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Chiropractic – A Brief Overview, Part I

When patients ask me if a chiropractor can help them with their problem, I often think to myself, “OK, do I give them the short answer or the long answer?” The difficulty is often in the fact that chiropractic is a diverse profession and it is difficult to even characterize what a “typical” chiropractor is likely to do. As a chiropractor once admitted to me – there are a great many things that happen under the umbrella of “chiropractic.”

In this article I will summarize some of the history and practice of chiropractic, highlighting what I consider to be many of the enduring problems with this profession.

History

Chiropractic was founded in 1895 by Daniel David Palmer, a grocer with an intense interest in metaphysics. Prior to his “discovery” of chiropractic, D.D. Palmer was a magnetic healer. He also had interests in phrenology (diagnosing disease based on the bumps of the skull) and spiritualism. Palmer reported to have discovered the principle of chiropractic when he allegedly cured a janitor of his deafness by manipulating his neck. The fact that the nerve which conveys sound information from the ears to the brain does not pass through the neck did not seem to bother Palmer, if he was even aware of this fact.

Palmer created the term “chiropractic,” which literally means “done by hand,” to refer to his new therapy. He argued that all disease is caused by subluxated bones, which 95% of the time are spinal bones, and which disrupt the flow of innate intelligence. He did not subject his ideas to any form of research, but rather went directly to treating patients and to teaching his principles to the first generation of chiropractors.

Subluxation Theory

Palmer believed in the pre-scientific vitalistic notion that health stems from the flow of a spiritual life force. Although vitalism was rapidly declining within scientific thought by the end of the 19th century, it was the centerpiece of early philosophies of health in most cultures. Palmer borrowed this ancient belief and renamed it “innate intelligence” which he claimed flowed from the brain to the rest of the body through the spinal cord and peripheral nerves. All disease, he argued, results from disruption in the flow of innate intelligence. Disruption in flow is caused by spinal subluxations, which are small misalignments in the spine that compress the spinal nerves.

Therefore, liver disease is caused by a subluxation which compresses the spinal nerve which supplies the liver with life force, depriving it of its vital innate intelligence. Palmer therefore believed he could cure by fixing these misalignments with manipulation.

This idea has remained the cornerstone of chiropractic despite advances in neurobiology and anatomy which have failed to show any evidence for innate intelligence or chiropractic subluxations. Many continue to ascribe all disease to the blockage of innate intelligence despite scientific advances in medicine which have discovered infectious, genetic, autoimmune, degenerative, nutritional, and other causes for many of the diseases which plague mankind.

Chiropractic was also not the only tradition based upon manipulating the bones. Of note, osteopathic doctors also developed an art of bone manipulation in order to heal, but they believed they were unblocking blood flow through arteries. Osteopathy and chiropractic had similar roots, but took very different paths, as we will see.

D.D. Palmer’s son, B.J. Palmer, became involved in the chiropractic movement early on, during the formative years. B.J shared his father’s metaphysical bent (prior to chiropractic, he worked with a mesmerist and worked in the circus), his tendency to make sweeping statements about health without justification, and his ignorance of contemporary scientific knowledge. He was reported to state, for example, “When I saw there was no use for a sympathetic nervous system, I threw it out, and then just had to put something better in its place, so I discovered Direct Mental Impulse.” B.J. also “discovered” a non-existent “Duct of Palmer” connecting the spleen to the stomach. In 1907 B.J. engineered a hostile take over of his father’s school of chiropractic.

B.J. Palmer set the tone that would later dominate the field of chiropractic. He emphasized salesmanship, advertising, and practice building. He was highly critical of medicine, stating that M.D. stands for “more death.” He continuously sought new methods for increasing revenues, such as his neurocalometer, which would pinpoint subluxations by measuring skin temperature and he decreed must be rented from him by other practitioners at exorbitant fees.

From the beginning chiropractors were also politically aggressive. They sought licensure as a protection from the growing scientific medicine with which they were completely at odds. Many legislators were reluctant to license chiropractors for this reason, but as more and more states voted in licensure, it became increasingly difficult to fight. Additionally, many legislators looked upon licensure as way of controlling the scope of chiropractic. By 1925, 32 states had instituted licenses for chiropractors. The struggle ended in 1974 when Louisiana instituted licensing.

Many states then began to pass basic science board requirements for licensure, making chiropractors pass the same tests of basic science knowledge as medical and osteopathic students. This was justified by the fact that chiropractors were presenting themselves as primary practitioners. However, where roughly 86 percent of medical students passed their basic science boards between 1927 and 1953, only 23 percent of chiropractors did. Chiropractors who could not pass the boards either moved to another state without the requirement, or practiced without a license. Between 1967 and 1979 all of the basic science laws for chiropractors were repealed.

Over the years chiropractic has never ceased its tireless struggle for growth and acceptance. Despite the fact that scientific medicine has continued to progress and chiropractic has never shed its pseudoscientific origins, they have been quite successful. After licensure, they gained coverage under Medicare. They have also successfully sued the AMA to stop their antichiropractic campaign. Today they continue to lobby hard for increased coverage and access under health insurance and HMO policies.

Straights, Mixers, and Reformers

Almost since the beginning, chiropractic has been fraught with many internal schisms. Today there is a wide range of differences between individual chiropractors, but most can be placed within one of three basic types.

Straight chiropractors consider themselves the only true or pure chiropractors because they limit their practice to the identification and treatment of spinal subluxations. They adhere strictly to Palmer’s concept of disease and believe that all ailments can be treated through manipulation to restore the flow of innate intelligence. Once freely flowing, they believe innate intelligence has unlimited power to naturally heal the body.

Straight chiropractors are the most extreme in their anti-scientific views. They openly advocate a philosophical rather than a scientific basis for health care, calling mainstream medicine “mechanistic” and “allopathic.” They call physicians “drug pushers” and disparage the use of surgery. They are careful not to give diseases names, but none-the-less they claim to cure disease with their adjustments. They oppose vaccinations. They also openly advocate the replacement of scientific medicine with chiropractic as primary health care. The statements of Dr. Wilson A. Morgan (who just passed away earlier this month), previous Executive Officer of Life College School of Chiropractic, are typical:

“Chiropractic: The health care system whose time as the official guardian of the public’s health is fast approaching!”
“On the other hand, it is equally appropriate for chiropractors to be viewed as generalists in that the far-reaching effects of their highly specific spinal adjustments usually are followed by the decrease and often disappearance of a very broad array of symptoms, disabilities and pathological conditions.”
“Unlike the medical profession, chiropractic has a very strong philosophical basis, which no doubt has contributed to its having been labeled ‘unscientific’ by the more mechanistically-oriented scientific community.”
“It appears that education will prove to be the best strategy in the ‘war on drugs,’ including education about the dangers of drugs available on the street and also those available from the physician as prescriptions.”

Mixers, comprising the largest segment of chiropractors, may at first seem more rational. They accept that some disease is caused by infection or other causes and they do not limit their practice to fixing subluxations. Most chiropractors in this group, however, do not supplement subluxation theory with scientific medicine, but rather with an eclectic array of pseudoscientific alternative practices. Mixers commonly prescribe homeopathic and herbal remedies, practice acupuncture and therapeutic touch, diagnose with iridology, contour analysis, and applied kinesiology, and adhere to the philosophy of naturopathy. This broad use of unproven, unscientific, and fanciful so-called “alternative” practices clearly indicates an antiscience attitude, as well as a lack of scientific knowledge, on the part of those chiropractors who employ them.

The rhetoric of Mixers indicates that they are attempting to become accepted into the scientific mainstream, rather than replace scientifically based medicine with a philosophy based approach. They no longer openly oppose immunization, like straights do, but they do advocate the freedom to choose whether or not to be immunized. Their appeal to freedom is emotionally effective, especially in the United States, but it fails to recognize that immunization is far less effective in eliminating or containing infectious diseases when it is not given to everyone. They also advocate a role for chiropractors as a primary care portal of entry system within HealthCare, despite the fact that they lack adequate training as generalists skilled in medical diagnosis.

A small minority of chiropractors, numbering only about 1,000, or 2% of all chiropractors (these are rough estimates because accurate figures are lacking), have been openly critical of their own field. They have called for absolute rejection of the subluxation theory of illness, disposing of pseudoscientific and unethical practices by chiropractors, and the restriction of chiropractic to treating acute musculoskeletal symptoms. They are attempting to bring their field into the scientific mainstream.

Occasionally chiropractic reformers have attempted to forge a new profession, entirely shedding the pseudoscience attached to the chiropractic brand. About ten years ago one group in Canada renamed themselves “Orthopractors,” and considered the new discipline of orthopractic as distinct from chiropractic. Orthopractic is the use of manipulation to provide symptomatic relief from uncomplicated acute back strain. They do not believe in maintenance therapy, treating medical ailments, or the use of pseudoscientific alternative practices.

Unfortunately, this reform effort died because “orthopractic” did not exist as a legal entity. This also partly explains why the “chiropractic” label persists and covers such a wide range of philosophy and practice – because it exists as a recognized licensed profession. It has a regulatory inertia that is hard to combat.

To further complicate things, spinal manipulation exists outside of the chiropractic profession, and not all manipulation is chiropractic manipulation. Some physiatrists, sports medicine doctors, and osteopaths legitimately employ manipulative therapy to relieve muscle strain, mobilize joints, and improve function. Chiropractors do this as well. But some chiropractors also do chiropractic manipulation designed to realign the spine and reduce imaginary chiropractic subluxations.

The Evidence – Subluxations

In the past 100 years, there has been very little research conducted into the basic principles of straight chiropractic. There is no research that indicates the existence of innate intelligence or that such a force plays any role in health and disease. Further, the evidence strongly suggests that chiropractic subluxations are a figment of the chiropractic imagination. And it also seems that spinal manipulation is not capable of realigning the vertebra of the spine.

A study carried out by Edmund Crelin, Ph.D. investigated the amount of force necessary to displace vertebral bones of the spine in order to cause impingement of a spinal nerve. The study was carried out on six corpses within 8 hours after death. His conclusion was that the amount of force necessary to actually displace the vertebra was great enough to break the spine, arguing strongly that chiropractic manipulation cannot significantly affect spinal alignment, and that misaligned spines do not caused pinched nerves (Crelin, 1973).

Pinched or impinged spinal nerves do occur, but they are caused by herniated discs, fractures, tumors, or overgrowth of the vertebral bones. When spinal nerves are impinged they cause pain, numbness, and tingling and may cause a decrease or loss of deep tendon reflexes and weakness of the muscles supplied by the affected nerve. Impinged nerves are not caused by subluxations nor do they result in diseases of the organs. Believers in subluxation theory must claim, implausibly, that nerve impingement causes only a blockage of innate intelligence without causing any of the known signs and symptoms of such impingement.

Ironically, spinal manipulation is contraindicated in cases of actual nerve impingement and should not be performed. In medical studies of manipulation, such as the RAND study, often cited by chiropractors as evidence for manipulation, spinal nerve impingement was considered a reason not to have manipulation and therefore was a criteria for exclusion from the study.

Another source of evidence that the chiropractic theory of subluxations and innate intelligence is completely false comes from the unfortunate victims of spinal trauma. There are many victims of complete transection, or disruption, of the cervical spinal cord in the neck. Such a complete injury leaves its victim quadraplegic, unable to move the arms or legs. If the injury is high enough in the spinal cord the victim may not even be able to breath on their own. In such victims no impulses from the brain are able to travel below the spinal cord in the neck, and therefore most of the communication between the brain and the body is interrupted. Certainly, this is a much more dramatic and complete interference of nerve flow than that of an impinged spinal nerve.

Yet, in these patients, the organs continue to work without difficulty and diseases do not develop at any higher rate than those without such an injury. Of course, there are some effects from the disruption of the autonomic nervous system, that part of the nervous system which regulates the bladder, the degree of bowel motility, and other functions. But all effects of spinal cord damage are caused by known neurological injury. If subluxation theory were correct, then patients with high spinal cord injuries would be ravaged by every conceivable disease.

So chiropractors cannot realign the spine to fix imaginary subluxations and restore the flow of nonexistent innate intelligence. Subluxation theory is pure pseudoscience, like homeopathy or therapeutic touch, and has no place in a 21st century scientific health care system.

Despite the extreme scientific implausibility of subluxation theory, specific applications have been tested with clinical research – with predictable results. For example, many chiropractors will use manipulation to treat asthma is children. The results of this research are soundly negative – chiropractic does not work on asthma.

Despite this many chiropractors persist in treating asthma. This led Simon Singh to write in the Guardian in 2008 that the British Chiropractic Association, which does advocate chiropractic for childhood asthma, “promotes bogus therapies.” In response to this statement the BCA notably did not provide the evidence that Singh claimed was missing. Rather, they sued him for libel (the case is ongoing).

Next week I will cover the evidence for musculoskeletal uses of chiropractic.

Posted in: Chiropractic

Leave a Comment (369) ↓

369 thoughts on “Chiropractic – A Brief Overview, Part I

  1. Esteleth says:

    I am sometimes embarrassed by my patronage of a chiropractor. He is, so far as I can tell, “mixed.” He has never dumped pseduoscientific stuff on me, but I’ve seen things in his office (like books about how allopathic medicine is bad). He’s never touched my neck, as I’ve vetoed this, firmly. I have scoliosis and sciatica, aggravated by a malformed pelvis. I know it sounds very silly (and unscientific), but my pain is less after a visit.
    I am a scientist (a biochemist, in fact). I know there is essentially no scientific justification for why this chiropractor helps me, but the point remains that somehow, he does. Perhaps it is the placebo effect? I am not sure. Perhaps I would be better served by obtaining the services of a massage therapist or osteopath, but there is a certain comfort in the known.

  2. Joe says:

    The British Chiropractic Association (BCA) is in bad odor now because their libel suit against Simon Singh has caused a large, public outcry. Currently, there are more than 10,000 signatures on a petition to have the law changed. Each time a news story on the topic comes up, the BCA’s suit is mentioned. This has the BCA complaining that they are being made out to be monsters rather than victims.

    Another result is that UK chiros are scrambling to cover their tracks by removing their web-sites and literature that make fraudulent claims of treatment. However, before they got to it, two people (independently) archived all the web-sites, and filed complaints with the various oversight boards against as many as 529 chiropractors.

    About 12 days ago, the BCA released their list of 29 articles supporting use of chiro for various pediatric conditions (e.g., colic and asthma) http://www.chiropractic-uk.co.uk/gfx/uploads/textbox/Singh/BCA%20Statement%20170609.pdf The articles are ridiculous http://www.ministryoftruth.me.uk/2009/06/18/examining-the-bcas-plethora-of-evidence/ (at the bottom of the blog post are links to more, critical sites). In short, 1/3 are irrelevant, and the rest suffered from some combination of being: unblinded, uncontrolled (or inadequately controlled) and too small. The studies of colic showed that the babies recovered in 2-3 weeks. That is what one expects without treatment.

  3. pec says:

    “Palmer believed in the pre-scientific vitalistic notion that health stems from the flow of a spiritual life force. Although vitalism was rapidly declining within scientific thought by the end of the 19th century, it was the centerpiece of early philosophies of health in most cultures.”

    And can you explain to us exactly why vitalism was declining? What exactly was the evidence, from controlled experiments, showing that there is no life energy? Or did the belief merely go out of style, to help separate modern medicine from earlier health practices?

  4. pec says:

    “From the beginning chiropractors were also politically aggressive.”

    This statement implies that MDs were not politically aggressive.

  5. Scott says:

    “And can you explain to us exactly why vitalism was declining?”

    Because there was no experimental evidence to support it.

    “This statement implies that MDs were not politically aggressive.”

    Ah, but the point is that the MDs also had actual facts, and evidence of effectiveness, to support their positions. Politics was the ONLY way chiropractors could support theirs.

  6. pec says:

    [“And can you explain to us exactly why vitalism was declining?”

    Because there was no experimental evidence to support it.]

    So you are implying that medical researchers made good attempts to find it and failed? Or was it just that no one tried because they already “knew” vitalism is wrong.

  7. Insight says:

    As a physician I can find several opinions in this blog that are more representative of personal belief and not that of science. First of all manual manipulation has many proven benefits. With that being said there are many more subjective benefits that are still in the research phase and are being pre-labeled as bunk. Now I have a science based practice and use proper judgement in the treatment of my patients. I do also recommend treatments that have a high subjective satisfaction but not allot of firm research supporting the eficacy. Can manipulation help disease processes? I think in some cases it can. There have been studies showing it to reduce asthma symptoms, lower blood pressure, etc..
    I am not saying we should abandon medication and use manipulation for these things. What I am saying is that DCs treating for segmental dysfunction problems and seeing changes in these disease processes warrants further study. Also, from what I see most DCs are better educated than most of my counterparts in nutrition and supplementation but that is a seperate debate altogether. I see no reason why someone should be embarrased to see a chiropractor. Referrals to DCs happen in this office every day. Osteopaths may understand or are open to manipulation however so that may be the reason for our focus at this clinic.

  8. Calli Arcale says:

    Extensive efforts had been made to find all sorts of forces which were widely believed to be real. Eventually, though, you have to concede that maybe the think you’re looking for doesn’t exist — especially when someone else walks up with an alternative explanation for which they’ve found real evidence.

    Palmer believed that the nerves convey an “innate intelligence” to vital organs. Yet quadriplegics do not suddenly undergo liver failure, despite the lack of a nervous connection to the brain. On the contrary, the liver only dies if you sever its arterial connections; it’s clearly the blood that sustains it, not some sort of vital force conveyed via nerves. Indeed, if you sever the nerves to a person’s hand, they lose the use of the hand, but the hand itself does not die or even suffer much (apart from gradual muscle atrophy due to disuse, and increased rate of injury because the patient can’t feel it and thus has a harder time protecting it). So Palmer’s idea of the innate intelligence is not supported by the evidence. However, other ideas *are* supported by the evidence, such as the idea that bodily tissues are sustained by being perfused with blood, while the function of nerves is much simpler — to detect, to relay, and to trigger muscle contraction.

    Obviously no one has proven that there is no vital force. Similarly, no one has disproven the ether. Michaelson & Morlay merely failed to detect it. But that failure was profound, which is why people don’t put a whole lot of stock by the concept of the ether anymore.

  9. Diane says:

    Pec: Just google “death of vitalism” and read all about it yourself.

  10. Smapdi says:

    Steve,

    How would you characterize the peer reviewed journals of chiropractic? Despite knowing that the logic behind chiropractic is severly flawed, if I were to engage a chiropractor in a discussion, I feel like I would be unable to defend myself against the claim that there is plenty of evidence of the effectiveness of chiropractic in the journals.

  11. daedalus2u says:

    When the liver, kidney and heart are transplanted, all neural connections are completely severed. If neural connections were necessary, then transplanted organs would not function at all.

  12. pec says:

    http://en.wikipedia.org/wiki/Vitalism

    “A refinement of vitalism may be recognized in contemporary molecular histology in the proposal that some key organising and structuring features of organisms, perhaps including even life itself, are examples of emergent processes; those in which a complexity arises, out of interacting chemical processes forming interconnected feedback cycles, that cannot fully be described in terms of those processes since the system as a whole has properties that the constituent reactions lack.”

  13. pec says:

    http://en.wikipedia.org/wiki/Vitalism

    “So popular did Mesmer’s ideas become that King Louis XVI of France appointed two commissions to investigate mesmerism; one was led by Joseph-Ignace Guillotin, the other, led by Benjamin Franklin, included Bailly and Lavoisier. The commissioners learned about Mesmeric theory, and saw its patients fall into fits and trances. In Franklin’s garden, a patient was led to each of five trees, one of which had been “mesmerized”; he hugged each in turn to receive the “vital fluid”, but fainted at the foot of a ‘wrong’ one. At Lavoisier’s house, four normal cups of water were held before a “sensitive” woman; the fourth produced convulsions, but she calmly swallowed the mesmerized contents of a fifth, believing it to be plain water.”

    That is how they “proved” that vitalism is incorrect. And I think that was the end of it.

  14. Pec:

    Just a few points:
    I went to the same wikipedia page you did. I’ve only included points clearly stated in that article. Using those points, here is a much stronger case against vitalism (using only wikipedia)

    - The “chemical” basis of vitalism (“organic” chemicals supposedly could not be synthesized from “inorganic” chemicals.) was disproved by the synthesis of urea. This was done by Wohler, who afterwards said he had seen “The great tragedy of science, the slaying of a beautiful hypothesis by an ugly fact.”

    - Starting in the 1600′s the microscope allowed us to visualise the body on a cellular level, which lead to:

    -The emergence of germ theory, and it’s scientific, empirically proved basis discredited a variety of vitalistic theories that were incompatible with germ theory.

    -Increased knowledge of cellular level anatomy, which lead to new theories of physiology. Each new theory, and new piece of knowledge on the inner workings of the body decreased the need for, and scope of “magical thinking” such as exists in most vitalistic theories.

    I’m amazed that you’re citing wikipedia as the authoritative source on “the death of vitalism.” Keep searching and you’ll find much more authoritative data.

    Smapdi:

    I feel like I would be unable to defend myself against the claim that there is plenty of evidence of the effectiveness of chiropractic in the journals.

    It’s always about the quality of the research. I’ve yet to see a positive article from a chiropractic journal that had decent controls, good statistical analysis, and any real time spent on experimental design. The onus is not on you to prove chiropractic doesn’t work, it’s on the chiro-advocate to show evidence that it works. If they tell you otherwise, they don’t understand that one can’t prove the negative.

    And the one I’m most concerned about:
    Insight

    As a physician I can find several opinions in this blog that are more representative of personal belief and not that of science.

    Based on the rest of your comments I’m curious, what kind of physician are you? I feel that your comments are representative of misunderstandings of evidence based medicine that wouldn’t have passed muster with my attendings on any of my wards time.

    First of all manual manipulation has many proven benefits.

    What KIND of manual manipulation. Noone has claimed physical therapy is bunk, and they use some manual manipulation. You have inadequately defined this term for it to be of value in this discussion.

    Noone talked about manual manipulation persya, claimed chiropractic’s theory is baseless. Further, the scientific evidence for any benefit is weak, and purely limited to the musculoskeletal system.

    With that being said there are many more subjective benefits that are still in the research phase and are being pre-labeled as bunk.

    Excessively vague. What are we calling a “subjective benefit.” What are the subjective benefits in question, how would you judge the quality of a study on “subjective benefits”?

    Now I have a science based practice and use proper judgement in the treatment of my patients. I do also recommend treatments that have a high subjective satisfaction but not allot of firm research supporting the eficacy.

    Then you don’t have a science based practice. That’s like saying “I practice evidence based medicine, AND homeopathy.” Well then, you don’t practice evidence based medicine.

    A caveat: with your treatments that have “high subjective satisfcation,” are you recommending UNproven therapies that are currently being researched, or therapies with significant evidence against their use. If you mean that you use drugs off label, or you recommend modalities that are currently in clinical trials with some promising data, that’s different than recommending tincture of arsenic 10C for panic attacks.

    Can manipulation help disease processes? I think in some cases it can. There have been studies showing it to reduce asthma symptoms, lower blood pressure, etc..

    Noone cares what you think. That’s not an insult. Even if you’re an expert, expert opinion is at the bottom of the pyramid of evidence. Show me these studies you speak of. I haven’t seen a valid (well designed, good controls, statistically powerful) study showing that manipulation reduces asthma symptoms, or hypertension.

    Trust me, I have asthma, I hate taking asthma meds. When I was a kid my parents tried me on every woo-ish crap practice around (including homeopathy, and ayurveda), because they didn’t know any better. You’re a doctor. You should know better.

    Having investigated the literature, I see no good trials on this. There are a good many criticisms of the studies I THINK you’re talking about elsewhere on this blog.

    Perhaps you could cite the studies you’re talking about.

    I am not saying we should abandon medication and use manipulation for these things.

    Good.

    What I am saying is that DCs treating for segmental dysfunction problems and seeing changes in these disease processes warrants further study.

    And such study has so far been negative.

    Also, from what I see most DCs are better educated than most of my counterparts in nutrition and supplementation but that is a seperate debate altogether.

    No. It’s not a separate debate. We’re well educated on education in medical school here. When you say your counterparts, I’m not sure if you’re talking about dieticians, or PCPs, or doctors who specialize in nutrition. In any of those cases, I would suggest you are incorrect, unless your colleagues are particularly bad with nutrition.

    Supplementation on the other hand is mostly pseudoscience. Niacin for cholesterol I’ll give you. Most of the rest of supplementation is based in orthomolecular “medicine”, which is, on balance, bull.

    At any rate, chiropractors are NOT formally educated on those subjects to the degree that a PCP doctor should be educated on those subjects.

    I see no reason why someone should be embarrased to see a chiropractor. Referrals to DCs happen in this office every day. Osteopaths may understand or are open to manipulation however so that may be the reason for our focus at this clinic.

    Osteopaths are doctors just like everyone else. MOST osteopaths recognize that much of osteopathic manipulation is just as baseless as chiropractic. When I applied to medical schools, I spent some time with DOs who practiced primarily manipulation at the nearest osteopathic school. They were quite hostile to evidence based practices. On the other hand, other DOs that I’ve worked with eschew all but the most limited manipulative practices on the basis of their lack of evidence.

  15. hatch_xanadu says:

    Burden of proof lies on the guy who says he saw the tooth fairy, not the guy who says he didn’t, Pec.

    Esteleth, I also saw a “mixer” chiropractor years ago, after a specific injury, and thought the manipulations helped. I never bought into the whole “life energy” bit, but the concept of, say, increasing blood flow to tense muscles or freeing a pinched nerve seemed plausible enough. That chiropractor also did acupuncture and employed a massage therapist, who was certainly helpful, and used the little electrode pads that zapped your muscles and made them contract, and I admit I loved those things and always made them crank them up to the highest settings. But all these seemed to have a mechanical explanation, and I could mix and match some of the services (massage cost a lot more, of course) for a flat fee, so I tried them.

    (The chiropractor also told me a lot of woo-woo stuff, too, though, in a “scolding” sort of way, like I shouldn’t eat X because it disrupts the flow of my Y, etc., and I politely ignored that stuff. I likened him to my hippie family practitioner, who would tell me to take valerian root but would also send me to get an MR just to be safe.)

    Now that I’m aware of the premise behind some of the treatments I did try — and now that I know that some of the mechanical explanations I postulated don’t really jive with the way the body actually works — I have a feeling that much of my relief was attributable to placebo effect — or, even more likely, the fact that my injury simply healed over time, independently of chiropractic.

    Looking forward to next week’s post.

  16. madder says:

    With prior apologies to everyone else for feeding the troll–

    Pec, I believe in the invisible pink unicorn because she helps me every day in ways subtle and profound. If you do not, please disprove her existence.

    Alternatively, please show us why the invisible pink unicorn is so qualitatively different from “life energy” that disbelief is warranted for the former but not the latter.

    You will do neither, of course, because you cannot.

  17. pec says:

    “I’m amazed that you’re citing wikipedia as the authoritative source on “the death of vitalism.” Keep searching and you’ll find much more authoritative data.”

    I didn’t cite it as the authoritative source. Vitalism is something I have studied. I posted those quotes because the first is an example of what I mean by the new vitalism. And the second because those 2 experiments really closed the case, for materialists, who did not feel a need to think about vitalism after that.

    Vitalism has been rejected primarily because of its connections with traditional magic. And of course we “enlightened” moderns must not believe in anything resembling magic.

  18. daijiyobu says:

    pec wrote: “vitalism has been rejected primarily because of its connections with traditional magic.”

    Wrong.

    This is generally the order of vitalism’s demise:

    Wohler, thermodynamics, genetic theory.

    -r.c.

  19. Emergent properties are not the “new vitalism”, this is one of the many ways in which wikipedia can mislead. The quote you gave is basically

    …the proposal that some key organising and structuring features of organisms, perhaps including even life itself, are examples of emergent processes; those in which a complexity arises, out of interacting chemical processes forming interconnected feedback cycles, that cannot fully be described in terms of those processes since the system as a whole has properties that the constituent reactions lack.

    None of that incoherant gibberish has anything to do with chiropractic, or vitalism in the sense that applies to chiropractic.
    Chiropractors aren’t saying that they can identify, and treat “subluxation complexes” that cannot be identified by any imaging modality, and can’t be diagnosed with any interoperator reliability because of emergent properties of the complexity of chemical systems.

  20. Scott says:

    “A refinement of vitalism may be recognized in contemporary molecular histology in the proposal that some key organising and structuring features of organisms, perhaps including even life itself, are examples of emergent processes; those in which a complexity arises, out of interacting chemical processes forming interconnected feedback cycles, that cannot fully be described in terms of those processes since the system as a whole has properties that the constituent reactions lack.”

    You really ought to check the actual citations if you’re going to reference wikipedia. If you had, you’d have found that this is an argument made by *philosophers* as to the philosophical meaning of emergent processes. It is in no sense whatsoever a scientific claim, so it cannot be cited as support for the idea that there is “life energy” by whatever name.

  21. OZDigger says:

    When looking at the history of Chiropractic in 1895, I am amazed that Dr. Novella did not have the courtesy to compare it “medicine” in the U.S. at this time. It was in a very poor state.
    For those that are interested, please look at the Flexner report. Wikipaedia has a very good review of it. I a time of pre-anti-biotics, U.S. medicine was a “trade”, in some cases.
    There is also some recent research published in the U.S. Journal of Hypertension that shows some very interesting results into the treatment of hypertension by treatment to the upper cervical spine.

  22. Insight says:

    whitecoattales,

    first of all I am a Osteopathic Physician, Boarded in Family Practice. I also teach for a residency program. Your comments regarding Osteopathic Manipulation are unfounded or based on your limited exposure to the kind. Though many DOs choose not to manipulate it is not due to the fact that they do not believe in it’s validity.
    Most do not feel comfortable due to lack of experience. Most don’t perform the advanced fellowship and lose the skill associated.

    You present very close minded arguments in an arrogant fashion, this is typical of conspiracy theorists and those of skeptical sites that refute their own stance. I practice science based medicine in regard to medication. I also recommend craniosacral therapy, yoga, Tai Chi and chiropractic care.

    I have seen the reference here trying to refute studies for lowering blood pressure with upper cervical manipulation (see U of Chicago study). Simply saying that findings are not conclusive enough to make claims, the typical comment I see refuting findings. Come on?? Not choosing to accept the validity of studies that show organ related change in manipulation is an cheesy way of saying, we see the evidence and don’t buy it.

    In regards to the comments on nutrition and supplementation, please give me an example of this extension nutrition training. Also, show me what courses on supplementation you received in med school. I went to DO school at Midwestern and I can tell you that I got nothing. Your biase against in this topic is unfounded. I see Medical School graduates from all over the world in our residency program and when we cover nutrition they are mostly undereducated at best. If you choose to be opposed to topics atleast have the decency to be honest and a bit less arrogant.

  23. Joe says:

    @Insight on 24 Jun 2009 at 2:42 pm

    As I see it, you are the conspiracy theorist.

    Insight on 24 Jun 2009 at 2:42 pm “I practice science based medicine in regard to medication. I also recommend craniosacral therapy, yoga, Tai Chi and chiropractic care. ”

    So, I suppose you can offer reliable data supporting craniosacral therapy and chiropracty.

    I suspect that you are one of those left behind when DOs adopted legitimate medicine. But I await you proof otherwise.

    Craniosacral therapy … the mind boggles.

  24. madder says:

    Insight–

    If you “practice science based medicine in regard to medication,” why don’t you extend that to your other areas of practice? I suspect that it’s because you look forward to the occasional negative results on medicines, but don’t want to risk having your favorite woo disproven (that said, yoga and tai chi are excellent forms of low-impact exercise, as far as I can tell).

    But come on… craniosacral “therapy?” At what age do the bones of the cranial vault begin to fuse together? How much movement is possible between unfused bones of the cranial vault in a young adult? Do craniosacral efforts have any likelihood of success on someone past the age of likely fusion?

    A head massage feels nice at the end of a long day, but one needn’t attribute magic powers to it.

  25. Versus says:

    You are scaring me, Insight. I thought that DOs with decent residencies were ok — my dermatologist is a DO and is well respected locally. But, craniosacral therapy? That’s biologically implausible AND has no studies supporting it. You don’t seem to be able to read and interpret studies either.
    I don’t understand the argument about nutrition. Beyond the basics, if a patient needs nutrition advice then refer him to a nutritionist or a registered dietician. They know a lot more about the subject than MDs, DOs or DCs. And except for the patient with special nutrition issues, you can get pretty much all the information you need at http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=1.

    Great post, Dr. Novella. I hope you will deal with some of the newer “hypotheses” (using the term loosely) put forth by chiropractors in support of the subluxation, or vertebral subluxation complex, or manipulable lesion, or spinal boo-boo, or one of the hundred other names they’ve come up with for this putative pathology.

  26. Calli Arcale says:

    My second baby was delivered by an osteopath. (I didn’t choose her; I had chosen a family practice MD, but the family practice docs generally aren’t qualified to perform c-sections. When it goes to c-section, they call the obstetric surgeon on duty that day, and on this particular day, it happened to be the DO.) She did an excellent job, even overlying the scar of a previous incision so that the new wound would look as nice as possible. What’s more, she got my baby out healthy despite breech presentation and a cord wrapped around the neck. I have nothing but praise for her.

    But she limited herself to science-based medicine. In an ideal world, the difference between a DO and an MD would be analogous to the difference between a BA and a BS in the same discipline; as far as their actual expertise goes, very little difference, assuming the degrees come from competent, accredited institutions. (Liberal arts is a popular whipping boy, but people forget that it’s not just humanities, and some very fine scientists have come out of liberal arts institutions. It’s just a slightly different approach.)

    If I saw her again, I would hope she would not suggest cranialsacral therapy to me. I have never seen any evidence to suggest that it works, and the suggested mechanisms are highly implausible (to put it charitably). I have heard anecdotes from those who say it works, but that is not the same thing.

  27. Fred Dagg says:

    Hello Dr. Novella,

    you comment about “Orthopractors” is incorrect. Orthopractic was the brain child of Canadian Paediatricain, Dr. Murray Katz. He invited some Chiropractors and Physiotherapists to join it. Respected New Zealand Physiotherapist, Mr Robin MacKenzie, founder of the MacKenzie technique refused to become involved.
    What is even more interesting is that you forgot to mention what a New Zealand, Royal Commission of Inquiry into Chiropractic said about Dr Katz.

    http://www.chiro.org/LINKS/New_Zealand_Report.shtml

    This is just one of the quotes from the commissioners,
    “we are abundantly satisfied that it would be quite unsafe to rely on his opinions, or on any of his evidence on matters of fact which were not completely verified from an independent and reliable source”.

    Why anyone would want to get involvred with Dr. Katz, or for that matter, Stephen Barrett of Quackwatchers is beyond belief. For you to even suggest that the orthopractic movement and Dr. Murray Katz were maore than what the commissioners said sullies your argument and drives it into no more than biased personal opinion. Stephen Barrett’s credibility was described by the commissioners as
    “We have considered material published over Barrett’s name. The chapter on chiropractic in The Health Robbers (entitled “The Spine Salesmen”) was written by him. It is plainly propaganda. What we have seen of the rest of his writings on chiropractic has the same tone. Nothing he has written on chiropractic that we have considered can be relied on as balanced”.

    For those of you in the U.S.A. who are not sure of the strength and integrity that a Royal Commission has, ask members of the British Commonwealth. It is very powerful.

    I am also surprised that Dr. Novella made no mention of the New Zealand Commissions report. It is the most extensive inquiry into chiropractic that exists in the world. It was very favourable!

    In regard to the research on hypertension,
    http://www.injurytv.com/chiropractic.html

    http://www.webmd.com/hypertension-high-blood-pressure/news/20070316/chiropractic-cuts-blood-pressure

    Finally, your comments on the history of Chiropractic are colored by your lack of comparison the the medical profession pre-Flexner

    http://en.wikipedia.org/wiki/Flexner_Report

  28. Insight says:

    Joe,

    I am 43 years old so I wouldn’t include me in your “those left DOs behind” category. You want to argue why I refer to DCs? Ok, let’s.

    Give me a better case study with published outcomes for IVD herniation, radiculitis or canal stenosis than of chiropractic with the Cox studies at Loyola medical school in conjunction with National College. Go ahead, I’ll wait. It will be awhile because there aren’t any. If you tell me you haven’t heard of the studies then I will know you aren’t well read and are being ignorant in the research.

    As far as Craniosacral Therapy, I know there is a large argument among PTs on the topic, even in our hospital system. When other means have failed and you have a symptomatic patient with Cephagia and they ultimately try this therapy and get better, what do you do. Once you try convential formulary and nothing helps and try CST and the patient says they got their life back. Tell them that there isn’t sufficient evidence to support trying it. Are you a physician??? If so what type?? Now I would like to see who you are. Being ignorant and close minded is far easier than to seek answers. I can see I am wasting my time. The nutrition comments I have made also have not been met with a truthful answer other than rhetoric. I went back for post graduate nutrition course work and it is obvious you are novice on the topic in practical patient application.

  29. healthnut says:

    Insight; you are using the logic of a physician who treats patient’s in the real world. You are also breaking a cardinal rule here, admitting the short falls in traditional medicine. They are mad because you are aiding those they deem unworthy and what they are trying to get rid of. Your energy is better served to continue educating your residents in being a good doc, the effort is wasted in here.

  30. tgobbi says:

    # OZDiggeron 24 Jun 2009 at 2:18 pm
    When looking at the history of Chiropractic in 1895, I am amazed that Dr. Novella did not have the courtesy to compare it “medicine” in the U.S. at this time. It was in a very poor state.
    For those that are interested, please look at the Flexner report. Wikipaedia has a very good review of it. I a time of pre-anti-biotics, U.S. medicine was a “trade”, in some cases.
    There is also some recent research published in the U.S. Journal of Hypertension that shows some very interesting results into the treatment of hypertension by treatment to the upper cervical spine.

    ***

    Correct. Dr. Novella didn’t compare the two at the time. He didn’t have to. Why? Because while medicine has outgrown its pre-scientific roots,chiropractic has remained the same, mired in the old subluxation / innate mode. Wait! That’s not entirely true. Chiropractic has added all sorts of innovations that weren’t part of the original scheme: applied kinesiology; craniosacral therapy; “nutrition;” “activators;” practice building companies; aggressive marketing schemes; various naturopathic treatments (I contend that “mixers” are just as much naturopaths as they are chiropractors; anti vaccination campaigners; and supplement pushers – to name but a few of their egregious affronts to science!

    A list of the advances made by mainstream, science based medicine would take volumes to enumerate.

    It has been said (perhaps by Bill Jarvis or maybe Wally Sampson?) that chiropractic has yet to demonstrate that it has made a single contribution to furthering healthcare.

    tgobbi

  31. healthnut says:

    Insight you are trying to argue logic from the standpoint of a doc that actually treats sick patient’s. You are scaring those on this site because you are admitting to medical short falls and validating techniques they choose to banish forever. You would be better served to focus your energy teaching your residents what its really like in primary care than to argue with the brain trust on this blog. You can site any study supporting chiropractic that you want, they will either say it is invalid, incomplete, lacking in substance or performed by unqualified individuals.

  32. criticalist says:

    “Atlas verterbral realignment and achievement of arterial pressure goal in hypertensive patients: A pilot study”
    Bakris et al, Journal of human hypertension, 2007, 21 (347-352)

    Not especially convincing , to be honest. The major problem seem to be that although the authors claim this was a double blind study, it was clearly not. In a double blind study neither the investigators nor the subjects know who is receiving treatment or placebo, yet here the investigators knowingly applied either a real or sham intervention. It is not clear from the methods if the same investigators then actually performed the blood pressure measurements; if so then is room for signifiant bias.

  33. Diane says:

    Insight -> “As far as Craniosacral Therapy, I know there is a large argument among PTs on the topic, even in our hospital system. When other means have failed and you have a symptomatic patient with Cephagia and they ultimately try this therapy and get better, what do you do. Once you try convential formulary and nothing helps and try CST and the patient says they got their life back. Tell them that there isn’t sufficient evidence to support trying it.”

    CST is unsupportable. I’m sorry, but that’s the truth. What can easily be done, however, is deconstruct the treatment construct itself, uncouple it from the actual physical handling, and toss all the anti-scientific stuff (which often requires Occam’s Chainsaw, Backhoe and Dumptruck); then you are left with simple human primate social grooming, one nervous system with its hands on another. The second nervous system uses information supplied kinesthetically by the first, to assist its own neuroplasticizing and downregulation of pain (which it came up with in the first place, so it can easily dispense with it). This is all congruent with the most elegant model that pain science has to offer these days, so far, the neuromatrix model by Ron Melzack. All that any physical contact from a caring practitioner can offer a nervous system in pain, is a change in the sensory-discriminative input reaching that brain. That is all there is to manual therapy of any kind. It’s great for pain, any kind of pain that is non-pathological in origin, that is. But it’s nothing tissue-based at all, it’s a nervous system affair, and a catalyst only. It’s ridiculous for entire professions to base themselves on manual therapy alone, or on the even narrower base of just one “kind” of manual therapy, or on keeping manual therapy wrapped and tied up in anti-, pseudo-, or prescience, then fighting to keep the packaging going.
    I say, let go of the packaging and the crazy treatment constructs. Let human primate social grooming live on, but start explaining it in ways that are congruent with science and that make sense in terms of modern pain science. Let any form of manual therapy that won’t do this simple update die by the side of the road, and good riddance.

  34. pec says:

    “start explaining it in ways that are congruent with science and that make sense in terms of modern pain science. ”

    Oh yes, let’s always stick with what we already believe. We must never modify our ideas. Never.

  35. Joe says:

    Insight on 24 Jun 2009 at 4:32 pm “I am 43 years old {snip}

    Give me a better case study with published outcomes for IVD herniation, radiculitis or canal stenosis …”

    Perhaps you are still young-enough to learn to provide a proper citation.

  36. Diane says:

    Pec -> “Oh yes, let’s always stick with what we already believe. We must never modify our ideas. Never.”

    Not sure what you’re on about Pec. “Modifying”"our ideas” is exactly what I am recommending.

  37. pmoran says:

    Diane, you see “human primate social grooming” as one of the elements in placebo reactivity to hands-on treatment methods?

    If so, I don’t understand why you say it should only affect “non-pathological pain”. Other placebo influences have been observed in all kinds of pain, even including severe post-operative pain and (especially) experimentally induced pain of various types.

  38. Insight

    first of all I am a Osteopathic Physician, Boarded in Family Practice. I also teach for a residency program.

    Argument from authority
    I don’t care. Provide a citation for ANY of the studies you’re referring too, or I have no proof that you even know how to find the studies you mention.

    Your comments regarding Osteopathic Manipulation are unfounded or based on your limited exposure to the kind.

    Courtier’s reply.

    I applied to both DO and MD medical schools when I applied. Since then I’ve volunteered with, and worked under a variety of both MDs and DOs. I’m intimately familiar with both philosophies of medicine. I’m also familiar with the published evidence on the subject. My anecdote’s just as good as yours unless you’re going to reveal something that proves you know what you’re talking about here.

    I don’t need to be a DO to understand the evidence concerning the subject.

    Though many DOs choose not to manipulate it is not due to the fact that they do not believe in it’s validity.

    Most do not feel comfortable due to lack of experience. Most don’t perform the advanced fellowship and lose the skill associated.

    Argument by assertion

    I’ve heard the opposite from quite a few DOs, you’re asserting one way, I’m asserting the other. Evidence, or no validity.

    You present very close minded arguments in an arrogant fashion, this is typical of conspiracy theorists and those of skeptical sites that refute their own stance.

    Ad hominem
    Also lying

    How is my argument close minded? I said prove it. I said provide citations. That’s close minded?

    What have I said that is a conspiracy theory?

    I practice science based medicine in regard to medication. I also recommend craniosacral therapy, yoga, Tai Chi and chiropractic care.

    Ridiculous. Craniosacral therapy! You might as well have come here and said you recommend emmenagogue herbs for contraception.

    I have seen the reference here trying to refute studies for lowering blood pressure with upper cervical manipulation (see U of Chicago study). Simply saying that findings are not conclusive enough to make claims, the typical comment I see refuting findings. Come on?? Not choosing to accept the validity of studies that show organ related change in manipulation is an cheesy way of saying, we see the evidence and don’t buy it.

    Firstly, do you even know what a citation looks like?

    Secondly, this shows a complete misunderstanding of science. This is a pilot study. Do you know what a pilot study is? It’s an initial, small study. If it shows an effect, you can move on to a bigger trial.

    We don’t make treatment decisions based on one paper published somewhere even if it’s a relatively large trial. That’s a 2nd year med student level mistake. I’m expected to know better than that as a fourth year student.

    It’s a much bigger mistake to make these decisions based on a pilot study, which is by nature designed to justify more research into an area.

    As criticalist mentioned, this was clearly not a double blinded placebo controlled study, as it was described by the authors.

    In medicine, we should survey the extant literature, and we make decisions based on all of the evidence.

    In regards to the comments on nutrition and supplementation, please give me an example of this extension nutrition training. Also, show me what courses on supplementation you received in med school.

    My preclinical curriculum was systems based, so it’s an incoherant statement to say “what courses on supplementation”

    Longitudinally throughout my curriculum we’ve had nutritionists, and doctors who specialize in nutrition educate us on the material.

    Relevant nutrition is given additional emphasis in didactic lectures throughout the clinical years.

    Within our pharmacology series we specifically discussed supplements and their relevancy to our practice.

    I went to DO school at Midwestern and I can tell you that I got nothing.

    Oddly enough, I’ve met students from Midwestern, and they weren’t anywhere near as disgustingly bad at science based medicine as you are.

    I know for a fact that students at Midwestern now are required to learn how to appropriately search the literature for relevant studies, and to survery the evidence. Either that wasn’t part of the curriculum when you went to school, or you never learned it there.

    <blockquoteYour biase against in this topic is unfounded.

    Give me a citation then. Show me the evidence.

    I see Medical School graduates from all over the world in our residency program and when we cover nutrition they are mostly undereducated at best.

    And I care becuase? You pile anecdote on top of anecdote and expect it to add up to something more. The plural of anecdote is anecdotes. Not data.

    If you choose to be opposed to topics atleast have the decency to be honest and a bit less arrogant.

    Again, what is arrogant? Why the ad hominem? Where am I wrong? You have only asserted that I am wrong. You have shown me nothing.

    Give me a better case study

    No. Case studies are pretty poor evidence. You should know that if you’re faculty somewhere.

  39. weing says:

    “Oh yes, let’s always stick with what we already believe. We must never modify our ideas. Never.”

    I wouldn’t put it that way. Maybe if you said “let’s stick with what we already know and work from there”, I might agree. Your statement is more like a projection and may illustrate how you approach things.

  40. Diane says:

    pmoran -> “Diane, you see “human primate social grooming” as one of the elements in placebo reactivity to hands-on treatment methods?

    If so, I don’t understand why you say it should only affect “non-pathological pain”. Other placebo influences have been observed in all kinds of pain, even including severe post-operative pain and (especially) experimentally induced pain of various types.”

    I wouldn’t argue with that, but would say that I see kinesthetically elicited placebo response as the main effect OF “human primate social grooming”… but I’m not sure if that was what you intended to ask or were implying.

    Manual therapy is useful for helping resolve non-medical, non-pathological pain, i.e., ordinary garden variety mechanical pain; i.e., the kind everyone gets sooner or later, but which worries people unnecessarily and leaves them open to exploitation by chiropractic etc.; i.e., the kind of pain that can mimic referred pain from pathological processes, relief of which can lead to claims of “cure” of various “ailments” which have similar pain patterns.

    If it’s just non-medical mechanical pain, it will usually go away and not come back. The person inhabiting the nervous system being treated with manual therapy usually needs to learn some individualized movement therapy to keep mechanical pain away long term. Manual therapy provided without individualized homework can become dependency-inducing. A practitioner who uses manual therapy on everyone without taking a careful history or without understanding pain science will be more apt to misapply it or overdo it.

  41. nobs says:

    Insight>> “As a physician I can find several opinions in this blog that are more representative of personal belief and not that of science.

    Whitecoattales>> “Based on the rest of your comments I’m curious, what kind of physician are you?

    Insight>> “first of all I am a Osteopathic Physician, Boarded in Family Practice. I also teach for a residency program.

    Whitecoattales>> “I don’t care.

    (Hey dude- YOU are the one that asked. Did you forget?)

    Insight>> ” Are you a physician??? If so what type?? Now I would like to see who you are.

    Whitecoattales>> “I applied to both DO and MD medical schools when I applied. Since then I’ve volunteered with, and worked under a variety of both MDs and DOs

    (This is not an answer. The “Whitecoatail” handle and your dodgy answer leads one to suspect you ATTENDED neither.)

    “““““““““““`

    Whitecoattales>> ” Provide a citation for ANY of the studies you’re referring too, or I have no proof that you even know how to find the studies you mention.

    Since I am familiar with the studies Insight is referring to, I will provide you with a few direct links:

    http://www.biomedcentral.com/1471-2474/7/16

    A non-surgical approach to the management of lumbar spinal stenosis: A prospective observational cohort study

    Donald R Murphy1,2,3 , Eric L Hurwitz4 , Amy A Gregory1 and Ronald Clary1

    http://www.springerlink.com/content/f32603l877144k77/

    A randomized clinical trial and subgroup analysis to compare flexion–distraction with active exercise for chronic low back pain

    Follow-up study:

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1574327

    Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain

    You will find additional information and studies here:
    http://www.coxtechnic.com/research.asp

  42. Mark Crislip says:

    Update 1 NUCCA and Hypertension. An evaluation of “Atlas vertebrae realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study.” Published in 2007 in the journal of Human Hypertension. 6/28/07

    I reviewed it in quackcast 17, http://www.quackcast.com/page2/page2.html

  43. nobs: Actually, I did forget. My apologies to insight.

    ” Are you a physician??? If so what type?? Now I would like to see who you are.

    Whitecoattales>> “I applied to both DO and MD medical schools when I applied. Since then I’ve volunteered with, and worked under a variety of both MDs and DOs

    (This is not an answer. The “Whitecoatail” handle and your dodgy answer leads one to suspect you ATTENDED neither.)

    From context, insight doesn’t appear to be talking to me when he asked “are you a physician?” , he appears to be addressing Joe.

    I was not answering him when I typed what you’ve quoted, I was commenting on my relative exposure to DOs.

    It’s amazing what you can do when you quote mine.

    For the record I’m (as of yesterday) a fourth year medical student at a midwestern MD university. This is widely written in my comments elsewhere on this blog, and on my own blog. Not meant to be a dodgy answer, because I wasn’t trying to answer his question.

    Also, it’s “whitecoat tales” It’s odd because you copy and pasted it, and then misspelled it.

    I am already familiar with the studies he’s referring to. They are unimpressive. When I have a little more time I can give you a detailed breakdown of why this is the case.

    My request was to highlight that he’s really not very familiar with the world of evidence. We pass citations back and forth constantly. When referring to a study, we generally give either a properly formatted citation, or a PMID, or a DOI.

    He also has only referred to studies in the vaguest of terms, claiming that they’re positive and supportive. Yet he never discusses the quality of the data, the design of the study, the controls, or why the study is worthwhile.

    In fact, he criticizes us for using all of those exact qualities to dismiss a study that was clearly a pilot trial. He also seemed unfamiliar with the definition of a pilot trial.

    He brought up a point along the lines of “I practice science based medicine, AND I practice (insert non evidence based practice here)”

    This is a statement that demonstrates one doesn’t understand SBM. SBM and EBM are as much about what therapies they suggest you DON’T use.

    Saying that you use both therapies that are recommended by SBM AND therapies that have been adequately researched, and without benefit by SBM/EBM is saying that you don’t practice evidence based medicine.

    It’s like saying “I’m a vegetarian, who regularly eats beef.”

  44. OZDigger says:

    whitecoat tales

    you are in for big shock when you get into practice. Patients do not read text books. They do not know what science based medicine is. There symptoms will not always follow what the text book says.
    They want to get better.
    When a patient does not fit the mold of what you learned at med. school, what are you going to do? If you do nothing, you will be seen as being incompetent. Are you going to call them a nut and say that is psycho-somatic. That will not do you credibility any good!!
    Keep an open mind of what is out there to help your patients. They respect you for telling them that you may not know ans answer. They will not respect you for burying you head in the sand. They will respect honesty and that comes from experience of dealing with patients, seeing what works and does not work in a clinical setting and realize that every presentation is different.

  45. Joe says:

    For more on the chiros vs Singh http://www.ebm-first.com/?cat=73

  46. Joe says:

    OZDigger on 25 Jun 2009 at 1:18 am “whitecoat tales

    you are in for big shock when you get into practice.”

    A major difference between quackery and medicine is that real doctors must have substantial, real clinical experience before they are licensed to practice independently. Chiropractors, for example http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53681 do not “Sometimes a [customer] asks me, “Who did you practice on when you were learning to adjust?” … we practiced on each other [classmates, not people with illness] …

    As a greenhorn DC, I clearly recollect the first patient who told me, straight out, that he needed a “good cracking. … He was a “firm believer” in chiropractic and apparently had always had great results. “Just roll my hips”, he offered, “and that should do it. And don’t be afraid to give ‘er all ya got!” Since I was just out of school and without any meaningful experience, this seemed perfectly reasonable.” [bold added]

  47. OZdigger:

    you are in for big shock when you get into practice. Patients do not read text books.

    Don’t be condescending. I’m on the wards now, full time. As in, I see patients for 70-80 hours a week, now, and have for the last year straight. I’m well aware that textbook presentation of disease is no more than 30% of total presentation. I’m well aware a good portion of my prescribing will be off label. None of that has anything to do with recommending BS therapies.

    They do not know what science based medicine is. There symptoms will not always follow what the text book says.
    They want to get better.

    I’m confused how a patients knowledge of medicine is relevant to this.

    When a patient does not fit the mold of what you learned at med. school, what are you going to do? If you do nothing, you will be seen as being incompetent.

    I’m going to use th fact that I exist within a broader world of medicine than only myself. When I’m outside the bounds of my knowledge, I’ll bring in appropriate outside resources. on the patients symptoms, that could be research the literature, consults to ancillary support staff (PT/OT/Speech pathology), other physicians.

    What do YOU do? Refer them to a chiropractor? Prescribe them a sugar pill? As far as the evidence goes, outside of some musculoskeletal complaints, there is no question that chiropractic is just an expensive, more dangerous sugar pill.

    Didn’t you learn medical ethics at some point? What did they tell you about the ethics on prescribing a placebo in practice? They told us not to do it, period. It’s unethical, it’s inappropriate.

    Are you going to call them a nut and say that is psycho-somatic.

    /eyeroll

    Are you saying that you never tell your patients if they have psychosomatic problems? Do you ever refer them to a psychiatrist, or a therapist? Because if you don’t, that’s malpractice for a large number of legitimately psychosomatic and psychiatric complaints.

    Noone goes “well Mr Smith, I’ve ruled out everything else. The problem is just that… you’re a nut!”

    Explaining a patient’s diagnosis and delivering bad news is always difficult, but it’s a skill that we learn! If your patient has conversion disorder or some other psychosomatic complaint, it may not be satisfying for them to be told that it’s not an organic disorder. Yet not telling them is unethical, and unlikely to lead to improvement. All the psychiatrics and PMR doc’s I’ve worked with say appropriate treatment of most psychosomatic complaints starts with acknowledgement of diagnosis.

    That will not do you credibility any good!!

    You’re just wrong here. On neurology I had to tell patients almost every day that their problems were psychosomatic. When done correctly, patients thank you. Because doctors who think like you dance around the issue and don’t tell patients the truth to the best of their knowledge.

    At base, patients want to get better, and want the truth. When they understand that psychosomatic illness is still illness, and that you’re validating their concern and trying to treat them, patient’s are generally willing to buy into your plan.

    What’s your alternative? Lie to them? Suggest yoga, chiropractic, naturopathy, anything to avoid telling them what you know?

    Keep an open mind of what is out there to help your patients.

    I’m always looking for what’s out there to help my patients. I know that I have a responsbility to be the expert, for my patient. That means I have a responsbility to investigate, and understand WHY I’m suggesting a particular therapy. It means I have an obligation to reject therapies that don’t work. There is a reason that we limit the use of leeches now.

    They respect you for telling them that you may not know ans answer.

    True. But irrelevant since noone suggested saying anything other than the truth. If you don’t know the answer, you don’t know the answer.

    They will not respect you for burying you head in the sand.

    True. But irrelevant since noone suggested otherwise.

    They will respect honesty and that comes from experience of dealing with patients, seeing what works and does not work in a clinical setting and realize that every presentation is different.

    Regardless of every presentation being different, and not every presentation being classic, this is gibberish.

    Patients respect your experience, your education, your motivation, and the hard work and concern you put into trying to make them better.
    Because of those things, they expect that if you suggest something, it has legitimacy, and it will work.
    Because of those things, you have an ethical responsibility to understand what actually works, and what might be you succumbing to, for example, recall bias.

    The whole point of science based medicine is to find out what actually works. Whether the patient understands that is irrelevant. YOU need to understand it. The patient is dependant on you for valid, good, treatments. If you prescribe them placebos if you prescribe them crap that doesn’t work, then you aren’t doing right by your patients.

    Doing so because there is no significant research on the subject is impossible to avoid. Doing so when we have alot of information to work with is just irresponsible.

  48. Basiorana says:

    “you are in for big shock when you get into practice. Patients do not read text books. They do not know what science based medicine is. There symptoms will not always follow what the text book says.
    They want to get better.”

    Wanting to get better is the #1 best reason to see a real doctor, speaking as a patient.

    If I had a physician recommend CST or chiro for non musculo-skeletal issues to me I would report them to every board I could find for recommending I try magical theories that are known not to work. It might do nothing, but maybe someday enough patients like me will complain about coming in for real problems and being given fake cures that these “physicians” will lose their licenses.

  49. Mojo says:

    @pec:

    Oh yes, let’s always stick with what we already believe. We must never modify our ideas. Never.

    I see you don’t get irony either.

  50. NeuroDawg says:

    http://www.biomedcentral.com/1471-2474/7/16

    A non-surgical approach to the management of lumbar spinal stenosis: A prospective observational cohort study Problems with this study? Let’s see:

    1. Was this a prospective study or chart review? It’s not clear from the methods statement. These statements, “Two were excluded because of absence of baseline data or failure to remain in treatment to FU” and “This was a practice-based project in which the data gathered were those data that are collected as part of the routine of practice at the Rhode Island Spine Center” would seem to indicate that this was a chart review, and not a prospective study. Just because they label it as such, doesn’t mean that it was. I can understand a patient being lost to follow-up, but if it was truly prospective how do you exclude one for “absence of baseline data”?

    2. No objective measurements of improvement. I realize that many studies of pain rely upon pain scales and patients’ self-reported symptoms and feelings of improvement. However, the authors of this study included people with neurogenic claudication as a clinical diagnosis and inclusion criteria. At the very least, put them on a treadmill and see how far they can walk pre- and post- treatment.

    3. No placebo or comparison with other treatments. At the very least a control group consisting with standard non-surgical treatment, i.e. physical therapy. Better yet, divide the groups into those getting chiropractic manipulation from a certified DC and those that see a non-chiropractor who spends time with them randomly moving their legs and back, and directing them on sham exercises at home.

    4. No control for non-chiropractic treatment. The authors clearly state, “No attempt was made to alter medication usage and continued medication usage after intake was not recorded, thus it is impossible to know how long each patient continued on his or her medication. Two patients were referred for epidural steroid injections.” How many other patients also saw physical therapy? How many had pain medications adjusted by their physicians? Later in the results section they state, “The mean total number of treatments was 13.3 (range 2–50). This included visits to both the chiropractic physician and physical therapist.” So clearly some patients were also seeing a physical therapist. How many? How often?

    5. Inclusion of 14 patients without a known diagnosis of spinal stenosis. Spinal stenosis is a radiological diagnosis, yet 14 of the 57 patients in this study didn’t have imaging. I’ve seen more than one patient who had classical symptoms of neurogenic claudication who then had normal imaging and vascular studies revealed that the claudication was actually vascular.

    6. Poorly defined exclusion criteria. What are “contraindications to the study treatments”? How was vascular claudication ruled-out?

    That’s just a quick summary of the issues I found in one study you have quoted. They’re enough to cause me to stop reading early on, as such methodological problems do not allow any meaningful conclusions to be drawn.

  51. Insight says:

    whitecoattales,

    to quote your earlier comment;

    “My request was to highlight that he’s really not very familiar with the world of evidence. We pass citations back and forth constantly. When referring to a study, we generally give either a properly formatted citation, or a PMID, or a DOI. ”

    This is not a grand rounds and and it was obvious you were aware of the studies I was referring. I am very familiar wtih formatted citations young man, you were showing arrogance and accusing me of ad homs when you through many my way with rebuttal. I see that from 4th years and the occasional first year resident but not to worry, they usually lose that when they have more experience and accept the gaps we have in the system.

    I will say one thing, clinical studies are some of the most valid information we get. Double blind, randomized trials are very good I will agree. But the information we receive from trials in MSK pain have been invaluable in my experience.

    Also, it is possible to use evidence based medicine and still be open to alternative delivery systems. You admitted being familiar with the Cox studies. I could give a rats behind if you don’t agree with the findings. I have send many patients for this treatment that have had significant subjective and objective improvement. Physical Therapy NEVER helped my IVD patients. I found Cox work from the chief of neurosurgery here who referred non-surg patients for the treatment because he informed me that he saw better outcomes in his patients.

    I wont get into a pissing match with a student barely in his 4th year. You have your ideals which is wonderful, let your mind open a bit. You and your patients will be better served for it.

    I am not talking about referring patients to DCs for organic processes and you know it. I do think the effects warrant further research. You come across as argumentative and bull headed and I will tell you that is not the same in the eyes of faculty as confident with compassion.

    I have spent more than enough time on this blog. And, by the way. You did cause me to contact my old med school and check into the nutrition peice. “1 Class on nutrition”. Thats it. If you are trying to tell people that combining your rounds, observations and morning reports and lectures makes you competent in nutrition than you forget who you are talking to. You are being disindenuous.

  52. I am not talking about referring patients to DCs for organic processes and you know it.

    I was talking to OZdigger, as indicated by “OZdigger:” at the top of the comment.

  53. Joe says:

    Insight on 25 Jun 2009 at 10:50 am “I am very familiar with formatted citations young man,” Then, young man (you are only 43- if you have 20 years more of ignorance than whitecoattales has education, it does not impress; I passed you decades ago with legitimate science), why haven’t you provided the complete citations? As I said, we teach proper citation to college undergraduates. I have asked for data supporting chiropractic and craneoscral therapy (which educated professionals reject) and you have not offered anything reliable.

    Insight on 25 Jun 2009 at 10:50 am “I wont get into a pissing match with a student barely in his 4th year.”

    That is a wise choice since you are obviously deluded and opposing someone who is better educated.

  54. INNATE says:

    Hello everyone. First of all, I am delighted that chiropractic is the subject of such ardent debate!!

    I am an upper cervical chiropractor. I also have a bachelor’s degree in biochemistry.

    To set the record straight, chiropractic students do indeed care for outpatients as part of their training (we didn’t just “practice” on each other).

    The main reason I’m writing is to shed contemporary light on this subject of Innate Intelligence (or simply “Innate” as we chiro’s call it). One of you wrote that there is no scientific evidence of the existence of Innate. This is because Innate is non-material and therefore immeasurable.

    Innate is the consciousness in every living thing that coordinates the infinite simultaneous space-time events required to sustain life! Presumably none of us consciously mitigates all of the processes occurring in our bodies on a moment to moment basis! A pregnant woman does not consciously create the human being developing in her womb. We don’t consciously initiate the clotting cascade each time we get a paper cut. (You get the picture). All of these things occur as a result of this Innate Intelligence working in our bodies; our bodies ARE the material manifestation of this immaterial intelligence. All of this is self-evident. If it is not self-evident to you, then I’d say you’ve lost your most valuable mental capacity—common sense! And, if YOU indeed mitigate all of these things in YOUR body, then you must be very, very smart! 

    Science (specifically, life science) is the pursuit of knowledge that attempts to discover and describe the inner workings of Innate! Physiology is Innate at-work; biochemistry is Innate at-work. Kidneys work the same way today as they did before science DISCOVERED how they work. Etc.

    The chiropractic argument is as such: Since the body is intelligent enough to coordinate all of these physiological processes in order to sustain life, then it is intelligent enough to restore wellness in the body that has fallen ill! Furthermore, the reason it does not readily do this is as a result of interference in the nervous system (specifically, in the brain stem). The cause of interference at the level of the brain stem is biomechanical dysfunction in the upper cervical spine. I’m sure you doctors are familiar with the concept of disafferentation and/or proprioceptive insult. I’m also sure that you are aware that the greatest density of proprioceptors/mechanoreceptors in the body reside in the area of the upper cervical spine and that the brain requires normal information from this area in order to properly adapt the environment. If the biomechanics of the upper cervical spine is altered by joint fixation, then the brain does not receive normal information from this area. This creates a cascade of dysfunction in the body which prevents it from adapting to the environment and ultimately from fending off disease. Restoring normal function to the upper cervical spine, in time, reverses nervous system dysfunction and ultimately restores the body’s innate ability to regain health. The chiropractic principle in-a-nutshell!!

    To scientifically describe how the body heals itself would require the ability of our finite minds to conceptually grasp the infinite mind of our bodies. Since our finite mind is the epiphenomenon of the infinite mind of our bodies, this is not possible. The proof is in the countless sick people that have gotten well as a result of upper cervical care.

    To set another record straight, the straightest chiropractors are upper cervical chiropractors! On a historic note, Dr. B.J. Palmer discovered upper cervical chiropractic and devoted his life to its development. Although many of his theories as to how and why this type of care worked were incorrect, he began a path that many others would help pave. And, although the path is not currently completely paved, significant advancements have been made since B.J.’s time.

    I strongly urge those of you that have diagnosed patients with psychosomatic disorders to refer them for upper cervical chiropractic care. You would be doing them a great service!

    Thanks for reading. I can go on and on but I understand that time is valuable. I hope what I’ve written has helped! And I hope I haven’t insulted anyone. For more information on upper cervical care please visit: http://www.thepowerofuppercervical.com or simply google upper cervical care.

    Be well!

  55. healthnut says:

    Joe, you are the only one here that believes Insight is being out educated. You appear to be more of the angry skeptical undergraduate educated poster who does not have the benefit of real world applications to properly use the research.

    I see you stomping your foot shouting, provide complete citations!!!!!!

  56. “I wont get into a pxxxing match with a student barely in his 4th year.”

    Sounds like argument from authority to me. Your authority, age, and experience trump his credentials, so he is not worthy of your arguing with him.

    That’s a bit of a BS position to take in the comments section of a semi open blog not limited to experienced MD’s. If you only want to have discussions with experienced MD’s, I’m sure there are sites out there that will serve your purpose.

    I don’t care if he’s a rodeo clown (no offense to rodeo clowns) and you’re a Nobel winner in medicine, can you logically refute his positions or not?

  57. Joe, you are the only one here that believes Insight is being out educated.

    Ah, so the preponderance of comments on this thread are in agreement with Insight?

    Or perhaps all of my arguments were logically refuted?

    Clearly you don’t read well, I’m not “undergraduate educated,” I’m a medical student. In medical school, (unlike in naturopath school) everything after the second year is in the hospital, which is real world applications.

    As for seeing us “stomping your feet,” you’ve ignored all the arguments.

  58. Harriet Hall says:

    Innate,

    “Innate is the consciousness in every living thing that coordinates the infinite simultaneous space-time events required to sustain life!” This statement is meaningless. There is no way to test it. There is no evidence that any kind of consciousness coordinates the life-sustaining processes; there is evidence that those processes are unconscious. It seems you are re-defining the word “consciousness” to suit your own vitalistic philosophy.

    Only a minority of chiropractors accept the upper cervical approach. There is no credible evidence to support it. The website you cited provides no supporting evidence, just a lot of testimonials and this laughable list of all the conditions alleged to be treatable by upper cervical adjustments:
    http://www.thepowerofuppercervical.com/symptoms/

  59. INNATE says:

    Reading all of you “duke it out” is great!!…Lot’s of laughs!

    I think you all have lost sight of a very important fundamental: We all decided to peruse careers in health care out of a genuine desire to help suffering people! We all have this one thing in common! Am I wrong? All forms of health care are valuable (complete citations or not) if the patient benefits in some way.

    Each form of health care has its place; I wouldn’t see a chiropractor if I broke a bone or if I incurred a life-threatening infection…I’d go to the ER!!; I wouldn’t see a surgeon if I have a headache. If we are to fulfill our desire to help suffering people, then we need to try to accept the value in all forms of health care with an open mind. Instead of immediately discrediting something based on lack of scientific support, try to use your educated mental faculties to figure out how it CAN work. The number one concern is the wellbeing of the patient, and not our egos!

  60. INNATE says:

    Harriet, You are right!! There is no way to test it…it is self-evident if you perceive it a certain way. For example, the way hemoglobin reacts to the partial pressure of oxygen surrounding it is a sign of intelligence; the self/non-self recognition mechanism exhibited my the immune system is a sign of intelligence; nerve conduction, DNA transcription/RNA translation, cell-membrane signal transduction…all signs of intelligence!!

    You certainly have a right to not associate intelligence with these (and other) processes. However, I coose to do so and this brings great meaning to my life.

  61. Joe says:

    @INNATE on 25 Jun 2009 at 2:04 pm “Each form of health care has its place …”

    Great, show us some reliable evidence supporting the place of your form of health care.

  62. INNATE says:

    Here you go Joe! It’s a great read. I’m not gonna spoon-feed it to you but it’s all in this book.

    http://www.diagnosispro.com/online_store/clinical-reference/078174198X.html

  63. Joe says:

    @INNATE on 25 Jun 2009 at 2:51 pm

    I asked for reliable literature, I am not going to spoon-feed you on what that means. Allow me to say that quack literature does not count.

  64. INNATE says:

    What are you talking about? That IS reliable literarture; it’s a collection of all the peer-reviewed journal articles dealing with this subject…excerpts from actual articles categorized by subject; and all the citations within it are complete (like you prefer). You can come over and I’ll read it to you like a bed-story if you want :)

    I have the book in my office. If you give me some time I will pull complete citations of key articles from it for you to read and review for yourself.

    Hey, I’m just trying to shed a little light in the midst of darkness. I’m not here to offend anyone. I’m just passionate about what I do as you are with what you do. I’ve witnessed results from this care first hand in my patients and in myself! There is definitly something to it, reliable literature or not.

  65. “For example, the way hemoglobin reacts to the partial pressure of oxygen surrounding it is a sign of intelligence”

    It is a sign that hemoglobin is (predictably, materially, and measurably) responding to the laws of physics and chemistry, it’s not a sign of intelligence.

  66. Fred Dagg says:

    Innate et al.

    I would like to remind you that Joe’s book of “science” is bigger than yours, only because the print is so big. He suffers from severe and debilitating myopia and tunnel vision.

  67. INNATE says:

    “It is a sign that hemoglobin is (predictably, materially, and measurably) responding to the laws of physics and chemistry, it’s not a sign of intelligence.”

    Karl, don’t you see that the very ACT of responding and adapting to the laws of nature (through its design) is in itself an act of intelligence?

    Like I told Harriet, you have the right to choose NOT to ascribe intelligence to this phenomena.

  68. Is anyone else amused by the claim that a phenomenon which is immaterial and immeasurable can have a physical effect?
    If it can affect matter/energy, it can be measured and is not immaterial.

    There are things in the universe (such as neutrinos) which are very difficult to detect, but that is because they interact with other matter very weakly. Any phenomenon that interacts strongly enough to produce significant physiological changes should be relatively easy to detect. The crickets are chirping while we wait for evidence of vitalism, which tells me either its effects are extraordinarily weak (weaker than the interactions between neutrinos

  69. Karl, don’t you see that the very ACT of responding and adapting to the laws of nature (through its design) is in itself an act of intelligence?

    … I must be misunderstanding you. My read on that statement means that when I throw a bowling ball off of the roof, it falls because of it’s innate intelligence responding to the laws of nature.

  70. INNATE says:

    Thoughts, beliefs, and perceptions are immaterial yet they cause physiological responses in the body. The perception of physical threat (real or not) will trigger a sympathetic response. A “broken heart” is the result of a perception that love has been lost. etc.

  71. Citizen Deux says:

    Make way, consumer coming through…

    Best comment ever;

    Patients do not read text books. They do not know what science based medicine is

    Patients do surf the net to find out about their condition. They do seek out information from many sources – some of it not so good (see Oprah).

    The problem is that there is a wealth of misleading information and “easy” cures promoted to consumers every day. From relentless ads for Viagra to bogus sites touting colonics as the cure all for humanity.

    I very much appreciate the desire of individuals to help people through healthcare. There are a lot of good providers out there, some in non-traditional (or adjunct) fields – massage therapy, personal coaching, etc.

    To claim that all providers are of equal value is not only inaccurate it dilutes the information and causes problems for consumers. A patient going to see a chiropractor as a GP is a fundamental error. They simply lack the skills, training and exposure to distinguish between lower back muscle strain and and acute condition of the kidney.

    Innate, your spiritual claims to the unknown aside, I have no doubt that you may “see” results from your practice. However, your attribution of its cause is fundamentally flawed. What more rational reason may exist for any positive result? Do you track the neutrals or negatives?

    Perhaps it is simply the therapeutic effect of an informal CBT session which is alleviating the patient’s psychosomatic pain. You seem like a nice, good natured person. Thanks for being so upbeat.

  72. INNATE says:

    No…so Innate Intlligence resides within LIVING things. Universal Intelligence governs the falling ball. The fact that the ball falls at a rate that can be mathematically described is a sign of intelligence. Universal Intelligence is the source of the laws of physics. Intelligence is exhibited by the mathematical predictability of these laws. Again, these laws were DISCOVERED and not created by man and (as far as we know) they are universal.

    I can imagine that all of this sounds like “quackery” to all of you but I feel it is important that you have a true understanding of chiropractic philosophy explained from an actual chiropractor and not from someone that is not.

    My goal is to shed light and not to master.

  73. Innate, all of this sounds like religion. I’m confused how these beliefs can guide or inform your chiropractic practice.

  74. INNATE says:

    Citizen, I did not say all forms are of EQUAL value. And, we are rigorously traind and tested to recognize conditions that are beyond our scope of practice as well as the appropriate referal to make in such a case.

    As far as the “results”, In my office (as well as in many other upper cervical care offices) we measure the instantaneous function of the nervous system through “paraspinal infrared thermography”. Very basically, this technology measures the skin surface temperature radiating from either side of the spine and calculates the difference in these temperatures; ideally there should be no differece. However, what we find in many cases is that this differecne exists. For you docs, a difference of more than 0.2 degrees is an indication of neuropathophysiology; basically, there is a problem with the vasomotor mechanism which is controlled by centers in the hypothalamus as well as in the brain stem. These neurologic pathways are part of the autonomic nervous system.

    IF and when we detect this kind of abnormality, the patient merrits a very specific and calculated adjustment to the upper cervical spine afterwhich they rest in a comfortable chair for about 20 minutes. We then run the thermography test once more to ensure that the abnormality has subsided. Bear in mind that if the abnormality is not initially detected, they DO NOT receive an adjustment that day.

    The above is very diferent from the public conception of chiropractic. The above is REAL chiropractic. All chiropractors that “crack your back” are merely doing spinal manipulation and although it may temporarily relieve back pain, it is not true chiropractic.

    Does that answer your questions?

  75. INNATE says:

    Whitecoattales, I agree that it sounds like a religion, but I assure you that it is not. It’s merely an understanding of nature and how it works.

    As far as how these beleifs guide my practice: all we do is ensure that the nervous system (as measured through thermography) is functioning normally. If it is not, then we make a very specific adjustment to one of the two upper cervical vertebrae (we ditermine the directionality of this adjustment by way of a specialized x-ray analysis protocol). We atest that if the nervous system is functioning normally then the body’s intelligence is free to repair anything that may be wrong with it. In Chiropractic philosophy, disease results from imbalance or an inabiltiy for the body to maintain homeostasis. We find that this inability results from interference in the nervous system. If we remove the interference then the body restores balance on its own (given enough time, of course). It’s all very simple if you think about it.

  76. pmoran says:

    “The above is REAL chiropractic.”

    This may well be “REAL chiropractic” but it is also unspeakable nonsense.

    While certain local pathologies including nerve damage can be associated with skin temperature changes, here we have medical innocents looking for common, insignificant, random, or externally produced temperature asymmetries, regarding them as pathological for no clear reason, then doing something that can hardly achieve anything relevant and is in the wrong area anatomically, and pronouncing a non-existent entity fixed when almost certainly the results would have been the same without the intervention.

    Have you tried merely allowing such subjects to “rest in a comfortable chair for about 20 minutes” without doing anything to their spines?

  77. Joe says:

    INNATE on 25 Jun 2009 at 4:30 pm “… IF and when we detect this kind of abnormality, the patient merrits a very specific and calculated adjustment …”

    Chiropractic is not specific to one vertebral joint.

    Lee RY, McGregor AH, Bull AM, Wragg P. “Dynamic response of the cervical spine to posteroanterior mobilisation.” Clin Biomech (Bristol, Avon). 2005 Feb;20(2):228-31.

    Kulig K, Landel R, Powers CM. “Assessment of lumbar spine kinematics using dynamic MRI: a proposed mechanism of sagittal plane motion induced by manual posterior-to-anterior mobilization.” J Orthop Sports Phys Ther. 2004 Feb;34(2):57-64.

  78. INNATE says:

    Yes! we have obviously tried just resting the patient without intervention and the abnormality does not subside…the abnormal thermographic “pattern” (as we call it) remains and it is exactly the same as proir to resting.

    “..doing something that can hardly acheive anything relevant…” please review the neurology of joint motion. Priniciples of Neural Science by Eric Kandel and James Schwartz.

  79. weing says:

    “I can imagine that all of this sounds like “quackery” to all of you but I feel it is important that you have a true understanding of chiropractic philosophy explained from an actual chiropractor and not from someone that is not.”

    Yes it does sound like quackery and that’s because it is. It’s not rocket science. You have done a great job of explaining chiropractic philosophy.

  80. My reply got posted before I was finished: the price of working on 3 different things at the same time

    …….The crickets are chirping while we wait for evidence of vitalism, which tells me either its effects are extraordinarily weak (weaker than the interactions between neutrinos and “regular matter”) or nonexistent.

  81. INNATE says:

    So, Joe…those articles deal with the spine caudal to C2. The anatomy of these vertebrae is such that they are locked into place by the the one above and the one below. C1 has no osseous locks, only muscles and ligaments holding it in place. Therefore it has a greater suceptability to misalignment. We look for (as one of the components of the misalignment) atlas laterality and so the adjustment at this level is mostly lateral to medial in nature.

    Thanks for doing your homework, though!

  82. Joe says:

    Mr. Innate, where is the data supporting your assertion?

  83. INNATE says:

    Joe…just look at an anatomy text book! If not, here you go:

    Iai H, et al. Three-Dimensional Motion Analysis of the Upper Cervical Spine During Axial Rotatin. Spine, 1993; 18(16):2388-2392.

    Jirout J. Changes in the Atlas-Axis Relations on Lateral Flexion on the Head and Neck. Neuroradiology, 1973; 6(4):215-218.

    Goodridge JP, Donalson BC, Roentgenographic Documentation of Atlanto-Occipital Sidebending. JAm Osteopath Assoc, 1992; 92(9):1129-1133

    Kappandji IA. The Physiology of the Joints. Third Edition, Churchill Livingstone, 1974.

    Goel VK, Clark CR, Galleas K, Liu YK. Moment-Rotational Relationships of the Ligamentous Occipito-Atlanto-Axial Complex. JBiomechanics, 1988; 21(18):673-680.

  84. INNATE says:

    Here’s one describing how an infarct to the brain stem results in skin surface temperature assymetries:

    Juha T. Korpelainen, Kyösti A. Sotaniemi, and Vilho V. Myllylä
    Asymmetrical Skin Temperature in Ischemic Stroke
    Stroke, Sep 1995; 26: 1543 – 1547.

    This just demonstrates that the regulatory centers for skin temperature are located in the brain stem. The conclusion is that measuring subtle skin surface temperature asymmetries indirectly measures the instantaneous integritiy of brain stem function.

  85. INNATE says:

    Gentlemen (and/or ladies)

    THANK YOU for such a vibrant discussion and for challenging me with such great skepticism! You have helped me to solidify these concepts in my own mind and to re-affirmed my commitment to my profession.

    I truely hope you have at least learned something about upper cervical care. I also hope that you maintain an open mind, as hard as that may be sometimes (I’m guilty of this as well). There is always more than meets the eye with most things.

    Good luck to all of you.

  86. Harriet Hall says:

    Innate has failed to provide us with any real evidence that upper cervical treatments benefit patients -for ANY condition, much less from the long list of conditions in the link he provided. He has not shown that thermography is a valid test to improve patient outcome.

    Thermography as a diagnostic aid for chiropractic has been discredited. See http://www.chirobase.org/06DD/thermography.html

    His arguments for upper cervical treatment are not even good enough to convince other chiropractors: the majority of his colleagues don’t use those techniques.

    All I have “learned” from him is that he personally believes in it and he can rationalize why he thinks it might work.

  87. pmoran says:

    “Yes! we have obviously tried just resting the patient without intervention and the abnormality does not subside…the abnormal thermographic “pattern” (as we call it) remains and it is exactly the same as proir to resting.”

    I find it hard to believe that anything about this chiropractic system of diagnosis and treatment has ever been validated in a rigorous manner.

    It fails to make sense in so many ways. If there were truly persistent and prominent local temperature variations the search should perhaps be on for more serious underlying pathology — neural, inflammatory or neoplastic . But thermography has been found far too unreliable to be used for that kind of screening. It is mainly affected by gross pathology, typically already very evident in other ways (such as ischaemic stroke in the case report you think somehow supports this practice). It is most unlikely to reliably pick up more subtle preclinical influences.

    I dislike this practice because of its its capacity to INCREASE the health care concerns of the public, rather than relieve any of their niggles and stresses.

  88. INNATE says:

    Here you go:

    Title Sixty patients with chronic vertigo undergoing upper cervical chiropractic care to correct vertebral subluxation: a retrospective analysis
    URL http://www.jvsr.com/abstracts/index.asp?id=276
    Journal J Vert Sublux Res. 2006 ;2006(NOV:8):Online access only 9 p.
    Author(s) Elster EL

    Subject(s) Thermography
    Vertigo
    Wounds and Injuries

    Peer Review Yes
    Publication Type Article
    Abstract/Notes Objective:The objective of this article is threefold: to examine the role of head and neck trauma as a contributing factor to the onset of vertigo disorders; to explore the diagnosis and treatment of trauma-induced injury to the upper cervical spine through the use of protocol developed by the International Upper Cervical Chiropractic Association (IUCCA); and to investigate the potential for improving and eliminating vertigo through the correction of trauma-induced upper cervical injury. Data from 60 chronic vertigo patients who recalled prior trauma, presented with upper cervical injuries, and received care according to the above protocol are reviewed.
    Clinical Features: Each patient was examined and cared for in the author’s private practice in an uncontrolled, non-randomized environment over an eight-year period. The 60 patients were diagnosed by their physicians with the following types of chronic vertigo: benign paroxysmal positional vertigo (BPPV), cervicogenic, disembarkment syndrome, labyrinthitis, Meniere’s, and migraine-associated vertigo (MAV). Of the 60 vertigo patients, 56 recalled experiencing at least one head or neck trauma prior to the onset of vertigo including auto accidents (25 patients); sporting accidents, such as skiing, cycling, or horseback riding (sixteen patients); or falls on icy sidewalks or down stairs (six patients).

    Intervention and Outcome: Two diagnostic tests, paraspinal digital infrared imaging and laser-aligned radiography, were performed according to IUCCA protocol. These tests objectively identify trauma-induced upper cervical subluxations (misalignments of the upper cervical spine from the neural canal) and resulting neuropathophysiology. Upper cervical subluxations were found in all 60 cases. All 60 patients responded to IUCCA upper cervical care within one to six months of treatment. Forty-eight patients were symptom-free following treatment and twelve cases were improved in that the severity and/or frequency of vertigo episodes were reduced.

    Conclusion: A causal link between trauma-induced upper cervical injury and the onset of vertigo appears to exist. Correcting the injury to the upper cervical spine through the use of IUCCA protocol appears to improve and/or reverse vertigo disorders. Further study in a controlled, experimental environment with a larger sample size is recommended.

  89. OZDigger says:

    Harriet,

    you should know better than to quote a blog as a reference. Peer review is good.
    As of interest, I have had a look at your bio. and Curriculum Vitae. Very impressive.
    Have you done any research that has been published in peer review literature?
    Have you any peer review publications?

  90. INNATE says:

    Here’s a few by Erin Elster:

    J Vert Sublux Res: 2006(2006:NOV:8): Online access only 9 p. Sixty patients with chronic vertigo undergoing upper cervical chiropractic care to correct vertebral subluxation: a retrospective analysis Elster EL
    http://www.jvsr.com/abstracts/index.asp?id=276

    J Manipulative Physiol Ther: MAR/APR 2004(27:3): Online access only 8 p Treatment of bipolar, seizure, and sleep disorders and migraine headaches utilizing a chiropractic technique [case report] Elster EL
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Citation&list_uids=15129207

    J Vert Sublux Res: 2004(AUG:2): Online access only 9 p. Eighty-one patients with multiple sclerosis and Parkinson’s disease undergoing upper cervical chiropractic care to correct vertebral subluxation: a retrospective analysis Elster EL
    http://www.jvsr.com/abstracts/index.asp?id=205

    J Vert Sublux Res: 2003(AUG:3): Online access only 10 p Upper cervical chiropractic care for a patient with chronic migraine headaches with an appendix summarizing an additional 100 headache cases [case report] Elster EL
    http://www.jvsr.com/abstracts/index.asp?id=174

    J Manipulative Physiol Ther: OCT 2000(23:8): 573-577 Upper cervical chiropractic management of a patient with Parkinson’s disease: a case report Elster EL
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11050615

  91. Oh OZDigger, you get more and more ridiculous with each post.

    Poisoning the well, you should know better.

    quoting a blog post to show the 10+ references ON that blog… completely valid.

  92. INNATE says:

    Harriet, the reason why the majority my colleagues don’t use these techniques is frankly because they don’t know how to…everything about this technique is based on maticulous specificity; from the patient positioning when we take the x-rays, to the x-ray analysis, the the thermographic scanning procedure, to the interpretation of this scan, to the actual adjustment itself. We take painstaking care in each of these. What the majority of my colleagues do and call “chiropractic” is quite careless…gross, general spinal manipulation. This is why they don’t get the results that UC Chiros get and thus have to resort to other PT modalities like massage, ultrasound, electric stim and the like… It’s quite a shame, actually. Even BJ Palmer himself claimed that the weakest link in chiroporactic was the adjustment (or the inability to deliver the correct adjustment).

    By the way, your thermography refrence isn’t the kind of thermography we use. We use the Titronics instrument and ChiroCET software:
    http://titronics.com/content/section/1/3/

  93. Mark P says:

    I am also surprised that Dr. Novella made no mention of the New Zealand Commissions report. It is the most extensive inquiry into chiropractic that exists in the world. It was very favourable!

    I’m not surprised by that. What it tells me is that Kiwi chiropractors aren’t heavily into woo.

    I’m a Kiwi and I’ve been to three chiropractors over 20 years. One for a rugby injury to my back, one for whiplash and one for a twisted upper spine.

    The first fixed me so amazingly, it was like magic. He was very matter of fact and precise. The second fixed the whiplash alright, but was physically somewhat clumsy, which was less nice. I had no idea from seeing them that chiropractic was infected by woo at all. They talked about misaligned spine — and I could clearly see on the X-rays (and feel) the results of my injuries.

    The third was the worry. His shelves groaned with woo nonsense. Instead of just fixing my problem, he seemed to be treating something else — I struggled to understand his reasoning. I can only assume it was a subluxation. The result was my money was wasted.

    It seems that the proportions are the other way round in other countries, with the woo-merchants in the majority, rather than an idiot sub-set.

  94. pmoran says:

    “By the way, your thermography refrence isn’t the kind of thermography we use. We use the Titronics instrument and ChiroCET software:
    http://titronics.com/content/section/1/3/

    This is not even a credible infrared scanner for the purpose– it’s a dinky, roller-equipped hand-held USB device — plenty of room for error, artifact and unconscious observer input.

    You are wrong about the “weakest link in chiropractic”. I think it is the inability of most chiropractors to assimilate the hard lessons that the mainstream has had to learn over the last century or so.

    Time and time again honest and otherwise sensible mainstream physicians have produced case series that supposedly prove the efficacy of a pet treatment, yet it has proved no better than sham treatment in subsequent controlled trials.

    You might think that the extraordinary number of competing medical theories within alternative medicine would have alerted EVERYONE to the ease with which the unwary practitioner can be misled by all the illusions of daily medical practice. (That is not to say that patients are not being helped in limited ways –there are scientific, ethical and legal issues at stake here, too.)

    If you have never studied this area of medicine you will never fully understand our skepticism or the ruthlessness with which one’s beliefs have to be tested out.

  95. vargkill says:

    Did you guys know you can cook beans in a can over a fire?

  96. Fred Dagg says:

    In the latest edition of the Lancet, two U.K. experts, Sir Iain Chalmers and Prof Paul Glasziou lament on the tens of billions of dollars wasted on medical research each year. The money is wasted because of badly designed studies and poor reporting. They say that biased reporting is common, and researchers do not focus on the issues that doctors and patients most want to know about.
    For example, a survey found that although 9% of patients with osteoarthritis of the knee wanted further research into drug treatments, – the rest would have preferred rigorous evaluations of physiotherapy and surgery.
    However, according to the article, more than 80% of private and publically funded trials into the condition (Osteoarthritis) were drug evaluations.

  97. vargkill says:

    INNATE,

    It does not matter what you say, or how you say it INNATE!
    You are dealing with a crude bunch of folks who will hang you
    by your nuts if you dare not believe anything they do!
    Its like trying to talk to 5 year olds about the theory of relativity!

    He’s a Chiro! ATTACK!!!

    What i find funny about it is that these people are perfectly
    happy and secure in thier knowledge they there is nothing
    more to life then chemicals and reactions that just so happened
    to stumble upon the earth a long time ago.

    People like this are functionally already dead.

    PS
    When i had acupressure done i also had Chiro work done by the
    same person. That was like a few months ago and im still feeling
    great!

  98. Joe says:

    Mr. Innate,

    You don’t know what reliable literature is. The Journal of Vertebral Subluxation is about your invisible friend, and JMPT is written by and for quacks. In both cases, peer-review is done by quacks that are the peers of those that submit papers.

  99. Fred Dagg says:

    Hi Joe,

    I think you must have failed

    “Bedside Manner 101″

    You rely upon sarcasm and snide remarks to validate your reponses, hardly the reflections of a thoughtful person.

Comments are closed.