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

  1. Joe says:

    Mr. Dagg- Snide remarks … like your notion that I need large-print texts. Bedside manner FAIL.

  2. INNATE says:

    I understand exactly what you mean, vargkill! Thanks for your support. This is actually quite entertaining for me; futile attempts to crack through impenetrable skulls…I love a challenge!

    Given the current major issue at hand (healthcare reform), upper cervical care is gaining ground as a result of increasing public disillusion with the (so called) mainstream healthcare system and it’s corrupt third-party payment companies. Not to mention the countless pharmaceutical drugs prescribed to them that not only drain their pockets but also carry a long list of dangerous side effects; at least half of the air-time devoted to a pharmaceutical drug television commercial is spent listing the side effects; “…and even death! ask your doctor if X is right for you :)” all the while a pleasant melody plays in the backgroud. If THIS isn’t “quackery” I don’t know what is.

    And, by the way, all of those side effects are clear evidence of the body’s innate intelligence VOILENTLY REJECTING this synthetic poisonous molecule that has been introduced into it!

    People are starving for an alternative to their suffering. Specific Upper Cervical Care safely provides this alternative with side BENEFITS (not side effects) by tapping into the body’s own healing mechanisms.

    I can already hear you…”what side benefits? where’s the complete citation? etc.” Side benefits include better rest, more energy, clarity of mind and many others.

    I think all of you skeptics are threatened by this as is evident by your hostility towards me. Skepticism is a natural human response to the unknown or unfamiliar but I’m telling you, the upper cervical (r)evolution is comming! get ready!

    goodnight everyone and thanks for the debate!

  3. pmoran says:

    Vargkill, are you now thinking that your personal experience validates EVERY “alternative” modality, no matter what the claim?

  4. Harriet Hall says:

    If we accepted the kind of evidence Innate offers for upper cervical treatments, we would still be doing bloodletting to balance the humours. There were bold claims, plenty of testimonials, case reports, uncontrolled case series, and a theoretical underpinning that was far more widely accepted in the general medical community of the time than upper cervical theory is in the general chiropractic community of today.

  5. pmoran says:

    “I can already hear you…”what side benefits? where’s the complete citation? etc.” Side benefits include better rest, more energy, clarity of mind and many others.”

    You are aware that such apparent effects can be readily induced by any kind of placebo?

    I am not denying that your patients are telling you of all the wonderful things that your treatments are doing for them (while sometimes having a different tale to tell elsewhere) and that some of these effects are even “real”

    I merely contend that this is a banal observation for your kind of practitioner, where you do not have to accept responsibility for the outcomes of any serious medical condition. You will be treating a high proportion of self-limiting conditions and subjective complaints, and if you cannot obtain a 70-80% or even higher apparent success rate by just turning up for work on time and being not too rude to anyone, then you are actually a bit weak at this “medicine” game.

    I am also confident that your apparent success has nothing to do with subluxations, or innate, or the fancy gadgetry, beyond these contributing to your “schtick”, meaning that conglomerate of features that permits the patient to feel that they are being treated for something.

    There is a mountain of evidence pointing to such an interpretation of what you do, including the obvious fact that dozens of practitioners with totally different perceptions as to what they do can achieve the very same apparent results. Millions of practitioners throughout history also.

  6. vargkill says:

    pmoran,

    “Vargkill, are you now thinking that your personal experience validates EVERY “alternative” modality, no matter what the claim?”

    When did the concept of all “alternative medicine” working
    ever pass my finger tips? Im having trouble finding that?

    You can read my post again! But hate to spoil your fun! Its not
    there!

    This is what i said…

    “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!”

    Now please show me kindly where i ever said that my personal
    experience validates every form of alternative medicine?

    I have indeed been helped more then once. I have indeed seen
    the person at work more then once. But i guess im not logical
    enough to make that assessment right? Cause im so stupid
    that myself and everyone else that has been helped by this
    person must have been bamboozled?

  7. vargkill says:

    INNATE,

    Yeah this blog is inhabited by a core group of colorful characters
    who just like to bloviate at length about their garbage and how
    SBM is the end all, be all of the world. They are struggling to
    bring light to the darkness of mankind!

    Bow down before the ones you serve!

  8. weing says:

    “They are struggling to bring light to the darkness of mankind!”

    Yeah. It’s a thankless job, but someone’s got to do it. Otherwise people might mistake philosophy for science and return us to the dark ages.

  9. Vargkill,
    “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!”

    So this guy runs a Chinese restaurant, does acupressure, has paranormal diagnostic skills, and does chiro to boot?

    Does he have any other interesting skills?

  10. Citizen Deux says:

    Despite attempted force through legislation – the market sill determines the credibility and effectiveness of “alt-med” and chiro. Both areas are used by a small percentageof the population and practioners continue to be excluded from insurance compensation and mainstream acceptance because their modalities are ineffective.

    One can argue from Innate’s perspective (appeal to other ways of knowing, religion, etc.), but the reality remains that these practices cling to life through the ignorance of their patients and practioners and enough “positive” anecdotes to sustain them.

    There are only 17 Chiro colleges, 16 listed as accredited, in the United States. They struggle with recruitment and accredidation and reaching minorities.

    Why is this? If chiro had been proven effective, reliable and credible, the number of practioners should have skyrocketed and there would not be a rolling battle led by lobbying organizations to establish credibility via legislation. In fact, it is government subsidized educaiton which has sustained the number of chiros in the United States. Despite rosy pictures painted by chiro organizations, the overall number of practioners seems to be holding steady at 20,000.

    Finally, as evidence of the lack of market support, most chiros provide many adjunct therapies which are further outside the scope of validated methods or even reasoned science.

    I have never doubted the genuine passion of those practioners, like Innate or Fred Dagg, in their desire to help people. I simply believe that they have attributed cause and effect incorrectly.

  11. Citizen Deux says:

    And of course, if you can’t beat them, join them

  12. Citizen Deux says:

    And just finally, wow. These last posts brought to you by the Journal of Chiropractic Education, which seems to be working to tease out the science and valid role for chiropractors in health care.

    As for Innate or Dagg, which of the colleges did you attend? Have you worked as an alumni recruiter? What is your appeal to prospective students (aside from the general “helping humanity” approach)?

    These comments are not from the forces of “evil” allopathic empire, whatever the hell that means, but from well intentioned and apparently determined DCs who want to add credibility to their practice.

  13. vargkill says:

    Karl Withakay,

    Yes he can cook beans in a can over a fire! That is even more
    interesting then all the other things he can do!

    weing,

    Thanks so much for fighting for me! For all of us! You’re
    an everyday hero in my eyes!

    On a serious note, i would like to make a documentry about
    the guy. Or maybe one of you can come down and we can
    go to him and test his skills yourself.

    Anyone interested? Lets do this in the name of science!
    Im not even joking.

  14. weing says:

    De nada.

  15. INNATE says:

    Here’s your “evidence”..and it’s all Joe-reviewed–I mean peer-reviewed by YOUR preers, not mine.

    Posture and Health:

    Lennon J, et al. Posture and Respiratory Modulation of Autonomic Function, Pain, and Health. Am J Pain Manag, 1994; 4(1):36-39

    Vaidya JA, Dhume RA. Influence of Lateral Posture on Sweating: Does Posture Alter the Sympathetic Outflow to the Sweat Glands? Indian J Physiol Pharmacol, 1994; 38(4): 319-322

    Whiplash:

    Otte A, Mueller-Brand J, Fierz L. Brain SPECT Findings in Late Whiplash Syndrome. Lancet, 1995; 345(8963):1513

    Nervous System and Immune Function

    Lee TN. Thalamic Neuron Theory: Theoretical Basis for the Role Played by the Central Nervous System (CNS) in the Causes and Cures of All Disease. Medical Hypotheses, 1994; 43(5): 285-302

    Felton DL, Felton SY, Bellinger DL, Madden KS. Fundamental Aspects of Neural-Immune Signaling. Psychother Psychosom, 1993; 60(1):46-56

    Connection between the C1-C3 anterior primary rami (disc and alar ligaments) and posterior primary rami (facets) and the Trigeminal Cervical Nucleus:

    Bogduk N. Anatomy and Physiology of Headache. Biomedicine and Pharmacotherapy; 1995, 49(10):434-445.

    Connection between the Trigeminal Cervical Nucleus and the Hypothalamus:

    Clark DL, Boutros NH. The Brain and Behavior: An Introduction to Behavioral Neuroanatomy. Blackwell Science, 1999.

    Connection between the hypothalamus and the: Locus cerelus, Rostral Ventral Lateral Medula, and the Intermediate Lateral Cell Column:

    Goldstein DS. The Autonomic Nervous System in Health and Disease. Marcel Dekker, Inc., 2001.

    Connection Between the Hypothalamus and the Pre- and Post-ganglionic sympathetics:

    Parent, A. Carpenter’s Human Neuroanatomy, 9th ed. Williams & Wilkins, 1996.

    Kandell ER, Schwartz JH, Jessel TM. Principals of Neural Science, 4th ed. McGraw-Hill, 2000.

    Connection between the Hypothalamus and the Immune organs and blood vessels (which validates the use of thermography–just in case you don’t “get it”; thermography measures the the heat radiating from the surface of the skin which results from the profusion of blood through the blood vessels of the epidermis which is controlled by the vaso-motor function of the autonomic nervous system):

    Ilia J, Elenkov IJ, Ronald L, Wilder RL, George P, Chrousos GP, Vizi ES. The Sympathetic Nerve, An Integrative Intergace between Two Supersystems: The Brain and the Immune System. Pharmacological Review, Vol. 52, December 2000, Issue 4, pp. 595-638

    Happy reading!

  16. nobs says:

    INNATE:

    YOU, myself, and Insight appear to be the ONLY ones bringing any citable evidence/links of the evidence, to this discussion. Whitecoattales, moran, joe, et al, have provided none the entire… ahem….discussion. Even Mr. Novella provided only one(1) in his op/ed piece, and that was NOT to any peer-reviewed journal or even an official chiropractic organization. It was to some individual DC practice. HUH????? Now THATS “science-based” evidence! ? YUP!!

    It appears that what is considered “Evidence” or what is declared “Andecdote” here is solely dependent upon who is making the claim….. “Science-based” appears to be an oxymoron here.

  17. weing says:

    “Connection between the Hypothalamus and the Immune organs and blood vessels (which validates the use of thermography–just in case you don’t “get it”; thermography measures the the heat radiating from the surface of the skin which results from the profusion of blood through the blood vessels of the epidermis which is controlled by the vaso-motor function of the autonomic nervous system):”

    I guess I don’t get it. How does that validate thermography? And validates it for what? If you want to learn the science behind medicine, get yourself a good anatomy and physiology textbook and start reading and learn. That would be a good start at least.

  18. pmoran says:

    .INNATE, those references are fluff. None relate directly to your diagnostic or therapeutic claims. You have not produced one study that seriously tests out any of the steps involved in your patient management.

    Admit it. What you do owes nothing to systematic scientific study. You believe in it because your patients seem to get better. “It works!!” will have also been the refrain of your teachers.

    I accept that that is a partly valid observation, but at a simplistic level that has proved capable of sustaining absolutely any old pseudoscientific nonsense.

    Cannot you yet see that? I’ll bet you cannot think of a single thing that has not been credited with healing powers at some point in history. Fly specks, anyone? How about a bit of a decaying dead person?

    “It works!!!”, in this primitive sense, only gets you as far as rubbing shoulders with homeopaths, therapeutic touchers, colonic cleansers etc — not beyond. All enable some people to feel wonderful. These are your true peers and your true competitors, not us.

  19. pmoran says:

    “Now please show me kindly where i ever said that my personal
    experience validates every form of alternative medicine?”

    Vargkill, I was responding to your offering support for what is a particularly egregious form of quackery, even if you are unable to see why it is that.

    Your post also clearly conveyed the idea that your experience with a completely different modality was relevant to this one, entitling you to state that INNATE’S critics were, and I quote “a crude bunch of folks who will hang you by your nuts if you dare not believe anything they do”.

    I have patiently tried to explain why I think the way I do.

  20. INNATE says:

    nobs!!! GREAT POST! thank you!

    Weing..you must have lost your capacity for common sense and critical thinking: I guess it’s all that brain washing they do to you in med school teaching you not to think for yourself but rather let “acceptable” literature do the thinking for you. Where do you think that literature comes from? does it fall from the sky? No, human beings like you and me write it. And how do you thing they write the “conclusions” section? they use common sense based on the data and/or results generated my the experiment.

    But regardless of that, let me connect the dots for ya:

    Staring with the IML: pre-ganglionic fibers descend via the IML, exit the spine via the vetral root and enter the white ramus communicans to either synapse at that level in the sympathetic chain ganglion or ascend or descend (via the sympathetic trunk) to synapse at ganglia above or below it, respectively.

    Once it synapses, the Post-ganlionic fiber (specifically the one that innervates the smooth muscle layer of the arteries of the epidermis) re-enters the vertral ramus via the grey ramus communicans to innervate the blood vessels, the arrector pili muscles, and sweat glands of the skin.

    Mind you that this happens bilaterally and if everything is normal, then the vaso-motor tone in the skin on each side of the body will be identical. The vaso-motor tone will dictate how much blood profuses through these blood vessels and since blood carries heat, the thermal energy radiating from the skin is a measure of how much blood is profusing through it.

    If one side of the body has a different vaso-motor tone than the other, then a difference in temperature will be evident and measurable. Since all of this is ultimately a function of the autonomic nervous system (as outlined above), any imbalance or asymmetry in temperature is an indirect measure of an imbalance in the ANS.

    The fact that patients present with a persistent “patern” of thermal imbalance which subsides as a rusult of a specific upper cervical adjustment (and remains without one) is an indication that a corrective adjustment to the UCS restores normal funciton to the ANS. It also validates the use of computed paraspinal infrared thermoghraphy as a tool for measuring the instantaneous function of the ANS.

    pmoron called the device “dinky” and that it has a lot of room for error etc…first of all he wouldn’t call it dinky if he actually held one in his hand; it’s actually a very-well constructed instrument and uses state-of-the-art infrared technology. And, like with any diagnostic instrument, the user must be properly trained to use it correctly in order to run a valid test.

    Does that answer you question?

  21. INNATE says:

    I guess pmoran needs me to connect the dots for him too.

    joint motion of the C1-C2 vertebral segments->Trigeminal cervical nucleus->Hypothalamus->locus cerelus, rostral ventral lateral medula, IML, pre/post ganglionic sympathetics, immune organs, blood vessels, viscera.

  22. pmoran says:

    “YOU, myself, and Insight appear to be the ONLY ones bringing any citable evidence/links of the evidence, to this discussion. Whitecoattales, moran, joe, et al, have provided none the entire…”

    Ah, yes! Of course there will be no, or very few contrary citations. The underlying claims are so inconsistent with everything else that is known about illness, anatomy, nervous system functions and what happens when neural pathways ARE seriously compromised in various ways, that no serious scientist would see in them any hypothesis worth testing.

    Also testing the various steps involved in patient management was always the claimant’s obligation.

    This seems to have been skipped. So far no evidence has been produced that the differences in skin temperature are conistent from observer to observer, stable, correlated with any illness, corrected by manipulation etc.

    If you would like evidence concerning placebo responses, biased reporting and other matters that make practitioners hopeless at assessing the true activity of their treatments then I will be happy to oblige.

  23. Harriet Hall says:

    Innate,
    You can connect the dots but you can’t show evidence that thermography is a clinically useful tool to guide treatment and improve patient outcome. You can’t show evidence from controlled studies that upper cervical techniques are effective for any of the long list of diagnoses in the link you cited.

    The parallel with bloodletting is striking. Bloodletters connected the dots. They had a plausible rationale based on the medical knowlege of their time: the 4 humours and the effect of removing blood to balance the humours. They had testimonials, satisfied patients, case reports, case series. They had “evidence.” But it wasn’t scientifically meaningful evidence. Controlled studies showed they were actually doing more harm than good.

  24. weing says:

    What exactly is an imbalance of the ANS?

  25. pmoran says:

    “I guess pmoran needs me to connect the dots for him too.

    joint motion of the C1-C2 vertebral segments->Trigeminal cervical nucleus->Hypothalamus->locus cerelus, rostral ventral lateral medula, IML, pre/post ganglionic sympathetics, immune organs, blood vessels, viscera.”

    You wish to teach a surgeon anatomy?

    I had hoped that chiropractic had moved on from the schoolground reasoning wherein so long as the most tenuous of neural connections can be claimed, anything is possible.

    Anything is not possible — a lot of other dots need to be joined before any medical condition can be attributed to these tiny filaments and yet others before it could form the basis of a medical treatment, other than as placebo.

    My little toe has more major and varied neural connections than C1,2 but we know that has limited significance for health.

  26. INNATE says:

    Harriet

    here’s a “controlled” study for ya:
    http://www.ucrf.org/themes/nuccra/images_new/pdf/Hypertension2007.pdf

    there’s a podcast on your favorite website “quackwatch” (or something like that) where the guy speaking (who sounds like a total a**) had to admit!(even though he hated to) that the results of the study were compelling…a 12 point drop in blood pressure for 8 weeks as a result of a single upper cervical adjustmet. (someone posted a link to this podcast in one of the earlier posts)

    also (and this goes to pmoran too), Erin Elster, in the list of refrences in one of my previous posts (refrences that you convenienly labled as invalid), used the EXACT same protocol with those patients as I use in my office!

    But I get it (and vargkill is right)!; It doesn’t matter HOW much evidence I present (or try to present)…all of you trying to slam me would rather cut off your right arm than to accept or even give the slightest credence or benefit of the doubt to what I’m trying to explain to you.

    Good luck!

  27. pmoran says:

    Erin Elster’s was a retrospective uncontrolled study of the type that are always giving spurious results. He admitted that controlled study was needed.

    The hypertension study has not been independently replicated and is too indirect evidence for the various claims that are being made concerning subluxations.

    There are direct ways of showing that subluxations exist and can be corrected by manipulation. That is absolutely essential research if the theory is to be taken seriously.

    I believe there are some studies showing that chiropractors cannot detect them when blinded.

  28. pmoran says:

    ‘I believe there are some studies showing that chiropractors cannot detect them when blinded.”

    You know what I mean. :-)

  29. vargkill says:

    pmoran,

    “Your post also clearly conveyed the idea that your experience with a completely different modality was relevant to this one, entitling you to state that INNATE’S critics were, and I quote “a crude bunch of folks who will hang you by your nuts if you dare not believe anything they do”.”

    I think you’re reading a little to deep into a 1 inch pool here
    pmoran. Just because i said the alternative medicine guy helped
    me does not mean im saying all forms of alternative medicine
    work. And just because im ripping on you guys on here that
    doesnt mean that i dont believe in or am against SBM.
    As a matter of fact, i think most alternative medicine is
    bullshit, yet i believe from personal expirence that some of it
    works.

    It was a simple statement and you decided to blow it way
    out of context.

    “I have patiently tried to explain why I think the way I do.”

    Ok thats good and great and all, but the point was that anyone
    else that tries to explain anything on here that goes against
    the popular belief is hung by their nuts to dry.

    You get it now? Or do i need to type it all in CAPS for you?

    I cant blame any of you for not believing due to lack of science
    based evidence. But just because something cannot be measured by science does not mean its quackery and does
    not mean its all placebo effects ect. Some things cannot be
    measured and thats just a fact.

    I have said this time and time again and still no takers!

    Lets all get together and conduct some kinda study to once
    and for all find out the truth. Come on some of you should
    be able to get funding for this!

  30. INNATE says:

    whatever…I can tell you are subluxated just by reading your posts.

    All I can say now is: don’t knock it till you try it. There’s a refrence resource of upper cervical chiros in your area at:

    http://www.upcspine.com

    go to “practitioners” and a list of geographical regions will show up. follow the links, choose your state and find a UC chiro near you. Your first adjustment will change your life! at least go to an office a observe the process in person; the worse that can happen is that you’ll have better ammunition for your next chiropractic debate.

  31. nwtk2007 says:

    pmoran – “Erin Elster’s was a retrospective uncontrolled study of the type that are always giving spurious results.”

    Do you know of any studies that show these retrospective studies give “spurious” results? How is “spurious” measured?

    pmoran – “The hypertension study has not been independently replicated and is too indirect evidence for the various claims that are being made concerning subluxations.”

    The study is on going and continuing. What do you mean by “too indirect”?

    pmoran – “There are direct ways of showing that subluxations exist and can be corrected by manipulation. ”

    If the “subluxation” is actually a joint segment with restricted motion, how could it be directly demonstrated?

    pmoran – “I believe there are some studies showing that chiropractors cannot detect them when blinded.”

    Is this anecdotal? What are the studies and where were they published?

  32. vargkill says:

    Im an IT pro for a living. MCSE, MCSA, MCDBA, Networking +,
    Security +, A +.

    Heres my point in telling you this…

    Computers, servers, OS’s, Hardware, Software, Coding, ect.

    All these things need repaires and maintaining just like the
    human body.

    I have invented a form of alternative repair, and maintainence
    for these things. Anyone interested in learning?

  33. INNATE says:

    WOW nwtk2007!!! way to sock it to ‘em. looks like the ball is in your court now!

    vargkill…you’re the man! thanks again for your support!

  34. weing says:

    Vargkill,

    Slap that computer on the side with your hand and it’s fixed. Used to work on my old TV set too. You can also put the sides of the computer into balance by squeezing in a particular way. That should fix any coding issues too. You gotta have a balanced code.

  35. vargkill says:

    weing,

    How did you learn my secrets!!!! Ill see you in court!

    INNATE,

    Man i cant let someone get hung to dry all by themselves!
    Seriously, can i get some free Chiro work done from you?

    Really now people, ever stop to think there might be something
    greater at work? Are you all Darwinists? Ill bet you all think
    Richard Dawkins is awesome to hey?

    My point is and has always been, its peoples choice to be
    treated how they wish and just because you feel alternative
    medicine is bullshit, then what do you care if i, or someone else
    chooses to seek that and not SBM?

    Also if we made health care in this fucking country a little easier
    to obtain, maybe more folk would embrace SBM and not look for
    an alternative? People need an alternative from what seems
    to be the only option and that is to go broke is you have no
    insurence. WOW! Now prove to the world that CAM is bullshit
    and you will win the fight! Until then shut up!

  36. Harriet Hall says:

    Innate said “don’t knock it till you try it”

    On the surface, that may sound reasonable, but in reality it is the worst way to proceed. All it does is generate another unreliable testimonial. If you try it and have a favorable personal experience, that only makes it harder to accept the real evidence of controlled studies. The people who have tried it and who are earning their living with it are too prejudiced to assess the scientific evidence objectively.

  37. INNATE says:

    OK, Harriet…I’ll give you that one. But what I really meant was for him to try it as a patient and not a practitioner. Frankly, I wouln’t let moran anywhere NEAR my atlas, surgeon or not!

    I have a request, though, if you would be so kind to oblige: can you please provide a simple outline of a “controlled” study that would satisfy your criteria for validity and would also demonstrate one way or the other the effectiveness of chiropractic?

  38. nwtk2007:

    Do you know of any studies that show these retrospective studies give “spurious” results? How is “spurious” measured?

    Results are considered spurious when the cannot be replicated.
    It is not quantitatively measured, but rather qualitatively. It’s measured by reading ALL of the literature. When there are very few positive trials, and lots of negative trials, it is appropriate to doubt the positive trials.

    This is the intelligent way to look at evidence, rather than cherry picking trials we like, partially because when “positive” is defined by p less than 0.05, a certain number of trials will produce a positive result due to chance alone.

    When the balance of evidence indicates that this is likely to have happened for a particular trial, we call that trial spurious.

    pmoran – “The hypertension study has not been independently replicated and is too indirect evidence for the various claims that are being made concerning subluxations.”

    The study is on going and continuing. What do you mean by “too indirect”?

    How is the study being ongoing relevant? That has nothing to do with independant verification.
    Indirect means that this study, if it can be replicated, and really works, shows that “spinal manipulation can work for hypertension, and should be further investigated”
    That does not prove “subluxation complexes exist” or “innate intelligence is the reason for the efficacy of spinal manipluation”, or “thermography works” – the claims Innate has been making.

    pmoran – “There are direct ways of showing that subluxations exist and can be corrected by manipulation. ”

    If the “subluxation” is actually a joint segment with restricted motion, how could it be directly demonstrated?

    pmoran – “I believe there are some studies showing that chiropractors cannot detect them when blinded.”

    Is this anecdotal? What are the studies and where were they published?

    Oh man, I’ve been waiting for this one! Here you go!

    Mootz RD, Keating JC Jr, Kontz HP, Milus TB, Jacobs GE. Intra- and interobserver reliability of passive motion palpation of the lumbar spine. J Manipulative Physiol Ther 1989;12:440-445.

    Nansel DD, Peneff AL, Jansen RD,Cooperstein R. Interexaminer concordance in detecting joint-play asymmetries in the cervical spines of otherwise asymptomatic subjects. J Manipulative Physiol Ther 1989;12:428-433.

    Troyanovich SJ, Harrison DD, Harrison DE. Motion palpation: it’s time to accept the evidence.J Manipulative Physiol Ther 1998;21:568-571.

    Christensen HW, Vach W, Vach K, et al. Palpation of the upper thoracic spine: an observer reliability study. J Manipulative Physiol Ther 2002;25:285-292.

    French SD, Green S, Forbes A. Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low back pain. J Manipulative Physiol Ther 2000;23:
    231-238.

    Hestbaek L, Leboeuf-Yde C. Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review. J Manipulative Physiol Ther 2000;23:258-275.

    Hawk C, Phongphua C, Bleecker J, et al. Preliminary study of the reliability of assessment procedures for indications for chiropractic adjustments of the lumbar spine. J Manipulative Physiol Ther 1999;22:382-389.

    Panzer DM. The reliability of lumbar motion palpation. J Manipulative Physiol Ther 1992;15:518-524.

    Haas M, Peterson D. A roentgenological evaluation of the relationship between segmental motion and malalignment in lateral bending. J Manipulative Physiol Ther 1992;15:350-360.

    You’ll note that the studies I’ve cited answer both of your questions. They show methods by which such a “subluxation” could be detected, if they existed, they also show that chiropractors lack intra and interoperator reliability on their diagnostic techniques of choice.

  39. Incidentally, I have a comment relevant to the discussion awaiting moderation.

  40. INNATE says:

    “The people who have tried it and who are earning their living with it are too prejudiced to assess the scientific evidence objectively.”

    Isn’t this true of the medical profesion too? or is medical research done by engineers to satisfy the “objectivity” clause.

  41. weing says:

    ““The people who have tried it and who are earning their living with it are too prejudiced to assess the scientific evidence objectively.”

    Isn’t this true of the medical profesion too? ”

    It’s true of anyone. That’s why we want full disclosure from study authors. That’s why studies need to be replicated by others. We want to factor out the bias, before accepting them.

    How about defining ANS imbalance?

  42. INNATE says:

    ANS = Autonomic Nervous System

    Imbalance has to do with one arm of the ANS dominating (in an abnormal way) over the other; what is known as “sympatheticotonia”: a state of excessive and prolonged sympathetic response AKA the stress response (AKA= also known as)

    The revesre is also possible but less frequent: “para-sympatheticotonia”

    Idially there should be a balanced interplay between these two states with the apropriate response given a certain stimulus. e.g. the sympathetic response dominating in the event of an emergency.

    does that help?

  43. INNATE says:

    I know..my spelling sucks. I wasn’t born in this country. I didn’t start american school untill the 4th grade so I missed out on a lot of the basic spelling priciples.

  44. weing says:

    No. It doesn’t help. What is a balanced interplay? If I see Megan Fox, or the lighting is dim, my pupil dilates, sympathetic. Shine a bright light and my pupil constricts, parasympathetic. I eat and the parasympathetic system activates, increasing stomach acidity to digest the food, etc. What is the imbalance you are talking about? Invasion of the stellate ganglion by a tumor, knocking out the sympathetic ennervation to the ipsilateral eye causing miosis, ptosis, and anhydrosis, ie a Horner’s syndrome?

  45. INNATE says:

    You kind of have the picture but it doesn’t have to be as catastrophic as a Horner’s syndrome. The interplay means that these responses occur for the most part simoultaneously in a state of homeostasis (sort of like an eb and flow) and if at any given point one dominates over the other due to a stimulus (cf seeing Megan Fox) then the other shuts down (although not completely) for that moment. Once the stimulus subsides (or is removed) then the body returns to this balanced interplay.

    I think (and this is my humble oppinion) that a good measure of health is the RATE at which the body returns to balance after the stimulus is removed. Now..actually measuring this rate is another story. we can hypothesize and consult on valid ways to do this. I think thermography is a good way (because it measures vaso-motor tone) but you guys don’t buy that.

    Think of this balanced interplay as analagous to a chemical reaction in equilibrium (in a beaker) and you add either reactant or product to the mix (analagous to the stimulant). le Chatlier’s principle takes effect by sifting the reation in the opposite direction untill equilibrium is reached again. I know that’s a loose analogy but it kinda works.

  46. INNATE says:

    I didn’t answer your question…in a state of imbalance, the body fails to return to homeostatic balance even though the stimulus has subsided (or has been removed)…this is para-/sympatheticotonia; an inappropriate autonomic state given the enviromental stimulus at hand.

  47. pmoran says:

    Responding to nwtk2007 — (My answers preceded by PM>

    pmoran – “Erin Elster’s was a retrospective uncontrolled study of the type that are always giving spurious results.”

    Do you know of any studies that show these retrospective studies give “spurious” results? How is “spurious” measured?

    PM> See Roberts, A. H., D. G. Kewman, L. Mercier, and M. Hovell. 1993. The power of nonspecific effects in healing: Implications for psychosocial and biological treatments. Clinical Psychology Review 13:375-391.

    PM> This study looked at the literature for four conventional treatment methods that were reported to have very high cure rates in uncontrolled personal case series similar to Elster’s . Even where multiple authors claimed good results, numerous subsequent controlled trials showed that the methods worked no better than sham treatment. (Uncontrolled studies are not always fallacious, but they always give exaggerated results — even simple unblinding in controlled studies is associated with 14% differences in effect size. ).

    pmoran – “The hypertension study has not been independently replicated and is too indirect evidence for the various claims that are being made concerning subluxations.”

    The study is on going and continuing.

    PM > I would seriously doubt that the author would now be risking the finding of negative results.

    What do you mean by “too indirect”?

    PM> Controlled clinical trials cannot show conclusively that a treatment works as claimed. — there may always be some unexpected factor producing the results. All it might take is the person giving sham treatment to also advise an hour’s rest to each patient every day.

    pmoran – “There are direct ways of showing that subluxations exist and can be corrected by manipulation. ”

    If the “subluxation” is actually a joint segment with restricted motion, how could it be directly demonstrated?

    PM> How would trivial loss of motion of the cervical vertebra produce the claimed ill effects, especially when everyone experiences restricted motion as they age? The subluxation hypothesis needs to have some substance.

    pmoran – “I believe there are some studies showing that chiropractors cannot detect them when blinded.”

    Is this anecdotal? What are the studies and where were they published?

    PM> See http://www.chirobase.org/01General/nalc.html I cannot find any formal studies, but that is in itself an indictment of chiropractic’s pretentions to be based upon real science.

  48. Harriet Hall says:

    Innate said “OK, Harriet…I’ll give you that one. But what I really meant was for him to try it as a patient and not a practitioner.

    That’s what I meant too. Someone who has been treated and felt better tends to believe and not to consider the possibility of a post hoc ergo propter hoc error.

    “can you please provide a simple outline of a “controlled” study that would satisfy your criteria for validity and would also demonstrate one way or the other the effectiveness of chiropractic?”

    You are missing the point. No one study suffices to “demonstrate one way or the other” the effectiveness of any treatment, whether it is a drug or a manual treatment. Studies would have to be replicated and confirmed by other studies approaching the question from different angles. We would look at the plausibility, the quality of studies, etc. and then would reach a provisional conclusion based on the weight of ALL the evidence.

  49. Harriet Hall says:

    Innate said,

    “Isn’t this true of the medical profesion too?”

    Not really. The medical profession uses many methods of treatment and readily gives up those that are shown not to work. Chiropractic can’t give up SMT because it is founded on that. And chiropractic has never given up any ancillary technique in over a century, except for Palmer’s “nerve tracing” where he thought he could palpate nerves not known to anatomy – I don’t think anyone is doing that any more.

  50. INNATE says:

    PM. Re: your response to nwtk2000:
    I see what you mean in the first section of your response. It’s actualy an OK point. But I know Elster somewhat personally and she’s not the kind of gal that would inflate her results like that (believe it or not). That’s a good insight though.

    pmoran – “The hypertension study has not been independently replicated and is too indirect evidence for the various claims that are being made concerning subluxations.”

    The study is on going and continuing.

    PM > I would seriously doubt that the author would now be risking the finding of negative results.

    I also know Dr. Dickholtz as well as some of his co-authors and I can confirm that a larger-scale study is on its way.

    PM> How would trivial loss of motion of the cervical vertebra produce the claimed ill effects, especially when everyone experiences restricted motion as they age? The subluxation hypothesis needs to have some substance.

    Fixation produces its ill effects through proprioceptive insult and dysafferentation arrising from joint mechanoreceptors by way of the neurologic pathway I outlined earlier.

    Are you saying that old people are the healthiest of us alive dispite their restricted motion? now THAT’s laughable! If this doesn’t add substance to the subluxation hypothsis I don’t what does…you pretty much proved it with that one.

    Motion is Life!! quite literally!

  51. nwtk2007 says:

    Really not much of a response yet.

    As to joint motion, the basics apply:

    If you don’t use it, you lose it. Use it and it develops or continues to thrive, although age is detrimental to all aspects of life, including joints. A good point INNATE.

  52. INNATE says:

    Harriet. thanks for the insight and I see what you mean about replicating studies etc.

    “Chiropractic can’t give up SMT because it is founded on that. And chiropractic has never given up any ancillary technique in over a century..”

    Actually, Palmer also gave up full-spine adjusting when he discovered that he could produce better and longer lasting results by only adjusting the upper cervical spine…in fact if you want to see some rigorous research, check out “clinical controlled research” which is one of his “green books”(as we call them). However, I doubt it will pass your validity test.

    Also, the procedure that we do in my office is an adaptation of a procedure he developed. the only difference is the technology that we use as far as x-rays and thermographic assessment. he used the thermocouple technology; we now use infrared technology.

  53. pmoran says:

    “Fixation produces its ill effects through proprioceptive insult and dysafferentation arrising from joint mechanoreceptors by way of the neurologic pathway I outlined earlier.”

    Oh, man!! This is US you are talking to, not some rube, or committee of laymen, that is going to be impressed by big words.

    There is no human, disease, or animal model demonstrating systemic ill-effects from such origins, other than the expected transient vasovagal effects from sudden and extreme spinal stress.

    Every day within hospitals a wide variety of and many extremes of “proprioceptive insult and dysafferentation” are seen as the result of spinal trauma, disease and paraspinal happenings, and even from deliberate surgery upon the sympathetic and parasympathetic nervous systems, without the health effects that chiropractors claim to be treating in accordance with subluxation theory.

    Subluxations are a failed hypothesis

  54. INNATE says:

    What you are talking about are acute incidences. What I’m talking about are chronic effects of persistent fixation…the effects take time to manifest. And if you know of no models demonstrating these effects it’s not because they don’t exsit, it’s either because they havn’t gained medical “acceptance”, or the medical proffesion has failed to look for one out of reluctance to do so.

    PubMed this one if you need controlled research demonstrating systemic effects arrising from the cervical spine:

    Carrick FR. Changes in brain function after manipulation of the cervical spine. J Manipulative Physiol Ther. 1997 Oct;20(8):529-45.

  55. Harriet Hall says:

    Innate,

    Wow! I can’t believe you cited that Carrick article. It is garbage, junk science, and not even logical. Please read my comments about that article at
    http://www.chirobase.org/06DD/blindspot.html When it was published in the JMPT, there were several letters to the editor that pointed out its flaws. I corresponded with Carrick and was not impressed: he was unable or unwilling to understand my points. I asked him for more information: he studied 500 subjects who all had unilaterally enlarged blind spots, but his article didn’t say how many patients he had to screen to find those 500, and he couldn’t or wouldn’t tell me. I got the impression that he found abnormalities in every patient. I also got the impression that he couldn’t understand simple logic.

    There was much more wrong with it that I explained in detail for an article in the Scientific Review of Alternative Medicine, but that is unfortunately not available online. Just one small example: he made a questionable statement and supported it with a reference that said exactly the opposite!

  56. pmoran says:

    “What I’m talking about are chronic effects of persistent fixation”

    So was I.

  57. OZDigger says:

    Hello Harriet,

    Carrick has a PhD in neurology. He has done the hard yards in academia, he is actually better educated than you are so unless you can show some semblance of a better education, or some form of peer review research and publication, then you should reserve your comments.

  58. Carrick has a PhD in neurology. He has done the hard yards in academia, he is actually better educated than you are so unless you can show some semblance of a better education, or some form of peer review research and publication, then you should reserve your comments.

    Courtier’s reply.
    To tell the emperor that his “new clothes” are really nonexistant, must we first “train in the shops of Paris and Milan”?
    Certainly not. We must only make valid arguments based on the evidence. Which is exactly what’s being done.

    nwtk2007:

    Really not much of a response yet.

    Really? thats all you’ve got to say to my 9 citations on why you’re wrong, and detailed response? Re-read the comment from me on 26 Jun 2009 at 8:53 pm

    Perhaps it was still in moderation when you made your comment.

  59. Harriet Hall says:

    OZDigger said,
    “Carrick has a PhD in neurology. He has done the hard yards in academia, he is actually better educated than you”

    Carrick’s PhD is in education, not neurology. Did you read my critique of his study? The study is junk science and his reasoning wouldn’t pass Logic 101. You don’t need to be an expert in anything to understand its flaws.

    If you think you can defend his study with anything but a fallacious appeal to authority, go ahead and try.

  60. INNATE says:

    Harriet, I read your piece. Interesting! But I have to side with OZ on this one. I think (and this is admittedly opinion and speculation) that if Carrick brushed you off, it’s not because you “stumped” him somehow, it’s because he’s extraordinarily busy truly helping people and making a difference in the world and arguing with someone like you over seemingly petty details is a waste of his time. You wrote in your piece regarding blind-spots:

    “We normally do not notice this because the brain fills in the missing information. The brain can give us the illusion of an uninterrupted visual field, but it cannot change the size of the blind spot…”

    Now, YOU are missing the point here or you do not understand the difference between the “anatomical” blind-spot and the “functional” blind-spot. What Carrick measured and what changed as a result of his intervention was the “functional” blind spot, not the anatomical (you suggested measuring the anatomical blind spot to confirm the accuracy of the functional blind spot test). You even admit that the brain “normally” fills in this in the missing information. Based on this, doesn’t it make common sense that if the missing information is not being filled in then the brain isn’t functioning normally? Oh…but you don’t validate the test itself therefore it’s really easy for you to shoot down any and all conclusions based on it (I forgot that skepticism is your JOB so I imagine that you have to come up with cleaver ways to invalidate studies and or concepts that go against what you hold to be true or that threaten the core values of your profession is some way). Just so you know, there’s a computerized version of the test now which eliminates many (if not all) of the variables you find questionable.

    You also wrote:
    “He concluded that (a) the blind spot must represent brain function or hemisphericity in the cerebral cortex or it wouldn’t have changed after manipulation, and (b) manipulation must affect brain function or the blind spot would not have changed. Neither conclusion is warranted, and the reasoning is circular.”

    Regardless of the conclusions you make about HIS conclusion, he is in a far better position (based on his education, accomplishments, knowledge and experience) to make them than you are (education or the process of learning IS a neurological process; cf your comment that he has a PhD in education and not neruology) It’s not like he’s garbage collector making these assertions (no offence to garbage collectors). Furthermore, his findings, if anything, merit further investigation into the subject, not immediate invalidation.

    I have refrained myself to this point but I think it’s time to point out some things about medicine now. Isn’t the #1 substance of addiction in America pharmaceutical drugs and not street drugs, and that children raid their parent’s medicine cabinets to get high, and that (some) medical doctors are essentially “legal drug-pushers” because they get financial kick-backs from pharmaceutical companies based on how many of their pills they prescribe? Isn’t it also true that the real #1 cause of death in America is medical mistakes (cutting out the wrong organ, fatal multiple drug interactions, misdiagnosis, etc.)? Isn’t it also true that the over-prescription of antibiotics is creating resistant strains of bacteria aka: “super bugs”? Also (to dispel your assertion that the body is not intelligent) isn’t the fact that pharmaceutical drugs are designed to interfere with some physiological process (by either blocking, stimulating or inhibiting some biochemical process) in and of itself an attempt to essentially “out-smart” the body’s intelligence? If the body is not intelligent, then why would you need to “out-smart” it with a drug? Also, judging from the long list of side effects pharmaceuticals carry, medicine isn’t really doing a good job at it—sure blood pressure went down but the kidneys and liver got destroyed in the process…oops; oh, well (shrug). This simply shows that the body IS intelligent and apparently, it’s more intelligent than you are! Medicine has failed to produce the “magic bullet” it has sought since its inception. The “one disease, one cure” model is therefore fundamentally flawed because it’s apparently impossible to interfere with one system without affecting others.

    The above is not to say that medicine to completely worthless, however: In my opinion, the following are acceptable applications of medicine: emergency room care (acute accidental life-threatening injury), advanced disease processes requiring immediate intervention (like the cases presented in the show “House”), and plastic or reconstructive surgery for deformities that result form gross injury or birth-defects. If you are a medical doctor specializing in these areas then you truly save lives and make a valuable contribution to humanity. If not, you should change your specialty to one of these.

    This is my last post as my vacation is nearing its end. It’s been fun and thank you for the challenge. For you professional skeptics…good luck with that (I actually see the value in your job; you fulfill a valuable roll in a system of checks and balances). For all of you medical students chiming in, the best of luck to you (sincerely) and please (I beg you) don’t become legal drug pushers (look at what happened to Michael Jackson).

  61. weing says:

    I doubt the truth of every claim you’ve made.

  62. I have refrained myself to this point but I think it’s time to point out some things about medicine now. Isn’t the #1 substance of addiction in America pharmaceutical drugs and not street drugs,

    Demonstrably false. The number one substance of addition is still alcohol.

    and that children raid their parent’s medicine cabinets to get high, and that (some) medical doctors are essentially “legal drug-pushers” because they get financial kick-backs from pharmaceutical companies based on how many of their pills they prescribe?

    No, doctors don’t get kickbacks based on how many pills they prescribe. Hell at my institution they can’t even give us pens.
    No, doctors aren’t “legal drug pushers.”
    Before I even suggest pain meds for a patient, we pull the record of all of the prescriptions they’ve had filled in the state to make sure there isn’t anything resembling a pattern of abuse.

    it also true that the real #1 cause of death in America is medical mistakes (cutting out the wrong organ, fatal multiple drug interactions, misdiagnosis, etc.)?

    Nope, and this one has been debunked on this very blog. Search for it. You’ll find it interesting to look for information instead of just spouting whatever you want.

    Isn’t it also true that the over-prescription of antibiotics is creating resistant strains of bacteria aka: “super bugs”?

    Here you may have a point. Certainly some overprescription occurs. Also patients don’t always finish their full course of antibiotics, which encourages resistance. It doesn’t help that for veterinary purposes, antibiotics come over the counter, and routinely go into feed prophylactically either. None of that however, makes chiropractic valid.

    (to dispel your assertion that the body is not intelligent) isn’t the fact that pharmaceutical drugs are designed to interfere with some physiological process (by either blocking, stimulating or inhibiting some biochemical process) in and of itself an attempt to essentially “out-smart” the body’s intelligence?

    Sorry? out-smarting the body’s intelligence? Didn’t you get some preclinical science? Doctor’s don’t talk like that. I even avoid using terms like that in explaining how things work to my patients. That’s just sloppy.

    We use physiology to create drugs that treat our patient’s conditions.

    If the body is not intelligent, then why would you need to “out-smart” it with a drug?

    well, when you put “out-smart” in quotes, you make the fact that this is an analogy, and a crappy analogy at that, perfectly clear.

    Also, judging from the long list of side effects pharmaceuticals carry, medicine isn’t really doing a good job at it—sure blood pressure went down but the kidneys and liver got destroyed in the process…oops; oh, well (shrug).

    Ah, so you also don’t know how blood pressure medications work. Our normal blood pressure medication regimen is kidney protective.

    This simply shows that the body IS intelligent and apparently, it’s more intelligent than you are!

    Medicine has failed to produce the “magic bullet” it has sought since its inception.

    Ah, so by bringing up analogies and sloppy language you seek to discredit medicine. That we can say we’ve failed at anything is a testament to science showing what we can and can’t do.
    That you maintain you can treat anything with your “one cure for all disease” says more about your inability to change your practice.

    The “one disease, one cure” model is therefore fundamentally flawed because it’s apparently impossible to interfere with one system without affecting others.

    Who even talks about this “one disease, one cure” model? I’ve never heard the term in medical school.

    In real medical education, we learn about the complexities of physiology. We don’t speak of “one disease, one cure” or even “all diseases, one cure” like you do. We just talk about how to make our patients better.

    emergency room care (acute accidental life-threatening injury)

    If I ever need validation for my career choice, I think I’ll go elsewhere for it. To someone who knows what they’re talking about

    advanced disease processes requiring immediate intervention (like the cases presented in the show “House”),

    Res ipsa loquitor

  63. Harriet Hall says:

    Innate has failed to understand my critique of Carrick. His crude paper and pencil test only measured the same thing more sophisticated mapping of blind spots does: the patient’s report of what he sees. There is no distinction between “anatomical” and “physiologic”. The physiology is limited by the anatomy, and Carrick has not demonstrated otherwise. Nor has he demonstrated that his measurements reflect brain function. He hasn’t even demonstrated that his measurements are real.

    Doctors have been mapping blind spots for decades, and they have never observed what Carrick did: that there was a marked asymmetry in every patient. The most parsimonious explanation is that Carrick’s test is not as reliable as previous tests. If he really discovered that one blind spot is always significantly larger than the other, this would be an important finding to submit in a paper by itself and invite replication and peer review. It would mean that previous observations were wrong and that he had discovered an entirely new phenomenon. He doesn’t even notice this or make this claim; he just proceeds to use his new test to guide chiropractic adjustments.

    If you develop a new way of measuring body temperature and you examine 500 people and find they are all running a high fever, your first thought should be that your new method might not be accurate. If your results are accurate, that would mean that all previous studies of body temperature were wrong and that conventional thermometers were defective. And that everyone has a high fever that is missed by every test but yours.

    The normal procedure when developing a new test is to validate it against older tests or a gold standard. In an e-mail exchange, I tried to get Carrick to recognize the necessity to validate his new test, but he just kept repeating “my results are reproducible and statistically significant.” Sure, so are studies of how much money the Tooth Fairy leaves – but they don’t tell you how the money got there.

    When I first read his paper, I tried to replicate his results. Following his detailed instructions, I tested several people and found no signficant difference in blind spot size between the eyes. Try it yourself – anyone can do it at home. But watch out – it’s easy to get false results by not maintaining perfect fixation. It’s easy to imagine how his subjects’ responses might have been subtly influenced by the fact that they were all Carrick’s students in his postgraduate chiropractic neurology course, and they knew which side had been manipulated and what Carrick was looking for.

    Junk science and poor reasoning. Poor writeup. Missing information. Conclusions not supported by the data. Citations that don’t support the points he cites them for. I could go on. No excuses. A PhD should have known better and the JMPT should never have published his article.

  64. pmoran says:

    Just remember, INNATE, that you are able to get away with what you do only because others are dealing with all the REAL illness, and the REAL disabilitoes, and all the really unpleasant things that doctors and nurses have to cope with every day.

    How nice to treat a condition that, existing only in your own mind, never kills anyone, or makes them bedridden, smelly and and incontinent, or gets you out of bed in the middle of the night, while also enabling you to avoid the slightest responsibility for the outcome of any real illness.

    Yet you wish to feign superiority and to pass judgement on us?

  65. weing says:

    His thermography machine detects a non-existent illness which he can then treat. That would be fine if he just waved his hands over his victims to perform the wallectomy. But these chiros actually engage in a practice that carries a real risk of damaging the victim.

  66. tmac57 says:

    Innate said:”pmoron called the device “dinky” ” . Uh…sneaky ad hominem there Innane.

  67. vargkill says:

    Harriet Hall,

    You’re a strikingly ravishing older women Mrs Hall!

    weing, pmoron,

    You’re both handsome older men!

  68. Fred Dagg says:

    Low Back Pain, Predictors of Chronic Disability.

    One risk factor/predictor of chronic disability is the choice of healthcare provider.
    “Workers whose first health visit for the injury was to a chiropractor had substantially better outcomes.”
    The percentage of workers diasled after one year was 5% with chiropractic care, 12% with primary care, 26% occupational medicine, 23% others.
    The authors of the study offer two possibilities for the better outcomes of those who consulted the chiropractor first.
    1) “….it is possible that workers who saw chiropractors differed in prognostically favourable ways.”
    2) “It is also possible that chiropractic care was more effective in improving pain/and or promoting return to work”.
    They conclude that more research is needed to investigate the effects of early care on work disabilty.

    Turner JA, Franklin G et al. (2008) ISSLS Prize Winner: Early Predictors of Chronic Work Disabilty: A Prospective, PopulatioBased Study of Workers with Back Injuries, Spine, 33(25):2809-2818).

  69. Joe says:

    @Fred Daggon 28 Jun 2009 at 4:10 pm “1) “….it is possible that workers who saw chiropractors differed in prognostically favourable ways.”
    2) “It is also possible that chiropractic care was more effective in improving pain/and or promoting return to work”.”

    What is the point of citing an inconclusive study?

  70. weing says:

    This is anecdotal, of course, but a lot of patients that I see for back pain have already seen a chiropractor, and are still symptomatic. If I am seeing more severely affected patients, it’s not surprising that the outcomes are different. If the patients aren’t better, I refer to the specialists and their outcomes appear paradoxically worse, because they are dealing with an even more severely affected population.

  71. Fred Dagg says:

    Weing, it is the first practitoner visit that is being taken into account.

  72. Joe says:

    Weing’s anecdote supports the notion the notion that “It is also possible that chiropractic care was more effective in improving pain/and or promoting return to work.” Then, the more difficult cases turn t medicine.

  73. Fred Dagg says:

    Weing,

    your comment about prognosis following care from a number of different practitioners is really interesting. Though anecdotal, would make a really good research project. Basically, the more practitioners a patients sees for a complaint, the worse the prognosis. I would be very interesting in your comment.

    Joe, sour grapes from you, as you are not looking at the intent of the research, but instead, just finding something to complain about.

  74. Fred Dagg says:

    At the recent World Federation of Chiropractic Conference in Montreal, one keynote speaker was Dr. David Eisenberg of Harvard. He spoke of the integration of chiropractic and other complimentary services (e.g. acupuncture and massage), with medical care at Harvard, and a pilot trial showing greatly improved outcomes for chronic back pain patients as a result. Dr. Eisenberg was apparently impressed at the calibre and depth of chiropractic research.

  75. Fred Dagg says:

    Carragee EJ, Deyo RA, Kovacs FM et al. (2009) Clinical Research: Is the Spine Field and Mine Field? Spine 34(5):423-430)

    These authors reviewed the current system for the approval of drugs and surgical proceedures based upon industry sponsored clinical research. They found that the system is “broken” and that “clinicians can no longer rely on the medical literature for valid and reliable information”.
    The authors note that the US Consumer Reports “recently listed spinal surgery as number one on its list of overused tests and treatments”.

    Very interesting, considering the reluctance of the site to address any of these issue in a contructive manner.

  76. pmoran says:

    “The authors note that the US Consumer Reports “recently listed spinal surgery as number one on its list of overused tests and treatments”.”

    If the incentive is there and they are given the opportunity, it is certain that some orthopoedic surgeons will be over-influenced by their lifestyle objectives and will operate more often than others.

    Most countries rely upon a mixture of professional ethos, keeping their specialists busy through restricting numbers, referral systems (you need a GP referral to see a surgeon in most systems), rationing of resources, and in a few countries non-incentive payment systems, to keep this in check. I cannot comment on America.

    The specifics matter. What type of spinal surgery and for what indication? With sciatica the studies show that patients get better quicker with surgery, so that the issue becomes how long the patient is prepared to tolerate the pain and disability. There will be a wide spread of possible answers depending upon who is paying, who has to suffer, and other factors .

    My son had to wait three months in pain from a massive disc protrusion, unable to work and bent over 90 degrees at the waist, before his GP would refer him. Two days after the op we met him walking down the hospital corridor, perfectly straight and already virtually pain free!!

    See. we are not ONLY supported by all those shonky scientific studies — we have anecdotes, too!! :-).

    You mentioned once before the difference in spinal surgery rates between your country and England. I would suspect much of it will be due to the comparative accessibility of surgery in your country rather than culpable misuse of it, and less than you think is indefensible.

    There was once a lot of similar criticism concerning differing rates of hysterectomy. It was found that the highest rates of all were in doctor’s wives!

  77. nwtk2007 says:

    Fact is that sometimes chiropractic care is just not enough to handle back and neck conditions, however, a combined effort of both chiropractors and orthopedists has a great likelihood of success with only a few cases out of hundreds eventually going to surgery.

    My experience is my guide. I have not one single double blinded study to back up what I have seen in practice over the past 13 years seeing over 15,000 patients.

    I would also point out that very, very few patients who saw me first, later switched and went the total medical route for their care. In fact, I don’t think a single one did that. Well OK, maybe a few. But many have come to me after first going the medical path having found little if any success there.

    And please don’t take that to imply that medical practitioners have no success in what they do with neck and back injuries.

  78. nwtk2007 says:

    I am glad to see some medical anecdotes finally rising to the level of this discussion.

  79. INNATE says:

    “Innane” is back!

    “His thermography machine detects a non-existent illness which he can then treat.”

    Report of the American Academy of Neurology, Therapeutics and Technology Assessment Subcommittee. Assesment: Thermography in Neurologic Practice. Neurology 1990;40:523-525.

    “Executive Summary: …Infrared thermography may provide information about *altered cutaneous temperatures useful in characterizing reflex sympathetic dystrophy*, *focal autonomic neuropathies*, focal nerve injuries, and for evaluation of faulty use of insensitive acral parts.”

    The italicized phrases are exactly what I’ve said I use it for, and the journal Neurology seems to agree that this is an appropriate use for the technology.

    “My little toe has more major and varied neural connections than C1,2 but we know that has limited significance for health.”

    This is blatantly not true; your little toe has nowhere near the density of proprioceptos as does the upper cervical spine and you know this!

    “…and yet others before it could form the basis of a *medical treatment*, other than as placebo.”

    I think I’ve figured out the fundamental source of the disagreement between MD’s and DC’s. What you fail to understand is that Chiropractic isn’t a “medical” ANYTHING! The term “chiropractic medicine” is the oxy of all morons and actually makes my skin crawl when I hear it. We don’t treat diseases; YOU treat diseases. We treat the PERSON that HAS the disease and herein lies the difference. When you treat the disease, you get “side effects”. When you treat the person, the disease subsided (within the limitations of matter, of course). All of you want evidence that chiropractic is an effective treatment for a specific disease and it never has been or never will be; the body’s own healing mechanism is the effective treatment!

    “How nice to treat a condition that, existing only in your own mind…”

    Really?..Tell that to “Betty” (not her real name) that used to have to decide how many Motrin pills it would take to get her out of pain enough so that she’d be able to do simple things like vacuum her house on Sundays. Or “Lisa” that was told “we can’t find anything wrong with you…it’s all in your head.” Or “Fred”… Or “Mike”… Or “Judy”. All were chronically ill and now no longer are…placebo effect…right.

    Just because the exact mechanism has not been described completely (or to your satisfaction), doesn’t mean it exists only in my mind. To my knowledge, we don’t know exactly how aspirin works but hey…”It works”, right? The good news is that, thanks to our exchanges, I now know the kind of evidence it will take to describe this mechanism in an irrefutable way; and fortunately, I’m in the position to do something about it….get ready for the 50-ton boulder rolling your way.

    “…never kills anyone, or makes them bedridden, smelly and incontinent, or gets you out of bed in the middle of the night…”

    We have YOU for that!..thank you (sincerely)! I never said I care for terminally ill patients; they are too far beyond chiropractic hope. They need to be made comfortable as they undergo the dying process (we all need to die someday, and no one claimed that chiropractic makes people live forever) I even admitted this, as you are far better equipped to do so in your hospitals.

    “…while also enabling you to avoid the slightest responsibility for the outcome of any real illness.”

    This is also blatantly false since the very livelihood of my practice depends on producing positive outcomes in my patients…outcome is my greatest responsibility!

    “Yet you wish to feign superiority and to pass judgement on us?”

    I never said I or Chiropractic am/is necessarily superior, just different. And the judgment you’ve passed on me far exceeds my little paragraph listing things that are obvious problems in your profession (as Dagg referenced in one of his last posts.)

    “That would be fine if he just waved his hands over his victims to perform the wallectomy.”

    I WISH it were that easy!! And I don’t do it for the money…the money comes as a proportion to the loving service and meaningful results I provide to my patients.

    “But these chiros actually engage in a practice that carries a real risk of damaging the victim.”

    The magnitude of risk was proven to be miniscule in another blog-roll on this site that dealt with the subject (I believe Dagg made compelling arguments for this). Besides, there is no rotation in the line of drive I use in my adjustment, and my x-ray analysis clearly elucidates the directionality of the biomechanical dysfunction I correct with the adjustment. On top of this, I pay FAR less in malpractice insurance than you (2-3 K per year!); and if anyone is a valid evaluator of “real risk”, its insurance companies (having an accurate value of risk is their business).

    Fred, nwtk2007, vargkill, et al…You are awesome! But you are wasting your time here (just as I have). This blog site is a trap; full of people that, I’m willing to bet, get paid to cut down any argument favoring chiropractic. If you’ve noticed, they don’t chime in until one of us decides to post a comment; and when we do, the replies they use seem to come out of a hat full of come-backs from which they pick. Really, we don’t need to prove ANYTHING to these people, especially since it’s clear they have a 5-foot thick brick wall around their head. It’s the public that deserves the proof; the people decide what is valid and what is not….of the people, by the people and for the people. They want to make you believe that THEY do, but they don’t.

    I’m sure they’ll get the last word on this: HH with her “INNATE has FAILED!!! Mwah ha-ha ha-ha!!…blood letting…the tooth fairy” and Joe with his sour grapes, weing with his “explain 5-foot thick wall”, pmoran with his blatant minimizings, misconstrusions and dismissals…etc. all a waste of time and not arriving at any consensus.

  80. Fred Dagg says:

    I thought Pmorans last post was very good, and from the heart.
    The 9 month post surgical result with sciatica is the same as the result without surgery, in terms of pateint pain. However, the surgical patient does get better faster.
    I always thought that the rates of hysterectomies were greater in Catholic women, who had finished having their children. (Just an aside)

  81. pmoran says:

    INNATE, I accept that you are helping some people, but it is not for the reason that you think.

    ANY kind of practitioner can, given the right kind of patient and the right circumstances, tap into that host of non-specific influences that can produce dramatic illness responses, and very high rates of apparent success with sham treatments of certain conditions.

    A comparable exercise to “upper cervical” might be glomectomy, a minor operation on the autonomic nervous system in the neck, denervating a chemoreceptor. Many physicians claimed dramatic success rates form this operation for asthma, even when intractable. (Incidentally, you cannot escape having to demonstrate some effect upon SOMETHING, no matter how you may wriggle around with “treating the patient not disease”)

    Nine independent authors published retrospective case series involving nearly 6000 patients in all, claiming success rates ranging from 51% to 95%!

    But there were still some skeptics. Ultimately no less than thirteen CONTROLLED trials were performed, three of them double-blinded, and these proved conclusively that a sham operation “worked” as well. One enthusiast produced a 58% success rate with glomectomy — but his sham op did better at 64%!!

    This is no isolated event in medicine. We are now at least as hard on our own as we are on you. So I won’t respond to the more paranoid elements in your last post. It is no fun having cherished beliefs challenged in this manner. I may tell you some stories against myself one day.

    Your approach would be more tolerable if it were not so prone towards becoming a practice-building exercise. It is can create a lot of wholly unnecessary “medical” activity.

  82. Mojo says:

    This blog site is a trap; full of people that, I’m willing to bet, get paid to cut down any argument favoring chiropractic.

    Why do CAMsters keep returning to this particular argumentum ad hominem? Perhaps they are just projecting their own motivations onto others.

  83. weing says:

    “This blog site is a trap; full of people that, I’m willing to bet, get paid to cut down any argument favoring chiropractic.”

    How much are you willing to bet? As far as I know, chiropractic may be of some use in lower back injuries.

    You mentioned in your diatribe that you “treat the PERSON that HAS the disease” and you use the thermography machine to diagnose diseases. Do you even know what the kappa statistic for thermography is? I certainly don’t. I’ve never seen any neurologists using it on my patients either.

  84. nobs says:

    weing asserts: >>”You mentioned in your diatribe that you “treat the PERSON that HAS the disease” and you use the thermography machine to diagnose diseases.

    Really? Will you please direct me to the post that Innate claims he uses thermography “to diagnose diseases”.

  85. weing says:

    ““Executive Summary: …Infrared thermography may provide information about *altered cutaneous temperatures useful in characterizing reflex sympathetic dystrophy*, *focal autonomic neuropathies*, focal nerve injuries, and for evaluation of faulty use of insensitive acral parts.”

    The italicized phrases are exactly what I’ve said I use it for, and the journal Neurology seems to agree that this is an appropriate use for the technology.”

    From the same post.

  86. nobs says:

    Is THAT what you are declaring as claiming to “diagnosing disease”?

  87. weing says:

    That’s what I understand him to mean. Unless he has a neurologist diagnose the patient first.

  88. nobs says:

    >>”Infrared thermography may provide information about *altered cutaneous temperatures useful in characterizing reflex sympathetic dystrophy*, *focal autonomic neuropathies*, focal nerve injuries, and for evaluation of faulty use of insensitive acral parts.”<<

    I see NOTHING here claiming to “diagnose diseases”.

    Do you also consider labs, CATs, MRIs, EMGs, NCVs, reflex hammer, pinwheel, ………..to “diagnose diseases”?

    IMO- Your assertion that it does, is either a disenguous distortion, or else you are confused as to the difference between “diagnosis” and “diagnostic tool”

  89. weing says:

    I utilize those tools to diagnose diseases.

  90. Scott says:

    “This blog site is a trap; full of people that, I’m willing to bet, get paid to cut down any argument favoring chiropractic.”

    You’d lose that bet quite badly. But even if your accusation were true, it boggles the mind that you’d make it when YOUR ENTIRE LIVELIHOOD depends 100% on convincing people that chiropractic is legitimate.

    So who would have the conflict of interest again?

  91. weing says:

    I mean, what else would you do those tests for if not as an aid to diagnosis?

  92. daedalus2u says:

    To maximize the effectiveness of the placebo effect.

  93. nobs says:

    daedalus2u- Interesting that you consider MRIs CTs, EMG, NCV, Reflex hammer, pinwheel, …….>>>>placebo effect! —????

    Please elaborate.

    BTW- Infrared thermography has a well estabished usefulness as a diagnostic tool—–especially in neuromusculoskeltal conditions.

  94. Harriet Hall says:

    Innate said,
    “This blog site is a trap; full of people that, I’m willing to bet, get paid to cut down any argument favoring chiropractic.”

    Who do you think is paying us? I didn’t get my check yet. And I will offer again an argument I have offered before in favor of chiropractic: chiropractors are skilled in SMT and SMT has value for certain types of low back pain. I fully support chiropractors who reject the subluxation myth, don’t employ any quack methods, and offer evidence-based short-term SMT for musculoskeletal problems.

  95. weing says:

    If he doesn’t diagnose, then isn’t he just treating the thermograph and not the patient? How can you have treatment without diagnosis?

  96. Harriet Hall says:

    Thermography has its uses, but there is no evidence that it can locate chiropractic “subluxations.”

  97. Mojo says:

    Is there any evidence that anything can locate “chiropractic subluxations”?

  98. Harriet Hall says:

    Is there any evidence that chiropractic subluxations exist to be located?

  99. nobs says:

    weing>>”If he doesn’t diagnose, then isn’t he just treating the thermograph and not the patient? How can you have treatment without diagnosis?

    WOW- This is getting really bizzare—– It was YOU that concluded the infrared thermography “DIAGNOSED diseases”, not Innate.

    Innate provided information as to how infrared thermography is used as a diagnostic tool. Please review previous posts.

    HH declares- >>”Thermography has its uses, but there is no evidence that it can locate chiropractic “subluxations.”

    Please direct me to a post by Innate(or anyone else for that matter) that supports this declaration BTW- A “boiled-down” version or “critique” does not qualify, obviously.

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