractors.

    Vertebrae do not have to be obviously dislocated to cause disruptions in nerves, since even slight stretching of a nerve will have some effect on its functioning. Subtle differences in posture can make large differences in health.

    It’s just too bad you, as well as most MDs, refuse to look at the evidence, or to experience it for yourself.

  23. Mojo says:

    @pec:

    I explained … that there are tons of scientific evidence for chiropractic subluxations.

    References please. Just to a few (say half a dozen) good papers – you needn’t provide “tons”.

  24. I read up on osteopathy and there is a lot of woo, but this doctor doesn’t seem to buy into the woo parts of it.

    Most American DOs don’t subscribe to the residual woo in osteopathy. Nevertheless, DOs are considerably more likely to be sCAMsters than are MDs. Overall, MDs outnumber DOs by about 15-fold. Yet look, for example, at the membership of the American College for Advancement in Medicine, the Mother of all PPOs. (Search by state or country to get a big list; many members don’t have a ‘credential’ entry, but it’s still clear that DOs are represented way out of proportion to their overall numbers). BTW: an easy way to disqualify an MD or DO is by finding out that he or she is a member of a Pseudomedical Pseudoprofessional Organization.

    Steve Barrett has a good article about modern DOs and their relation to the dubious history and residual woo of the field. Pay special attention to the responses from osteopaths and osteopathic students.

  25. Versus says:

    Pec, to save you some research time, here is an excerpt from research I did on the subluxation. The sources are chiropractic journals, a chiropractor writing in a mainstream journal, and chiropractic textbooks :

    Keating, et al.,[13] reviewed the evidence and concluded:
    “. . . the sum of all the evidence that we are aware of does not permit a conclusion about the clinical meaningfulness of subluxation. To the best of our knowledge, the available literature does not point to any preferred method of subluxation detection and correction, nor to any clinically practical method of quantifying compromised ‘neural integrity,’ nor to any health benefit likely to result from subluxation correction. ”

    Keating and his co-authors are not the only ones within the profession to take chiropractors to task for their continued belief in chiropractic ideology, “some aspects of [which] are now known to be at odds with scientific facts.” [14] Nelson, Lawrence, Triano, Bronfort, Perle, Metz, Hegetschweiler, and LaBrot,[14] warned: “To date, the chiropractic profession has failed to develop the legitimacy necessary to defend its autonomy and cultural authority. It has not shown the will or ability to define for itself a coherent and consistent identity. . . . If the profession fails to do so its future will be imperiled.”

    More recently, the push to legitimacy again inspired Murphy, Schneider, Seaman, Perle and Nelson,[15] to join in blunt criticism of loyalty to the subluxation:
    “One of the problems that we encounter frequently in our interaction with chiropractic educational institutions is the perpetuation of dogma and unfounded claims. Examples include the concept of spinal subluxation as the cause of a variety of internal diseases and the metaphysical, pseudo-religious idea of ‘innate intelligence’ flowing through spinal nerves, with spinal subluxations impeding this flow. These concepts are lacking in a scientific foundation and should not be permitted to be taught . . . Much of what is passed off as ‘chiropractic philosophy’ is simply dogma, or untested (and, in some cases, untestable) theories . . . . (footnotes omitted)

    Homola [16] concurs: “Scientific consensus does not support the theory that nerve interference caused by vertebral misalignment or subluxation is a cause of organic disease. . . . a subluxation has never been proved to exist.

    Perhaps surprisingly, the conjectural nature of the subluxation is admitted in several chiropractic textbooks.[6, 17,18,19] Yet, these same texts go on to describe the diagnosis and treatment of subluxations and the many conditions for which such treatment is or “may” be beneficial.

    Notes cited:
    6. Peterson DH, Bergmann TF: Chiropractic Technique: Principles and Procedures. 2nd edition. St. Louis: Mosby; 2002.
    13. Keating JC Jr., Charlton KH, Grod JP, Perle SM, Dikorski, Winterstein JF: Subluxation: dogma or science? Chiropr Osteopat 2005, 13 no. 17, doi:10.1186/1746-1340-13-17, http://www.chiroandosteo.com/content/13/1/17.
    14. Nelson CF, Lawrence DJ, Triano JJ, Bronfort G, Perle SM, Metz RD, Hegetschweiler K, LaBrot T: Chiropractic as spine care: a model for the profession. Chiropr Osteopat 2005, 13, no. 9, doi: 10.1186/1746-1340-13-9, http://www.chiroandosteo.com/content/13/1/9.
    15. Murphy DR, Schneider MJ, Seaman DR, Perle SM, Nelson CF: How can chiropractic become a respected mainstream profession? The example of podiatry. Chiropr Osteopat 2008, 16, no. 10. doi: 10.1186/1746-1340-16-10, http://www.chiroandosteo.com/content/16/1/10.
    16. Homola S: Chiropractic: history and overview of theories and methods. Clin Orthop Relat Res 2006, 444 doi:10.1097/01.blo.0000200258.95865.87, http://ovidsp.tx.ovid.com/spb/ovidweb.cgi.
    17. Callender AK, Plaugher G, Anrig CA: Introduction to Chiropractic Pediatrics. In Pediatric Chiropractic. Edited by Anrig CA, Plaugher G. Philadelphia: Lippincott Williams & Wilkins; 1998: 1-13.
    18. Cleveland CS III: Vertebral Subluxation. In Fundamentals of Chiropractic. Edited by Redwood D, Cleveland CS III. St. Louis: Mosby; 2003): 129-153.
    19. Keating JC Jr., Plaugher G, Lopes MA, and Cremata EE: Introduction to Clinical Chiropractic. In Textbook of Clinical Chiropractic: A Specific Biomechanical Approach. Edited by Plaugher G, Lopes MA. Philadephia: Lippincott Williams & Wilkins; 1993:1-11.

  26. cheglabratjoe says:

    Says pec:

    “It doesn’t matter how many people have experienced something directly, you will deny it if it hasn’t been recognized by a majority of the mainstream medical authorities.”

    “Of course you think millions of people are hallucinating — that’s your explanation for everything the mainstream authorities don’t acknowledge.”

    “[M]illions of people experience this, not just me …”

    Well, then, pec, I’m assuming you believe in all of the following things: a handful of disparate deities, alien abductions, ghosts, bigfoot, the loch ness monster, sixth sense(s), astrology, and countless other things that many people believe but mainstream authorities won’t recognize. I’d hate to accuse you of inconsistency, of course …

  27. pec says:

    “… and countless other things that many people believe but mainstream authorities won’t recognize.”

    Whenever a similar phenomenon is experienced by millions of people in many different eras and cultures, I consider it to have some possible validity. It might not be exactly what the experiencers think it is, but there is probably something worth investigating. I do not see humanity, in general, as a bunch of hallucinating gullible idiots. I do not see truth as something owned exclusively by the modern scientific establishment. And that’s where we differ. I have always been interested in parapsychology and I know that at least some of the things you listed scornfully are supported by scientific evidence. I also believe that the universe is infinitely stranger than the universe as described by materialist ideology, and I believe that what is currently understood by science is the tip of an infinite iceberg.

    The scientific method is great, but we should not disbelieve all our experiences until science gets around to investigating them. And most things might never be investigated, for political and financial reasons. And I also believe that all of us follow an informal scientific method in our everyday reasoning. Ideas that are contradicted by clear and obvious evidence, or that are never supported by any positive evidence, die out.

    I do NOT believe every quack and kook, but I DO have faith in the reasonableness of humanity in general. And I do not dismiss my own experiences as hallucinations and delusions just because they are not sanctioned by materialist science. I do not scornfully dismiss ancient practices like yoga or energy healing merely because they originated before modern science.

    Materialist extremists like Richard Dawkins, Susan Blackmore, James Randi, etc., are just as way out and kooky as extremists in the other direction.

  28. cheglabratjoe says:

    pec, I’m surprised to say that I agree with the majority of what you just wrote. Unfortunately, you’re painting your actual views with an extremely forgiving brush, and you’re setting up quite the strawman to tilt against.

    Let’s stick with examples of what you DO believe. Humouralism is an ancient belief that millions of people apparently had positive experiences with. It is still used today as a CAM modality (Unani medicine). Do you believe in it? Why or why not? How did you arrive at this opinion? How would you feel if it were in the news rather than chiropractic? Would you (or do you) defend it as passionately as you do other CAM modalities here? One of SBM’s “friends” (Orac) just posted a blog entry about a little girl dying after being unsuccessfully “treated” with homeopathy; how would you feel if she’d died after a bloodletting treatment?

  29. Mojo says:

    @pec:

    Whenever a similar phenomenon is experienced by millions of people in many different eras and cultures, I consider it to have some possible validity.

    Surely you mean “mass existing in well-distributed people since long“?

  30. Harriet Hall says:

    pec says “I do not scornfully dismiss ancient practices like yoga or energy healing merely because they originated before modern science.”

    I don’t think anyone on this blog (scornfully or otherwise) has ever dismissed any ancient practices merely because they originated before modern science. In fact, science doesn’t “dismiss” anything. It asks for evidence, and if the evidence is not there, it reaches a tentative conclusion but is always willing to look at new evidence and change its tentative conclusions if the new evidence warrants.

  31. Prometheus says:

    Pec – again:

    Chiropractic subluxations are real. Of course you think millions of people are hallucinating — that’s your explanation for everything the mainstream authorities don’t acknowledge.

    IF chiropractic subluxation were real, you’d think that chiropractors would be able to consistently diagnose them. However, the same spinal X-rays read by different chiropractors are “diagnosed” as showing “subluxations” at different locations.

    Of course, “millions of people” aren’t hallucinating – just the thousands of chiropractors who think they see subluxations. And even the chiropractors aren’t “hallucinating” – a more appropriate word would be “imagining”.

    Their training – such as it is – has taught them to see “subluxations” where trained radiologists see overlapping shadows, rotation and normal variants. That’s why no two chiropractors can read an X-ray the same way – they’re misinterpreting “noise” as “signal”.

    As for the much talked about but rarely seen “mainstream authorities”, I don’t put much stock in what they say. What matters is the data, and the data say that chiropractic is about as useful as physiotherapy for low back pain and almost as useful as placebo for anything else.

    Here’s something for “pec” to chew on – what financial motivation do real doctors have to put chiropractors out of business? It is often asserted that the only reason “mainstream” (real) medicine wants to see chiropractic (or homeopaths or naturopaths or…) eliminated is fear of competition, but I don’t see real doctors having any difficulty keeping busy.

    They may have problems with insurance company reimbursements and paperwork, but I don’t think that getting rid of chiropractic (etc.) will solve those problems. And I’ve yet to find a doctor who has enough free time in their schedule that I can get a same-day appointment without feigning serious illness.

    So, tell me – why would real doctors care about chiropractors (etc.) if it was just about the money?

    Maybe the real doctors are concerned about people spending their hard-earned money on useless treatments. Maybe they’re concerned about people treating real illnesses with fake medicines? Maybe – just maybe – the real doctors don’t like seeing people exploited and harmed?

    How’s that for a radical thought?

    Prometheus

  32. tgobbi says:

    Suggestion to PEC and that “Nyah, nyah, nyah – there is TOO such a thing as a subluxation!”

    Read this:

    http://www.chirobase.org/02Research/crelin.html

    We learn that in 1973 Edmund S. Crelin, Ph.D. demonstrated that there simply is no such thing. (At the time, Dr. Crelin was Professor of Anatomy and Chairman of the Human Growth and Development Study Unit at the Yale University school of medicine – rather impressive bona fides). A Google search (Crelin subluxation) provides all the details of his study.

    tgobbi

  33. coryblick says:

    If subluxations exist, and they exist in a specific place or segment, then a specific treatment should be necessary….right?

    Wrong:

    http://ajp.physiotherapy.asn.au/AJP/49-4/AustJPhysiotherv49i4Chiradejnant.pdf

    Also, if you claim to be able to find them how do you get around motion palpation being found both unreliable and unvalid consistently when studied?

    And, even if you could find a specific segmental alignment with palpation (can’t), would it even be possible to deliver a force to a specific segment?

    Nope:

    http://www.ncbi.nlm.nih.gov/pubmed/15621330?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    http://www.ncbi.nlm.nih.gov/pubmed/15029938?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

  34. pec says:

    [science doesn't ‚"dismiss‚" anything. It asks for evidence, and if the evidence is not there, it reaches a tentative conclusion but is always willing to look at new evidence]

    Well you don’t. Your opinions always conform to the mainstream medical authorities, on every point. Why is subluxation theory rejected? Simply because MDs and chiropractors have always been at political war. It is obvious and well known that bad posture can result in fatigue and pain. How do you explain this if subluxations can’t possibly exist? The spine can be out of alignment without any dislocations or pinched nerves, yet nerve functioning is impaired.

  35. pec says:

    “Let’s stick with examples of what you DO believe.”

    I don’t have dogmatic beliefs and disbeliefs. I consider the evidence.

  36. Dr Benway says:

    Why is subluxation theory rejected? Simply because MDs and chiropractors have always been at political war.

    That’s your dogmatic belief in spite of this evidence: Groups of chiropractors cannot reliably identify a chiropractic subluxation in a given patient.

  37. Deetee says:

    It is obvious and well known that bad posture can result in fatigue and pain. How do you explain this if subluxations can’t possibly exist?

    You clearly think that these hypothetical “subluxations” of the spine are the only explanations of backache in someone with poor posture. There are many mechanisms for pain in this situation. One of the commonest is a discomfort induced by the strain put on muscles and ligaments which are trying to compensate for incorrect spinal alignment from poor posture. Why would subluxations come into it, and why invent them to explain something readily explicable by more obvious mechanisms? Occam’s razor and all that, you know.

    This weekend I noticed residual pain and fatigue in my dominant forearm because I spent an hour or so contorting it to get behind a storage tank in my loft to fix it into position. Can you explain which bit of my spine has “subluxed” to cause this? Surely a more rational explanation is that I was forcing my arm into an unnatural position and performing unaccustomed actions, which put strain on the muscles, ligaments and tendons in the forearm?

    Same thing happens to spines.

  38. weing says:

    “It is obvious and well known that bad posture can result in fatigue and pain. How do you explain this if subluxations can’t possibly exist?”

    Why do you have to have subluxations to explain this?

  39. Mojo says:

    @ pec:

    I consider the evidence.

    Please post some references to your evidence so we can consider it as well.

    See above:
    http://www.sciencebasedmedicine.org/?p=474#comment-18802

  40. weing says:

    “… and countless other things that many people believe but mainstream authorities won’t recognize.”

    Practicing on that basis would be considered “claim” based medicine and not evidence or science based medicine. Would you really like us to practice medicine based only on claims that a drug or procedure works?

  41. tmac57 says:

    Pec-”I do not see humanity, in general, as a bunch of hallucinating gullible idiots.”
    While most people are not idiots, we all hallucinate and tend to be gullible. That’s why critical thinking skills and the scientific method were developed.
    Pec-”I believe that what is currently understood by science is the tip of an infinite iceberg.
    I don’t think anyone on this blog would disagree with this, but it doesn’t support your argument in any way .
    Pec-”The scientific method is great, but we should not disbelieve all our experiences until science gets around to investigating them.”
    Nor should attribute an unproven or disproven modality as being the cure or fix for what we experience.
    Pec-”And most things might never be investigated, for political and financial reasons. ”
    You left out plausibility.
    Pec-”And I also believe that all of us follow an informal scientific method in our everyday reasoning. Ideas that are contradicted by clear and obvious evidence, or that are never supported by any positive evidence, die out.”
    First, I don’t think there is any such thing as “informal scientific method” Maybe you mean heuristics , but those can be notoriously misleading. Second, many false beliefs hang around for centuries. Just think of astrology.
    Pec-”I do NOT believe every quack and kook….”
    Maybe not every one, but from your previous posts, it is obvious that you buy into many dubious beliefs.
    Pec-”I do not scornfully dismiss ancient practices like yoga…
    I don’t think that mainstream science dismisses some of the benifits of yoga such as exercise,stretching, improvement of balance,strength etc. as unproven, just some of the energy (chi) claims, and other unproven health claims.
    Pec-”Materialist extremists like Richard Dawkins, Susan Blackmore, James Randi, etc., are just as way out and kooky as extremists in the other direction.”
    Please give examples.

  42. Harriet Hall says:

    pec said “Your opinions always conform to the mainstream medical authorities, on every point.”

    pec knows this is not true. In fact, she has agreed with me on more than one occasion when I challenged mainstream practices, for instance:
    http://www.sciencebasedmedicine.org/?p=461 See her comment on 21 April at 10:06.

  43. David Gorski says:

    pec uses the same schtick with me. She seems to forget the multiple posts I’ve done criticizing conflicts of interest, big pharma chicanery (as my post earlier this week did) and various surgical dogma that is no longer supported by evidence but still in use.

    It doesn’t matter, though. If you point out how unscientific nearly all CAM practices are, to pec you “always conform to the mainstream medical authorities.”

  44. cheglabratjoe says:

    pec, you’re ridiculous. You consider the evidence? Forget evidence for chiropractic subluxations; where is your evidence for this vast “political war” (code for conspiracy) you keep referring to? Of course, I’m sure the lack of evidence is just evidence that MDs are successfully suppressing chiropractic Truth.

  45. pec says:

    Ok yes, there are times when Harriet Hall and David Gorski have criticized some mainstream establishment practices, and when I have agreed with them. However it is true that neither of you are willing to consider the evidence regarding non-mainstream theories, such as chiropractic subluxations. Joints do not have to be dislocated for nerve function to be impaired, and anyone can easily experience this fact for themselves.

    The spine has an optimal curve, which we all depart from to some degree, and health suffers correspondingly. This is important, and can make a real difference for your patients. For example, fibromyalgia patients are now given an anti-seizure drug such as Lyrica, even though a major cause — or the major cause — of fibromyalgia is vertebral subluxations.

    These patients are taking a strong drug indefinitely, maybe for life, instead of getting the advice that could cure them.

    And I do NOT think every chiropractor helps their patients; it is probably only a minority who have the skill to find and correct subluxations. And even then, muscle habits are powerful and the subluxations will return, so I do not think chiropractic is the answer. Yoga, physical therapy, etc., are probably more useful.

    So you can see I am not an advocate for chiropractors, or for any other CAM practitioners. I am interested in getting past political and ideological bias and finding out what works.

  46. Harriet Hall says:

    pec,
    I would be willing to consider the evidence if I could find it. I searched for “subluxation” and “fibromyalgia” on PubMed and on the Index to Chiropractic Literature. I found zero articles.

    Have you really thought this through? How do you differentiate between “subluxations” and mechanical factors like poor posture, muscle strain and associated pain? How is the optimal curve defined and how do you know when it is achieved?

    You are right that “Joints do not have to be dislocated for nerve function to be impaired” – ruptured discs are a prime example. With a ruptured disc, nerve impairment can be objectively measured. Where is the evidence for such nerve impairment with the chiropractic “subluxation”?

  47. shadowmouse says:

    pec is the adult version of Veruca Salt – demanding to have her way no matter what, escalating her tantrums and constantly trying to get her way, facts be damned.

    Just a bad nut(ter).

  48. pec says:

    [Have you really thought this through? How do you differentiate between “subluxations” and mechanical factors like poor posture, muscle strain and associated pain? How is the optimal curve defined and how do you know when it is achieved?]

    Yes I have really thought this through and there are no simple answers to your questions. I know that the nerves are affected by subtle changes in vertebral alignment. I’m sure many chiropractors and physical therapists would agree with me — there is nothing very new or surprising in what I am saying. Your argument that you can’t find it in PubMed is a tired one. Yes I know the mainstream has not been interested — that is the problem.

    And you can find articles in the chiro index by just searching for fibromyalgia.

  49. weing says:

    So, in over 11 years they haven’t been able to get at least 81 patients to see if there is anything to it? That’s not evidence that’s a claim. Ok, I guess, if you want to practice claim based medicine.

  50. Harriet Hall says:

    pec said “I know that the nerves are affected by subtle changes in vertebral alignment.” Please explain how you know this.

    The study you cited is a preliminary one and the results were not statistically significant. The reported results could be due to simple physical therapy and a placebo response to hands-on treatment. Anyway, it does nothing to support your claim that subluxations are associated with fibromyalgia.

  51. pec says:

    weing,

    I said it was ONE EXAMPLE. So of course you conclude that only one example exists. But you are only interested in reflexively disagreeing with anything I say, not in learning from it.

  52. Harriet Hall says:

    pec,

    It was not ONE EXAMPLE showing that subluxations are real or are associated with fibromyalgia. Do you have ONE EXAMPLE of that?

  53. Diane says:

    Pec-> “I know that the nerves are affected by subtle changes in vertebral alignment.”

    I’m a PT who is big on nerves, on doing things manually, ostensibly help them oxygenate optimally/”breathe”, to help a nervous system downregulate somatic pain.

    Assuming there is some veracity to your statement, therefore, I have a couple questions, Pec, if you would be kind enough to indulge me:

    1. Nerves can be affected by pretty much anything. Why are you thinking that the only place they can ever be “pinched” is at a vertebral level?

    2. Why do you think that “vertebral alignment” causes the “subtle changes” (which implies defect, i.e., some kind of noun, called “subluxation”)?

    3. Have you ever considered that perhaps the nervous system itself is unusually cranky for some reason, maybe lack of simple movement, or that a nerve can become entrapped somewhere at a considerable distance from the spine, subverting the entire motor output to a posture of defence? (Maybe the spine looks a tad off center or something, but the situation is much more verb than noun, and correlation still does not equal causation.)

    Pec -> “I’m sure many chiropractors and physical therapists would agree with me — there is nothing very new or surprising in what I am saying.”

    I disagree – I think there’s a lot wrong with looking at a postural adaptation devised by a nervous system under some stress somewhere, as a noun instead of a verb, then developing an entire so-called profession around the whole conceptual hallucination, insisting that everyone see the verb as a noun, then complaining for a century because people who see the difference prefer to consider the verb and refuse to acknowledge it as any kind of noun.

  54. pec says:

    Ok Harriet I linked the first one I found, since it was in PubMed. I don’t really have time to search extensively, and of course I do not have subscriptions. Most of the information, as I said, is not in mainstream publications anyway, since mainstream medicine prefers drugs and surgery. A lot of what I know is from my understanding of yoga and VERY extensive direct experience. But of course you will say it’s just me — and of course it isn’t. The principles are well known, although fibromyalgia has not been recognized for very long. But the same would apply to arthritis and many other disorders.

    Tense muscles, fixated joints, vertebral misalignment — all can seriously impair the functioning of nerves, and health and subjective well-being are NOT independent of the nervous system!

    MDs have largely ignored the mechanical aspects of health — ironically since their approach is supposedly “mechanistic.” The mechanics of the body is extremely important, extremely complicated, and can be damaged by injuries, emotional stress, inactivity, etc.

  55. pec says:

    “I think there’s a lot wrong with looking at a postural adaptation devised by a nervous system under some stress somewhere, as a noun instead of a verb,”

    Ok, I am not an advocate for chiropractic. Yes, there is often a postural adaptation, or compensation, for a stress somewhere (old injury, etc.) and this can put a strain on many joints. The joints can lose some mobility and nerves can be stretched or in some way stressed. I think it’s important to consider the myelin covering, not just the nerve fiber. Of course I do not know exactly how it all works — I doubt anyone does — and I do not claim to be all-knowing.

    Yes, you have to consider the spine as a whole. You cannot have a misalignment in one place without the whole spine being affected.

  56. Harriet Hall says:

    pec said, “A lot of what I know is from my understanding of yoga and VERY extensive direct experience. But of course you will say it’s just me — and of course it isn’t.”

    If it isn’t, it’s up to you to show us evidence that it isn’t.

  57. Karl Withakay says:

    pec said,: “However it is true that neither of you are willing to consider the evidence regarding non-mainstream theories, such as chiropractic subluxations.”

    Wrong. They have looked at the so called evidence and came away unimpressed and unconvinced for various reasons already explained numerous times before. (Low quality studies with poor controls, no blinding or randomization, small sample sizes, lack of reproducibility, etc)

    While I don’t want to put words in either of their mouths, what I believe is true is that neither of them are willing to accept unscientific theories such as chiropractic subluxations without good quality, scientific evidence. They and many others are still waiting for that evidence.

  58. Diane says:

    Pec -> “Yes, you have to consider the spine as a whole. You cannot have a misalignment in one place without the whole spine being affected.”

    I’d say you can’t consider the spine in isolation at all, under most circumstances. It has an entire body affixed to it after all… Nerves are sensitive everywhere – they are, after all, excitable tissue. The nervous system’s job is to protect the life of its organism, keep it working together, be a threat detector, maintain metabolic and autonomic business as usual. As a PT practitioner I barely ever even worry about the “spine”. I take a look at its behaviour but certainly don’t immediately blame it for pain presentations or look for postural “defects” or assume that if postural asymmetries do exist they are automatically a “cause”. One cannot lift up a single finger, after all, without muscles around the spine (driven by reflexive mechanisms) physically “adjusting” the organism to the effort, to maintain the whole body axis in accordance with said effort. This is behavioural output or habit as opposed to a specific condition. Like I said before, the situation of spinal posture is much more verb than noun. Subluxations of a chiro kind are mythical beasts.

    Pec -> “Ok, I am not an advocate for chiropractic.”

    Whew. For awhile there I thought you were.

  59. pec says:

    But don’t worry Harriet, I am searching for osteopathic research relating to vertebral alignment and diseases such as fibromyalgia. There are some open access journals.

  60. pec says:

    This is a pilot study showing osteopathic manipulation was effective for fibromyalgia:

    http://www.ncbi.nlm.nih.gov/pubmed/12090649

  61. Harriet Hall says:

    pec,

    That was a preliminary study with poor controls (no attempt at sham manipulation) and no blinding. Positive results in that situation are compatible with PT and placebo effects. There is nothing in that study to confirm the existence of subluxations, to show that fibromyalgia is related to subluxations, or to show that manipulation treats subluxations.

  62. pec says:

    “poor controls (no attempt at sham manipulation) and no blinding.”

    You know very well that trying to use sham manipulation as a control is ridiculous. You say the same thing about every successful study of chiropractic or acupuncture, because you know they can’t do anything about it.

  63. weing says:

    pec,

    Come on! 6 subjects in each group? Don’t call that evidence, please. It’s been at least 7 years, you’d expect a positive study to be done by now. I guess they wouldn’t publish a negative one.

  64. Harriet Hall says:

    pec,
    you’ve done it again. You’ve completely ignored my main point: No matter how good or bad the study is, there is nothing in that study to confirm the existence of subluxations, to show that fibromyalgia is related to subluxations, or to show that manipulation treats subluxations.

    Yes, the impossibility of adequate controls or blinding severely limits the credibility of most chiropractic research. Instead of assuming the reality of subluxations and doing Tooth Fairy research, they need to go back to square one and test whether subluxations and nerve interference are really present. We have sophisticated new imaging methods and we can measure nerve conduction. If the subluxation is real, they ought to be able to demonstrate it.

  65. fergie34711 says:

    Oh dear what’s this I see? Who’s nutty enough to suggest that fibromyalgia can be treated with spinal manipulation? You know, my doctor gave Lyrica to treat my fibromyalgia and it worked like no other drug or treatment before it did. I also did some physical therapy but not for Fibromyalgia; I had some other low back pain issues and neck pain which the physical therapy really helped.

    But I am telling you now that the physical therapy did very little to help my fibromyalgia. Not that therapy wouldn’t or couldn’t help some fibromyalgia patients, though.

    But this subluxation is nonsense. It has nothing to do with fibromyalgia. I’ve already suffered enough physical pain. Spare the intellectual pain.

  66. pec says:

    “they need to go back to square one and test whether subluxations and nerve interference are really present. ”

    That’s why I had linked the animal nerve experiment in the first place. This kind of thing really requires animal research, and at this point I don’t know how much has been done. Hopefully someone has done it , or is doing it, and hopefully there is funding. Again, I will see what I can find out, with my limited access to journals.

    And I do think you will have to admit it is reasonable to suppose that when a vertebral joint is far from its ideal alignment, that the nerves passing through might be adversely affected in some way that is not yet well understood.

    The clinical experience of chiropractors and osteopaths over many decades, the personal experiences of millions (or hundreds of millions) of people who practice yoga, along with plain old common sense suggests there is something to the subluxation theory.

    Yes I understand you “skeptics” have no faith whatsoever in common sense, but please note that is only one item out of several on my list of reasons to think before rejecting the theory.

  67. pec says:

    “But this subluxation is nonsense. It has nothing to do with fibromyalgia.”

    Well it’s too bad you won’t consider it and instead are planning on a lifetime of drug use. I wouldn’t actually recommend chiropractic, since I think their skill levels vary tremendously. But you should explore every avenue of physical therapy, exercise and yoga. When your faith is in MDs, as mine was long ago, you can suffer needlessly for many years.

    It’s very easy for the spine to depart from its ideal alignment, and all kinds of symptoms can result. Most people probably have some misalignment and compensation, but don’t even notice because the symptoms are subtle, or they blame it on the “normal” aches and pains of aging.

    It’s really really too bad that everyone accepts all those aches, or takes drugs for them. No one knows the long-term effects of taking anti-convulsants every day.

    I recommend thinking twice about this and not having blind faith in modern drug-oriented medicine.

  68. Harriet Hall says:

    pec said, “it is reasonable to suppose that when a vertebral joint is far from its ideal alignment, that the nerves passing through might be adversely affected in some way that is not yet well understood.”

    But when chiropractors say a joint is out of alignment, x-rays prove it ISN’T out of alignment. Even the chiropractors were convinced: they changed their definition of subluxation so that it no longer requires a bone out of place.

    Anyway, we know actual subluxations can occur with no nerve interference. Spondylolisthesis is an example. It can be asymptomatic and picked up on x-ray by chance.

    I’m wondering if you are confusing the chiropractic subluxation with things like poor posture and curvatures: in those cases there is muscle strain that can lead to symptoms, but that has nothing to do with subluxations.

    You want to rely on clinical experience and common sense: but we have learned that we need science precisely because experience and common sense can mislead us. Bloodlettters in the Middle Ages had plenty of clinical experience and their common sense told them bloodletting ought to correct the imbalance of the humours.

  69. Harriet Hall says:

    pec said,

    “you should explore every avenue of physical therapy, exercise and yoga. ..I recommend thinking twice about this and not having blind faith in modern drug-oriented medicine.”

    pec, you have no business giving medical advice to anyone. Fergie tried other things like PT and finally found a drug that helps. That is not “blind faith.” You seem to be the one who has “blind faith” that conventional medicine is bad.

  70. pec says:

    “Bloodlettters in the Middle Ages had plenty of clinical experience”

    You always rely on that example. You never consider that physicians in the Middle Ages used what they knew, just like physicians today. Bloodletting probably helped in certain conditions, so the evidence was ambiguous. If it never worked for anything, they would have given up on it after a short while. We have similar situations today, for example with chemotherapy for cancer — MDs believe it works for some cases so they use it for most, even though there is no scientific research comparing chemo to no chemo. It might be useless or harmful for many patients, just like bloodletting was.

  71. pec says:

    “But when chiropractors say a joint is out of alignment, x-rays prove it ISN’T out of alignment.”

    It all depends on exactly what you mean by “alignment” or “subluxation.” We do not have unambiguous definitions for these concepts. It is not hard to notice when the spine fails to conform to its ideal curve, and you can see that some vertebrae are incorrectly aligned. MDs will not believe it because they think there must be intense pressure on a nerve before its functioning can be affected.

    The subject is, at least, controversial and very far from having been settled.

  72. pec says:

    “you have no business giving medical advice to anyone”

    My advice should not be considered medical advice. I would tell anyone the same thing if they complained about joint or muscle pains. I would warn anyone that some of the most commonly used drugs have not been tested for long-term effects.

    I am not an MD, and no one has to take any of my advice. I really think Lyrica is bad, even though it may decrease pain. I really think it’s another case of MDs and the public having too much confidence in the “wisdom” of the drug companies.

  73. pec says:

    “Recent neuroscience research supports a neurophysiologic rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function.”

    http://www.ncbi.nlm.nih.gov/pubmed/10714536?dopt=Abstract

  74. Joe says:

    pec on 07 May 2009 at 12:26 pm cited an abstract of a symposium presentation.

    The abstract is in a chiro magazine and, essentially, concludes that chiros are right about the subluxations (surprise!!) which they cannot succinctly define and which nobody else can detect.

    That is only evidence tat chiros still believe in subluxations (which we already knew) despite all evidence to the contrary.

  75. weing says:

    “We have similar situations today, for example with chemotherapy for cancer — MDs believe it works for some cases so they use it for most, even though there is no scientific research comparing chemo to no chemo.”

    That’s quite a claim. Evidence for it? Reeks of conspiracy.

    I think sham arthroscopic surgery would be a much better example:
    http://content.nejm.org/cgi/content/full/347/2/81?ijkey=d86d72705a5ba87b42d21de333ed95e6039c3595

  76. pec says:

    “The abstract is in a chiro magazine”

    It’s in a journal concerned with the spine and SMT; I don’t know if that makes it a chiro journal. But either way, I would not expect people from outside the field to take the trouble of researching subluxations. An MD who thinks chiropractic subluxation theory is a mass delusion would not waste time studying it.

    Pseudo-skeptics will continue denying subluxation theory until there are hundreds of RCTs paid for by Big Drug showing subluxations are real. Clinical experience doesn’t count, personal experience doesn’t count, research in chiropractic journals doesn’t count.

    And, of course, you don’t want subluxation theory to get research funding since it belongs to CAM. So, as usual, your minds are nailed shut.

  77. pec says:

    weing,

    We do not have good evidence that chemotherapy for cancer works in most, or even in many, cases. But, just like bloodletting, it is used in every case because that’s what MDs were taught to use. Because of over-diagnosis and lead-time bias we cannot know the real cancer cure rates. And the chemo/no chemo comparison can never be made, because it would involve depriving patients of a “proven” treatment. Of course, it never was proven, just accepted. New cancer drugs are not compared to no drug, they are compared to older drugs. If a small number of patients survive a little bit longer with a newer drug, it is considered effective. But maybe the newer drug is just a little less lethal than the old one; no one can really know.

    And all that is accepted without question or complaint by the pseudo-skeptics.

    Your standards for CAM are very different from your standards for mainstream.

  78. Harriet Hall says:

    pec fallaciously tries to compare bloodletters to modern scientific doctors. The difference is that bloodletters never tested their beliefs. Weing’s sham surgery example is a prime example of modern medicine testing its own assumptions and abandoning something that doesn’t work.

    She says “there is no scientific research comparing chemo to no chemo.” Maybe. There is no scientific research comparing appendectomy to no treatment or antibiotics for pneumonia to no treatment or casts for broken bones to no treatment, because the treatment is effective and it is unethical to deny patients effective treatment.

    Chemo “might be useless or harmful for many patients, just like bloodletting was.” Yes, chemo is useless or harmful for some patients, but overall it is beneficial. We can’t yet predict which patients will benefit, so we look at risk/benefit ratios and statistics and make the best decisions we can. That is completely different from the situation with bloodletting, where we can predict which patients will benefit (for example, those with iron storage disorders).

    “I really think Lyrica is bad.”
    What you “think” is irrelevant.

    As I thought, you are confused about definitions. When the neck is pulled out of its optimal curve by torticollis, the bones are still in alignment with each other. Confusing muscle phenomena with bony misalignment only muddies the waters.

  79. Harriet Hall says:

    pec said “An MD who thinks chiropractic subluxation theory is a mass delusion would not waste time studying it.”

    There are DCs like Samuel Homola who wasted 4 years of chiropractic school studying it and then realized it was a mass delusion. I did not think it was a mass delusion when I started researching it; I came to that conclusion based on the evidence I found.

    “Your standards for CAM are very different from your standards for mainstream.”
    You can say this as many times as you want but it still won’t be true. The whole point of this blog is to apply the same rigorous scientific standards to every claim.

  80. weing says:

    So, again you claim that chemotherapeutics are lethal and that there is a conspiracy to keep using them. So, now what? You simply look for evidence to confirm these claims and ignore any evidence that contradicts them. You call that skepticism?

  81. Joe says:

    pec on 07 May 2009 at 1:24 pm “It’s in a journal concerned with the spine and SMT; I don’t know if that makes it a chiro journal.”

    http://www.journals.elsevierhealth.com/periodicals/ymmt
    Journal of Manipulative and Physiological Therapeutics (JMPT) is dedicated to the advancement of chiropractic health care.”

    Life does not get much simpler than that, pec.

  82. Harriet Hall says:

    “Recent neuroscience research supports a neurophysiologic rationale for the concept that aberrant stimulation of spinal or paraspinal structures may lead to segmentally organized reflex responses of the autonomic nervous system, which in turn may alter visceral function.”

    Does this show that subluxations exist, that they cause nerve dysfunction, or that chiropractic adjustments can correct them? I don’t think so!

    For crying out loud – it only says research “supports a rationale” – not that research has found any evidence!

  83. pec says:

    [“I really think Lyrica is bad.”
    What you “think” is irrelevant.]

    What I think is relevant. What everyone thinks is relevant. We don’t have to trust the medical priesthood; we can think for ourselves. Patient report websites are valuable and it’s sometimes surprising what you won’t hear from your MD and what the TV drug ads fail to mention.

  84. pec says:

    [ it only says research “supports a rationale” - not that research has found any evidence!]

    I could not read the article. But certainly, by “supports a rationale” they must mean there is evidence. Would you say research supports a rationale for something that was contradicted by the research? Harriet, even Wikipedia seems to be open-minded about subluxations, and they are generally very skeptical.

    It is a common sense concept supported by massive clinical and anecdotal evidence. I know you have no use for common sense or clinical/anecdotal evidence, but in reality they are the basis of most medical decisions. As they should be.

    “Weing’s sham surgery example is a prime example of modern medicine testing its own assumptions and abandoning something that doesn’t work.”

    Most of the time sham surgery would be impractical or unethical, so most of the time it is not done. Decisions are made based on common sense and clinical experience.

    ” There is no scientific research comparing appendectomy to no treatment or antibiotics for pneumonia to no treatment or casts for broken bones to no treatment, because the treatment is effective and it is unethical to deny patients effective treatment.”

    And none of those are comparable to chemotherapy for cancer. And you have just contradicted your whole philosophy that clinical experience is worthless.

  85. Diane says:

    HH -> “What you “think” is irrelevant.”
    Pec-> “What I think is relevant. What everyone thinks is relevant.”

    What anyone “thinks”, individually, is only opinion. It doesn’t count scientifically. Everyone is entitled to his or her opinion, but when the opinion has little or no substance or is inherently contradictory, it will be weighed only briefly by others then discarded. Repetitious assertion of it thereafter will only annoy, not convince.

    Opinion based on objective reality, i.e., that which has been determined scientifically, and which has been subjected to a heartless pruning with Occam’s Chainsaw, preferably by the opinion holder him/herself, may carry a bit more weight.

  86. vargkill says:

    Wow i never knew that MD’s where at odds with chiropractors…

    I guess you learn something new each day right?

  87. Harry says:

    @Vargkill,

    Physicians aren’t so much at odds with chiropractors as they are at odds with bad chiropractors.

    Re:http://www.chirobase.org/01General/respect.html

  88. tgobbi says:

    vargkill states: “… I never knew that MD’s [sic] where [sic] at odds with chiropractors.”

    And I assumed that everyone was familiar with Wilk v. American Medical Association. Then I realized how many years it’s been since that case was adjudicated; it all began in 1976! (I’m getting too old).

    See: http://en.wikipedia.org/wiki/Wilk_v._American_Medical_Association

    The AMA lost the case, but only on a legal point: restraint of trade. The judge had these comments about the scientific validity of chiropractic.

    “The plaintiffs clearly want more from the court. They want a judicial pronouncement that chiropractic is a valid, efficacious, even scientific health care service. I believe that the answer to that question can only be provided by a well designed, controlled, scientific study… No such study has ever been done. In the absence of such a study, the court is left to decide the issue on the basis of largely anecdotal evidence. I decline to pronounce chiropractic valid or invalid on anecdotal evidence.”

    Despite the above pronouncement and against the warnings of the ACA (American Chiropractic Association), “doctors’ of chiropractic went out of their way to proclaim that their legal victory was a validation of chiropractic theory and treatment. They read what they wanted to see into the judge’s remarks.

    tgobbi

  89. vargkill says:

    I honestly never heard that chiropractors where under such
    scrutiny! I really had no clue until i came on SBM and heard
    folks talking about how its nothing more then CAM.

    I have never personally been to one but everyone iv ever
    talked to that went to see one claims it makes them feel better.

    Interesting indeed!

  90. vargkill says:

    I honestly never heard that chiropractors where under such
    scrutiny! I really had no clue until i came on SBM and heard
    folks talking about how its nothing more then CAM.

    I have never personally been to one but everyone iv ever
    talked to that went to see one claims it makes them feel better.

    Interesting indeed!

  91. Joe says:

    pec on 07 May 2009 at 6:25 pm “I could not read the article. But …”

    I’ll finish that for you ‘… but certainly I can imagine what it says; after all, nobody would publish nonsense in a chiro magazine. Would they?‘ How is that? And you, pec, can ignore the big kids that tell you there is no tooth fairy.

  92. tgobbi says:

    Vargkill writes (in part): “I have never personally been to one but everyone iv [sic] ever talked to that went to see one claims it makes them feel better.”

    This is all a matter of perception and can be influenced by any number of factors. It happens following just about any intervention: chiropractic prodding; acupuncture poking; naturopath colon cleansing, witch doctor shaking sticks, etc. It’s called the placebo effect. For many, if not most, of us ANY intervention of ANY kind may have an effect on our perception, especially of pain – which is highly subjective. For a thoroughly enjoyable read that explains placebo in depth I urge you to read “Snake Oil Science: The Truth About Complementary and Alternative Medicine” by R. Barker Bausell. It’s a must read for anyone who doesn’t already understand what placebo is all about. It will give you a lot of insight into why people “feel better” after being treated by quacks of any stripe.

    tgobbi

  93. pec says:

    “The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic SMT.”

    http://linkinghub.elsevier.com/retrieve/pii/S0161475400900733

  94. Scott says:

    Pec,

    Impossible to properly evaluate that paper without paying AFAICT. One example point – in most such papers I’ve seen the “control” was medication. That is NOT a suitable control for ruling out the placebo effect, and would render the results entirely useless for the purposes to which you’re attempting to use them.

    “It is a common sense concept supported by massive clinical and anecdotal evidence.”

    If you think it’s “common sense” that displacements of the vertebrae so tiny that they cannot be detected nevertheless profoundly affect all aspects of the body’s functioning, then you’re completely lost to all hope.

    You also neglect to mention that said concept is firmly rebutted by even more massive quantities of higher-quality evidence, so the anecdotes lose quite badly.

  95. cheglabratjoe says:

    I can get the paper through my school. The control group received “detuned interferential therapy,” whatever that is. It looks like they were hooked up to a machine that was turned off, and moreover they were explicitly informed that they were either going to get chiropractic or a noneffective placebo. Sounds to me like the “blinding” was anything but … obviously the people hooked up to dead electrodes would know they were getting the placebo, and the people seeing the chiropractor would know they were getting the real deal.

    So, the placebo wasn’t a medication, but medication did play a role. One of the outcome measures was frequency of medication usage for treating migraines. Not sure how (or whether) that would affect the results, but it seems like a serious complicating factor.

    Another complication is a comment the article kept coming back to: that most of these folks’ migraines are brought on by stress. Wouldn’t a real chiropractic appointment be stress-reducing compared to being hooked up to a machine you know isn’t doing anything? Personally, that would stress me out to no end: “I signed up for this experiment to get actual treatment, not to have some putz pretend this machine is doing something when we both know it isn’t!”

  96. Harriet Hall says:

    pec,

    Studies showing symptomatic improvement after spinal manipulation do nothing to establish whether subluxations exist, whether they cause nerve interference, or whether manipulation fixes subluxations.

    Just as showing that there is money under the pillow the morning after a tooth is left for the Tooth Fairy does not establish the existence of the Tooth Fairy.

  97. Harriet Hall says:

    vargkill said

    “everyone iv ever talked to that went to see one claims it makes them feel better”

    That’s why you can’t rely on personal experience. Studies have shown that 50% of patients seeing a chiropractor report mild to moderate discomfort after treatment, with 26% of symptoms lasting longer than a day. Chiropractic malpractice insurance regularly pays claims for

    Disc 32.7%
    CVA (Stroke) 9.0
    Vicarious liability 4.7
    Professional discipline 10.2
    Aggravation 5.6
    Failure to Dx 7.8
    Fracture 10.4
    Other 19.6 (Treatment, burns, strains, sprains, soft tissue, TMJ)

    This is from the major American chiropractic insurance company in 2002.

    Also, I have a friend who called on a Friday to make an appointment with a chiropractor for Monday. Over the weekend, his back pain disappeared. If he had seen the chiropractor on Friday, the chiropractor would have been falsely given the credit for a cure.

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