Articles

Chiropractic and Deafness: Back to 1895

Chiropractic originated in 1895 when D.D. Palmer claimed to have restored deaf janitor Harvey Lillard’s hearing by manipulating his spine. This makes no anatomical sense, and few if any chiropractors claim to be able to reverse deafness today. But now a chiropractic website is attempting to vindicate D. D. Palmer. They list deafness among a long (wrong) list of “Conditions That Respond Well to Chiropractic”

They list 6 supporting studies. Three are case reports, two are case series, and one is a review of the literature that is labeled in its title as “A Search to Validate” D.D. Palmer.

Study No. 1

One study is a case report entitled “Hearing Loss, Otalgia and Neck Pain: A Case Report on Long-Term Chiropractic Care That Helped to Improve Quality of Life.” I’ll copy the entire abstract to give a flavor of the quality of evidence these chiropractors find acceptable:

Objective: To describe symptom reports, multiple chiropractic assessments and adjustments over 7 years with a patient experiencing neck pain and complex ear symptoms consistent with Meniere’s syndrome.

Clinical Features: A 43-year-old female, injured years earlier in a motor vehicle collision, suffered recurrent exacerbations of otherwise continuous neck pain. Later she developed aural symptoms of severe otalgia, hearing difficulty, tinnitus and dizziness that increased and decreased in severity with her neck pain.

Intervention and Outcome: The intervention was repeated application of chiropractic adjustments using a modified Pettibon adjusting device. Over 7 years of observation, the subject consistently reported reduction in symptom severity after adjustments, with relief lasting up to 2 months. Consistent with the natural history of Meniere’s syndrome, an overall deterioration was noted during the observation period. Hearing fluctuated in approximate synchrony with changes in angular displacements of upper cervical vertebrae during the treatment period.

Conclusion: Observation over an extended period assists in understanding the progression of chronic disorders. This patient experienced substantially reduced symptoms with chiropractic care during the 7-year observation period. Of note is the repeated exacerbation of neck pain that often precedes exacerbation in ear symptoms, along with the relief of both following adjustment and an association between improved hearing and improved cervical alignment.

Comments: This woman’s deafness was part of her Meniere’s disease and was presumably not related in any way to her auto accident or her neck symptoms. The association of reported increases in neck pain with exacerbation of Meniere’s symptoms could be due to the fact that people in pain and people who are in a depressed mood are more likely to report other physical symptoms. Reduction in symptoms after adjustment is compatible with nonspecific effects of any treatment, with placebo response, or with the natural course of illness. Fluctuating hearing loss is one of the characteristics of Meniere’s disease. The Pettibon system is an upper cervical method that is not supported by any credible evidence. The finding of “angular displacements of upper cervical vertebrae” is an upper chiropractic delusion: actual displacements have not been confirmed by conventional radiologists. “Improved cervical alignment” cannot be scientifically demonstrated.

Study No. 2

This was a case report of a 41-year-old woman who had bilateral ear pain, tinnitus, vertigo, “altered or decreased hearing acuity,” and headaches. She had a history of ear infections treated with antibiotics. She had been diagnosed and treated for temporomandibular joint syndrome (TMJ). The chiropractor diagnosed an atlas subluxation and after 9 treatments her symptoms resolved.

Comments: We don’t know what was wrong with this patient. What does “altered or decreased hearing acuity” mean? Hearing can be temporarily decreased by infections with fluid in the middle ear. TMJ does not cause deafness. Atlas subluxations are mythical. Symptoms like these typically fluctuate and may resolve spontaneously over time.

Study No. 3

A case report of a 75 yr old woman with longstanding vertigo, tinnitus and hearing loss. Her symptoms increased over a 5-week period before she sought chiropractic care. Her symptoms improved during upper cervical chiropractic treatment.

Comments: Symptoms fluctuate over time. The chiropractor saw her when the symptoms were at their worst, and regression to the mean explains why she improved. Did she have Meniere’s disease? A fluctuating hearing loss is characteristic of Meniere’s. Upper cervical chiropractic treatment has never been shown to cure anything. There is no reason to think the treatment had anything to do with her improvement.

Study No. 4

“Improvement in Hearing after Chiropractic Care: A Case Series.” Full text available online The subjects were a “sample of convenience” of 15 patients who presented for chiropractic care and whose chief complaint was not hearing loss. All subjects were found to have hearing loss, more in the left ear than the right, and after a single chiropractic visit 8 patients improved in one ear, 3 improved in both ears, four were unchanged, and 3 were worse. The post-treatment tests continued to show worse hearing in the left ear than the right. The author indulges in wild speculation about possible mechanisms including brain plasticity and the effect of peripheral stimulation on thalamic activity in the brain.

Comments: The discussion section of the report admits that this study can’t prove a cause and effect relationship. To support his speculations, the author references Carrick’s ridiculous blind spot study which I critiqued at length in The Scientific Review of Alternative Medicine and briefly on Chirobase. Just citing Carrick’s article is enough to completely discredit the author in my mind. It is junk science and its conclusions depend on circular reasoning. One thing that particularly bothers me about this study is the finding of more hearing loss on the left side. As far as we know, hearing loss should be evenly distributed. What could account for the discrepancy?

Study No. 5

“Vertebrogenic Hearing Deficit, the Spine, and Spinal Manipulation Therapy: A Search to Validate the D.D. Palmer/Harvey Lillard Experience.” This review of the medical and chiropractic literature

suggests that hearing deficits may be associated with spinal joint motion restriction, spondyloarthrosis, irritation of the sympathetic nervous system, decreased cervico-cerebral circulation and/or decrease in tinnitus…It is proposed that some cases may benefit from SMT. Further research is needed to determine the role of SMT in the treatment of vertebrogenic hearing deficits.

Comments: The very title indicates bias. This author cherry-picked the literature in a vain attempt to validate D.D. Palmer. While the literature may “suggest” the associations he lists, it does not “prove” those associations, much less show that any association represents a causal relationship. He does not provide any evidence that SMT can restore hearing. He calls for research into the treatment of “vertebrogenic hearing deficits” but that would just be Tooth Fairy science, since we have no evidence that hearing deficits can be due to vertebral causes.

Study No. 6

“Cervicogenic Hearing Loss.”
The author of this case series starts by admitting “there remains a dispute whether a “vertebragenic hearing disorder” exists. This latter disorder is believed accompanied by tinnitus, a feeling of ear pressure, otalgia and deafness as symptoms of a functional deficit of the upper cervical spine.” It studied 259 patients with “well-defined functional deficits of the upper cervical spine and symptoms of cervical vertigo,” and found subjective hearing disorders in 15% and audiometric threshold shifts in 40%. 62 patients with vertebragenic hearing loss improved during chiropractic management. He concludes that the therapy of choice is chiropractic manipulation of the upper cervical spine.

Comments: He doesn’t have any evidence that the disorder exists, but he diagnoses it in 62 patients (!?) At best, this is a case series of questionable significance; at worst it is Tooth Fairy science, studying something that probably doesn’t exist. There were no controls. How can he conclude that the treatment of choice is chiropractic manipulation when he has not compared that to any other treatment?

Elsewhere chiropractic apologists have hypothesized how problems in the spine might lead to effects in the ear. The vertebrobasilar artery passes through the neck and a branch of it supplies the inner ear. Conceivably a neck injury could damage the artery and reduce blood supply to the ear, but it is inconceivable that manipulating the neck could then reverse the damage. Some have posited effects via the autonomic (sympathetic and parasympathetic) nervous system, but they have not demonstrated that an autonomic problem is present, that it could account for the symptoms, or that autonomic effects could be corrected or compensated for by manipulation. Some argue that sensory stimulation of the body can affect stuff in the brain. Sure, if you hit your toe with a hammer, there will be a change in brain activity. That’s a truism, not an argument for spinal manipulation.

There is a rumor (unconfirmed) that Harvey Lillard’s widow later said he was deaf until the day he died. We will never know enough about his case to understand what really happened. But I think we can reasonably conclude that spinal manipulation is not an effective treatment for hearing loss. And that the authors of this website have no understanding of what constitutes credible scientific evidence.

Posted in: Chiropractic

Leave a Comment (82) ↓

82 thoughts on “Chiropractic and Deafness: Back to 1895

  1. Versus says:

    This speaks volumes about their education and training.

  2. seemstome says:

    “we can reasonably conclude that spinal manipulation is not an effective treatment for hearing loss.”

    Controlled experimental studies would be required for that conclusion. It is not reasonable to reject the chiropractic observations because of lack of scientific evidence, unless you have scientific evidence that contradicts them. In other words, lack of good evidence for is not the same thing as good evidence against.

    I think that many people have experienced ringing in the ears that comes and goes depending on neck position. It seems obvious that the auditory nerves can be affected in some way by the alignment of cervical vertebrae.

    These personal experiences and the clinical observations of chiropractors should be subjected to unbiased scientific study before any scientific conclusion is reached.

  3. Diane Jacobs says:

    “These personal experiences and the clinical observations of chiropractors should be subjected to unbiased scientific study before any scientific conclusion is reached.”

    Maybe chiropractors should figure out how to use Occam’s Razor on themselves and their own profession. Why ask others to do work they should do for themselves? It seems they only listen to what they want to hear regardless.

  4. daniel says:

    I learned this “fact” in my high school health class. Although it may have been done as a student-led presentation, since one of my classmates was the daughter of a local quack.

  5. Todd W. says:

    @seemstome

    I think that many people have experienced ringing in the ears that comes and goes depending on neck position. It seems obvious that the auditory nerves can be affected in some way by the alignment of cervical vertebrae.

    Another explanation could be a shift in the fluid of the inner ear, no? Seems a more likely explanation to me.

    Another question: do any of the nerves involved in hearing pass through the neck? I would have assumed that they would go in a more or less direct path from the ears to the brain. Shortest route and all that.

  6. Harriet Hall says:

    Seemstone challenged my statement “we can reasonably conclude that spinal manipulation is not an effective treatment for hearing loss.” I stand by it. (Such conclusions are always provisional.) It is up to chiropractors to find evidence to support their “clinical observations” and patient testimonials. It is not up to us to try to prove something “doesn’t” work. Science can reject or not reject the null hypothesis; it can’t accept the null hypothesis.

    To me it doesn’t “seem obvious that the auditory nerves can be affected in some way by the alignment of cervical vertebrae.” My article explained why this is implausible. You offer only unsupported speculation. Do you have a testable hypothesis?

  7. seemstome says:

    ” I would have assumed that they would go in a more or less direct path from the ears to the brain.”

    No that assumption is not true.

  8. seemstome says:

    [It is up to chiropractors to find evidence to support their “clinical observations” and patient testimonials.]

    Chiropractors would probably like to do these studies, as long as they can get funding. Otherwise, clinical and personal experiences are all they have. I do not think clinical and personal experiences should be rejected without consideration– these experiences lead the way in suggesting directions for future scientific research. When there is a large amount of anecdotal evidence, then formal experiments should be considered.

  9. Harriet Hall says:

    Seemstone,

    (1) What anatomy book are you reading? Where do you think the auditory nerves go?
    (2) There is a lot of historical anecdotal evidence for bloodletting to balance the humours. Do you advocate formal experiments to test that? One of the points we repeatedly try to make on this blog is that prior plausibility should be considered in choosing what to test. Do you disagree? Do you know of any implausible hypothesis from alternative medicine that was tested, found to be true, and then incorporated into mainstream medicine?

    Chiropractic has had 114 years to test this claim. They got funding to do the studies I critiqued.

  10. TsuDhoNimh says:

    seemstone –
    The auditory nerves do not pass through the neck or spine, they go straight to the brain from the inner ear.

    The changes in hearing on changes in head position are from just that: positional changes. it’s especially noticeable if the inner ear has fluid in it from an infection or allergy.

  11. weing says:

    I guess it’s probable that impingement of the recto-olecranal branch of the auditory nerve is relieved by chiropractic manipulation.

  12. Prometheus says:

    “Seemstome” states:

    “It is not reasonable to reject the chiropractic observations [that chiropractic "cures" deafness] because of lack of scientific evidence, unless you have scientific evidence that contradicts them. In other words, lack of good evidence for is not the same thing as good evidence against.”

    Absolutely right! Or, at least, it would be if chiropractors had actually any data showing that chiropractic manipulation treat deafness. Instead, what we have is the assertion that people have been “cured” of their deafness after chiropractic manipulation, that the chiropractic manipulation “cured” the deafness (see: post hoc ergo propter hoc).

    Until chiropractors demonstrate that their “therapy” can treat deafness, there is actually no need for anyone to “prove” that it doesn’t, any more than someone needs to “prove” the absence of unicorns, leprechauns or the Tooth Fairy.

    Prometheus

  13. Harry says:

    @seemstome
    I think that many people have experienced ringing in the ears that comes and goes depending on neck position. It seems obvious that the auditory nerves can be affected in some way by the alignment of cervical vertebrae.

    Check out an anatomy text book (or wikipedia) and review the course of Cranial Nerve VIII, Vestibulocochlear nerve. Also look at branches of CN VII, Facial nerve and CN IX, Glossopharyngeal. CN VII has a nerve to the stapedius muscle and CN IX has the Tympanic nerve. Why those two CN VII and IX are associated with the ear, CN VIII is really the nerve for hearing. More specifically, (Doc, double check this) the Cochlear nerve is both necessary and sufficient for hearing. The cochlear nerve attaches to the brain stem at the Cochlear Nuclei. I don’t see how the cochlear nuclei could be manipulated through the spine.

    How do I quote someone using those nice brackets? I’m not 1337.

  14. seemstome says:

    “I don’t see how the cochlear nuclei could be manipulated through the spine.”

    I think the concern is with the atlas joint, which is influenced by misalignment of the spine.

  15. nwtk2007 says:

    I think it is innane to speak of anything curing deafness when there are so many forms of hearing loss, both total and partial, related to neural deficit or mechanical/conductive insufficiency.

    Anecdotally, I have had a good number of patients who reported the “opening” of their head or ears after cervical manipulation for neck injury. They usually report that with the “release” of “pressure”, as many have put it, they feel that they are able to hear more clearly.

    It seems perfectly plausible that cervical manipulation can effect the deep muscles of the pharyngeal areas of the neck which, one in particular, is attached to the tissues adjacent to the Eustachian tube. The blockage of this tube which runs from the middle ear to the oropharynx helps to equalize pressure between the middle ear cavity and the atmosphere. Anyone who has done any diving can attest to the effects of a blocked Eustachian tube when there is a significant pressure difference.

    Has it been researched. Don’t know. I don’t treat deafness.

    Also, I think that original manipulation was to a thoracic vertebra. Even more implausible.

    Thus very few chiro’s claim to cure deafness but some might claim to possibly help decrease hearing loss in certain conditions.

  16. Todd W. says:

    @Harry

    How do I quote someone using those nice brackets?

    Use pointy brackets around the word blockquote to start the quote, then put the text you’re quoting, then put /blockquote in pointy brackets at the end.

  17. Harry says:

    @Seemstome

    The anatomy just doesn’t work out that way. Again, hearing is from the eighth cranial nerve, called Vestibulocochlear nerve. The cochlear nerve originates at the cochlea and carries sensory information from the inner ear, travels through the internal acoustic meatus and enters the brain stem at the cochlear nucleus of the medulla oblongata. The Medulla oblongata is inside the cranium, above the foramen magnum and the occipital-atlantal joint as well as the spinal cord. The nerve tracks from the cochlear nucleus travel up the brain stem, not down.

    The idea that the misalignment of the spine by the atlas joint effects hearing is not compatible with anatomy. If you were to have your head removed above C1 you would still be able to hear. Likewise, if you were to have your spinal cord severed above the atlas, you would still be able to hear. You would have other problems, but deafness would not be one of them.

    tl;dr

    Harry

  18. “we can reasonably conclude that spinal manipulation is not an effective treatment for hearing loss.”

    I accept that statement, but if others don’t, perhaps a more conservative statement would be, “We can reasonably conclude that there is no quality evidence to support the effectiveness of chiropractic treatment for hearing loss, and thus no reason to recommend it for such.”

    “In other words, lack of good evidence for is not the same thing as good evidence against”

    Why would you use a treatment for which there was no good evidence to support its use?

    Warning: (Weak) arguement by analogy time. Would you trust your money to someone just because they had no criminal record or indictments against them, or would you want to see some history of effective, successful investment strategies as well?

  19. nwtk2007 says:

    I think it is silly to speak of anything curing deafness when there are so many forms of hearing loss, both total and partial, related to neural deficit or mechanical/conductive insufficiency.

    Anecdotally, I have had a good number of patients who reported the “opening” of their head or ears after cervical manipulation for neck injury. They usually report that with the “release” of “pressure”, as many have put it, they feel that they are able to hear more clearly.

    It seems perfectly plausible that cervical manipulation can effect the deep muscles of the pharyngeal areas of the neck which, one in particular, is attached to the tissues adjacent to the Eustachian tube. The blockage of this tube which runs from the middle ear to the oropharynx helps to equalize pressure between the middle ear cavity and the atmosphere. Anyone who has done any diving can attest to the effects of a blocked Eustachian tube when there is a significant pressure difference.

    Has it been researched. Don’t know. I don’t treat deafness.

    Also, I think that original manipulation was to a thoracic vertebra. Even more implausible.

    Thus very few chiro’s claim to cure deafness but some might claim to possibly help decrease hearing loss in certain conditions.

  20. nwtk2007 says:

    I changed the word innane to silly. I didn’t know I was specifically slated for comment moderation. Perhaps it is something I disagreed with. I don’t think I have qualified myself for moderation apart from disagreeing and pointing out bias where I see it and where it is denied to exist. I certainly haven’t been profane, nor argumentative. I also do not post comments under any other name.

  21. The Blind Watchmaker says:

    Just don’t call such treatments “Bogus”, that is if you are in England. Inane and silly would probably be ok.

    Go Simon!

  22. seemstome says:

    “The idea that the misalignment of the spine by the atlas joint effects hearing is not compatible with anatomy. If you were to have your head removed above C1 you would still be able to hear. Likewise, if you were to have your spinal cord severed above the atlas, you would still be able to hear.”

    I think it’s possible that the alignment of the atlas joint can influence the brainstem in some indirect way. I have no opinion on whether deafness can result. But I do know of a lot of anecdotal evidence that agrees with some of the chiropractic claims. Anecdotal and clinical evidence is only suggestive, not conclusive. But I don’t think it should be ignored.

  23. Scott says:

    But I do know of a lot of anecdotal evidence that agrees with some of the chiropractic claims. Anecdotal and clinical evidence is only suggestive, not conclusive. But I don’t think it should be ignored.

    Ignored, no. Discounted when it’s contradicted by abundant more rigorous evidence, it most certainly should be.

    An attitude of “hey, the anecdotal evidence suggests there might be something to this, we should look into it” is only reasonable when people didn’t already do the looking into it.

  24. nobs says:

    Harriet writes an editorial on “deafness”, yet negligently fails to provide us with her definition of “deafness”.

    I find it curious that someone/anyone claiming to be a critical thinker would overlook this crucial element. How can an intelligent exchange ensue when there is no established definition of that which is being discussed????????

    The absence of a clearly defined definition of the authors’ definition of “deafness” is imperitive——without that—–no one knows what the discussion is.

    So Harriet- Please clarify for us—-What is your operating definition of “deafness”?

  25. seemstome says:

    “Ignored, no. Discounted when it’s contradicted by abundant more rigorous evidence, it most certainly should be.”

    Where is all the rigorous evidence showing that the alignment of the atlas joint cannot influence the cranial nerves?

  26. Scott says:

    I was referring to the evidence on the general concept of chiropractic.

    Frankly, if you want to focus on the one particular indication independent of chiropractic in general, you’re on even worse ground since you’re basically trying to argue against the anatomy without ANY theoretical basis. And while that can be justifiable in some extraordinary cases, it requires far more than a couple anecdotes to justify expending any resources on it at all.

  27. Calli Arcale says:

    Where is all the rigorous evidence showing that the alignment of the atlas joint cannot influence the cranial nerves?

    Forgiving for the moment that you’ve gone from hearing-related nerves to *all* the cranial nerves (some of which emerge from the medulla), are you seriously asking for clinical evidence to disprove an unproven theory before clinicians *stop* performing it?

    I’m not aware of any clinical trials rejecting bloodletting or emesis to balance the humors. Yet both practices have been abandoned for a long time. Why? Because there is no clinical trial supporting them, and, more importantly, because we now know that the whole principle is complete bunk. The body doesn’t run on four humors, with disease occurring when they are imbalanced, therefore there is no reason to waste time testing to see if draining some blood would make a person better. The whole concept is absurd, given what we know.

    Same with this. Alignment of the atlas has no influence whatsoever on the nerves required for hearing. A profoundly deaf person could not be cured by adjustment of this joint.

    Let’s flip it around for a moment. What if chiropractors really can treat so many conditions by adjusting these bones? If this were true, isn’t there a huge potential for mistakes? Couldn’t they make a person *deaf*, as well as cure deafness? Given that, why would any chiropractor even dream of treating a patient if an accident could cause deafness, without someone having rigorously studied the situation so as to provide the knowledge that will enable safe practice?

    Yet chiropractors don’t often submit their practices to testing. They seem to be content to experiment on their patients. Mainstream medical practitioners criticize them for sometimes causing strokes, a claim which many chiropractors reject. Yet if chiropractic treatment really works the way they say it does, shouldn’t there be the potential for much worse and much more common side effects? Don’t chiropractors *ever* slip, adjust a joint a little bit the wrong way, and turn a person with asthma into a person with asthma *and* irritable bowel syndrome?

    That is why I think chiropractic institutions are so unethical. If they are right about how chiropractic works, then they are knowingly exposing their patients to a substantial but unquantified amount of risk, with no real interest in systematically reducing that risk.

    If they’re wrong, of course, chiropractic is just bogus. So whether they’re right or wrong, they’re seriously disregarding their duty to their patients and to chiropractic medicine as a whole.

  28. Harriet Hall says:

    Nobs said,

    “Harriet writes an editorial on “deafness”, yet negligently fails to provide us with her definition of “deafness”.”

    Thanks for pointing out a critical flaw in the chiropractic studies that I failed to emphasize in my post. None of them defined deafness and it was not clear what was initally wrong with the patients – not even whether it was sensorineural or conductive hearing loss, which would make a BIG difference! One of them just referred to the patient’s report of “hearing difficulty” – whatever that is! Perhaps the hearing threshold was normal but the patient was having trouble understanding what she heard for some unrelated reason. Once the daycare teacher told me to have my daughter’s vision checked because she was having trouble seeing the TV. I asked my daughter about it and she explained that a boy’s head was in the way. :-)

  29. seemstome says:

    “if chiropractic treatment really works the way they say it does, shouldn’t there be the potential for much worse and much more common side effects?”

    The body is very good at protecting itself from that kind of thing. If we turn our head a little too far we don’t usually create a lasting misalignment or injury. The voluntary muscles have strong habits that usually keep joints within a predictable range. A chiropractor’s adjustment would not be forceful enough to traumatize a joint (I assume; I am not an expert on chiropractic).

    I think it’s usually traumas — physical or even emotional — that can pull joints slightly away from their optimal alignment. A chiropractic adjustment tries to jolt them back. Of course, the strong habits of the voluntary muscles will try to undo the adjustment (which is why, I think, chiropractic can be ineffective).

    I do believe it’s possible that subtle misalignments can interfere with health in ways not acknowledged by mainstream medicine. There probably has not been much controlled research on this, either for or against.

    There is an enormous amount of anecdotal and clinical evidence, though, from people who practice various kinds of body work and physical therapy, or have experience with the type of stretching exercises included in hatha yoga.

  30. nobs says:

    Harriet replies:

    “One of them just referred to the patient’s report of “hearing difficulty” – whatever that is! ”

    Exactly Harriet!! The Author describes “hearing difficulties” yet……. you appear to be including it in your personal version/ critique/editorial of “DEAFNESS” ???? Do you consider them equivalent? Is ALL deafness of one eitiology?

    HMMM? Please elaborate on this.

    AGAIN: Please provide your definition(and a link to the definition you are using) of “DEAFNESS” as it pertains to your editorial.

  31. Scott says:

    Ah, nobs, you might want to reread the post. HARRIET isn’t saying that “hearing difficulties” should be included in “deafness.” http://www.chiro.org is, by including that study in their list supporting the effectiveness of chiropractic for “deafness.”

  32. OZDigger says:

    Harriet,

    from a bio-ethical point of view of Beneficence, nonmalficience, patient advocacy and social justice, this article is very poorly written. You expounded these view recently, yet you do not have the integrity to follow your own writings.
    You do not reference your quotes properly. You have taken an attitude of strong paternalism and take no cognizance of the intent of the authors of the articles you criticize. Thus, your article is, nonsense.

  33. Harriet Hall says:

    OZDigger,
    My article is not nonsense, but your comment is.

  34. weing says:

    “There is an enormous amount of anecdotal and clinical evidence, though, from people who practice various kinds of body work and physical therapy, or have experience with the type of stretching exercises included in hatha yoga.”

    There is an enormous amount anecdotal evidence supporting the existence of Santa Claus and the Tooth Fairy from children that have experienced tangible effects from them. That is not science.

  35. Joe says:

    @nobs on 12 Aug 2009 at 1:02 pm: This is really simple- refer to the 6 items that HH cites and you will see what is meant, to the extent that those authors know. I have to think of everything myself …

    OZDigger on 13 Aug 2009 at 3:46 am: You use the word “integrity”, I don’t think that word means what you think it means.

    You do not reference your quotes properly.

    Did you notice the blue text (called a “hot link”) in the body of the post? If you use your mouse (do you know what that is?) to move that arrow-shaped thingy (cursor) over it and then click the mouse- it takes you to proper references.

    You have taken … no cognizance of the intent of the authors of the articles you criticize.

    Please, I beg you, make us cognizant. Display your beneficence.

  36. Joe says:

    @weing on 13 Aug 2009 at 11:18 am,

    Last weekend, there was a news item from Bangladesh concerning the government’s plans to fix the problem of high mortality from (toxic) snake-bites. It seems that 95% of victims are taken to traditional healers, and most of them die. The anecdotes from that have to be overwhelmingly negative. Yet, people continue to believe because the healers claim some success. Disabusing belief in quackery is nearly impossible when most of the anecdotes (in developed nations) concern the “worried well” and people with self-limiting conditions.

    There are some people who can learn, though. My brother’s friend told me he (the friend) had an appointment to see a chiro, as he had done in the past, for a sore neck. I explained how that could result in serious death. He looked shocked, then he went to a doctor and had the problem diagnosed and treated.

  37. Scott says:

    It seems that 95% of victims are taken to traditional healers, and most of them die. The anecdotes from that have to be overwhelmingly negative.

    Not necessarily true. The 95% who died aren’t talking, so the only victims telling anecdotes are the ones who survived. The relatives of the 95% may be talking too, but people often discount second-hand information in favor of first-hand.

    The selection effect of “dead men tell no tales” is a very interesting one.

  38. nwtk2007 says:

    Joe – “There are some people who can learn, though. My brother’s friend told me he (the friend) had an appointment to see a chiro, as he had done in the past, for a sore neck. I explained how that could result in serious death.”

    Get real Joe. Serious death? You did get a chuckle out me on that one.

    And Joe, did you see on the Today Show this morning (it might have been one of the other major network morning shows) where their medical expert was explaining how 40% of strokes are misdiagnosed by medical doctors. The truly funny part was that their medical expert blamed this on the patient. They were promoting a book for patients on how not to be misdiagnosed.

    The entire idea is “utter fail” and and simply reinforces the fact that medical mistakes continue to destroy life at an alarming rate. I wonder Joe, did you advise your brother’s friend about that aspect of medicine when you suggested he go to the MD instead of the chiro to avoid “serious death”?

    I also agree that the article above lacks merit. I would say that it is about 20% analysis and 80% bias. And Joe, did you even read any of the cited articles? I seriously doubt it.

  39. Harriet Hall says:

    nwtk2007,

    The subject is the claim that deafness is one of the “conditions that respond well to chiropractic.” Don’t change the subject.

    Which 80% is bias and why?
    Do you think those 6 studies constitute acceptable evidence?
    Do you believe neck manipulation can restore hearing? If so, why?

  40. Calli Arcale says:

    seemstome:

    “if chiropractic treatment really works the way they say it does, shouldn’t there be the potential for much worse and much more common side effects?”

    The body is very good at protecting itself from that kind of thing. If we turn our head a little too far we don’t usually create a lasting misalignment or injury. The voluntary muscles have strong habits that usually keep joints within a predictable range. A chiropractor’s adjustment would not be forceful enough to traumatize a joint (I assume; I am not an expert on chiropractic).

    I’m not talking about causing trauma here. (And note that the rare deaths associated with chiropractic have not involved trauma to the joints, but rather to blood vessels in the vicinity — collateral damage, essentially, and easily prevented if a chiropractor is willing to pay attention to the evidence. Fortunately, some chiropractors aren’t so dismissive of the fragility of the arteries in the neck, and have indeed modified their practice.)

    I think it’s usually traumas — physical or even emotional — that can pull joints slightly away from their optimal alignment. A chiropractic adjustment tries to jolt them back. Of course, the strong habits of the voluntary muscles will try to undo the adjustment (which is why, I think, chiropractic can be ineffective).

    I do believe it’s possible that subtle misalignments can interfere with health in ways not acknowledged by mainstream medicine. There probably has not been much controlled research on this, either for or against.

    If subtle misalignments can interfere with health, why is it implausible to you that a chiropractor could inadvertently cause a problem? If the body is so good at correcting problems that a gentle shove from a chiropractor cannot possibly screw anything up, why is a chiropractor needed at all?

    I stand by my statement that if chiropractic really works as advertised, then it should have negative side effects. If you can cure deafness with chiropractic, surely you can induce it by performing chiropractic maneuvers incorrectly.

    As far as the “enormous” amount of anecdotal and clinicial evidence, I remind you again that there is at least as much evidence to support bloodletting. Also trepanation, which some people do practice today, and not just to relieve intracranial pressure after a concussion. Would you think it sensible to rely on this testimony alone and go drill a hole in your head?

  41. Joe says:

    @Scott on 13 Aug 2009 at 12:07 pm “Not necessarily true. The 95% who died aren’t talking, …” You are disorganized, try reading/understanding it again. I cannot fathom your confusion. What point, that traditional healers are ineffective, don’t you understand?

    @nwtk2007 on 13 Aug 2009 at 12:14 pm “And Joe, did you see on the Today Show this morning …” No, unlike you chiropractors I don’t get medical information from TV.

    I would say that it is about 20% analysis and 80% bias.”Great, provide us with your scholarly analysis, please.

  42. Joe says:

    I will try again

    I would say that it is about 20% analysis and 80% bias.

    Great, provide us with your scholarly analysis, please.

  43. Scott says:

    @Scott on 13 Aug 2009 at 12:07 pm “Not necessarily true. The 95% who died aren’t talking, …” You are disorganized, try reading/understanding it again. I cannot fathom your confusion. What point, that traditional healers are ineffective, don’t you understand?

    Take a closer look at what I quoted of your post. My point was that it’s not necessarily true that “The anecdotes from that have to be overwhelmingly negative.” The anecdotes could STILL be positive even though it doesn’t work!

  44. Harriet Hall says:

    Re snakebite – only something like half of snake bites involve envenomation. There will always be “cures” of those who wouldn’t have died anyway.
    I have a video about Guru-busters in India, where a traditional healer confidently treats a dog for snakebite and the dog dies miserably in front of a huge village audience. The audience seemed impressed when his treatment didn’t work, but I’d be willing to bet the healer told himself “Well, it usually works” and just moved on to another village.

  45. Todd W. says:

    @Calli Arcale

    Great point. I hadn’t really thought about the idea before that a minor misstep by a chiropractor should, if chiropractic works like they say it works, lead to the inducing of an adverse condition. Makes sense that if a misalignment in a certain way can cause deafness (or cholic or ear infections, etc.) that a chiropractor, if not careful, could put the spine into that same misalignment. This becomes all the more pertinent when they claim that a misalignment of less than a millimeter is enough to cause an illness or condition.

    Oh, and seemstome, before arguing further, try finding something actually substantial to back up your arguments, instead of being all wishy-washy with “anecdote this” and “I assume that”. For example, you claim that:

    the strong habits of the voluntary muscles will try to undo the adjustment (which is why, I think, chiropractic can be ineffective).

    Give us some citations that back up this claim (let alone the others you argue in your chiro apologetics).

  46. Joe says:

    Quoting myself: Joe on 13 Aug 2009 at 11:58 am “Last weekend, there was a news item from Bangladesh concerning the government’s plans to fix the problem of high mortality from (toxic) snake-bites. It seems that 95% of victims are taken to traditional healers, and most of them die.” [bold added]

    Scott on 13 Aug 2009 at 12:07 pm “The 95% who died aren’t talking, so the only victims telling anecdotes are the ones who survived.”

    I see your confusion, you think that only survivors have stories to tell. My bad- the traditional healers and the witnesses to the deaths have overwhelmingly negative stories to tell.

  47. nwtk2007 says:

    Both sides of this argument are goofy.

    Manipulation doesn’t cure deafness but might have an effect on hearing loss related to clearing the middle ear cavity of fluid. If manipulation does anything more then it is only theoretical and not clearly proven and, as has been pointed out, not clearly plausible. And I can give only anecdotal evidence of even this effect clearing out the middle ear cavity. Doesn’t mean it doesn’t happen and certainly doesn’t mean I haven’t seen it. Those pro SBM commenters here seem to think that even if they see something with their own eyes that they can’t believe it if there are no double blinded officially published studies to prove that what they saw actually happened. I don’t do chiropractic research and I don’t treat blood pressure or deafness, but I can attest to what I have seen indirectly while treating patients with neck injuries.

    And this idea of “subluxation” being a misalignment or manipulation restoring alignment is also a bit silly. The restoration of motion of fixated joints is the most plausible explanation of the effects seen in manipulation, although the NUCCA’s are pretty clearly dealing with misssalignments but I would venture to say that their decision to manipulate is not based entirely on alignment.

    You want my scholarly analysis Joe? When you actually start reading studies and articles cited by others who might, or might not, oppose your position, then you can have it.

  48. Joe says:

    @nwtk2007 on 13 Aug 2009 at 6:06 pm “Manipulation doesn’t cure deafness but might have an effect on hearing loss …” Where’s the beef?

    I can give only anecdotal evidence …

    As usual, and you probably still think it is “evidence.”

    If manipulation does anything more then it is only theoretical …

    You use that word “theoretical” but I don’t think that word means what you think it means.

    When you actually start reading studies …

    All you have to do is cite studies in the medical literature, not the chiro’s “Weekly Reader” (that was something we got in grade-school in the 1950s). The problem with the “literature” you cite is that it is published by and for, and “peer reviewed,” by people who are incompetent. Sorry if that hurts your feelings; but I have read enough to know I don’t need to read any more. Why is it so hard for you to find legit literature? … Wait, I know why … there is none on quackery.

  49. nwtk2007 says:

    Your bend on merely being insulting is boring and is, in fact, your undoing. Extreme bias simply cannot ever be objective and thus your comments and insults fall on “deaf” ears. In other words you could never in your wildest dreams hurt my feelings. It is pathetic to even imply that you could.

    Do you simply lack the scientific knowledge to speculate or even hypothosize about anatomic relationships or even be able to distinguish between the simple idea of position versus mobility?

    You remind me of other range mouthed individuals on other forums who seem to have the sole objective of shutting down chiropractic, thus fostering the idea that they are themselves failed chiropractors who now try to buddy up and enlist with the “other side” as you see it.

    Sorry if that hurts your feelings.

  50. pope111 says:

    I’m getting in alittle late on this one but i thought i would just offer an opion as someone who diagnoses hearing loss every day.

    The idea that Chiropracty can treat hearing loss (of any kind) has very low plausibility. The idea that Chiro can treat sensorineural hearing loss (nerve deafness) lacks plausability entirely.

    But it gets worse, it is indeed dangerous from my point of view in that patients recieving chiro treatment for hearing loss are often delaying getting proper diagnosis and/or treatment.

    Two examples from my own experience

    1) I diagnosed an infant with a very significant hearing loss (cochlear or nerve deafness), the parents refused conventional treatment (hearing aids and/or cochlear implant) and took him to thier chiro who performed neck re-alignments on the baby and pronounced that his hearing had been restored. Now the parents are think thier child is hearing well and does not need help. Not only will he not be able to hear but this also means he will likely not speak and learn (unless of course we can convince the parents otherwise).

    2) Patient was seeing their Chiro with complaints of imbalance (dizzyness), hearing loss in the Left ear and tinnitus. The Chiro was treating her for some time and she had apparently convinced herself that did feel better after an adjustment,despite this the condition slowly got worse. By the time she saw her doctor and was sent to an ear nose and throat specialist and for CT/MRI she was in a fairly bad way and was found to have a very large cerebello-pontine angle tumour. I beleive becuase of the size of the tumour the hearing nerve could not be spared and she lost the hearing in that ear post surgery.

    … having read the chiropractors articles it is clear that they lack both a basic understanding of hearing and hearing disorders and a basic understanding of science and the scientific method.

  51. nwtk2007 says:

    I agree with you that chiro’s should not be taking on hearing loss as something they can treat. But your last comment is lacking in credibility:

    pope111 – “having read the chiropractors articles it is clear that they lack both a basic understanding of hearing and hearing disorders and a basic understanding of science and the scientific method.”

    I heard yesterday a medical expert and another doctor state that medical doctors fail to diagnose 40% of strokes in progress. Based upon your blanket statement about chiro’s and these two anecdotal tales, are all medical doctors obviously then, not qualified to diagnose and treat stroke?

  52. Joe says:

    @nwtk2007 on 11 Aug 2009 at 5:13 pm “… Anecdotally, I have had a good number of patients who reported the “opening” of their head or ears after cervical manipulation for neck injury. …

    It seems perfectly plausible that cervical manipulation can effect the deep muscles of the pharyngeal areas of the neck which, one in particular, is attached to the tissues adjacent to the Eustachian tube. …”

    nwtk2007on 14 Aug 2009 at 7:10 am “I agree with you that chiro’s should not be taking on hearing loss as something they can treat.”

    Are we to understand that you don’t trust your own anecdotes and rationalizations?

  53. nwtk2007 says:

    Joe, I truly don’t think you can read objectively nor understand what you read because you are so utterly blinded by your bias.

    You’ll have to forgive me for not responding to your total lack of understanding of what I have said.

  54. pope111 says:

    nwtk2007 -But your last comment is lacking in credibility

    Not at all, read the papers, they are terrible, i mean, really poor.

    -almost all the authors fail to make even the most basic of efforts to discuss what type of hearing loss they are trying/claiming to treat.

    -the authors fail to recognise that many conductive hearing losses (and some sensorineural ones) spontaneously recover and include no control groups to account for this.

    -they generally use inapproprite and insufficient tests to quantify and classify hearing loss.

    - i could go on….

    If a doctor published a study claiming that they could treat strokes with some new drug or procedure

    -without apprpritely assessing whther the patient had actually had a stroke

    -failed to address what type of stroke they were claiming to treat

    -failed to include a control group whom had a sham treatment or control condition.

    Then this would be an adequate analogy for what Chiro’s are claiming /doing and in this case i would roundly critisise these doctors.

    I think you will find that when scientists and doctors make claims based on case studies or preliminary studies, for the efficacy of a treatment they are usually very cautious and suggest that BEFORE these treatments are adopted an adequate controlled study needs to be performed. When they do not follow these type of guidlines skeptics will be just as quick to quack in thier general direction.

  55. Scott says:

    I see your confusion, you think that only survivors have stories to tell. My bad- the traditional healers and the witnesses to the deaths have overwhelmingly negative stories to tell.

    Yeah, obviously that’s what I think:

    The relatives of the 95% may be talking too, but people often discount second-hand information in favor of first-hand.

    Way to read the post before blasting it.

  56. nobs says:

    Joe posts:

    “All you have to do is cite studies in the medical literature, not the chiro’s “Weekly Reader” (that was something we got in grade-school in the 1950s).
    The problem with the “literature” you cite is that it is published by and for, and “peer reviewed,” by people who are incompetent. Sorry if that hurts your feelings;…..”<<

    Really?…..Actually Joe, if you had looked beyond Harriet's "boiled down"/abstract review/editorial, you would find, contrary to your assertion, all the studies to be published in PubMed listed peer-reviewed journals. Sorry if that hurts YOUR feelings.

    Joe continues with:
    "…. but I have read enough to know I don’t need to read any more. Why is it so hard for you to find legit literature? … Wait, I know why … there is none on quackery."

    Really Joe?—— It does not appear that you have read any of the text of the studies at all! AND,…. additionally, are not interested in an objective exchange of the data. Instead you choose to cling to a biased, un-supported, tabloid-esque editorial to bolster your pre-conceived bias. But hey,…….., you are entitled to your bias/dogma. Just do not call it anything else. Sorry if YOUR feelings get hurt when it gets de-constructed.

  57. nwtk2007 says:

    pope111, you might actually be correct, but Joe didn’t read them and that is for sure, thus his comment is “lacking is credibility”.

  58. Harriet Hall says:

    nwtk2007, Could you manage to stop insulting other commenters long enough to answer the questions I asked?

    “Which 80% of my analysis is bias and why?
    Do you think those 6 studies constitute acceptable evidence?”

  59. Joe says:

    nwtk2007 on 14 Aug 2009 at 11:19 am

    pope111, you might actually be correct, but Joe didn’t read them and that is for sure, thus his comment is “lacking is credibility”.

    nobs on 14 Aug 2009 at 11:11 am

    JMPT and Chiro & Osteo are not medical literature. The cluelescenti in Congress forced them to be indexed in PubMed, not medical professionals. Congress is no better-informed on health than chiropractors.

  60. nobs says:

    Joe posts:

    >>”JMPT and Chiro & Osteo are not medical literature. The cluelescenti in Congress forced them to be indexed in PubMed, not medical professionals. “<<

    Oh really? Please provide your cites to support this ahem…objective…. declaration.

    Thank-you in advance

  61. Harry says:

    @ # nwtk2007on 11 Aug 2009 at 5:13 pm

    It seems perfectly plausible that cervical manipulation can effect the deep muscles of the pharyngeal areas of the neck which, one in particular, is attached to the tissues adjacent to the Eustachian tube. The blockage of this tube which runs from the middle ear to the oropharynx helps to equalize pressure between the middle ear cavity and the atmosphere. Anyone who has done any diving can attest to the effects of a blocked Eustachian tube when there is a significant pressure difference.

    I’m having trouble understanding the anatomical plausability that manipulation of the cervical region will effect the Pharyngotympanic Tube (Eustachian tube). I’m quoting here from my anatomy text book:

    The [pharyngotympanic tube] is opened by the expanding girth of the belly of the levator veli palatini as it contracts longitudinally, pushing against on wall while the tensor veli palatini pulls on the other. Because these are muscles of the soft balate, equalizing pressure (“popping the eardrums”) is commonly associated with activities such as yawning and swallowing.

    Tensor veli palatini- Superior attachment: “Scaphoid fossa of medial pterygoid plate, spine of sphenoid bone, and cartilage of pharyngotympanic tube.” Inferior Attachment: “Palatine aponeurosis.” Innervation: “Medial pterygoid nerve (a branch of mandibular nerve, CN V3) via otic ganglion.

    Levator Veli Palatini- Superior Attachment: “Cartilage of pharyngotympanic tube and petrious part of temporal bone.” Inferior Attachment: “Palatine aponeurosis” Innervation: “Pharyngeal branch of the vagus nerve (CN X) via pharyngeal plexus.

    The most plausible muscles that would affect the pharyngotympanic tube and thus the ability to hear would be either the Tensor veli palatini or the Levator Veli Palatini.

    There are two other muscles that are associated with the pharyngotympanic tube, Salphngopharyngeus and Tensor tympani

    Salphngopharyngeus- Origin; Cartilaginous part of pharyngotympanic tube. Insertion; Blends with palatopharyngeus. Innervation; Pharyngeal branch of vagus (CN X) and pharyngeal plexus. Main Action; Elecate (shorten and widen) pharynx and larynx during swallowing and speaking.

    Tensor tympani- is a short muscle that arises from the superior surface of the cartilaginous part of the pharyngotympanic tube, the greater wing of the sphenoid, and the petrious part of the temporal bone. The muscle inserts into the handle of the malleus. The tensor tympani pulls the handle medially, tensing the tympanic membrane and reducing the amplitude of its oscillations. This action tends to prevent damage to the internal ear when one is exposed to loud sounds. The tensor tympani is supplied by the mandibular nerve (CN V3)

    The a dysfunctional Salphngopharyngeus just doesn’t ‘work’ for causing hearing problems.

    A dysfunctional Tensor tympani could plausibly cause hearing problems but the mandibular nerve goes no where near where a misplaced vertebra could affect it.

    Could you please explain how hearing it seems perfectly plausible that cervical manipulation can effect… [hearing]?

    -Harry

  62. Harry says:

    Please excuse my numerous typo’s. Med school fries the brain.

    The text I used was Moore and Dalley’s Clinically Oriented Anatomy. 5th ed.

  63. nwtk2007 says:

    OK Harriett, I just go with the first one:

    1. This woman’s deafness was part of her Meniere’s disease and was presumably not related in any way to her auto accident or her neck symptoms.

    Not analysis. That point was made. The point was that the hearing loss decreased with treatment of the neck pain.

    2. The association of reported increases in neck pain with exacerbation of Meniere’s symptoms could be due to the fact that people in pain and people who are in a depressed mood are more likely to report other physical symptoms.

    Not analysis. I saw nothing about depression or being depressed.

    3. Reduction in symptoms after adjustment is compatible with nonspecific effects of any treatment, with placebo response, or with the natural course of illness.

    Not analysis. But are you suggesting that decrease in hearing loss is a non-specific effect of manipulation?

    4. Fluctuating hearing loss is one of the characteristics of Meniere’s disease.

    No argument here but not analysis.

    5. The Pettibon system is an upper cervical method that is not supported by any credible evidence.

    Not analysis. This is your bias coming through. There are some who believe there is credible evidence for the Pettibon’s benefit.

    6. The finding of “angular displacements of upper cervical vertebrae” is an upper chiropractic delusion: actual displacements have not been confirmed by conventional radiologists. “Improved cervical alignment” cannot be scientifically demonstrated.

    There are a good many NUCCA’s out there who would disagree with your here and are able to demonstrate the displacements of which you speak. Conventional radiologists don’t even begin to get that quantitative about measurements made on film. I understand there are a great many factors in radiological measurements, but it is precision, not accuracy that is important in these measurements. This is also not analysis.

    I might have been wrong. It could be only 10% analysis.

    As to insulting Joe or yourself, I am sorry. Joe was asking for it and I will rephrase my statement about your article. Since it is so filled with bias and not analysis, I feel that it is an inconsequential and simply an attempt to jab at chiropractic by offering a platform for others to make blanket statements about chiropractic.

    Off the subject Harriett, do you also feel it is the patients fault that 40% of all strokes in progress are misdiagnosed by medical doctors as was stated by two medical experts on the boob tube yesterday?

    I personally don’t feel it is the patient’s fault that they might ever be misdiagnosed although many of their nature’s make them contributory to the misdiagnosis. It should not be an excuse however.

  64. nwtk2007 says:

    Sorry Harry, I couldn’t give you a mechanism. Maybe one of the NUCCA’s could or a good neurologist. I would speculate that it is related to some sort of proprioceptive afferentation effect that restores some sort of resting state or homeostatic state in which the auditory tube is opened briefly and then returns to it’s normal position. I have had a great many patients report this “opening” of their head and a clearing of their ears after cervical manipulation while treating their neck injuries but I have never had one report the “barrel” efect which occurs when the auditory tube remains in an open position.

    I say speculate because I don’t know if that would be testable as a hypothesis.

  65. Harriet Hall says:

    nwtk2007,
    I showed why those 6 articles did not support the claim, I speculated about other possible reasons for their observations, and I commented on other chiropractic claims that are not supported by the evidence. Samuel Homola, DC has written about NUCCA from the perspective of a chiropractor who “gets” science-based medicine, and he explained “The Problem with Chiropractic NUCCA” here: http://www.sciencebasedmedicine.org/?p=606
    If you think you have evidence for NUCCA, please present it to Dr. Homola in the comments to that articles.

    Is this bias? Would it be bias against the Tooth Fairy to suggest that she might not be real and that parents might be leaving the money? Is it bias to only accept evidence-based claims?

  66. Harriet Hall says:

    nwtk2007 said,

    “it is precision, not accuracy that is important in these measurements.”

    What on earth do you mean? Something can be measured pecisely and be completely inaccurate: both precision and accuracy are required to establish validity. There is a good explanation at http://en.wikipedia.org/wiki/Accuracy_and_precision

    You could measure the amount of money left by the Tooth Fairy with great precision, but you would not be accurately recording the behavior of the Tooth Fairy, because she is nonexistent.

  67. nwtk2007 says:

    Harriett, your toothfairy comments are falling on deaf ears. Now whos being insulting?

    Just to clarify, when NUCCA doctors do their x-rays and measurments, they are not dealing with absolute measures due to magnification factors associated with x-ray; angle of the beam, distance of the structure to the film, variations in bucky thick nes, etc. But when they repeat their x-rays, being consistent about all of those factors, any changes can be related to previous films because the consistency maintains precision. Absolute measures relate to accuracy, repeatability relates to precision.

    Your wiki reference is appreciated but not needed.

    Dr Homola might be correct, I am not questioning that. I only point out that your article is not analysis of the articles but a biased slant on them, measnt, as I said, to provide a platform for broad based, blanket bashing of chiropractic in general. I showed your article to an ortho I work with and he could see the same thing I saw.

    I guess being “science based” doesn’t rid one of their biases and thus they never become as objective as they would like to think they are.

  68. Harry says:

    @ nwtk2007on 15 Aug 2009 at 12:19 pm

    Just to clarify, when NUCCA doctors do their x-rays and measurments, they are not dealing with absolute measures due to magnification factors associated with x-ray; angle of the beam, distance of the structure to the film, variations in bucky thick nes, etc. But when they repeat their x-rays, being consistent about all of those factors, any changes can be related to previous films because the consistency maintains precision. Absolute measures relate to accuracy, repeatability relates to precision.

    I find this statement very interesting because I am currently learning Osteopathic Manipulation, I am a second year medical student.

    I am curious about the inter-examiner reliability of somatic dysfunction diagnosis. In other words, I think this vertebra is going in a different direction than the others, what about you? We are taught to diagnosis C1, C2 and everything else for that matter by palpation. Why is it that NUCCA Chiros use x-rays and fancy equipment but DOs trained in OMT will just use their hands?

    Have NUCCA Chiros done research to show that diagnosis by palpation is flawed? If so, why do you think that the DOs have not been convinced of the Chiro’s data?

    -Harry

  69. Harriet Hall says:

    nwtk2007,
    Do you think the 6 articles support the claims? Do you think I was wrong to reject them? Please favor us with your own “unbiased” analysis.

  70. nwtk2007 says:

    Harry,

    Inter-examiner reliability is a problem in all areas of medicine, not just somatic dysfunction, where doctors are going by touch to identify a particular biomechanical lesion such an alignment or fixation.

    For example, in medical science dealing with diagnosis of any particular condition based upon symptomatology, the variability is very much evident. As I had pointed out earlier this week, a doctor on TV and another who is apparently a doctor and also the medical expert for the station, were discussing the misdiagnosis of stroke in progress. According to them, 40% of strokes in progress are misdiagnosed by the medical practitioner. I would say that means there is 40% loss of inter-examiner reliability. They also looked at 5 other conditions.

    As to why NUCCA’s use X-ray for their examination, I would have to refer you to a NUCCA doctor. I am not one.

    Even in imaging, such as with MRI and CT there is a huge descrepancy in inter-examiner reliability. I have a patient with an obvious disc lesion and radiculopathy based upon examination. The first MRI report said no disc lesion, bulge, HNP or otherwise. I got the films and to me it was clear there was at least a bulge at L5-S1. I had the radiologist take another look and he stood by his report of no bulge or HNP. This patient has begun to show signs of a possible cauda equina syndrome and as it was Friday, I had him go to the ER. They did an MRI and their radiologist saw an HNP at L5-S1 and at L4-L5. This is an ongoing type of event in orthopedics and is such that an ortho I work with has told me that he will always go by his examination if there is a discrepancy with the imaging.

    I find it baffling to say the least. I know there are different quality MRI and CT, but even with the same films being examined there is a lot of difference in what the examiners claims to see.

    Why is that? Don’t really know for sure. Could be bias! One guy thinks a 2mm bulge is insignificant and won’t report it and another knows from clinical experience that it is and thus, reports it. This I have seen, but other examples are beyond explanation.

  71. Harry says:

    @ # nwtk2007on 15 Aug 2009 at 2:55 pm

    Inter-examiner reliability is a problem in all areas of medicine, not just somatic dysfunction, where doctors are going by touch to identify a particular biomechanical lesion such an alignment or fixation.

    Of course different areas of medicine are going to have issues with inter-examiner reliability. But I wasn’t asking about other areas of medicine, I am talking about diagnosing somatic dysfunction, or vertebral subluxations and the reliability of diagnosis by palpation.

    Specifically I’m wondering why two different fields which use manipulation have different methods of diagnosing. I am interested in particular because both forms of manipulation have questionable research and is seen by the scientific majority as psuedoscience. It’s like disagreeing over the protocols used by the toothfairy, without addressing whether or not the tooth fairy actually exists. Osteopathy in the Cranial Field and CranialSacral Manipulation are the most obvious offenders but even the strongest claims for manipulative treatment, lower back pain, is still questionable.

    -Harry

  72. nwtk2007 says:

    One part of the point I was making with regards to other areas is that it inter-examiner reliability is lacking in all areas of science and medicine and should not be used as evidence for Woo or pseudo science or quackery.

    As to what you are referring to with regard to osteopathy and chiropractic, I really don’t think they are that dissimilar. I also think lack of evidence is not a true statement. There is evidence, but is it dismissed by most of the medical community or that portion of the community that doesn’t do manipulation. Also, it is next to impossible to do sham manipulations and thus there is not going to be much in the way of double blinded studies. There is old research in the old journals but no one ever goes back that far. It simply is not available on line and thus never looked at. No one goes to the library anymore, including me.

    Additionally, the idea of finding “subluxations” is a part of chiropractic that I am not involved in and thus cannot comment on it except to say that I don’t think that”misalignments” are the cuplrit elleminated in manipulative therapies. I think the true relief from manipulation comes form restoration of motion of fixated or partially fixated segments of the spine.

    I’ll give you a simple example: knee sprains, internal derangements, etc. Strengthening of the medial portion of the quads can eliminate all symptoms in a good deal of these cases. Thus restoration of “normal” motion to the knee reduces pain and the subsequent knee problem. It’s a biomechanical issue, especially where there are meniscal tears. Many orthopedical surgeons will not even do a knee consult and evaluation unless there is documentation of quad strengthening prior to the consultation and exam by the surgeon.

    Take that to the arena of spinal joints and facet segments, and it is a matter of feeling for altered or reduced motion in those segments. It is very difficult to do and thus the inter-examiner variability. Most of us aren’t good enough to be able to consistently identify single segments of fixation, thus there is a kind of broad based approach to manipulation. The end result is the same, restoration of motion and usually decreased pain. Not realignment.

    Beyond that, I’ll let the NUCCA’s speak for them selves.

  73. nwtk2007 says:

    Restoration of motion also explains why the manipulation cannot induce negative effects as has been implied.

  74. pmoran says:

    nwtk: “One part of the point I was making with regards to other areas is that it inter-examiner reliability is lacking in all areas of science and medicine —- ”

    Please name a few. I personally can think of very few examples where that might be so within medicine, and typically these are subject to similar disputes as to the reality of the condition being diagnosed and treated. None are used as the basis of a whole competing system of medicine.

    nwtk: ” —- and should not be used as evidence for Woo or pseudo science or quackery.”

    Why not?? The inability to demonstrate it completely undermines a core claim, one that HAS to be true.

  75. Harriet Hall says:

    nwtk2007 said,

    “There is evidence, but is it dismissed by most of the medical community”

    Show us some of that evidence. Otherwise, I can only assume it was dismissed by most of the medical community because it was inadequate, like the 6 studies above.

  76. nwtk2007 says:

    pmoran, I did name a few. I gave a specific example. Anything which is misdiagnosed 40% of the time is inter-examiner reliability problems.

    Did you even read the whole comment?

  77. pmoran says:

    pmoran, I did name a few. I gave a specific example. Anything which is misdiagnosed 40% of the time is inter-examiner reliability problems.

    Doctors failing to diagnose a stroke in progress? That is an example of either poor competence or subtle and confusing clinical features. The underlying condition is real.

  78. daedalus2u says:

    nwtk2007, could you find a link that is the basis of your statement that 40% of strokes are missed by MDs?

  79. nwtk2007 says:

    Don’t have one. Like said above, I heard it on one of the morning shows this week. Two doctors, one apparently the medical expert for the show, were discussing a new book on How to Avoid Being Mis-diagnosed. That might not be the actual title.

    I found it humorous in that they were saying the blame for the mis-diagnoses was the patient’s.

    Sorry. No link. No reference. No nothing. No double blinded study. Totally anecdotal. Just something I heard. No way it could be true.

  80. weing says:

    Sounds like someone trying to sell a book. I’m sure it happens. I remember a couple of times making rounds on my patients and noting they had stroked out during the night. Nobody could tell me when. I always thought it was the nurses that missed a change in the patient’s condition.

  81. Diane Jacobs says:

    Here is a little Montreal Gazette piece about chiropractic “science.”

    http://www.montrealgazette.com/health/Faith%20Sweet%20Science%20Double%20Blind/1898590/story.html

    Diane Jacobs

Comments are closed.