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269 thoughts on “Adverse Effects of Chiropractic

  1. Harriet Hall says:

    “The evidence we already have says that in comparison to other forms of care, SMT is as safe, if not safer.”

    Maybe in comparison to SOME other forms of care, but certainly not to ALL other forms of care.

  2. Fred Dagg says:

    Personally, I think we have flogged this topic to death. We could argue semantics, citations and repeat ourselves ad nauseum, but not really get any further than this state.

  3. Harriet Hall says:

    Can we at least agree that SMT has frequent minor benign side effects and rare serious complications?

  4. Fred Dagg says:

    I think the word ”occasional” is more accurate than “frequent”, however that would be being pedantic.

  5. nwtk2007 says:

    How many CMT induced strokes have occurred since Ms Nette had hers? With all the attention on the potential occurrence and it’s apparent frequent incidence, you would think, after hearing the arguments here, that it must occur almost daily.

    Where as we know the dangers of just one drug, ibuprofen, and that causes about 2 – 3 deaths per day. Yet it is still over the counter and still readily available to anyone.

    You say the little packet inside describes the risks. Just how literate do you really think the public actually is? Have yo been out in the real world lately? Have you been to the getto and into the immigrant world of most of the USA? Do you really, honestly think people actually read those “little packets” or even the back of the bottle or any such thing that comes with the bottle of ibuprofen? If they did then they might actually know that Advil, Motrin and ibuprofen are the same thing and could actually converse on the dangers and risks associated with it’s use.

    And this is just ONE drug available to an unknowing public.

    Yes we can agree that CMT has some adverse effects and some very rare serious complications. I am just wondering how many of these serious complications have occurred since Ms Nette’s stroke now that the medical community is so keenly aware of the possibility of it happening?

  6. Fred Dagg says:

    ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ!!!!!!!!!!!!!!!

  7. Citizen Deux says:

    nwtk2007 – Ibuprofen causes 2-3 deaths per day.

    Please cite references – a rate of mortality attributable to a drug would have it removed from the shelves so fast it would make your head spin.

    By the way – if there is agreement on the SMT / CMT discussion, can someone identify which “principles” of chiropractic they follow? I note that the BC College of Chiropractic provides some of the most restrictive practice constraints on their members – although the wide range of therapies offered in by Vancouver DCs seems to ignore this covenant.

  8. nobs says:

    Harriet- Here is the full text you requested.

    http://www.springerlink.com/content/dtx8628t82177061/fulltext.pdf

    “All cervical manipulations were performed in different
    private practices. Orthopedic surgeons conducted
    the neck manipulation in 18 subjects. Four procedures
    were conducted by a chiropractor and 5 by a physiotherapist
    while maneuvers performed by neurologists
    (n=1), homeopaths (n=1) and general practitioners
    (n=2) accounted for 4 incidents.”

    Would you kindly provide me with the full text of the referenced systematic review? Thank-you in advance.

    I’d also like to comment on THIS: (which you reference in your “chiropractic ‘explanation’”)

    HH-” An intriguing study using PET scans concluded that cerebellar hypoperfusion (decreased

    blood flow to the base of the brain) may occur after cervical spinal manipulation. This

    could explain reports of headache, dizziness, vertigo, nausea, blurred vision, etc. It also

    raises the possibility that some of the minor reactions were strokes that almost happened

    but didn’t.”

    It is important to note, that while you quote this study in your “chiropractic explanation” —-ALL manipulations performed in this study were done by physiotherapists.—

    Yesterday you posted a link to a newwpaper column about legislation regarding chiropractic informed consent. – What type of informed consent do you advocate for manipulating MDs and PTs? -Should not that also be part of the legislation here?

  9. Harriet Hall says:

    nobs,

    The full text of the systematic review? There is no free access. You can buy it with the pay-per-view option on the Spine website at http://journals.lww.com/spinejournal/toc/2009/05150

    About the legislation: If you will go back and read the link again you will see that the proposal has been modified to also apply to non-chiropractors who use manipulation. Yet chiropractors still feel that they have been singled out.

    Yes, studies like the one you cite use imprecise terminology. It’s no wonder. Chiropractic has claimed manipulation as its raison d’etre, and has strongly identified itself with manipulation in the public mind. It is only natural that when others do the same procedure they think of it as “chiropractic.” Interestingly, that study was done in Germany, and chiropractors are not licensed in that country. The semantics might have lost something in translation.

    The risk is with the procedure and it is irrelevant who provides it.
    My post begins by saying “There is a very good chance that you will feel worse after seeing a chiropractor” and I think there are sufficient data in the review to support that. I could have added “There is a smaller chance that you will feel worse after seeing other practitioners who provide manipulation, because other practitioners use manipulation on a smaller percentage of their patients.”

  10. nwtk2007 says:

    Dear Citizen,

    I only have a couple of minutes so here is a quickie:

    http://www.drugwarfacts.org/cms/?q=node/30#nsaid

    The resource is JAMA.

    Also – “NSAIDs, such as ibuprofen, are among the most widely used drugs in the world for the treatment of chronic pain and inflammation with more than 90 million prescriptions written each year for the treatment of arthritis and other types of mild-to-moderate pain. However, NSAIDs are associated with a range of adverse side effects, which primarily affect the GI tract. Up to 30 percent of patients taking NSAIDs experience GI ulcers, and even more suffer from upper GI symptoms (e.g., dyspepsia, heartburn). Serious NSAID-induced GI toxicity causes an estimated 16,500 deaths and more than 107,000 hospitalizations annually in the U.S. alone.”

    This from
    http://www.medpagetoday.com/PRDir/PressRelease.cfm?id=2553&sid=77&cid=10

    To get the actual sources you’ll have to do some digging if you are so inclined.

    That was about 1 min of looking. I’m not on my computer so I can’t give you too many others. It is very easy to see the rates in many different sources. It is essentially common knowledge in the scientific community.

    So how many CMT induced strokes since Ms Nette anyway? A very rare occurrance indeed.

  11. nwtk2007 says:

    Feel worse after seeing a chiro?

    Then why do they keep coming back. You would think that if they feel beter after seeing someone they would come back.

    I’m just saying.

  12. Harriet Hall says:

    nwtk2007,

    Any risk statistics are meaningless until they are put into perspective with benefit statistics. The question is not how many people have suffered side effects, but what the risk/benefit ratio is. The benefits of neck manipulation for health maintenance are non-existent, so even one Sandra Nette is too many.

    The repeated assertions by chiropractors that NSAIDS kill more patients than neck manipulation are technically true, but they imply an unwarranted assumption that those are the only two options, and they completely disregard the fact that the benefits and risks of NSAIDS have been clearly demonstrated and even quantified, whereas the benefits of manipulation are not so clear and the risks are known but not so well quantified.

  13. nobs says:

    HH->>”About the legislation: If you will go back and read the link again you will see that the proposal has been modified to also apply to non-chiropractors who use manipulation. Yet chiropractors still feel that they have been singled out.”<<

    What it says is:

    “Fasano has modified his proposal to say that any PHYSICIAN who performs neck manipulation must practice informed consent. The chiropractors say this still singles them out.” (Italics are mine for emphasis)

    Since PTs cannot legally use “physician”, that would nullify them from this legislation. What is your opinion on that?

  14. nobs says:

    HH- >>”Yes, studies like the one you cite use imprecise terminology. It’s no wonder. Chiropractic has claimed manipulation as its raison d’etre, and has strongly identified itself with manipulation in the public mind. “<<

    In the “public mind” perhaps, but surely we should expect more accuracy in scientific publications. Do you not agree?

  15. Harriet Hall says:

    nobs asked “Since PTs cannot legally use “physician”, that would nullify them from this legislation. What is your opinion on that?”

    I thought by now my opinion would be crystal-clear to everyone. Any legislation should apply equally to anyone offering the procedure.

  16. Harriet Hall says:

    nobs said, “In the “public mind” perhaps, but surely we should expect more accuracy in scientific publications. Do you not agree?”

    Well of course I agree! We should always strive for precision of terminology. Unfortunately, public understanding has a strong influence on our language. I use the term “alternative medicine” even though I don’t accept that there is any validity to that concept. It’s easier to use the popular term than to explain my thinking every time. Sometimes I call it “so-called alternative medicine.” Maybe I should say “so-called chiropractic treatment which is really just the same spinal manipulation therapy that other providers use.”

  17. nobs says:

    HH- >>”Well of course I agree! We should always strive for precision of terminology”<<

    Yes- Scientific papers and so-called scientific-medicine op-ed pieces should not contribute to further confounding the public, with improper language and misuse of terminology.

  18. Fred Dagg says:

    Harriet (one T, not two)

    You do not seem to address the issue of how many people take NSAIDs, for maintenance, just in case they get a headache, or just because they feel the odd niggle.

    Is every one of those scripts necessary? I do not think so.

    Does every person read the enclosed information sheet?.
    Well, in my experience they are written in very small print, and in such a way that they are incomprehensible to the average U.S. reader.
    You just about need a medical degree just to make sense of these sheets. This would hardly be considered to be adequate informed consent or even good information.

  19. Harriet Hall says:

    “You do not seem to address the issue of how many people take NSAIDs, for maintenance, just in case they get a headache, or just because they feel the odd niggle. Is every one of those scripts necessary? I do not think so.”

    I don’t think so either. Please read what I wrote about overuse of medications at http://www.sciencebasedmedicine.org/?p=126 Incidentally, NSAIDS do not require a script – they are available over the counter.

    I didn’t address overuse of NSAIDS because that was not the issue. You did not address the issue of how many chiropractic patients get adjusted for maintenance and other bogus indications, either. I didn’t address the cost of treatment or a lot of other things. You keep complaining about what I didn’t say, and you quibble about my use of words, but you haven’t actually disagreed with what I did say: that a significant number of patients report mild adverse effects and that there are rare serious complications from neck manipulation.

  20. Harriet Hall says:

    nwtk2007 said
    “Feel worse after seeing a chiro?
    Then why do they keep coming back. You would think that if they feel beter after seeing someone they would come back.
    I’m just saying.”

    Apparently he didn’t notice that I had asked the same question and answered it in the post. I didn’t elaborate on the psychological factors that can keep patients coming back, but they are legion.

  21. pmoran says:

    I have to say that I was surprised when ibuprofen was made available over-the-counter. But it has now been available for short term pain relief in relatively low dosage for over two deacdes in most advanced countries, so I suppose it is proving about as safe as paracetamol, antihistamines and many other OTC drugs. I just hope our ADR reporting system is working as it should.

    Trying again to convey the gist of our concerns, chiropractic gets singled out in relation to the stroke issue because of the perception that the vast majority of the neck manipulation performed within chiropractic is unnecessary medically.

    It is believed that unnecessarily long programs of treatment are advised (against BJD advice), even life-long supposedly preventative treatments — even in children, AND sometimes babies, whose necks are like jelly.

    There are other treatments that will SERVE “work” about as well for neck pain, the major indication. Neck manipulation may well yet have a place with neck pain but it is up to chiropractors and others who wish to use neck manipulation for that purpose to lay down some ground rules so that a minimum number of necks are at risk for the greatest likely benefit. We don’t see that happening within chiropractic, even in the BJD material.

    There is no good evidence that CMT works for anything else *other than as placebo* and only highly unusual circumstances might justify even the tiniest risk from placebo treatments. There are plenty of quite safe ones to choose from.

    What do you have to say to this?

    “Medical treatments kill people too”, is in my opinion a childish response. Patients prefer not to be killed or to know at minimum that any risks are justified by unique properties of the treatment offered.

  22. nwtk2007 says:

    Harriet, of course I read your answer to your own question which I just re-iterated.

    I guess chiropractors are just really good at the “psychology” of patient compliance. Perhaps we should conduct some work shops for medical doctors in this regard and thus improve their compliance to their treatments such that these patients would not come running to us for help when their medical doctor has failed them.

    But again, I’m just saying.

    And I am still surprised that ibuprofen OR tylenol were made OTC. The warnings are an empty gesture at best. Come down to the ghetto or even to the average “people” world and lets take a poll on the risks of the drugs people take in such huge amounts.

    I know, it’s not the issue.

    Also, there is an article by DrVertebrae at

    http://www.TruthinTreatment.blogspot.com

    about full disclosure that I find interesting when talking about informed concent.

  23. Fred Dagg says:

    I advocate that for all proceedures a patient undergoes from a registered health care provider, that they are informed of the dangers of this proceedure. The patient/consumer is informed of the likely risks of complications and signs a waiver to say that they understand the risks involved.
    That will also include all OTC medications such as NSAIDS, Asprin and Tylenol etc.

    The savings to the U.S. community will be huge. No more mal-practice cases and no more drug companies being sued, unless they with-hold information from the public as to the dangers. (Just like the tobacco companies)

    Any problems with that?

  24. Harriet Hall says:

    .Informed consent is not sufficient to prevent malpractice suits, and the cost of all the paperwork would be immense. Trees would die. If people had to sign an informed consent to get an aspirin, they would be majorly annoyed.

    Talk about “slippery slope.” You could extend the concept to include getting on a bus or plane, buying a bicycle, buying a hammer, getting a shampoo in a beauty parlor, visiting a beach

    Even going outdoors is hazardous to your health (sunlight, skin cancer, wrinkles). You can’t require informed consent for everything. The existing situation is a reasonable compromise.

  25. Fred Dagg says:

    Harriet,

    “What is good for the goose, is also good for the gander”,

    a common expression in the British Commonwealth.

    We are only talking of Registered HealthCare Providers, in this circumstance. While it may be inconvenient, it is also fair and safe.
    Trees will not die, but electrons and digital signing would be appropriate.

    People may get annoyed, but that will be the price they pay to be informed.

    I wonder if the literacy skills would be up to suitable standard so that consumers actually understood what they were signing. Now, that is a major concern!!!!!!!!!!!!!

  26. Joe says:

    @Fred Dagg on 16 Jun 2009 at 6:32 pm “I wonder if the literacy skills would be up to suitable standard so that consumers actually understood what they were signing.”

    That would put you out of business. Maybe, even, prevent you from going to chiro school.

  27. Harriet Hall says:

    Fred,
    You haven’t actually disagreed with what I said in my post: that a nontrivial number of patients report mild adverse effects and that there are rare serious complications from neck manipulation. Can we just agree on that and end this discussion? It has gotten way off topic.

  28. Fred Dagg says:

    Hi Harriet

    yes, we are off topic. No need for snide remarks from Joe.

    I will look forward to your next item on the “Perils of Informed Consent”.

    Now we can concern ourselves on the use of the word “Science”.

  29. Citizen Deux says:

    nwtk2007 – you cited a pro-legalization marijuana page which then references a 1997 article on gastropathy in elderly patients in a small study in Canada. You must be out of your mind. This is not indiciative of mortality due to NSAIDS – which cover far more than Ibuprofen.

    If you’re going to cite something – know where it leads.

  30. Fred Dagg says:

    ZZZZZZZZZZZZZZZZZZZZ!!!!!!!!!!!!!!!!!
    Wake me up when someone says something important.

  31. nwtk2007 says:

    (1996): “Each year, use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) accounts for an estimated 7,600 deaths and 76,000 hospitalizations in the United States.” (NSAIDs include aspirin, ibuprofen, naproxen, diclofenac, ketoprofen, and tiaprofenic acid.)

    I guess you didn’t see this. Or this:

    The side effects related to Ibuprofen, though fewer in number, can be more intense in symptoms. The most common side effects are GI (gastrointestinal) in origin. They include complaints of nausea, vomiting, anorexia, diarrhea, and abdominal pain and occasionally even ulcers of the upper intestinal tract. There are other possible and less frequent side effects involving the central nervous system, liver and even allergic reactions like rashes.

    Heavy use of nonaspirin pain relievers does increase the risk for high blood pressure. In one groundbreaking study, women who took nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen, 22 times a month or more were 86% more likely to have high blood pressure than those who did not take NSAIDs. Those taking acetaminophen were twice as likely to be hypertensive. Aspirin did not increase the risk.

    or this:

    Adverse drug reactions affect a far greater number of hospital patients than was previously thought and may rank as high as the fourth leading cause of death in the United States, according to a report in the April 15th issue of The Journal of the American Medical Association.

    Jason Lazarou, and Drs. Bruce H. Pomeranz and Paul N. Corey of the University of Toronto in Ontario, Canada, conducted a meta-analysis of 39 prospective studies that occurred between 1966 to 1996 and focused on the incidence of adverse drug reactions in US hospitals.

    For purposes of the study, an adverse drug reaction was defined as “…any noxious, unintended and undesired effect of a drug, which occurs at doses used in humans for prophylaxis, diagnosis, or therapy.” Incidents involving errors in drug administration, noncompliance, drug abuse, overdose or therapeutic failure were not included.

    “The overall incidence of serious [adverse drug reactions] was 6.7%,” the researchers conclude, “…and of fatal [adverse drug reactions] was 0.32%.” For the year 1994, this amounted to an estimated 106,000 adverse drug reaction-related fatalities. The researchers say that adverse drug reactions may be the fourth to the sixth leading cause of death in the US.

    or this:

    This medicine can cause ulcers and bleeding in the stomach and intestines at any time during treatment. Ulcers and bleeding can happen without warning symptoms and can cause death.

    This is a general search which to about 1 minute. If you actually try to look then you will find much more. Still not on my computer so this will have to suffice.

    For a science based web cite I shouldn’t even have to site evidence such as this. It is common knowledge in the entire scientific community. You might as well have me cite articles and studies showing the formula for water.

    Is science about ignoring that which we already know?

    More bias.

  32. nobs says:

    HH->>”A retrospective study of medicolegal cases suggested that chiropractors may have failed to recognize a stroke in progress. “The sudden onset of acute and unusual neck and/or head pain may represent a dissection in progress and be the reason a patient seeks manipulative therapy that then serves as the final insult to the vessel leading to ischemia.” Strokes occurred at any point during the course of treatment and there was no dose-response relationship.”<<

    Harriet- It did not suggest that at all. First of all, this study was not about chiropractors, and your attribution to chiropractors is a total distortion Then you wonder why the general public is confused? I know you know better. Here is the actual quote I suspect you were “explaining”:

    “The results of this study suggest that stroke, particularly vertebrobasilar dissection, should be considered a random and unpredictable complication of any neck movement including cervical manipulation. They may occur at any point in the course of treatment with virtually any method of cervical manipulation. The sudden onset of acute and unusual neck and/or head pain may represent a dissection in progress and be the reason a patient seeks manipulative therapy that then serves as the final insult to the vessel leading to ischemia.

    wonhttp://www.springerlink.com/content/dtx8628t82177061/fulltext.pdf

    There are also some very important findings in the body of the work that you chose not to “explain”.

    The authors report:

    “There has also been increasing utilization of manual manipulation by medical physicians and physical therapists around the world.”
    AND:
    “Eight of these 16 patients were seen in an emergency room or by their family physician prior to seeking spinal manipulation.”
    AND:
    “These data do not, however, exclude the possibility that skill plays a role in etiology of these complications.”
    AND:
    “Our data raise the possibility that in certain cases manipulation may not be the primary insult causing the dissection but rather an aggravating factor or coincidental event precipitating ischemia. It is clear that the majority of reported vertebrobasilar artery dissections occur and progress to brain ischemia without manipulation.”

    From Harriet’s “explanation”, It is hard to even recognize this study, and Harriet’s “Adverse Effects of Chiropractic” “explanation” is unraveling, chiropractically. Very little of her cited supporting evidence has to do with chiropractors at all. I have just noted the third study where the major players were not DCs at all. There are more.

  33. Fred Dagg says:

    I think this is falling on deaf ears.

    Harriet has moved on to the subject of “science”, where she has got confused between “science”, (“If you do not believe me, you are a pseudo-scientist”), and the scientific method. In this post, apparently being a “skeptic” is seen as qualification enough to criticize anything she does not agree with.

    However, I believe, everybody should sign informed consent prior to any treatment being received. Funnily enough, she did not agree with me. Gave some woo excuse!!

  34. nobs says:

    “# Harriet Hall on 16 Jun 2009 at 1:15 pm
    nobs asked “Since PTs cannot legally use “physician”, that would nullify them from this legislation. What is your opinion on that?”

    I thought by now my opinion would be crystal-clear to everyone. Any legislation should apply equally to anyone offering the procedure.”

    THEREFORE:
    Since the legislation in question here, as it stands, does not “apply equally to anyone offering the procedure”, Shall we consider you a party that is non-supporting of this bill?

  35. pmoran says:

    “However, I believe, everybody should sign informed consent prior to any treatment being received. Funnily enough, she did not agree with me. Gave some woo excuse!!”

    While certainly needed, I fear that even informed consent will not enable a “steady as she goes” approach to neck manipulation.

    Fully informed consent would include imparting the knowledge that there may be similarly effective but safer forms of management (including simply waiting a bit longer for things to resolve themselves– works better for most conditions than most people think).

    With relatively rare events informed consent can aslo end up being applied in such a desultory manner that there will still be strokes ending up in the law courts and hence the newspapers.

  36. pmoran says:

    Nobs, what makes you think we are not familiar with every aspect of this argument?

    So, some patients may have a VAD (vertebral artery dissection) in progress. This CANNOT explain many of the cases — those with no relevant prior symptoms, or chronic or recurring complaints.

    It may well explain a few, but even that has implications for sensible use of neck manipulation, suggesting delay if the history of high neck pain or occipital pain is short or atypical. Stretching a dissecting artery can only make matters worse, helping to explain sudden onset of neurological symptoms after manipulation .

    So, even going to the hairdresser can be associated with a VAD. But is it not ridiculous assert that ANY movement of neck can precipitate a VAD in susceptible people but that having the neck more purposefully manipulated by a chiropractor cannot — not even in all likelihood in people with a less vulnerable anatomical associations of the vertebral artery to C1? (which raises the matter of the very strong plausibility — no artery in the body is so vulnerable to stretch)

    The fact that other doctors and physiotherapists also cause the problem is accepted. But there is no question that chiropractors cause many too. Ask those carrying your malpractice insurance if you have douvts concerning that.

  37. Fred Dagg says:

    ZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZZ!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    Wake me up when somebody says something new, that is not just a rehash of what has already been discussed.

  38. nwtk2007 says:

    I am not so sure that this VAD is actually related to CMT, at least in the sense that manipulation of segments below C2 are involved. I am also not so sure there could be any connection between the so called HVLA manipulation.

    In some of my treatment of my patients today I looked closely at my “technique” for lack of a better word. In the cervical spine manipulations, I move the lower and mid cervical joints to the end if a somewhat lateral, only slightly rotated position and simply give a slight thrust, no more than a fraction of an inch, in a slightly anterior/medial direction and attain a very effective manipulation of the segment I have contacted and the one above and below it in a very consistent manner.

    The “gentle mobilization” I have observed performed by both chiro’s and PT’s involves a lot or rotation as well as extension of the neck, particularly at the C1/C2 segment, it is held and then repeated in the opposite direction.

    Based upon the “mechanism” of “injury” as described by Dr Hall in her previous post, I just don’t see how the manipulation as I do it could be any where close to as dangerous as the “gentle mobilization”.

    Perhaps the upper cervical manipulations could be more risky, but as I understand it, there is no rotation at all involved in those manipulations.

    Based upon what I have seen of CMT, there are moves that I would think would or could compromise the vertebral artery as it undulates around and over C1 from it’s position at C2. Those moves involve full rotation followed by a thrust increasing the rotation.

    Based upon the anatomy, I am surprised that there are not more VAD’s in the population involved in sports, or even while driving as in actively checking one’s “blind spot”, for example. This represents a great deal of rotation and if the move is sudden, would be nearly the equivalent of the rotational moves in mobilization and the rotational CMT moves.

    Are any of the patients who haave had the alleged VAD after manipulation known to have had recent MVA’s or other types of related activities occur?

  39. nwtk2007 says:

    Just to reiterate a previous point about the dangers of OTC NSAIDS, didn’t the New England Journal of Medicine say, in 1999, that chronic use of NSAIDS like ibuprofen caused more deaths than myeloma, asthma, cervical cancer and Hodgkin’s disease combined? that something like 50,000 or 100,000 people are hospitalized each year due to complications related to the use of OTC NSAIDS.

    I guess people just aren’t reading those warnings and informed consents on the little papers in the bottles after all.

    I would also guess that if they were only available by prescription then all these harmful effects would cause a significant rise in malpractice cases after all. At least with them being OTC, the victims can only blame them selves and the poor education society has given them, not their doctor.

  40. Joe says:

    nwtk2007 on 18 Jun 2009 at 11:39 am “Just to reiterate a previous point about the dangers of OTC NSAIDS”

    Just reiterate a previous point, your argument does not convince us that chiro is safe and/or effective.

  41. nwtk2007 says:

    I know there is no convincing you (us) Joe, but you (them) have not convinced me or any other chiro that NSAIDS like ibuprofen aren’t a thousand thimes more dangerous, yet you (us) ask for informed consent and warn against the “dangers” of chiropractic, specifically CMT while denying the need for informed consent for medicines like ibuprofen which truly should not be sold OTC in such an uncontrolled way.

    Bias, hyprocricy, what ever it is, I know that I won’t change your mind.

  42. Fred Dagg says:

    Hello Joe,

    I am sure this will raise your blood pressure!!!!!!!!!

    http://www.youtube.com/watch?v=5TTzKwvNbP0&feature=PlayList&p=1077234FE2C07552&playnext=1&playnext_from=PL&index=5

    What I appreciated was the very ethical and honest response from the AMA.

  43. nobs says:

    Looks like Harriet went mia. Darn- She left before answering several of my questions.

    ADDITIONALLY-
    I also would like her to comment on the evidence I brought to her attention in this thread: the inappropriate use of, and misuse of “Chiropractic” and “chiropractic terminology” in the literature; and it’s subsequent mal-influence on information synthesis(eg. systematic reviews). In particular, I would like to know how she is going to use and incorporate this new-found information in her upcoming presentation in Las Vegas: Scientific Critique of Chiropractic (Harriet Hall, MD) What aspects of her presentation is she going to change/alter in light of this information?

  44. Fred Dagg says:

    Harriett

    is it possible to get a transcript of your talk in Las Vegas, before you present it, so that is can be scanned for obvious errors.

  45. daedalus2u says:

    Fred, Harriet’s (one “t”) talk is a continuing education course. She may deliberately put errors in it for the audience to catch.

  46. Joe says:

    Fred Dagg on 20 Jun 2009 at 2:09 pm :”Harriett is it possible to get a transcript of your talk in Las Vegas, before you present it, so that is can be scanned for obvious errors.”

    Mr. Dagg, we have no evidence that you can find errors beyond a sophomore, high-school level of “sophistication.” That is the sort of pedantry up with which we shall not put. (W. Churchill)

  47. pmoran says:

    nwtk2007 “Are any of the patients who haave had the alleged VAD after manipulation known to have had recent MVA’s or other types of related activities occur?”

    I don’t know, but the anecdotal evidence associating CMT with stroke remains very strong and the correlation is strong in nearly every study that has looked at the problem,

    Only one study contradicts such an association. I have not been able to examine that fully, but the abstract suggests many possible flaws including that patients with neurological symptoms from an emerging VAD such as giddiness would be more likely to attend a doctor than a chiropractor, and many of the patients attending a chiropractor may have also attended a doctor.

    From what you say, your technique may be unlikely to cause a VAD, or at least no more than many other common activities.

    Thit, I suppose, suggests another reasonable response for chiropractic — to try and find a safer way of manipulating the neck. I am fairly sure that those dinky little toys that some DCs use are unlikely on their own to be harmful. Difficult research, though. with such an infrequent condition. Also, the less the “manipulation” actually does to the neck the more it looks like placebo.

  48. Fred Dagg says:

    I would have thought that if Harriet had nothing to hide, she should provide a transcript.
    However, as you say that she may put obvious errors in it for the audience to determine. By someones own admission on this site, about the American education system, where they do not know what 25% of 100 is, and cannot identify China on a map, how do you think they are going to be able to find obvious errors in Harriet’s talk.
    If it is on “Continuing education”, how can she object to peer review, before giving the talk?

  49. Fred, it’s peer review.
    So far you have demonstrated no basic knowledge of the subject that would indicate you could do any such review.

  50. Fred Dagg says:

    Nice one Whitecoat, however, as it is peer reviewed, I hope, there are enough people on this site with some very good degrees who could audit it. Not just me. If Harriet had nothing to hide, she should let us all have a look at it.
    I will not hold my breath.

  51. daedalus2u says:

    Fred, if you want to see Harriet’s presentation, you should pay for it like everyone else. I am quite sure that there will be a question and answer session following her presentation and I have no doubt that there will be some very knowledgeable people in the audience who will not let any errors slip by. You could be there too. Perhaps you might learn something about how real SBM is done.

  52. Mark Crislip says:

    ”Harriett is it possible to get a transcript of your talk in Las Vegas, before you present it, so that is can be scanned for obvious errors.”

    “I would have thought that if Harriet had nothing to hide, she should provide a transcript.”

    I try very hard, as much as I would like to, not to make personal comments on the blog and to date I have not.
    But.
    Jesus.
    What a……..
    There. I still haven’t.
    But the temptation is so strong.
    So strong.

  53. Fred Dagg says:

    Thank you Mark for your comment.
    However, asking Harriet Hall to talk about Chiropractic is wrong. She is not a Chiropractor and she has a “propagandist Quackwatch” stance. I am surprised that she did not say to the organizers, “I am not a Chiropractor.,To discuss the science of Chiropractic, you would be best to have a Chiropractor present the required information”.
    I do not see how this cannot be seen fair. I am sure anyone in the audience who queried it, would be able to do so.
    It is an arrogant approach and inflammatory.

  54. nwtk2007 says:

    Dr Hall is also very biased with regards to chiropractic, at least as goes the “scientific” evidence for CMT causation for stroke.

  55. Joe says:

    @Fred, there is no science in chiropractic. Chiropractors have written a lot of books and articles that anyone can read and critique.

    The British Chiropractic Association has recently a furnished a list of 29 papers that they say “support” chiro efficacy for pediatric complaints (colic, asthma, etc.). http://layscience.net/node/598 Several of them are totally irrelevant, and the rest are seriously flawed. After 114 years of claiming to treat those problems they cannot find one proper study to support any claim. Just looking at those papers tells us that chiros don’t know squat about science.

  56. David Gorski says:

    is it possible to get a transcript of your talk in Las Vegas, before you present it, so that is can be scanned for obvious errors.

    No.

    Next question.

    (I’m with Mark Crislip, BTW, except that occasionally, try as I might not to, I do succumb to the temptation to make personal comments when the offense is bad enough. Not this time. For the moment.)

  57. Peter Lipson says:

    Fred, “peer review” doesn’t mean, “gimme a copy NOW cuz i wanna”. Peer review is a process done prepublication by someone’s PEERS. Talks are not subject to your whim. If they were, you would at least need to by Harriet’s professional peer, meaning an expert in human medicine with a clear understanding of science-based medicine.

    You will never, however, be her personal peer as a compassionate professional who has bravely served her patients and country for years.

  58. “I am not a Chiropractor.,To discuss the science of Chiropractic, you would be best to have a Chiropractor present the required information”.

    Courtier’s reply.
    Fredd this one seems especially hypocritical coming from you, you’ve been talking about, and criticizing people on all sorts of things that you clearly don’t know the first thing about.

    I do not see how this cannot be seen fair.

    Where there is an objective truth, one does not need to be “balanced” or “fair”. If we were talking about civil rights, we could just have a civil rights leader talk. We wouldn’t need to balance him or her with a white supremacist.

  59. nobs says:

    Fred-

    # Peter Lipsonon 21 Jun 2009 at 7:49 am posted:

    “Fred, “peer review” doesn’t mean, “gimme a copy NOW cuz i wanna”. Peer review is a process done prepublication by someone’s PEERS. Talks are not subject to your whim.”
    …………………….

    Fred- While this is a flip and sarcastic representation of “peer review”, it does, indeed, have a few elements of accuracy.

    Any journal, (or op/ed piece), can claim to be “peer-reviewed, (eg. Barrett’s SRAM). This claim is meaningless, and misleading, if one does not understand, or is misled by the term: “peer-review”.

    Credible papers are published in and referenced by —–INDEXED—–”peer-reviewed” journals. That requires, as Peter posts, a pre-publication review by the journal’s peer-review board. Their review determines if a submission meets standards for publication. Being—-INDEXED—–is key. (Barrett has repeatedly applied to get his “SRAM” journal indexed, and because it fails to meet ‘indexed’ standards, has been repeatedly denied listing in the index).

    Harriet is not submitting her “critique” for publication in a “peer-reviewed” journal.

    Since she is not submitting her “talk” to an indexed, peer-reviewed journal, she does not have to submit to the scrutiny of a peer-review, and thusly defend/document her “critique”.

    She is being paid to give a “talk”, and as such, she can say anything she chooses……..be it: true, misleading, biased, appropriate, inappropriate, informed, uninformed, ……………………even “tweek it” to the ilk of those that are paying her.

    What I DO find a bit confounding is, that this “conference” is elgible for CMEs…….

  60. Fred Dagg says:

    She is being paid to give a “talk”, and as such, she can say anything she chooses……..be it: true, misleading, biased, appropriate, inappropriate, informed, uninformed, ……………………even “tweek it” to the ilk of those that are paying her.

    What I DO find a bit confounding is, that this “conference” is elgible for CMEs…….

    This is the most relevant part of the last few posts. When I go to the local hospital to listen to lectures and gain CME points, I expect and so do all of the audience, the facts to be unbiased and correct. The fact that Harriet may not do this, with your agreement, is somewhat perplexing for me. I wonder if the organizers of the talk know that Harriet may not be totally accurate in her talk.

  61. Peter Lipson says:

    Fred, your concept of what a medical talk, or a CME activity are is fundamentally flawed. CME isn’t always, “what is the BUN/Cr ratio c/w prerenal azotemia.” It’s usually less basic and more interesting.

    However, if someone showed up at grand rounds, which is a CME activity, and presented “evidence” that chiropractic might help anything but a sore back, they’d be torn apart in seconds by their betters.

  62. David Gorski says:

    She is being paid to give a “talk”, and as such, she can say anything she chooses……..be it: true, misleading, biased, appropriate, inappropriate, informed, uninformed, ……………………even “tweek it” to the ilk of those that are paying her.

    You truly are ignorant of how the SBM conference is being put together. First off, we are organizing it. Specifically, Steve is in charge of organizing it, and we are giving talks. None of us are being paid. Originally, we were going to get nothing more than free registration to TAM7 for our efforts. In other words, when we all agreed to this, we did so with the expectation that we would all have to pay our own travel and lodging in order to keep costs down, although the latest news is that we may now be getting some travel reimbursement. Be that as it may, when we agreed to do this conference, we all did it with the expectation that we would lose money because we’d have to pay all of our airfare and lodging. Even if we do end up getting some travel reimbursement, we speakers will not exactly be making money on this. We will all have put significant funds of our own into coming to give these talks.

    No, Steve organized this conference, and we agreed to give talks there not for the purposes of being paid, but rather because we all believe in science-based medicine.

  63. David Gorski says:

    What I DO find a bit confounding is, that this “conference” is elgible for CMEs…….

    This is the most relevant part of the last few posts. When I go to the local hospital to listen to lectures and gain CME points, I expect and so do all of the audience, the facts to be unbiased and correct. The fact that Harriet may not do this, with your agreement, is somewhat perplexing for me. I wonder if the organizers of the talk know that Harriet may not be totally accurate in her talk.

    CME conferences are not peer-reviewed publications or grant applications. There are certain requirements that need to be met by a lecture or conference in order to qualify for CME credit. The curriculum and materials to be used for the SBM conference have met these requirements. End of story.

    Your “demands” to see Harriet’s slides beforehand so that you can subject them to “peer review” are, quite frankly, risible.

  64. Barrett has repeatedly applied to get his “SRAM” journal indexed, and because it fails to meet ‘indexed’ standards, has been repeatedly denied listing in the index…

    SRAM–The Scientific Review of Alternative Medicine–is not “Barrett’s” journal. It was founded and edited for 10 years by our fellow blogger Wally Sampson. I am currently the acting editor.

    SRAM is indexed by Google Scholar and CINAHL, but not by the National Library of Medicine (NLM), whose website is PubMed. This is not because SRAM ‘failed to meet indexed standards,’ however. Dr. Sampson explained the reasons here, and also showed that the NLM indexes several “CAM” advocacy journals that have no credible claim to objectivity or science.

  65. >>>
    “is it possible to get a transcript of your talk in Las Vegas, before you present it, so that is can be scanned for obvious errors.”

    “I would have thought that if Harriet had nothing to hide, she should provide a transcript.”

    EPIC FAIL/FACE PALM:

    Pick a thousand conferences with presenters at random, and ask every one of the presenters for those conferences the same question and let us know what kind of success you have.

  66. “I am surprised that she did not say to the organizers, “I am not a Chiropractor.,To discuss the science of Chiropractic, you would be best to have a Chiropractor present the required information”.”

    EPIC FAIL/FACE PALM #2:

    By this reasoning, Reductio Ad Absurdum:

    Never listen to anyone but child molesters about what child molesters do.

    The police are not the people to listen to about crime prevention; buglers, rapists, and murderers are the people you want to talk to.

    To avoid financial ruin, seek the advice of a deposed Nigerian prince.

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