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Chiropractic Neurology

Chiropractic is a diverse collection of beliefs and practices occurring under a broad regulatory label. The differences among various chiropractics are so stark that it is difficult to make general statements about chiropractic practice. At one end of the spectrum, however, are so-called “straight” chiropractors who adhere to the original philosophy of D.D. Palmer – that a vital force they call innate intelligence is response for health, and blockages in the flow of this magical force through the nerves are what cause illness. Such chiropractors believe they can influence non-neuromuscular conditions by restoring the flow of innate blocked by mysterious “subluxations” in the spine.

From chiropractors.org we have this definition of “straight” chiropractors:

Because straight chiropractors believe that nearly all diseases are caused by issues with the spine, they don’t believe they need any diagnostic tools. Traditional testing done by medical doctors and hospitals is not even considered by a straight chiropractor as being necessary. Diagnosis is done by finding the subluxations in the spine so that those can be corrected.

This particular version of chiropractic (by some estimates about a third of chiropractors follow this philosophy) is pure pseudoscience. It is, as indicated by the quote above, hostile to science-based medicine.  After a century of such belief there isn’t a bit of evidence to support the notion of innate intelligence, chiropractic subluxations, or health benefits from this approach.

Some straight chiropractors even “specialize” – one specialty, chiropractic neurology, has been getting some press because hockey star Sidney Crosby has been going to a chiropractic neurologist, Ted Carrick, to treat his concussion. The main idea behind chiropractic neurology is the same as for straight chiropractic in general, just applied to neurological disorders.

Carrick claims that he can treat a variety of brain disorders with targeted manipulation and elaborate exercises and routines. In a PBS interview he said:

Well, we’re finding every day that more and more things that we didn’t think were associated with chiropractic treatment can be affected very nicely. There are testimonials from people who have had their eyesight and hearing back, and people waking up from comas.

Waking a patient from a coma is perhaps the ultimate rehabilitative claim in neurology. You will notice, of course, that Carrick refers to only “testimonials”. The reason for that is because there are no published articles establishing such bold claims. Chiropractic neurology does not appear to be based on any body of research, or any accumulated scientific knowledge. I am not aware of any research that establishes their core claims. A search on PubMed for “Carrick T” yielded nothing, and searching on “chiropractic neurology” yielded mostly studies about neurological complications from chiropractic treatment. There was one letter from the President of the International Academy of Chiropractic Neurology.

I followed that link to the IACN website, but found no references or links to any published studies establishing the scientific basis of chiropractic neurology. There was no science at all. I also noted that the IACN mission statement does not make any mention of promoting  scientific research or science-based standards. Here it is:

The mission of the IACN is to provide an outlet for expression and communication of professional opinions for the benefit and enhancement of the neurological sciences as they relate to the chiropractic profession for the best service to humankind. Further, the IACN promotes the proper use of principles and techniques in the field of chiropractic neurology and support those principles, policies and practices that seek the attainment of the highest order of excellence in neurologic skills directed at patient care by doctors of chiropractic.

The IACN serves to promote the highest standards of moral and ethical conduct amongst chiropractic neurologists.

The wording is interesting – they talk about opinions, principles, and practices. They refer to the “enhancement of the neurological sciences” but it is not clear what that means.

Chiropractic neurology appears to me to be the very definition of pseudoscience – it has all the trappings of a legitimate profession, with a complex set of beliefs and practices, but there is no underlying scientific basis for any of it.

It should be noted that neurological symptoms are often especially vulnerable to placebo effects.  Many symptoms, like vertigo, or “fogginess” are highly subjective. There is also a well-established “cheerleader” effect – if you take anyone with chronic neurological symptoms (such as chronic deficits from a stroke) and then give them any intervention, they will perform better. Just getting patients off the couch and moving will have some effect. Careful research is necessary to separate the specific effects of an intervention from the non-specific effects of  motivation, mood, activity, and also just time. The brain can heal itself to some degree, and after an injury there can be an improvement for even years afterward.

Some symptoms are also susceptible to conditioning. Vertigo is perhaps the best example of this. At present the most effective treatment for chronic vertigo (a subjective sense of movement, such as spinning) is vestibular therapy – physical therapy designed to condition the patient to the symptoms, to diminish them over time. It is therefore possible that some chiropractic neurology interventions are simply providing this known mechanism. For example, here is a description of Carrick’s treatment of Hockey player, Crosby:

Carrick then signals to restart the gyroscope—with one difference. This time Crosby will be turned upside-down while he is also spun around. He hasn’t experienced this dual action yet. The door clangs shut. Above it, a stack of red, yellow and green lights shines while 10 high-pitched beeps signal the gyroscope is about to start. Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding! Ding!

This is a very dramatic treatment, sure to impress the naive. It follows a common philosophy in dubious neurological treatments – the notion that you can “rebuild the brain” by stimulating it. While it is true that activity and simulation are better than no activity and stimulation, it does not follow that simply increasing stimulation will increase the brain’s plasticity or recovery (a simplistic more-is-better philosophy). That basic notion was researched and discarded decades ago, for example with specific reference to psychomotor patterning treatments.

Chiropractic neurology is an excellent example of exactly why we need science-based practices. Without a grounding in objective evidence there does not appear to be any limit to the degree that beliefs systems can be led astray. Any treatment can deceptively seem to work, and humans are very good at backfilling in justifications and explanations for phenomena that do not even exist. Left to our own devices we will tend to develop elaborate, but entirely fictitious, belief systems.

We figured our centuries ago, however, that systematic methods of controlling variables, controlling for bias, and rigorous statistical analysis can compensate for such human foibles. Until chiropractic neurology (and similar practices) avail themselves of such methods there is no reason to take their claims seriously.

Posted in: Chiropractic, Neuroscience/Mental Health

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247 thoughts on “Chiropractic Neurology

  1. Great article as usual, Dr. Novella.

    One thing I’m curious about. How do these “doctors” actually “specialize” in these sorts of fields? I always see them claiming to be “Chiropractic Pediatricians” or “Chiropractic Neurologists”. Is there any sort of regulatory body for these groups (laughable as though that may seem) or do a bunch of them just get together and decide to hang up a shingle and make a specialty? I’ve even seen “Chiropractic Veterinarians” claiming to adjust horses, dogs, and other animals! As far as I’m aware, doing so is illegal in my home state of Ohio, and several other states as well.

  2. AlexisT says:

    Yesterday, I passed an office that had a shingle out for a “chiropractic neurologist”. Very timely. I wondered what the angle was, other than “advanced woo.”

    (I was actually unaware of what happened to Sidney Crosby, despite living in Pennsylvania. Clearly, I am under a rock.)

  3. I’ve often wondered about the angle as well. If the mystical “subluxation” is the cause of all disease, why do you need numerous specialties?

  4. borealys says:

    Thank you for this, Steve. I had a chance to read the Macleans issue with the Crosby story in it. My heart just dropped. Sid is arguably the most likable player in the game, a real national treasure, and I was devastated to learn that he’d pinned his hopes for recovery to such rank nonsense — and horrified to see Canada’s most popular news magazine giving the situation a stamp of approval. (Not that I’ve taken Maclean’s seriously in recent years — as news magazines go, the respect it gets is far out of proportion to the quality of its content.)

  5. Citizen Deux says:

    This is the same “science” under which Robert Melillo has launched his Brain Balance chain of “fraudchises”. He is a student of Carrick’s and claims all sorts of credential which don’t exist. I am all for the pursuit of alternate views and ideas, however, at some point we need to call it a day and recognize what can be supported by science and what can not.

    A treatment which seems to have positive effects with no mechanism of action should be rigorously deconstructed to better understand it and to permit the prolieferation of its positive effects to other possible patients. To claim efficacy based upon false premises, irreproducible results is simply criminal.

  6. DevoutCatalyst says:

    Specialties, you ask why, Chris Repetsky? Amongst other things, maybe so as to snooker NASA out of some advanced subluxation technology and snag an endorsement (sort of) while they’re at it is why,

    http://www.spaceref.com/news/viewpr.html?pid=18731

    A thirst for legitimacy runs deep in every chiropractor’s heart is my guess. Chiropractic Neurology, Chiropractic Astronautics, why the hell not? Eye hath not seen, nor ear heard, neither have entered into the heart of man, the things that Chiropractic will soon do — for duty and humanity.

  7. How horrid. I wonder how much lobbying money was tossed at the Space Foundation to achieve that. Why else would someone like NASA agree to certify something with absolutely zilch in the way of proven clinical value? Maybe my youth has made me too optimistic…

    I often find myself in debates with my peers here at med school. Sadly, I’m the odd man out in terms of woo and pseudoscience. I always advocate for 100% informed consent and the removal of non-scientific healthcare modalities from treatment regimens, yet I meet with opposition when voicing these opinions. It may be a lonely post to occupy, but I’m sticking to my guns, popular opinion or not!

  8. Quill says:

    The mission statement is, indeed, quite interesting. Rather wordy, though. Let me offer some editorial help:

    “The mission of the IACN is to be a propaganda mill for the infiltration of a legitimate medical specialty by quacks. IACN will promote its ideology at the expense of new patients drawn in by pseudoscientific claims. IACN will also make sure everyone in this new fake specialty toes the line and doesn’t give the game up.”

    There. That expresses the meaning and intent without all the high falutin’ words. :-)

  9. cervantes says:

    It’s kind of hard to follow how a subluxation in the spine can be the cause of a concussion when we already know it was caused by a blow to the head, no? I mean, this is beyond implausible, it’s tautologically false.

  10. Scott says:

    The mechanism by which the blow to the head causes the concussion is by the force of the blow transferring down to the neck and producing a subluxation there. Any swelling is then a consequence of the subluxation.

    Isn’t it obvious?

    *remove tongue from cheek*

  11. Quill says:

    @ Scott: Indeed it is obvious! ;-) I recall being given a good lesson in chiropractic cause and effect when I was in grade school, via a song: “The head bone connected to the neck bone….” So of course the force applied to the head transfers down via bone connection to the neck and then to the back producing a subluxation. And equally of course, when the back is adjusted, a healing force is transferred “back” up the same pathway and takes care of the concussion. What could be simpler? And you can verify it all by reading testimonials.

    I don’t know why chiros feel a need for this whole neurology angle. Their methods obviate the need for any other kind of medicine, especially as they fix everything from asthma to zygomycosis. :roll:

  12. pmoran says:

    We figured out centuries ago, however, that systematic methods of controlling variables, controlling for bias, and rigorous statistical analysis can compensate for such human foibles.

    Agreed that the scientific claims are bunkum, even if patients can be helped a little by the non-specific influences you describe.

    However, I disagree with the “centuries ago” in the above. It is somewhat humbling to note how very recently mainstream medical teaching was dominated by the opinions of ancient philosophers and, more latterly, the opinions of the esteemed professors of one’s particular country or city.

    Possibly the first ever mathematical comparison of outcomes (not a RCT) was performed by Pierre Charles Alexandre Louis on the effects of blood-letting on fevers. That was not published until 1835, but bloodletting continued, I believe, until the beginning of the last century.

    The first ever randomized controlled trial was of a serum treatment for diphtheria performed in 1898 (Fibiger J. Om Serumbehandling af Difteri. Hospitalstidende 1898; 6: 309-325, 337-50.)

    “The British Medical Research Council’s trial of streptomycin for pulmonary tuberculosis, published in 1948, has been proposed as the first randomised trial in which random numbers were used and allocation of patients was effectively concealed.” (from “The controlled clinical trial turns 100 years: Fibiger’s trial of serum treatment of diphtheria”. Asbjørn Hróbjartsson, PhD student, Peter C Gøtzsche, director, Christian Gluud, chief physician.© British Medical Journal 1998).

    I suggest that despite occasional more sophisticated studies the medical literature was dominated by personal case series and individual case presentations until shortly after the second world war. I don’t know for sure, but I suspect that penicillin, radiotherapy for cancer and the early chemotherapies and many other commonly drugs entered wide use without the kind of testing we would consider necessary today. (Of course, they did have clear and consistent objective effects in patients able to serve as their own control).

    What’s more, the technology of the clinical trial and how we interpret them is still evolving.

  13. lizditz says:

    But Dr. Novella, you forgot to mention how much post-graduate (that is to say, post DC) training the “chiropractic neurologists” have.

    This (or a variation) appears on the blogs and or webpages

    Dr. X is board certified by the American Chiropractic Neurology Board. Certification is granted to those who complete the 300+ hours of post-graduate training and pass the practical and written board examination.

    300 hours! Imagine that! Isn’t that a big number! Well, except that I invested twice that many hours commuting to work in a single year.

    Emily Willingham recently calculated the number of hours of study to complete a PhD in the sciences. Her estimate? 15,000.

    Going back to the “chiropractic neurolologists” — how do they get those “300 hours”? Well, you can do almost all of it online.

    Whether you are taking a single session, a Certificate series or the whole Diplomate program, these classes will train you in Chiropractic Neurology the right way, and you will appreciate the very important role of the Chiropractic Neurologist every day in your clinical practice.

    Classes may consist of a videotaped lecture, a unique, studio-prepared video presentation, or a videotaped patient case presentation. Online Chiropractic Neurology classes will consist of lecture, video cases and audio-visual presentations. Complete class notes are provided. For the live, practical class, you are encouraged to go to live class locations, at any time, as the Sunday class at every session at every Diplomate location will be a “hands on” session. Additionally you may take a dissection class (module 15) or clinical neurology rotations (module 16).

    Sunday classes? If you elect to do your training live, classes are held Friday, Saturday and Sunday at various hotels convenient to airports and other impressive academic venues.

    And yet the “chiropractic neurologists” claim their training and experience are equal to MDs and DOs:

    Chiropractic Neurology incorporates similar training to medical neurology but differs in it’s application, treatment and therapies.

    I found that wording on 27 chiropractic websites. It also goes along with

    Chiropractic Neurology married the biomechanical and orthopedic aspects of chiropractic care with the latest techniques of assessment and rehabilitation of the central nervous system (brain and spinal cord). The result is a model of diagnosis and care that incorporates all of the patient’s symptoms into once complete treatment plan. This is accomplished via an intimate knowledge of clinical and physiological neurology as well as pathogenic neurology and how the different systems can afferentate (stimulate) the central nervous system and in turn, affect function in any or all of these systems. Chiropractic Neurology married the biomechanical and orthopedic aspects of chiropractic care with the latest techniques of assessment and rehabilitation of the central nervous system (brain and spinal cord). The result is a model of diagnosis and care that incorporates all of the patient’s symptoms into once complete treatment plan. This is accomplished via an intimate knowledge of clinical and physiological neurology as well as pathogenic neurology and how the different systems can afferentate (stimulate) the central nervous system and in turn, affect function in any or all of these systems.

    Boy, gaining an “intimate knowledge of clinical and physiological neurology” all in 300 hours!

    To me, the worst part of “chiropractic neurology” is (as Citizen Deux mentioned) is that they prey on desperate parents of children with autism, ADHD, and other issues. It’s worse than despicable.

  14. Harriet Hall says:

    I first ran across Dr. Carrick (his PhD is in Education) after I saw a chiropractor’s ad for “brain mapping” in my local newspaper and I investigated and wrote about the appallingly poor research behind it. http://www.chirobase.org/06DD/blindspot.html. Carrick retaliated with a virulent ad hominem attack on me http://www.blindspotmapping.com/hariett_hall_syndrome.html that misrepresented what I had written and failed to respond to my specific criticisms of his work. He accused me of deception and fraud and included an indirect threat of legal action. He claimed I had attempted to “tarnish the credibility of an entire profession by inference.” He called me “confused and perhaps psychotic.” He says I did not discuss validity vs. reproducibility with him. (I did, and I have the e-mails to prove it.) His misunderstanding of validity was also pointed out by other chiropractors in letters to the editor following publication of his study. He demonstrates that he still does not understand what validity means. IMHO he is not a good scientist and is not a nice human being.

  15. Cowy1 says:

    So if a regular chiropractor strokes out a patient does he refer to a chiropractic neurologist?

    There are also Chiropracty Internists (http://www.councildid.com/index2.html) and radiologists (www.dabcr.com). Kind of hilarious.

  16. lizditz says:

    Edzard Ernst has taken up referring to chiropractic as “Marketing Based Medicine”.

    This is particularly appropriate to the chiropractors claiming neurologic expertise.

  17. pmoran – I agree that significant adoption of scientific methods into the practice of medicine is as recent as you suggest. I was referring more broadly to scientific methodology.

  18. rwk says:

    Dr Novella,
    What is your opinion of Dr.Carrick’s rebuke of Harriet Hall and the neurophysiology contained therein ?

    http://www.blindspotmapping.com/hariett_hall_syndrome.html

  19. Chris says:

    rwk, probably the same way Dr. Hall thinks about it, as she mentioned above: “He called me “confused and perhaps psychotic.” He says I did not discuss validity vs. reproducibility with him. (I did, and I have the e-mails to prove it.)”

  20. rwk says:

    Chris,
    why not read it yourself?

  21. Chris says:

    Yes, I read Dr. Hall’s comment, didn’t you?

  22. Chris says:

    And I don’t have access to her emails.

  23. rwk says:

    Dr Hall should now prove she was unfairly beaten up in that arcticle.

  24. NMS-DC says:

    @ Dr. Novella

    There are several factual errors in your post that I would like to address. These factual errors keep coming up at SBM, especially when chiropractic medicine is the topic.

    First, the SBM site and authors claim to providing evidence to support science, yet your research was poorly done, not factual, incomplete, misleading with a false, invalid conclusion.

    Error 1

    “This particular version of chiropractic [straight] (by some estimates about a third of chiropractors follow this philosophy)

    You cite chiropractic.org, a website. Why isn’t didn’t you cite some peer-reviewed literature? A google search is lazy, Dr. Novella and this figure is inaccurate (and overestimated). Please see Chiropractic Technique Principles and Procedures (3rd ed) or Principles and Practice of Chiropractic (Haldeman et al).

    You also state incorrectly “Because straight chiropractors believe that nearly all diseases are caused by issues with the spine”.

    Truth:

    “Although the profession today emphasizes the important relationship between health and the structure and function of the neuromusculoskeletal system, it does not promote a monocausal concept of subluxation induced disease” (Chiropractic Technique: Principles and Procedures, 3rd ed, 2011).

    This nonsense that contemporary DCs “believe” that subluxation causes organic disease is demonstrably false. Repeating this falsehood again and again does not make it true.

    Error 2:

    Dr. Carrick, DC, PhD is not a straight chiropractor, he is a CMCC grad class of 1979. He happens to work at Life University. The article you might be referring to, in last week Macleans, demonstrates that Sidney’s Crosby’s treatment plan was multi-modal (thus not only manipulative therapy which is what “straight” chiropractic is founded on (i.e. only manipulation not “mixed” with other forms of therapy). The treatment plan included using the gyrostim, opticokinetic tracking exercises, music therapy, proprioceptive exercises and strength and conditioning exercises. This is not straight chiropractic Dr. Novella. I have to ask, to you even read the article in Macleans?

    Error 3

    ” A search on PubMed for “Carrick T” yielded nothing.”

    Another classic example of poor research and laziness on behalf of a so called “expert” in science-based medicine. Dr. Novella, Dr. Carrick’s name is not Ted. It’s Frederick. Frederick Carrick. A bit of research into the matter before your critique would have produced a different result when correctly inserting Dr. Carrick’s name in a PubMed search.

    “Carrick FR”[Author]
    http://www.ncbi.nlm.nih.gov/pubmed?term=%22Carrick%20FR%22%5BAuthor%5D

    This has got to be the most incredibly ignorant thing I have seen yet in the latest chiropractic bashes that occur at SBM. You did not conduct a proper research. The methodology of you post is flawed and invalid. Also, Dr. Carrick is a clinician and not a researcher exclusively. His latest research involves the use of the Gyrostim and its effects on balance. Do you think that the Mayo Clinic and US Air Force, the only other 2 locations in the world that have this technology are interested in placebo effects, Dr. Novella? Please.

    Futhermore, Dr Carrick has a 3 year waiting list, all patients who have “failed” at the hands of “medical specialists”. Do you really think that any doctor, regardless of field of study, would have a 3 year waiting list if his outcomes weren’t largely successful? Can’t you see how you are grasping at straws to make your argument? More errors:

    Error 4

    “Chiropractic neurology does not appear to be based on any body of research, or any accumulated scientific knowledge. ”

    Please see aforementioned PubMed results for a brief introduction to some of the concepts behind chiropractic neurology. For a more in depth look into precisely what is chiropractic also known as “functional” neurology, please refer and buy the textbook “Functional Neurology for Practitioners of Manual Therapy” by Dr. Randy W. Beck, DC, PhD.

    http://www.amazon.ca/Functional-Neurology-Practitioners-Manual-Therapy/dp/0443102201

    I have this text. Feel free to buy it and truly investigate chiropractic neurology. I have the text myself and we could debate “contentious” points. But it’s fully referenced and cites peer-reviewed literature.

    Error 5

    “It should be noted that neurological symptoms are often especially vulnerable to placebo effects. Many symptoms, like vertigo, or “fogginess” are highly subjective.”

    Sidney Crosby, the best hockey player in the world since Wayne Gretzky had 8 months of the “gold standard” of treatment with Dr. Michael Collins. 8 months of treatment with the best neurologists, physicians, neurocognitive specialists etc.. all using their best clinical experience and brain-based research into vestibular rehabilitation. None of them could get Sidney Crosby symptom free. Your argument doesn’t hold water. He would be highly susceptible to their “cheerleader effect”. Especially because they were considered “the best”.

    So, your argument rests on the premise that one of the best athletes in generation, aged 24, who underwent the “gold standard” in vestibular rehabilitation, was somehow placeboed by a chiropractor? It’s the world’s best case study in my opinion and as a DC, this is going to be investigated and researched to the hilt because Dr. Carrick may have found an innovative way of diagnosing and treating concussions. There is nothing to hide in this case. This is being investigated already. I’ll be the first guy to post results of the study here, regardless of the results. From what I have heard from academics (it’s not only DC/PhDs who are researching this area) who are working alongside Dr. Carrick is that the initial data is favourable and it’s been replicated.

    Then you continue:

    “Chiropractic neurology appears to me to be the very definition of pseudoscience – it has all the trappings of a legitimate profession, with a complex set of beliefs and practices, but there is no underlying scientific basis for any of it.”

    You say this despite not a) knowing anything regarding the subject except what you’ve “heard” from the outside without any real or legitimate investigation into the matter. Proof of this is your PubMed search which you didn’t even know Dr. Carrick’s name is Frederick and not his colloquial name “Ted”.

    Then the grand (incorect, infactual) conclusion

    ” Without a grounding in objective evidence there does not appear to be any limit to the degree that beliefs systems can be led astray. Any treatment can deceptively seem to work, and humans are very good at backfilling in justifications and explanations for phenomena that do not even exist. Left to our own devices we will tend to develop elaborate, but entirely fictitious, belief systems.”

    Beliefs systems Steven. This post is about your belief system that chiropractic is illegitimate. You don’t even both to research ahead of time the content of your post. You simply could have written an inquisitive commentary, but instead you but your own bias’ and “belief system” into it. Read the research, and if you really want to learn about chiropractic neurology, then read the textbook. It’s there for everyone to see. Then, maybe go observe a treatment and get educated rather than making wild guesses and labelling some pseudoscience rather truly investigating and researching the matter.

    Albert Einsten wrote “Condemnation without investigation is the highest form of ignorance”. You sir, have just proven this to the highest order. I await your reply.

    NMS-DC

  25. GLaDOS says:

    NMS-DC, that was tl;dr.

    Chiros inventing their own neurology without studying neurology as practiced by actual neurologists –total scam.

    Everyone in this scam suffers, including the poor young people deluded into thinking they’re becoming “functional neurologists.”

  26. NMS-DC says:

    @GlaDOS

    Sorry that my post does not meet your attention span requiring less than 2 minutes of reading.

    It’s not chiropractors “inventing” neurology, it’s chiropractors interpreting neurosciences in a functional way. We (DC and MD) are both using the same pool of information, we’re just applying it differently. But, what do you really care, you aren’t interested in truly learning about chiropractic neurolog; you’re content being a lemming and not critically thinking for yourself.

    Regards,
    NMS-DC

  27. GLaDOS says:

    NMS-DC, your references are freakin’ hilarious:

    http://www.ncbi.nlm.nih.gov/pubmed/17604555

    J Altern Complement Med. 2007 Jun;13(5):519-26.
    Posturographic changes associated with music listening.
    Carrick FR, Oggero E, Pagnacco G.
    Source
    Carrick Institute for Clinical Ergonomics Rehabilitation and Applied Neuroscience, Cape Canaveral, FL, USA. drfrcarrick@gmail.com

    Abstract

    DESIGN:
    Computer dynamic posturography (CDP) provided stability scores in 266 subjects without a history of falls or vertigo. Subjects were randomized into several different music listening groups and one control group. The music listening groups were given a daily specific music listening task and CDP was obtained 10 minutes, 1 week, and 1 month after the subject’s treatment in a blinded fashion.

    RESULTS:
    Tests of postural stability have shown that 73% of 266 subjects without neurologic signs or symptoms were found to have balance abnormalities [lolwut?] associated with an increased probability of falling. We have demonstrated positive changes in stability scores in these subjects who underwent a variety of music listening tasks, with the music of Nolwenn Leroy found to be significantly superior to other music tested. [L O L W H A T ?]

    Also, Int J Adolesc Med Health has an eigenFactor rating equivalent to “nobody cares.”

  28. moderation says:

    NMS-DC

    DC’s may be using the same pool of information, but don’t you actually have to get in the pool, not just dip your toes in to be experienced enough to swim? With only 300 hours … let me repeat that … 300 hours of training, it is obvious that chiropractic neurologist are trying to swim without actually getting in the pool.

  29. Quill says:

    Harriet Hall wrote: “I first ran across Dr. Carrick (his PhD is in Education)….”

    Ahhh. If there is one doctoral degree that is used outside its scope to generate really crazy things, it’s this one. It seems to be the default degree for someone wanting a PhD after their name yet having just enough integrity to avoid diploma mills. However in Carrick’s case, his degree is apparently a distance-learning-online thing from a “respected virtual institution” called Walden University, a place with a non-competitive admissions setup. (You pay, you can go.)

    Add all that to a DC degree and I don’t think one can claim to be a neurologist of any kind.

  30. GLaDOS says:

    It’s not chiropractors “inventing” neurology, it’s chiropractors interpreting neurosciences in a functional way.

    Oh the ol’ “interpreting” gambit –i.e., “You and I are seeing the same dots. We just connect them differently.”

    Guess you didn’t follow the whole biology verses intelligent design debates.

    What you are calling an interpretation might be considered a proto-hypothesis. It’s not worth much until you formulate your explanatory model in a manner that

    a) differentiates it from the current scientific consensus
    b) can be subjected to some test that might prove it false.

    So good luck with that.

  31. Quill says:

    @lizditz: Thank you for that wonderful link to the “chiropractice neurology diplomate courses” online. Great stuff. I especially liked their summary on all the wonderful things that happen when you take their courses and get your largely distance-based degree:

    Reasons To Become a Chiropractic Neurologist:

    -Continue your pursuit of clinical excellence, and have FUN!
    -Function as a consultant for lawyers, industry, insurance, other doctors, etc.
    -Credentials for managed care panels.
    -Function as an expert witness.
    -Perform Independent Chiropractic Examinations (IME’s) and utilization review.
    -Teach and author in post-graduate Chiropractic Neurology.
    -Increase your confidence, and your patient’s confidence in you.
    -Stand Up to Utilization Reviews With Authority!

    The first is vague but with the all-caps seems an invitation to feeling good. The second is about making more money. Third, social status. Fourth, fifth, and sixth, status and money. Seventh, something right out of “The Power of Positive Thinking” with hints of multi-level marketing. And the eighth, a feverish, status-protecting sort of thing with early Protestant-like use of overcapitalization of nouns (in deference to anything that might be connected to god.)

    That is truly quite a list of reasons to add another layer of sCAM to your portfolio.

  32. Harriet Hall says:

    One of Carrick’s 6 studies listed by NMS-DC is http://www.ncbi.nlm.nih.gov/pubmed/9345682 I analyzed that study at length in the Scientific Review of Alternative Medicine. There is so much wrong with it that it serves as a good example of bad science and poor reasoning.

    “Physiological cortical maps were used as an integer of brain activity before and after manipulation of the cervical spine” What does this mean? Translation: a paper-and-pencil map of the blind spots where the optic nerve enters the retina was proclaimed to be a physiological map of cortical function! The size of the blind spot was interpreted as an “integer”of brain activity! This is not even understandable scientific terminology, and it puts the lie to NMS-DC’s claim that “We (DC and MD) are both using the same pool of information.” The pool of information in medical science is that the size of the blind spot is an anatomical feature and that it does not vary significantly between the two eyes. Carrick found that everyone had a blind spot on one side that averaged half again as large as that on the other side and he didn’t even appear to notice that his observation contradicted all previous observations and even the conclusions of one of the references he cited in support of his hypothesis!

    I may decide to post the entire text of my analysis of that article: it’s illuminating and amusing. It demonstrates that Dr. Novella’s poor opinion of the concept of chiropractic neurology is spot on.

  33. Cowy1 says:

    I’m just about to finish my Neurology clerkship; shelf tomorrow. When all is said and done I’ll have ~300hrs of in hospital time this month actually taking care of sick patients. This is opposed to watching some video for a few weekends in a Motel 8 banquet hall.

    While rigorous, I’m really only scratching the surface of neurology here, really only learning enough to realize I don’t know jack about it and if someone comes to my practice someday with MS, instead of trying to mess with it myself, I’ll be involving a real (MD/DO) neurologist who probably has 20k hours of formal training in it so they can be taken care of appropriately.

    It is actually incredibly ridiculous that chiropractors, who have probably never actually taken care of a person with MS or parkinson’s or insert-stroke-type-here are trying to pass themselves off as neurologists. I mean, if all it really takes to learn this stuff is some shoddy coursework learned part-time over a few weekends, then I ought to be able to call myself a Neurologist, a Family Practice doc and an honest-to-god internist (but I get bonus points here because that rotation was 3 months long). Of course I wouldn’t do this as I’ve got the humility to know that I shouldn’t be pretending to be something I’m not.

  34. “There are several factual errors in your post that I would like to address. These factual errors keep coming up at SBM, especially when chiropractic medicine is the topic.”

    First things first, Chiropractic is not medicine. Medicine is treatment modalities proven to work by science, not testimonials.

    “This nonsense that contemporary DCs “believe” that subluxation causes organic disease is demonstrably false.”

    Then why does it abound in their literature?

    “Although the profession today emphasizes the important relationship between health and the structure and function of the neuromusculoskeletal system, it does not promote a monocausal concept of subluxation induced disease” (Chiropractic Technique: Principles and Procedures, 3rd ed, 2011).”

    Then what, may I ask, makes Chiropractors unique at all? If they don’t believe their adjustments are fixing nerve interference, then they are just performing generic manipulations already practiced by physical therapists, a profession that is already established in science and not anecdotes.

    “His latest research involves the use of the Gyrostim and its effects on balance. Do you think that the Mayo Clinic and US Air Force, the only other 2 locations in the world that have this technology are interested in placebo effects, Dr. Novella? Please.”

    Hasn’t really stopped them before? The Mayo Clinic has an entire department dedicated to “alternative medicine”, utilizing numerous treatments with absolutely zilch in the way of demonstrated scientific benefit. They have patient testimonials, and nothing more.

    “Futhermore, Dr Carrick has a 3 year waiting list, all patients who have “failed” at the hands of “medical specialists”. Do you really think that any doctor, regardless of field of study, would have a 3 year waiting list if his outcomes weren’t largely successful? Can’t you see how you are grasping at straws to make your argument?”

    Hulda Clark also had a ton of patients clamoring to get to her. Doesn’t mean a thing.

    “http://www.amazon.ca/Functional-Neurology-Practitioners-Manual-Therapy/dp/0443102201
    I have this text. Feel free to buy it and truly investigate chiropractic neurology. I have the text myself and we could debate “contentious” points. But it’s fully referenced and cites peer-reviewed literature.”

    Who exactly does this peer review? Real scientists, or more DCs trying to justify a 300 course hour specialty?

    “Sidney Crosby, the best hockey player in the world since Wayne Gretzky had 8 months of the “gold standard” of treatment with Dr. Michael Collins. 8 months of treatment with the best neurologists, physicians, neurocognitive specialists etc.. all using their best clinical experience and brain-based research into vestibular rehabilitation. None of them could get Sidney Crosby symptom free. Your argument doesn’t hold water. He would be highly susceptible to their “cheerleader effect”. Especially because they were considered “the best”.
    So, your argument rests on the premise that one of the best athletes in generation, aged 24, who underwent the “gold standard” in vestibular rehabilitation, was somehow placeboed by a chiropractor? It’s the world’s best case study in my opinion and as a DC, this is going to be investigated and researched to the hilt because Dr. Carrick may have found an innovative way of diagnosing and treating concussions. There is nothing to hide in this case. This is being investigated already. I’ll be the first guy to post results of the study here, regardless of the results. From what I have heard from academics (it’s not only DC/PhDs who are researching this area) who are working alongside Dr. Carrick is that the initial data is favourable and it’s been replicated.”

    Please provide sources to the statements of these academics concerning Carrick’s research and outcomes.

    “Albert Einsten wrote “Condemnation without investigation is the highest form of ignorance”. You sir, have just proven this to the highest order. I await your reply.”

    Einstein also said “Most people say that is it is the intellect which makes a great scientist. They are wrong: it is character. “

  35. NMS-DC
    “Although the profession today emphasizes the important relationship between health and the structure and function of the neuromusculoskeletal system, it does not promote a monocausal concept of subluxation induced disease” (Chiropractic Technique: Principles and Procedures, 3rd ed, 2011).
    This nonsense that contemporary DCs “believe” that subluxation causes organic disease is demonstrably false. Repeating this falsehood again and again does not make it true.
    Error 2:
    Dr. Carrick, DC, PhD is not a straight chiropractor, he is a CMCC grad class of 1979. He happens to work at Life University. The article you might be referring to, in last week Macleans, demonstrates that Sidney’s Crosby’s treatment plan was multi-modal (thus not only manipulative therapy which is what “straight” chiropractic is founded on (i.e. only manipulation not “mixed” with other forms of therapy). The treatment plan included using the gyrostim, opticokinetic tracking exercises, music therapy, proprioceptive exercises and strength and conditioning exercises. This is not straight chiropractic Dr. Novella.”

    NMS-DC didn’t add the “nutritional service” that most all our local chiropractors seem to be advertising. I suspect that today’s chiropractors have found increased competition from the acupuncturists, naturopaths and nutritionists and have needed to diversify the “treatments” that they offer.

    The title of chiropractic neurologist seems to me custom made to attract parents of children with real and imagined learning disabilities, developmental delays, behavior problems…a growing market in the times of increased parental focus on such things.

    Our son has an annual consult with a pediatric neurologist who is on his crania-facial team. Thus far, she has always been happy with his progress and seen no reason to believe that any delays that he has are due to neurological differences rather than his cleft/hearing differences. She has seen no need for additional tests or treatments. Which is great, because he already have his plate full with needed tests, treatments, therapies.

    From the little I have heard about the local chiropractic neurologist, I have very little faith that I would get the same opinion from him.

  36. @micheleinmichigan

    You bring to mind another good point I’ve often wonder. Does your average joe ever walk into a Chiro office and get told “Nope, you’re perfectly healthy! No adjustment or other therapies needed!”

    Though it’s only my opinion, somehow, I doubt it.

  37. nobs says:

    # Harriet Hallon 17 Nov 2011 at 2:54 am
    Posts:
    “One of Carrick’s 6 studies listed by NMS-DC is http://www.ncbi.nlm.nih.gov/pubmed/9345682 I analyzed that study at length in the Scientific Review of Alternative Medicine. There is so much wrong with it that it serves as a good example of bad science and poor reasoning.

    “Physiological cortical maps were used as an integer of brain activity……….snip….”"

    1.- “Scientific Review of Alternative Medicine”? – I cannot find this among the indexed journals at pubmed. Please provide a pubmed link.

    2.- You failed to provide a link to your chosen snipped quote. A partial quote without a link to the entire body of text referenced is…well …. just not very ‘sciencey’.

  38. Zetetic says:

    I see the objectives of “Functional Chiropractic Neurology” and in particular, the application to neurological rehabilitation, as an obvious parallel to the usual Alt-Med strategies. The DC will do nothing meaningful in terms of treatment for the patient and, as is usually the case, slight improvements will be perceived in the patient’s condition due to the normal wax and wane of these kinds of maladies – AND THEN – They will take all the credit!

  39. Harriet Hall says:

    @nobs,

    1. SRAM is not in PubMed. When it was reviewed for inclusion, CAM advocates on the committee shot it down. It is now defunct, but it was a far more scientific, reliable source than some of the PubMed listed CAM journals. I am planning to post my article on SBM so you can judge for yourself.
    2. I DID provide a link to my snipped quote: it is taken from the abstract of Carrick’s study: http://www.ncbi.nlm.nih.gov/pubmed/9345682 The complete text is “DESIGN:Physiological cortical maps were used as an integer of brain activity before and after manipulation of the cervical spine in a large (500 subjects), double-blind controlled study.”
    3. Can you envision any context where “Physiological cortical maps were used as an integer of brain activity” could make sense? Do you know what the definition of “integer” is? Do you think it is possible to get a “cortical” map by mapping the blind spots on the retina? Have you read Carrick’s study? What do you think of his data and reasoning?

  40. Regarding Ted vs Frederick Carrick – I read numerous articles on Ted Carrick (which is who I was asked about), including his own website, without there being the slightest hint that “Ted” is a nickname for “Frederick”, which is the name under which he has published. I find that very odd, even unprofessional. Most people who have published in the literature are clear about their professional name.

    I also searched for articles on chiropractic neurology, and could find none. I am familiar with the studies that Harriet examined before, but did not make the connection to this Carrick.

    The rest of the so-called “errors” are not. I quoted a chiropractic source which states that straight chiropractors believe all illness comes from the spine. So at least some believe this. I had already stated that there is a variety of views and practices under the umbrella of “chiropractic.”

    I maintain there is no scientific basis for chiropractic neurology. Incorporating mainstream functional practices does not count – because they are not “chiropractic” nor developed by or unique to chiropractic neurologists. Their practice seems to be based on pseudoscientific principles with some functional interventions thrown in. That doesn’t make them science-based. This is similar to naturopaths throwing in some basic nutritional advice and calling it “naturopathic.”

    The defense of Crosby’s anecdote is absurd. It’s still just anecdotal. I would note that in the interview Carrick said Crosby’s function was “supernormal”, but when he was formally examined he was just mildly improved. Never underestimate the power of delusional marketing.

    Without a carefully documented cased description, we cannot make anything of this case. Carrick also believes that he woke up the brain of a comatose patient, and offers us only anecdote.

    The studies he has published are all terrible – not compelling evidence for anything.

    As I said – there is no body of scientific evidence that establishes chiropractic neurology, or that they have anything specific to offer. It is classic pseudoscience.

  41. Chris says:

    micheleinmichigan:

    Our son has an annual consult with a pediatric neurologist who is on his crania-facial team. Thus far, she has always been happy with his progress and seen no reason to believe that any delays that he has are due to neurological differences rather than his cleft/hearing differences. She has seen no need for additional tests or treatments. Which is great, because he already have his plate full with needed tests, treatments, therapies.

    Our oldest son was seen by a pediatric neurologist when he was younger due to his history of seizures and lack of speech. He did a series of tests (EEGs, blood test for a metabolic disorder) and several in office examinations. The visits were often about an hour long.

    Here is the one thing I got from him and his staff: they were willing to admit that they did not know everything, that neurology was still evolving and brains are very complex. I especially learned this when the final diagnosis was not Landau-Kleffner Syndrome, but “static encephalopathy.” His physician’s assistant told me that there is something, they don’t know what, but it is not changing.

    Which is in stark contrast to a woman I met who claimed to be a neurologist, but revealed what kind when she suggested I should get my son cranialsacral therapy. She seemed quite offended when I told I did not thing gentle head massages would repair the damage in Broca’s and Wernicke’s areas of my son’s brain. She avoided be for the duration of the function we were both attending.

  42. @Steven Novella – Very interesting and understandable article. Vestibular therapy was a good example of how some of these practitioner may happen upon an effective therapy without a full understanding of it’s evidence or applications. It seems to me, one problem is, without understanding the evidence or how that therapy is working, the chiropractic neurologist can not research or apply that therapy to it’s best effect. Then, also, the occasional effective therapy gets mixed in with other ineffective therapies, taking up more time and resources with less results.

  43. @Chris, I would have thought the one thing worse than being avoided by a chiropractic neurologist is being sought out by one. ;)

  44. lizditz says:

    Back story here that some readers may be unfamiliar with:

    Carrick’s protégés Robin Pauc (UK), Robert Melillo (US) and Gerry Leisman (US) have ginned up the (false) notion of something called “developmental delay syndrome”. In their minds, ADHD, autism (including Asperger Syndrome and PDD-NOS), dyslexia, OCD, and Tourette Syndrome as discrete syndromes or conditions don’t exist — they are just differing manifestations of “Developmental Delay Syndrome”. They explain this by claiming that the left and right hemispheres of the brain are not developing in appropriate synchrony, called by Melillo “functional disconnection”.

    Of course, Melillo has a fix: his franchise empire of Brain Balance emporia, usually purchased by (what else?) chiropractors.

    Harriet Hall published a critical evaluation of Melillo’s theory of functional disconnection here on September 14, 2010, here Brain Balance.

    The one study presented as evidence for the Brain Balance program does not constitute evidence. While some aspects of the program’s interventions are already used in more conventional programs and might prove helpful to individual children, there is no indication that the theoretical concepts of “functional disconnectivity,” “brain balance,” or “hemisphere specific training” are clinically useful. The Brain Balance program is based on speculation, not on credible evidence.

    Steven Novella published another critical evaluation of the Brain Balance program at Neurologica on November 18 2010, and concluded:

    While presenting itself as a genuine neurological theory of disease, “brain balance”, in my opinion, is nothing more than a marketing strategy within the pseudoscience of “chiropractic neurology.” The claims are simplistic, not evidence-based, and seem blissfully unaware of the long and complex history of the relevant ideas.

    The Brain Balance program is essentially a movement program, with some other bells and whistles (such as aromatherapy) thrown in. Earlier this year, the journal published by the International Dyslexia Association published an issue on questionable therapies, which included the article Physical Exercise and Movement-Based Interventions for Dyslexia

    The accumulation of scientific evidence suggests that children would be more likely to benefit from receiving intensive reading instruction to address phonologically-based reading difficulties directly than from exercise therapies. It seems reasonable to suggest that children would also benefit from a general program of daily exercise and from reading daily with their parents in a non-threatening, supportive atmosphere, activities that do not require investment in expensive programs that lack adequate evidence to support their claims.

    As Citizen Deux wrote about Brain Balance earlier:

    Until enough parents realize that they have been duped and are spending precious time, money and energy pursuing unproven treatments, these folks will thrive. Sadly, the children affected have no say in this.

    I don’t fault parents for falling for this stuff. The marketing is pretty slick.

  45. NMS-DC says:

    @Dr. Novella

    “The rest of the so-called “errors” are not. I quoted a chiropractic source which states that straight chiropractors believe all illness comes from the spine. So at least some believe this. I had already stated that there is a variety of views and practices under the umbrella of “chiropractic.”

    You cited a website, the ICA. Straight chiropractors, in 2011, do not believe all illness comes from the spine. I provided you a reference with that, in a text published in 2011. Your statement is inaccurate. You should own up to your mistake. See Villanueva-Russell 2011 for a more balanced, objective sociological look at the profession. She is a PhD and not a DC and does not work for a chiropractic school.

    I maintain there is no scientific basis for chiropractic neurology. Incorporating mainstream functional practices does not count – because they are not “chiropractic” nor developed by or unique to chiropractic neurologists.

    If chiropractic neurology incorporates established, scientific based functional practice, alongside with SMT, which is clearly established at having value for spinal pain, in addition to the emerging research which suggests it alters sensorimotor function, is perfectly chiropractic. It’s simply a neurological rehabilitation using manual techniques combined with a holistic paradigm.

    “Their practice seems to be based on pseudoscientific principles with some functional interventions thrown in. That doesn’t make them science-based. This is similar to naturopaths throwing in some basic nutritional advice and calling it “naturopathic.”

    You make this declaration without having read the functional neurology text, not having spoken with Dr. Carrick or his associates nor having read the Macleans article. Seems? RTFA!

    The defense of Crosby’s anecdote is absurd. It’s still just anecdotal. I would note that in the interview Carrick said Crosby’s function was “supernormal”, but when he was formally examined he was just mildly improved. Never underestimate the power of delusional marketing.

    It may be anecdotal, and the article did not state he was “mildly improved”. The quote was “the best we’ve seen” which is attributed to Dr. Michael Collins. You are deliberately misquoting the article. Also from the article “Carrick had a very prominent role Sidney’s current recovery process” (pg 66). What’s absurd is your flat out denial that a DC could play a prominent role in the rehabilitation in one of the hockey players of the last 25 years.

    “The studies he has published are all terrible – not compelling evidence for anything.”

    Why are they terrible Dr. Novella? You offer no specific critique or rebuttal because you didn’t read them. You claim something is terrible without even reading it. Is this the type of scientific investigation your promote here? Sad. You failed to address the majority of my arguments, which is par for the course here. If you had even read the Macleans article, you would have seen that it stated Dr. Carrick’s name was Frederick. It’s more proof that you have no clue of what you’re talking about. And that is just bad science.

    @Dr. Hall

    Your rebuttal of Dr. Carrick’s article was rebutted quite thoroughly on an earlier post. You have offered to rebuttal to his critique. I agree, the “psychotic” remark was not appropriate, but your rebuttal of his work was half-assed and he thoroughly deconstructed your rebuttal proving his case quite clearly, and he referenced it as well. Why didn’t you take him up on his offer to speak to him directly? Why didn’t you publish your rebuttal? Debate is important in science, but the debate has to to be fair and objective. None of commentary I’ve read here at SBM regarding chiropractic medicine approaches any level of objectivity. Why?

    The rest of the posts are white noise, posturing really, that gets away from Dr. Novella’s main argument. He did not research this topic and I’ve proven that. His rebuttal which is one big anecdote in itself full of special pleading, straw man arguments and circular logic. I await your replies.

    NMS-DC

  46. NMS-DC says:

    @Chris

    What makes Chiropractic unique? Well, the emphasis of spinal manipulation and it’s role in health. The effects of SMT is neurological. That the holistic paradigm is superior to the conventional biomedical paradigm.

    PTs replacing DCs are the main provider of SMT when DCs perform >90% of SMT in North America? Ok there.

    We are not talking about Hulda Clark nor are we talking about your personal opinion of the Mayo Clinic. You are critiquing the integrity of Mayo Clinic? On what basis? Inclusion of proven techniques for specific conditions? Do you follow the literature Chris regarding SMT?

    @GladOS

    Prohypothesis
    a) differentiates it from the current scientific consensus
    b) can be subjected to some test that might prove it false.
    So good luck with that.

    The current consensus for vestibular rehabilitation with respect to concussions is the wait and see approach. DCs favour a more active approach.

    The testing of the gyrostim with respect to balance is currently being done. The study will be published in 2012. The gyrostim was a component of Sidney’s rehab, but it was multi-modal. Basic sciences in neurology and concussion treatments will be furthered with this type of research.

    Regards,
    NMS-DC

    @nobs

    It’s amusing to see the senior SBM editors wither under the spotlight when their assertions are challenged with research. It proves that they are far from objective but have a genuine xenophobia of any natural healing arts. I looked back at my posts on chirotalk circa 2005-2006 and they actually proved to be prophetic. The same will happen here in 5-10 years when the research accrues and many of the fundamental principles of chiropractic have been validated by scientific investigation. The profession has developed the capacity to conduct research and have made affiliations and partnerships with universities. It’s already crossed the tipping point, SBM just refuses to admit it. Mainstream chiropractic research is not only scientific, but contributes to health care by gaining a better understanding of how the human body functions. I look forward to debating them and I’m still waiting for Dr. Homola to make an appearance (5th request). I bet these guys think that Dr. Haldeman is quack. Just goes to show how fringe their thinking really is (just like their hero Ernst).

    Regards,
    NMS-DC

  47. Cowy1 says:

    @NMS-DC

    If a chiropractor takes a half-assed 300 hour course at the motel down by the airport and can call himself a neurologist then I demand, having just finished 300+ hours of legitimate neurology (with actual patients), to be able to call myself a neurologist.

    Seriously, you can’t be defending what is such a clearly shoddy course of study. It is actually bordering on fraud that these people call themselves “neurologists” or “radiologists” despite having basically zero exposure to the real thing. Actually, given that, I feel completely comfortable saying that they (DC “neurologists”) are quacks or, at least, lack the humility and self-reflection to realize that they probably shouldn’t hold themselves out to the (ignorant) public as something they aren’t.

    If anything, you ought to feel embarrassed by these people who clearly aren’t neurologists and shouldn’t hold themselves out as such.

    As for Sidney Crosby, who cares? Professional athletes do stupid things all of the time; have you seen how many of them wear those idiotic “hologram” bracelets?

  48. I did read the Mcleans article. They call him “Ted Carrick” at the top of the article and “Carrick” from then on. I read back and still don’t see any reference to “Frederick Carrick.” If there is anything further in the print version that is not online I did not read it. I maintain it’s unprofessional not to use your real name, the name under which you publish. I managed to read a dozen articles about Ted Carrick (including his own website) without there being any mention of “Frederick.”

    But after you pointed it out I went back and read his articles. They are not compelling. I’m not going to go into a detailed analysis in a comment – perhaps I will do a follow up in a later post. I agree with Harriet’s analysis of his blind spot mapping article. The claims is simply absurd, his evidence is not adequate to support his claim, and there are no replications. There is no body of research, with independent corroborative evidence, etc. There are a few studies by a lone researcher promoting an extreme claim – that is the pattern of pseudoscience, not legitimate science. He references a lot of studies, but none support his claims. They are mostly case reports printed in a chiropractic journal.

    The core criticism of his study holds – it is unblinded and uncontrolled. Given the extreme nature of his claims, it is absolutely unscientific to base clinical claims on such flimsy and notoriously unreliable evidence.

    Carrick claims he woke up a comatose patient – where is the science behind this. This claim demonstrates he is disconnected from reality, or simply not interested in rigorous science. The other example I gave is that he claims Crosby was “super-normal” after his treatment. This claim was contradicted by examination. All they could say is that he was improved (I acknowledge they did not say “mildly”, I misremembered that) We can’t know from the article how much improved he was, and if it was only subjective. The uncritical Macleans article is not an adequate source of information.

    I’m afraid you have proven nothing but your own bias. You make many distracting points that have nothing to do with the core claim – there is no established body of science behind chiropractic neurology. It is at odds with modern science. It is a marketing scheme, nothing else. And stop assuming you know what I have read or researched – you don’t.

  49. Chris says:

    NMS-DC:

    What makes Chiropractic unique? Well, the emphasis of spinal manipulation and it’s role in health. The effects of SMT is neurological. That the holistic paradigm is superior to the conventional biomedical paradigm.

    Cranialsacral therapy is just a homeopathic head massage. I noticed you did not mention it.

    If you have any evidence that spinal manipulation can improve oral motor dyspraxia with functional dysarthria and some dysphasia due to damage to mostly Broca’s area, and some of Wernicke’s area of the brain (which may or may not have been caused by seizures, especially the one suffered during a now vaccine preventable illness) then…

    … please post the journal, title, date and authors of the papers. Thank you.

  50. Cowy1 says:

    “What makes Chiropractic unique? Well, the emphasis of spinal manipulation and it’s role in health. The effects of SMT is neurological. That the holistic paradigm is superior to the conventional biomedical paradigm”.

    You know, you had me going there what with the “nothing here but us little science-based back cracking” routine. I actually took you kinda seriously for a while and then your belief in the good old subluxation comes out.

    Kudos though, that you were able to hide it that long.

  51. Harriet Hall says:

    @NMS-DC, “Your rebuttal of Dr. Carrick’s article was rebutted quite thoroughly on an earlier post. You have offered to rebuttal to his critique. I agree, the “psychotic” remark was not appropriate, but your rebuttal of his work was half-assed and he thoroughly deconstructed your rebuttal proving his case quite clearly, and he referenced it as well. Why didn’t you take him up on his offer to speak to him directly? Why didn’t you publish your rebuttal?”

    It appears that you have fallen hook, line, and sinker for Carrick’s misrepresentation and distortion of what I wrote. Before you judge me, it would only be fair for you to read my SRAM article with my complete analysis of his blind spot study. I plan to publish it here on SBM in the near future so you will have that opportunity. Carrick’s attack on me was not responsive to my specific criticisms of his study, and as an offensive and irrational diatribe it does not deserve any further response from me. He and I had a long e-mail exchange. I can provide copies of the e-mails to anyone who is interested. You will find that they don’t sound at all like Carrick’s portrayal of them. In them, I politely asked a number of questions about his research and he failed to answer, and he made no effort to understand my point about the difference between a reproducible measurement and a validated one (think two identical but falsely high blood glucose readings from a malfunctioning or uncalibrated glucose meter). I “spoke” to him directly and at length through our e-mail discussion. I chose not to speak to him on the telephone because I generally find telephone calls less useful than communicating in writing, and there would be no record of it.

  52. GLaDOS says:

    I Googled “Ted Carrick gyrostim,” and got this page:

    http://www.drtituschiu.com/neuroessene/Blog!/Entries/2010/10/9_A_Magical_Time_in_Atlanta.html

    Where I read,

    You see, Dr. Carrick has been making tidal waves around the world with his clinical results that are nothing short of miraculous.

    Which is pretty funny in light of the pics of ol’ Ted on that page.

    Also he magically cures cortical blindness, lol.

  53. NMS-DC says:

    @DrNovella

    I did read the Mcleans article. They call him “Ted Carrick” at the top of the article and “Carrick” from then on. I read back and still don’t see any reference to “Frederick Carrick.” If there is anything further in the print version that is not online I did not read it. ”

    Therefore you missed 3/4 of the article. You’re basing opinions on a article which you just admit haven’t fully read. His full name is on pg 66, Frederick R. Carrick. But if you had read the full article you would have known this.

    His research is preliminary and should be judged according its content. It’s not a double blinded RCT, but that’s not what he was researching. Double standards though, par for the course here.

    What claim are you specifically saying that Dr. Carrick is making? Do you have a specific quote or reference? Because you’re losing me here with your line of argumentation. His research is not published just in a chiropractic journal as you claim. Of the 6 articles I found at PubMed, two were in JMPT, which is a chiropractic journal (which has seen it’s impact factor double in the last 5 years, just saying…)

    “Carrick claims he woke up a comatose patient – where is the science behind this.”

    The family had witnessed this. Also, new research suggests that 20% of “vegetative” patients are aware. He claims he used stimulation techniques to areas of the brain which were inhibited. This was done by doing a neurological exam (muscle tone, reflexes, eye movement patterns, asymmetries, etc..)

    All they could say is that he was improved (I acknowledge they did not say “mildly”, I misremembered that) We can’t know from the article how much improved he was, and if it was only subjective.

    This is patently false and if you read the article you would have realized that Dr. Collins put Crosby though the same baseline tests that he had done throughout his treatment and ran computerized tests called IMPACT which compared his neuro-cognitive abiilties prior to Carrick’s treatment. Dr Collins’ quote “the best we’ve seen since Crosby got hurt” Playing with the facts Novella is not good science either and it discredits your argument. You should have at least told readers you had not read the full article.

    More from you

    “I’m afraid you have proven nothing but your own bias. You make many distracting points that have nothing to do with the core claim – there is no established body of science behind chiropractic neurology. It is at odds with modern science. It is a marketing scheme, nothing else. And stop assuming you know what I have read or researched – you don’t.”

    I presented to you a textbook, that goes into detail of exactly what is chiropractic/functional neurology. It’s published by Beck DC/PhD. You can even glimpse a few pages online for free at amazon.com. This book is the foundation of the principles and the scientific manner at which a DC would look at diagnosis and treatment of neurological cases. It’s not at odds with modern science, it’s just a different perspective than modern science. There you go with the false dichotomy again. If it doesn’t come from an MD, it’s terrible. Science is a two headed coin, it can be viewed by conventional/orthodox methods and be viewed by holistic/traditional methods. We differ in our approach to healing, but our intent is the same: good outcomes for the patient. Re: marketing scheme, that’s a nice copy of Edzard’s take on chiro, so come up with an original thought of your own. And, I do know what you read and researched with respect to this article, because you’ve been wrong the whole time about facts!! RTFA!

    Regards,
    NMS-DC

  54. GLaDOS says:

    He claims he used stimulation techniques to areas of the brain which were inhibited.

    Fascinating. I assume you are referring to areas within the cerebral cortex?

  55. Harriet Hall says:

    @NMS-DC
    Dr. Novella said “Carrick claims he woke up a comatose patient – where is the science behind this.”
    You answered: “The family had witnessed this.”
    Oh, wow! Hearsay, second-hand anecdotal testimonial evidence from a patient’s family = science? Since when?

    And since when does a single textbook chosen by you get to trump all the evidence from other sources? I have a copy of a chiropractic textbook entitled “Somatovisceral Aspects of Chiropractic: An Evidence-Based Approach” – it doesn’t contain anything that a scientist would call “evidence-based,” only poor quality uncontrolled studies and case reports. It falsely claims that chiropractic manipulation is effective for all sorts of non-musculoskeletal ailments. It has sections on “Practical Vitalism: An Emerging Paradigm,” “The Ergonomics of Neurologic Holism,” “Subluxation and the immune system,” “Subluxation and the pediatric central nervous system,” etc. It’s really pretty funny: for instance, a patient with MS had a long list of symptoms that all vanished within minutes of diversified adjusting. Another piece of “evidence” for chiropractic’s effectiveness for MS is that a report of a literature review described a 35 year old man who “apparently responded well to unspecified cervical and upper thoracic adjusting.”

    And before you accuse anyone here of parroting Edzard Ernst’s take on chiro, do some research into the history of criticisms of chiropractic. You will find that Ernst has only come to the same conclusions that many others had previously reached for the same reasons.

  56. Quill says:

    That the holistic paradigm is superior to the conventional biomedical paradigm.

    That is a sales slogan — meaningless, vacuous words with no application outside the marketing of CAM.

  57. GLaDOS says:

    Oh strike the above. I’m too busy to play cat-and-mouse at the moment.

    NMS-DC, you are arguing that 300 hours of study in something you call “neurology” which strangely does not involve any neurologists, is just as good as a medical education and a residency program in neurology. Your position is stupid. Just stop before you embarrass yourself further.

    If chiropractors would use the term “chiropractor” in their business name, and if they would avoid calling themselves “neurologists,” I could go back to largely ignoring them. But fooling vulnerable patients, this doesn’t sit well with me.

  58. NMS-DC says:

    @Harriet

    I simply was referring to what was presented. The family claimed that Dr. Carrick helped awaken a “comatose” patient. Maybe the patient wasn’t really comatose afterall. Like I alluded to in my most, preliminary research by EEG demonstrated in an albeit small sample, 20% of patients who were diagnosed as “vegetables” where actually conscious. Please see the link here for the story

    http://www.cbc.ca/news/health/story/2011/11/09/vegetative-eeg-research.html

    Your rant regarding the Somatovisceral Effects of Chiropractic, is a red-herring and is not pertinent to our discussion on chiropractic neurology. I’d be more than happy to purchase the book and objective critique it, if you provide me the author(s). But for now let’s stick to the topic at hand.

    You write

    “And since when does a single textbook chosen by you get to trump all the evidence from other sources?”

    This article is specifically discussing the merits, or lack thereof of chiropractic neurology. There is a text that is specific to chiropractic neurology, that discusses the principles and practice of chiropractic neurology and which is written by a DC/PhD with a foreward by Dr. Carrick. This book does trump all other sources provided in this thread because it is the only source that specifically addresses the topic of chiropractic neurology in its entirety and not an opinion based commentary written by Dr. Novella who didn’t read the Macleans article, didn’t conduct a proper PubMed Search, did not read the studies by Dr Carrick and was not aware of the textbook which is centre of this discussion. RTFB!

    Also, I call ‘em as I see ‘em. The majority of SMB editors and posters are parrots of Ernst and it doesn’t take a genius to figure out the talking points that you espouse are directly from his plethora of anti-chiropractic articles. Even the phrasing of the “rebuttals” here are either direct or very close to the same language used in Ernst papers.
    Being a DC Harriet, I am intimately familiar with the criticisms of my profession both from internal and external sources. In gauging the criticisms, I look for objective and valid criticisms that are fair and balanced which take into account the both historical and contemporary practices of chiropractic. The criticisms here are of such hyperbole with parrots and lemmings parading it who mostly have 0 expertise in neuromusculoskeletal medicine its virtually impossible to have a reasonable debate with any of you who are on the fringe, much like Ernst, when it relates to complementary medicine.

    And to be specific about Ernst, his obsession and witch hunt about chiropractic (65 articles published about chiropractic in the past 14 years, the majority coming from 2003 onwards , see here http://www.ncbi.nlm.nih.gov/pubmed?term=Ernst%20and%20chiropractic) has done more to discredit as a serious, objective scientist. His conclusions regarding chiropractic, ranging from effectiveness of SMT, to cost effectiveness of SMT, to safety including outrageous conclusions that “the risks of cervical manipulation including death outweigh the benefits” are merely an attempt to distort and misinform the public, policy makers and the ignorant. He can write all the systematic reviews he wants, but they are a house of cards waiting to crumble. His lit search omits any supportive papers and chooses papers espoused by “straight” DCs to make the majority of the profession to look as though it is stuck in 1895.

    But, thankfully, there will be a concluding chapter into the safety of SMT, particularly with cervical manipulation, that one that gets so much attention around here. This paper will be the gold standard and will settle the matter once and for all: patient safety and SMT.

    http://www.research.ualberta.ca/en/VP%20Research%20News/2011/05/Researcherstaketeamapproachtopatientsafetyduringspinalmanipulation.aspx

    Good night,
    NMS-DC

    1. Harriet Hall says:

      @NMS-DC,
      “I simply was referring to what was presented,”
      Yes, that’s the point. Dr.Novella asked for science and you responded with hearsay.

      “Your rant regarding the Somatovisceral Effects of Chiropractic, is a red-herring and is not pertinent to our discussion on chiropractic neurology.”
      Yes, it is pertinent, as it is a chiropractic textbook that discusses the interface between chiropractic treatment and neurology. http://www.amazon.com/Somatovisceral-Aspects-Chiropractic-Evidence-Based-Approach/dp/0443061203
      It’s also relevant in that it is an example of what passes for “evidence-based” in schools of chiropractic.

      In his medical training in Germany, Ernst learned spinal manipulation along with homeopathy, acupuncture, and herbal medicine. He then turned to rigorous science and, through his own research as well as assessing the evidence published by others, tried to find out what worked and what didn’t in CAM. He was appalled to learn that the evidence failed to support what he had been taught. He eventually concluded that chiropractic offered some benefits and that homeopathy was a total crock. When he omits papers from his systematic reviews it is only because they do not meet the review criteria – many of the supportive studies are too poorly designed to pass muster. He doesn’t have any vendetta against chiropractic. If we seem to you to be “parroting” Dr. Ernst, it is only because we have all looked at the evidence in the same objective fashion so we have reached the same inescapable conclusions.

      I had never heard of Ernst until long after I formed my own opinions of chiropractic. I started my investigation by reading everything I could find both pro- and anti- chiropractic and comparing the two sides. It was no contest: I found the “pro” information from chiropractors badly lacking in evidence and reasoning. I can honestly say that I learned almost everything I know about chiropractic from chiropractors themselves.

      Your desperate efforts to defend chiropractic and chiropractic neurology are understandable, but you are hopelessly lost in confirmation bias. You are striking out in the only way you can, with ad hominems and diversions rather than evidence. You are not making any headway here. It’s really rather sad.

  59. Chris says:

    Wow. So, where is the evidence that chiropractic neurology has anything to help my kid’s issues? I laid it out for NMS-DC, but I did not see anything resembling journal articles with solution via spinal manipulation.

    Screw the difference between the 300 hours for a chiropractor to get qualified as a “chiropractic neurologist” compared to the years Dr. Novella spent to become a real neurologist. I have a feeling I know more about neurology as a parent of kid with neurological issues. And I am only an engineer (okay, I used to be a “rocket scientist”… but having a kid with medical issues put an end to that).

    And all I did was check books out of the library (like Conversation With Neil’s Brain by Ojemann and Calvin), and go on the internets. One of the best articles was on the uselessness of Doman/Delcato patterning by Dr. Novella. I should also add, I also learned lots from my son’s pediatric neurologist, especially his twelve page report on my son after his initial visit.

    Unfortunately the neurological issues have taken a back seat to the kid’s heart. I’ve now had to learn too much about a genetic heart condition, which has involved more visits to the cardiac clinic in the last two months since he was initially diagnosed eight years ago. I really hate riding in ambulances with a kid.

    So what miracles does spinal manipulation provide for damaged mitral valves caused by excessive heart muscle growth due to genetic manifestation of hypertrophic cardiomyopathy? Don’t bother since that would be off topic.

  60. off-topic post

    @Chris, sorry to hear about your son’s heart condition. That completely sucks. My thoughts will be with him, you and your family.

  61. The Mcaleans article is a lay press article – and very poor quality. I did not rely upon it for scientific information – I used the information that was in the version I read. You are not contesting the quotes that I pulled out. So what’s your point?

    My point remains – Carrick, who presents himself as a professional, an expert, with a published record – should use his professional name consistently, and if he uses his nickname should put it in parentheses. It is just odd how much I was able to read about him without running across his real name.

    Obviously in the last two days I have not read a print textbook I don’t currently have access to. I almost never read textbooks these days anyway. They are hopelessly outdated, even if they are originally high quality. The published literature is the place to go to see if the science supports any claim.

    My other points remain, unrebutted:

    Carrick overstates his claims and any alleged effectiveness of his treatment. It is highly unprofessional, unethcial, and pseudoscientific to claim that you can treat a serious condition like coma based upon a single unverified anecdote.

    Carrick also overstated the response of Crosby. His claims of “super-normal” had to be specifically contradicted by his doctors. Saying “the best so far” is another way of saying “improved” and is compatible with the slightest improvement. And – this is all heresay – how about at least a published case report.

    The evidence I was referring to above was in the rebuttal to Harriet’s criticism. Carrick reference almost exclusively from the journal of manipulative therapy, and his specific references often did not even support his claims. His rebuttal was classic diversion and character assassination.

    The bottom line is this – the basic claim that functional interventions can significantly affect brain recovery, so as to reverse damage and even “wake up the brain” from a coma is pure hokum. It is based on ideas that were disproved decades ago. There is no published clinical evidence to back up such claims. It seems that chiropractic neurology is mostly based on this flimsy premise.

    Please point me to references in the published literature that establish any of Carricks claims – where is the basic science, where is the clinical science?

    You claim it’s not fair to judge his preliminary studies for being preliminary. This completely misses the point. Preliminary exploratory studies should not be used as the basis for clinical claims and practice. That is what Carrick is doing – another sign of pseudoscience. Even as preliminary studies, they are highly dubious.

    The general experience is that such results will be like N-rays – they will vanish the moment double-blinding procedures are put into place.

  62. What makes Chiropractic unique? Well, the emphasis of spinal manipulation and it’s role in health. The effects of SMT is neurological. That the holistic paradigm is superior to the conventional biomedical paradigm.

    Shouldn’t we determine scientifically that SMT has a role in health to begin with before we base an entire profession around it? Please provide research outlying some of these claims. And please don’t fall prey to the age old “I don’t have time, go find them yourself!” I’m specifically looking for good quality studies published in peer-reviewed medical journals with sound methodology and statistical reporting. The burden of proof is on the claimant.

    We are not talking about Hulda Clark nor are we talking about your personal opinion of the Mayo Clinic. You are critiquing the integrity of Mayo Clinic? On what basis? Inclusion of proven techniques for specific conditions? Do you follow the literature Chris regarding SMT?

    If my personal opinion of the Mayo Clinic doesn’t matter (which it probably doesn’t in this sort of discussion, I’ll admit) then don’t use YOUR opinion of those facilities offering Carrick’s “treatments” as support of your argument against Dr. Novella. Only fair. And yes, I am critiquing the integrity of the Mayo Clinic when it allows unproven, unscientific nonsense to proliferate inside it’s doors, nonetheless offering it to patients and giving it an un-earned air of legitimacy with their organization’s name.

    I do follow the literature for SMT. I have found almost nothing to date worthy of even being called “scientific”, aside from the Cochrane Collaboration’s findings that SMT is as effective as other modalities for treatment of lower back pain. If that’s the only headway a profession has made in it’s long history of establishment, well…

    Again, I’m not claiming this literature cannot exist. I’m simply saying in my years of research, I have never been able to find anything worthwhile. I’d gladly accept a source or two if you have them. I’m willing to admit I’m wrong.

  63. Quill says:

    FWIW, I’ve never read anything by Ernst unless it was somebody else quoting him.

    My own interest in understanding chiropractic came from an acquaintance who was trying to treat all his medical problems “naturally.” He claimed to me that he’d been cured of “chronic fatigue syndrome” by a chiropractor who found that one of his legs was longer than the other. (The myth of symmetry is used for so many odd things.) I found this explanation weird and set about looking into the world of chiropractic thinking and practice and concluded it was mostly based on pseudoscience and speculation wrapped up in the language of persuasion and marketing.

    The efforts of nms-dc have only added to my original conclusion. (Assuming of course nms-dc is a chiropractor.)

  64. NMS-DC says:

    @Dr. Novella

    I’m contesting that you misquoted the article, then you attempted to correct yourself, only to misquote it again.

    “My point remains – Carrick, who presents himself as a professional, an expert, with a published record – should use his professional name consistently, and if he uses his nickname should put it in parentheses. It is just odd how much I was able to read about him without running across his real name.”

    You’re just embarrassed that you said in your original post that he had 0 publications and you didn’t even know his real name nor did you bother to even find out. Obviously Carrick and Hall have crossed paths, you could have easily found out through her. Your search was lazy.

    “Obviously in the last two days I have not read a print textbook I don’t currently have access to. I almost never read textbooks these days anyway. They are hopelessly outdated, even if they are originally high quality. The published literature is the place to go to see if the science supports any claim.”

    You made a post and a point to discuss chiropractic neurology without getting any facts. This is lazy journalism/editorializing on your behalf. You can writhe all you want about the utility of textbooks, but if you had any bit of credibility or objectivity on the topic of chiropractic neurology you would go the foundational textbook. Your comments and opinions remain uninformed, thus not credible nor reliable. And don’t try appealing to authority in your rebuttal.

    “Carrick overstates his claims and any alleged effectiveness of his treatment. It is highly unprofessional, unethcial, and pseudoscientific to claim that you can treat a serious condition like coma based upon a single unverified anecdote.”

    Please show me the reference, or quote where Carrick claims that he can “effectively treat” a coma. Also, even though it is anecdotal, it did allegedly occur. What is unprofessional Dr. Novella is to profess knowledge of a subject and not even bother to research it, like the case here with your rant on chiropractic neurology and then making unfounded conclusions based on your terrible methodology. Again, if you want to learn about chiropractic neurology, buy the text, and we can discuss points you may have an issue with and debate it accordingly. Otherwise this is a smoke show.

    “Saying “the best so far” is another way of saying “improved” and is compatible with the slightest improvement.”

    Slippery slobe Dr.Novella. You can’t try to interpret Dr. Collins words so suite your own personal bias’. Also, the quote “best so far” and the quote from Sidney Crosby’s agent was “Carrick had a very prominent role in Sidney’s recovery status. he progressed extremely well under Carrick”. These are the actual quotes. Your reasoning is “best so far” = “improved” = “slightest improvement”. What a joke. Stick to the actual quotes. Your personal interpretation is worthless. It’s just a pathetic attempt to minimize the “prominent” role Carrick played in which Crosby “extremely well”. Not slightest improvement. Extremely well.

    “The evidence I was referring to above was in the rebuttal to Harriet’s criticism. Carrick reference almost exclusively from the journal of manipulative therapy, and his specific references often did not even support his claims. His rebuttal was classic diversion and character assassination.”

    That was not the case whatsoever. And you got the journal title wrong (another factual error). It’s JMPT, Journal of Manipulative and Physiological Therapeutics. It wasn’t character assassination. It was a thorough, referenced rebuttal of Harriet’s half-assed, poorly researched and referenced reply. She is embarassed by it because she bit off more than she could chew. Just like what you’re going through right now by doing a lazy, half-assed post and I’m pointing out all the flaws.

    The bottom line is this – the basic claim that functional interventions can significantly affect brain recovery, so as to reverse damage and even “wake up the brain” from a coma is pure hokum. It is based on ideas that were disproved decades ago. There is no published clinical evidence to back up such claims. It seems that chiropractic neurology is mostly based on this flimsy premise.

    “Please point me to references in the published literature that establish any of Carricks claims – where is the basic science, where is the clinical science?”

    What claims are you referring to?

    “You claim it’s not fair to judge his preliminary studies for being preliminary. This completely misses the point. Preliminary exploratory studies should not be used as the basis for clinical claims and practice. That is what Carrick is doing – another sign of pseudoscience. Even as preliminary studies, they are highly dubious.”

    Did you even read the studies Dr. Novella, oh, that right you didn’t. Carrick didn’t make any claims with his research. What he did do was to test out the validity and reliability of equipment to measure posture and balance. For the record, 2 of the 6 studies were in non-chiropractic journals. Do you consider Biomed Sci Instrum, Int J Adolesc Med Health, and Disabil Rehabil. to be unscientific journals?

    Regards,
    NMS-DC

  65. NMS-DC says:

    @Chris

    I’m sorry to hear about the health of your son. It’s not a matter for debate, I hope he gets the care that he needs and hope he makes a good recovery.

    @Chris R

    “Shouldn’t we determine scientifically that SMT has a role in health to begin with before we base an entire profession around it?”

    SMT, at a minimum is effective for back pain, neck pain and certain forms of headache. Manual therapy, which includes many other hands-on techniques that aren’t HVLA have been found to useful for MSK disorders. Please see a literature review on effectiveness of manual therapies published in 2010:

    http://www.ncbi.nlm.nih.gov/pubmed/20184717

    Scientifically there is effectiveness for manual therapy and DCs are the experts at manual therapy. Chiropractic literally means “done by hand”. MSK disorders are a huge health issue. DCs are experts in diagnosing and managing MSK disorders.

    Regarding the Mayo clinic, we will have to agree to disagree. If you think that the Mayo clinic would bring in useless therapies that have no benefit and that are potentially unsafe, to somehow appease CAM, I think that’s grasping for straws.

    “I do follow the literature for SMT. I have found almost nothing to date worthy of even being called “scientific”, aside from the Cochrane Collaboration’s findings that SMT is as effective as other modalities for treatment of lower back pain. If that’s the only headway a profession has made in it’s long history of establishment, well…

    Again, I’m not claiming this literature cannot exist. I’m simply saying in my years of research, I have never been able to find anything worthwhile. I’d gladly accept a source or two if you have them. I’m willing to admit I’m wrong.

    You want RCTs. Ok, I will provide them. I took the liberty of doing a PubMed MeSH and shortening the url because it was really, really long. Take a peak, and we can discuss afterwards.

    http://1.usa.gov/ujkJ49

    Regards,
    NMS-DC

  66. Cowy1 says:

    @NMS-DC

    Weak sauce man, trying to make someone read a textbook. If there is enough literature to write the textbook why don’t you just give us a salient reference from each of the chapters; I’d be happy to read some of those.

    And you still can’t be defending “Chiropractic Neurology”. The “training” (if you can call it that) is so superficial and limited it doesn’t even rise to the level of a junior college, let alone that of a physician. So sorry, but Drs Novella and Hall are right, it is just a marketing ploy to prey on patients.

    Finally, who really cares about Sidney Crosby? Time probably has more to do with his “recovery” than anything else; the real test will be to see how he handles playing an actual game.

  67. Cowy1 says:

    “Regarding the Mayo clinic, we will have to agree to disagree. If you think that the Mayo clinic would bring in useless therapies that have no benefit and that are potentially unsafe, to somehow appease CAM, I think that’s grasping for straws”.

    Uh, its just a low-risk money grab for the clinic/university. They usually have some cheesy “whole-person wellness” angle although the needles are really treating anything at all except the practitioner’s pocketbook. Even my own university/medical center has a CAM clinic (thankfully it is PsyD and nursing driven so at least it isn’t directly connected with the docs).

  68. Harriet Hall says:

    @NMS-DC

    “It was a thorough, referenced rebuttal of Harriet’s half-assed, poorly researched and referenced reply. She is embarassed by it because she bit off more than she could chew.”

    How dare you say that when you have not even read what I wrote!

    I am not embarrassed, I am proud. A real neurologist agrees with my analysis. It is Carrick who should be embarrassed by his inability to reply to my valid criticisms or answer my questions and by his need to resort to distortions and ad hominem attacks.

    If you are going by the article I wrote on blind spots for Quackwatch, the only one that is available online, it only briefly alludes to the defects in Carrick’s work. Carrick’s tirade was in response to the article I wrote in Skeptical Inquirer: have you read that? It was a humorous version of my SRAM article, written for the general public. I don’t know if Carrick has even seen my SRAM article, but my main points were explained in the SI article and he has failed to understand or respond to them appropriately. He is defending his turf with emotion, not responding as a scientist would to valid criticism.

    Please do me the common courtesy of reading my SRAM article and then explain exactly what you think is wrong with my analysis. I don’t think you will be able to persuade anyone here that it was half-assed.

  69. Quill says:

    “You want RCTs. Ok, I will provide them. I took the liberty of doing a PubMed MeSH and shortening the url because it was really, really long. Take a peak, and we can discuss afterwards.
    http://1.usa.gov/ujkJ49

    Nice shotgun blast of all sorts of things, many of which are irrelevant. Some are simply test reports, indicators of further proposals, feasibility studies, reports of what’s in the literature. A selection from the first couple of pages of the conclusion sections of some of the papers:

    “Neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.”

    “Differences in outcomes between medical and chiropractic care without physical therapy or modalities are not clinically meaningful, although chiropractic may result in a greater likelihood of perceived improvement, perhaps reflecting satisfaction or lack of blinding. Physical therapy may be more effective than medical care alone for some patients, while physical modalities appear to have no benefit in chiropractic care.”

    “Further investigation of the possible benefit of chiropractic maintenance care (extended schedule) for balance and pain-related disability is feasible and warranted, as well as both limited and extended schedules for patients with idiopathic dizziness.”

    “Although the sample size was smaller than initially required, a statistically significant and clinically important effect was obtained for the combined treatment group. There are considerable difficulties with recruitment of subjects in such a trial. This trial should be replicated with a larger sample.”

    “It is important that complementary and alternative medicine (CAM) research can be successfully conducted at CAM institutions. However, the costs associated with recruitment efforts for studies conducted at CAM institutions may be higher than expected and many self-identified participants are users of the CAM therapy. Therefore, strategies for efficient recruitment methods and targeting nonusers of CAM therapies should be developed early for CAM trials.”

    Not exactly a ringing endorsement of chiropractic. Be that as it may, since there is no fundamental scientific basis for most of what chiropractic claims, all the dodgy studies available can’t suddenly find it, not even in a perfect post hoc word.

  70. NMS-DC says:

    @Quill

    I read the papers and know the conclusions. Your point? Besides acknowledging that you didn’t read the studies and just skipped through the first 2 of 9 pages? I was asked before to provide evidence of RCTs because the basic sciences papers I provided “were worthless” and “bad and backwards science”. I guess that’s a step up from pseudoscience. We’re making progress here, let’s keep it up!

    Important point to consider: HVLA manipulation is not the only manual therapy DCs provide to our patients. Mobilizations can also be done and should be done in the appropriate circumstances. No reasonable clinician would ever say it’s SMT or bust. But, nice try to again steer the debate away with yet another red herring.

    I also heard from SBM senior editors that there were no good RCTs showing SMT and manual therapies were good for anything. Proven wrong, once again. Here has been a summary of how slippery the slope is for you anti-chiropractic bashers

    DCs are quacks and are useless charlatans -> patients who improve under DCs are all being placeboed –> it’s all a cult –> it’s all pseudoscience –> there is no research –> there is no good research –> there is no basic science research –> the basic sciences research is worthless, terrible, backwards and bad –> there are no RCTs –> the RCTs are bad.

    The medical profession has actively sought to contain, discredit, eliminate and destroy the chiropractic profession. This has been proven by Wilk vs. the AMA. Now the same type of BS is happening in the literature, attempts to discredit, misrepresent, distort, etc. Good thing that DCs have DC/PhDs and objective MDs who truly want to further science by understanding the mechanisms behind manual therapies and their effects on MSK specifically and general health, broadly.

    Time to work out,
    NMS-DC

  71. NMS-DC says:

    @Harriet

    Please provide me a link to your SRAM and I will read it following my work out. I will be objective and honest.

    Regards,
    NMS-DC

  72. Jann Bellamy says:

    @NMS-Dc

    “It’s not chiropractors ‘inventing’ neurology, it’s chiropractors interpreting neurosciences in a functional way. We (DC and MD) are both using the same pool of information, we’re just applying it differently.”

    If the DC neurologists’ interpretation/application of neuroscience had any validity then obviously MD neurologists would be employing the same interpretation/application and using the same therapies. It would be well within their scope of practice. You can quibble all you want about citations to textbooks and journal articles, but basically you seem to be arguing that somehow DC neurologists are better at interpreting and applying neuroscience than MD neurologists. You’re not going to get anyone to agree to that — I doubt even a DC neurologist would agree.

  73. Harriet Hall says:

    @NMS-DC,
    “Please provide me a link to your SRAM and I will read it following my work out. I will be objective and honest.”

    You haven’t been paying attention. It is not available online and I have promised to post it here on SBM in the near future, tentatively scheduled for Nov 29. Stay tuned. By the way, I think an apology is in order for insulting me before reading what I wrote.

  74. Quill says:

    “The medical profession has actively sought to contain, discredit, eliminate and destroy the chiropractic profession.”

    Oh dear, nms-dc. Playing the conspiracy card now? That’s pretty bad. What’s next, claiming Pfizer is tapping your phone? (And still no acknowledgement let alone apologies for your vile scriblings here, your juvenile personal attacks and your constant use of ad hominems and lashing out instead of rationally and logically attempting to persuade. You are, as they say about preachers who scream at people, a poor witness for your cause.)

  75. Harriet Hall says:

    @NMS-DC

    I have repeatedly seen a different slippery slope in my discussions with chiropractors.

    Chiro: X works.
    Me: How do you know X works?
    Chiro: Quotes article.
    Me: Article isn’t acceptable evidence because….
    Chiro: Yeah, I admit it is poor quality evidence, but we’re working to get better evidence.
    Me: What if better studies show X doesn’t work?
    Chiro: I know it works on my patients.
    Me: You could be mistaken; that’s what science is for – to test our beliefs.
    Chiro: You’re prejudiced and ignorant and I’m not talking to you any more.

  76. Cowy1 says:

    I still want to hear the justification for allowing DCs to call themselves “neurologists” after a shoddy 300 hour course at the La Quinta next to the airport.

  77. Quill says:

    @Cowry1: That’s easy, you see, as their holistic, meta-cognitive paradigm is superior to the ol’ stodgy, knowledge-based medical one. Which therefore gives them special and rapid insight into things and that requires only 300 motel-hours instead of 15,000 clinic-lab-classroom hours. It’s all in the paradigm!

  78. lizditz says:

    Questions for @NMS-DC:

    1. Do you consider a chiropractic neurologist to be the equivalent of an MD or DO neurologist in education, training, and expertise?

    2. The program offered by the Brain Balance franchises advertises itself as “clinically proven to help children overcome unique challenges”. I am particularly interested in dyslexia. How does chiropractic neurology characterize dyslexia and how can spinal manipulation improve reading?

  79. lizditz says:

    More for @NMS-DC:

    You wrote:

    … I looked back at my posts on chirotalk circa 2005-2006 and they actually proved to be prophetic. The same will happen here in 5-10 years when the research accrues and many of the fundamental principles of chiropractic have been validated by scientific investigation.

    My word, chiropractic has been around since 1895, and still needs another 5 to 10 years to be validated by research?

    You wrote:

    See Villanueva-Russell 2011 for a more balanced, objective sociological look at the profession. She is a PhD and not a DC and does not work for a chiropractic school.

    You are implying she is objective. Oopsie. She is married to a chiropractor who was named Head of the New Zealand College of Chiropractic last year. I think that would have an impact on her objectivity.

  80. @NMS-DC

    Thank you for responding to me. I apologize it took me a while to respond and review the literature, I just got home from class.

    I was beginning a write-up of my findings, but Quill addressed a number of concerns I had with what I found. Just so I don’t completely ride on Quill’s coat-tails, I included the first few remarks I had in my review I was penning:

    Chiropractic manipulative therapy and low-level laser therapy in the management of cervical facet dysfunction: a randomized controlled study.
    http://www.ncbi.nlm.nih.gov/pubmed/21492750

    Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.
    http://www.ncbi.nlm.nih.gov/pubmed/21036279

    These trials contained no placebo control group. Therefore, it’s impossible to determine whether or not the method works better than sham intervention, which I believe is very important.

    The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.
    http://www.ncbi.nlm.nih.gov/pubmed/20889389

    The patients in this trial received their manipulation along with other conventional treatment modalities. Therefore, it would be wrong to attribute any measured benefit to just one of the given treatments.

    A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain.
    http://www.ncbi.nlm.nih.gov/pubmed/20801246

    This study also did not have a placebo group. However, it did find that manipulation was not superior to simple mobilization.

    These sorts of things were the problems I mentioned I was finding over and over again when it comes to the literature. That’s part of my problem, is that I’m trying to find something that meets the criteria, but keep coming up short.

  81. GLaDOS says:

    You know NMS…

    Can I call you Neims?

    Anyway, Neims, around these parts we like to keep our posters as honest as they’ll come. So, Neims, since we’re pals now, I’d like you to answer the following questions as truthfully as you can. There’s no wrong answer, so don’t worry about getting any wrong. Just, you know, be truthful.

    1) Some people think that Apex Digital makes shitty products, but I think that if you want a TV on the cheap, they’re really not bad. Would you agree?

    2) Who’s better on Friends, Chandler or Joey?

    3) What’s your favorite flavor of Arizona Ice Tea? (Mine’s green with plum.)

    4) Is the program at Palmer College hard, or would you say it’s more of a party school?

    Pencils down!

  82. GLaDOS says:

    In addition to their party-school education, chiropractors are suckers. Many subscribe to practice management firms run by Scientologists –e.g., Singer Consultants, Sterling Management, Hollander Consultants, Silkin Management Group, Stellar Consultants, BackTrack, etc. There’s a bunch of spin offs with new names, to avoid the Hubbard tech association.

    NMS sounds a lot like a Hubbard Admin tech head to me. He hits that “always attack; never defend” note hard, and he’s got that delusional level of unwarranted self importance. Even though both strategies are very self-defeating from a PR perspective, the tech is the tech and the people who buy into it can’t deviate from it.

    Here’s another little test, NMS. See if you can say the following out loud:

    “I am not actually a neurologist. Neurologists have far more training and experience with diseases of the nervous system than I will ever have.”

  83. GLaDOS says:

    “The medical profession has actively sought to contain, discredit, eliminate and destroy the chiropractic profession.”

    Oh dear, nms-dc. Playing the conspiracy card now? That’s pretty bad.

    Actually NMS is correct. See Wilk v AMA.

  84. Quill says:

    Actually, GLaDos, he’s not. It was not “the medical profession” as a whole but a group that was doing the litigating. Had he wrote “the AMA” then he’d be right. (The AMA’s own current data says that less than 20% of us doctors belong to the group.) So it’s not a conspiracy of the entire medical profession (which as commonly used would also include nurses, NPs, dentists, etc.) but only one group.

  85. GLaDOS says:

    I agree that not every doctor was against chiropractic back in the day. But you could get in trouble with your medical society if you referred patients to chiros. So it wasn’t just AMA members hatin’ on the chiros.

    The chiros (not all of them, just most) really do do a lot of bad stuff, like pretending you can fight a scientific battle using political shenanigans, law suits, and dead agent tech. That is not ok. As long as they do things like that, I will want them to go away.

  86. Chiropractic is like astrology (actually in many ways), but in one particular way relevant to this discussion – they are varied in belief and practice. So when science trashes sun-sign astrology, the stellar astrologists claim that’s not “real” astrology.

    NMS-DC is playing the same game.

    Some chiropractors use vitalistic philosophy to treat non-neuromuscular disease. There is zero science behind this.

    Some chiropractors treat childhood disorders without evidence. The BCA defended this, but was unable to defend the practice with actual evidence. They, in fact, inadvertantly demonstrated that the evidence does not support such practices.

    Some chiropractor use a host of unscientific modalities, like homeopathy (the #1 prescribers of homeopathy in the US are chiropractors).

    Some chiropractors limit their practice to functional and manipulative therapy for neuromuscular conditions, and do so in a deliberately science-based manner. By all accounts, this is a small minority (a few percent). They end up being a combination of physical therapist and sports medicine specialist. This is the only legitimate and evidence-based chiropractic, in my opinion.

    And then there are chiropractors like Carrick, who are pushing the envelope of dubious marketing, creating fake specialties, making claims that are not evidence-based, desperately trying to build a pseudoscience by going through the motions of science.

    NMS-DC actually demonstrates this by saying that evidence will validate chiropractic in the future. That’s putting it backwards. To be science-based, you have to already have the evidence to support your claims, not use science to back fill in claims and practices you already have. Classic pseudoscience.

    So, the reason that you hear different kinds of objections from us at different times is because we are talking about different aspects of chiropractic. Some of it violates basic science. Some of it uses poor science. Some has no evidence, some uses bad evidence. And some (spinal manipulation for acute uncomplicated lower back strain) actually has evidence of efficacy (but not superiority to other options) It depends upon what specific chiropractic claim or practice you are talking about.

    So – let’s see the published scientific evidence adequate to establish that any chiropractic practice can improve traumatic brain injury or wake someone from a coma. I’ll wait.

  87. marcus welby says:

    And one more type of chiropractor of less renown but a major source of chiropractic income in some spheres:

    The chiropractor who is linked casually to plaintiff attorneys (some MDs do this also) and in auto insurance PIP states where there is the first 10,000 dollars in medical bills available ripe for the pickings, no questions asked…the auto accident with subjective complaints gets treated 3 times a week with every modality available in the office, each report after the visit describes improvement. When the 10K runs out, the lawyer gets the plaintiff back and files a suit for permanent injury, with the chiropractor a witness that there is permanent injury to this disc space and that disc space, etc. and with most MRI studies of the spine in adults showing disc abnormalities, and with no pre-accident MRI to compare, combined with the awareness of the plaintiff that permanent injuries are more handsomely compensated….you can see where this is going. Be aware that the science of rating permanent spine injury in order to come up with an objective numerical figure for compensation purposes is equivalent to magic and is basically subjective. Then add that for a plaintiff under such circumstances to be challenged or doubted regarding pain (which cannot be measured in another) results in an escalation of subjective symptoms, often described as catastrophizing, or symptom magnification…and voila! a permanently impaired invalid is created. Next step: application for SSI or other disability claim. What an awful system. Some auto accident claimants embroiled in this system report two or more simultaneous claims under litigation, presenting an impossible situation for analysis.
    In some arenas, this scam is a major source of income for chiropractors. A similar scam was recently uncovered in New York involving some MDs and union officials, as I recall, perhaps with the Long Island RR?

  88. Intraneural says:

    I just read this awesome post by Dr. Novella, Thank you again. I am only about halfway through the comments and this may not be that profound of a thought. But I just sat down and made a rough estimate of my anesthesiology training, including call and normal days of the week. This comes to roughly 10,000 hours of providing anesthesia to patients. I also did a fellowship which focused specifically on acute pain/regional/ nerve blocks and that was an additional 3000 hours. As a new anesthesiology attending for the last six months a few times a week I am consulting my more experienced colleagues regarding specific patient problems, different anesthetic approaches, and different managment decisions. It is a challenge everyday. I could not imagine performing as a board certified anesthesiologist on 300 hours of training. To say it would be dangerous is an understatement. The practice of any medical or surgical specialty is so varied and complex. Reading the American Chiropractic Neurology Board website provided a good laugh. I look forward to the day when chiropractors want to lay claim to my chosen specialty with dread.

  89. GLaDOS says:

    The auto accident routine is being translated into a VA service connected disability routine, with chiropractic neurologists hoping to position themselves as TBI experts. They’re actively inserting themselves into brain injury networks. So it’s really important that we educate the public about the difference between chiro neurologists and real neurologists ASAP.

  90. jhawk says:

    @ chris repetsky

    “Again, I’m not claiming this literature cannot exist. I’m simply saying in my years of research, I have never been able to find anything worthwhile. I’d gladly accept a source or two if you have them. I’m willing to admit I’m wrong.”

    here are a few studies:
    http://www.ncbi.nlm.nih.gov/pubmed/20053720

    http://www.ncbi.nlm.nih.gov/pubmed/21334541 (this one is preliminary and has limitations which are fully stated but interesting nonetheless)

    http://www.ncbi.nlm.nih.gov/pubmed/21407100

    http://www.ncbi.nlm.nih.gov/pubmed/20889389

    I would also like to add that most LBP studies to date are suffering from a serious design flaw as LBP is not a specific diagnosis, it is a symptom. When studies using clinical prediction rules and subgrouping of LBP patients come along the efficacy for SMT will be better understood. Most of the studies to date would be equivalent to taking patients with abdominal pain and randomly perfroming appendectomies. It will work for those with appendicitis, some will have benefit via placebo and some it will not help at all.

  91. jhawk says:

    @ lizditz

    “1. Do you consider a chiropractic neurologist to be the equivalent of an MD or DO neurologist in education, training, and expertise?

    I can not speak for NMS DC but would like to address your first question and the answer is an unequivocal no. Furthermore, if a chiropractic neurologist is using the term neurologist without chiro before it then this person should be reported to their respective state board.

  92. jhawk says:

    @ cowy1

    “There are also Chiropracty Internists (http://www.councildid.com/index2.html) and radiologists (www.dabcr.com). Kind of hilarious.”

    The radiology program is actually a 3 to 4 year residency with a minimum of 4000 hours on top of the 400 hours of radiology in chiro school. Are chiro radiologists the same as MD radiologists? No. The chiro radiologists focus on MSK imaging.

    Here is an iteresting little study:

    http://www.ncbi.nlm.nih.gov/pubmed/12221360

  93. NMS-DC says:

    A lot of commentary has been added since my visit yesterday, if I forget to address specific questions, please remind me and I’ll get to it

    @Harriett

    I was referring to your rebuttal of Dr. Carrick’s 1997 paper on blind spot mapping. I believe I read it at QuackWatch. I do apologize for my tone towards you, we can disagree and not be disagreeable.

    You wrote:

    I have repeatedly seen a different slippery slope in my discussions with chiropractors.
    Chiro: X works.
    Me: How do you know X works?
    Chiro: Quotes article.
    Me: Article isn’t acceptable evidence because….
    Chiro: Yeah, I admit it is poor quality evidence, but we’re working to get better evidence.
    Me: What if better studies show X doesn’t work?
    Chiro: I know it works on my patients.
    Me: You could be mistaken; that’s what science is for – to test our beliefs.
    Chiro: You’re prejudiced and ignorant and I’m not talking to you any more.”

    I understand your argument and agree how those types of conversations can degenerate and be unproductive. If I could make a constructive suggestion it would be that you engage these debates with chiropractic academics, or chiropractic scientists (DC/PhDs). We will discuss chiropractic sciences critically, objective and unemotionally. I do appreciate your reply though. I look forward to Nov 29th post.

  94. NMS-DC says:

    @Quill

    “Oh dear, nms-dc. Playing the conspiracy card now? That’s pretty bad. What’s next, claiming Pfizer is tapping your phone?”

    Quill, with all due respect, I was referring to the Will vs. AMA case antitrust case. Have you not heard of it? In fairness I didn’t either until my first year in my history of chiropractic course. Please see the link provided http://en.wikipedia.org/wiki/Wilk_v._American_Medical_Association

    @Jann

    “If the DC neurologists’ interpretation/application of neuroscience had any validity then obviously MD neurologists would be employing the same interpretation/application and using the same therapies.”

    Well, MDs generally don’t perform spinal manipulation, and generally aren’t interested in conservative therapies. I would like too add that chiropractic neurology is more than just applying manipulative techniques to neurological cases. The Crosby case I was referring to was multi-modal and didn’t involve anything controversial like homeopathy or other alt-med approaches.

    “basically you seem to be arguing that somehow DC neurologists are better at interpreting and applying neuroscience than MD neurologists. You’re not going to get anyone to agree to that — I doubt even a DC neurologist would agree.”

    I did not state that Jann. I do not think DC neuros are better at interpretation and application of neuroscience. I just think that they have a different way of looking at rehabbing neuro cases, and that their approach might broaden the spectrum of how science understands and treats neuro conditions, and specifically to this article, vestibular rehab.

    Regards,
    NMS-DC

  95. Harriet Hall says:

    “most LBP studies to date are suffering from a serious design flaw as LBP is not a specific diagnosis, it is a symptom. When studies using clinical prediction rules and subgrouping of LBP patients come along the efficacy for SMT will be better understood. Most of the studies to date would be equivalent to taking patients with abdominal pain and randomly perfroming appendectomies. It will work for those with appendicitis, some will have benefit via placebo and some it will not help at all.”

    Why is it that chiropractors doing these studies have not defined what kind of LBP they can treat successfully?
    I don’t have the reference handy, but I believe the existing clinical prediction rules for SMT were developed by non-chiropractors. Why have chiropractors not studied their various techniques in comparison with each other and rejected those that are less effective? Can you imagine surgeons continuing to lump all abdominal pain patients together and doing appendectomies on them all? After over a century of study? This really highlights the difference between the scientific approach and the chiropractic approach.

  96. Harriet Hall says:

    @NMS-DC ” If I could make a constructive suggestion it would be that you engage these debates with chiropractic academics, or chiropractic scientists (DC/PhDs). ”

    Do you know who Stephen Perle is? We had a long discussion with him on the Quackwatch Healthfraud list. He was courteous and rational, but ultimately could not support his claims with satisfactory evidence and he gave up and exited the list.

  97. lizditz says:

    GLaDOS,

    Thanks for the info re the chiropractic neurologists infiltrating the VA to provide TBI “expertise”. I’d like to hear more about the VA connection.

  98. NMS-DC says:

    @lizditz

    1. Do you consider a chiropractic neurologist to be the equivalent of an MD or DO neurologist in education, training, and expertise?

    No I do not.

    2. The program offered by the Brain Balance franchises advertises itself as “clinically proven to help children overcome unique challenges”. I am particularly interested in dyslexia. How does chiropractic neurology characterize dyslexia and how can spinal manipulation improve reading?

    I am not familiar with the BB franchise so I can’t directly comment on it. I can provide you with a bit of information however regarding some of the concepts (not proven) regarding conditions like ADHD/autism/dyslexia. Here in the exerpt:

    “We outline the basis of how functional disconnection with reduced activity and coherence in the right hemisphere would explain all of the symptoms of autistic spectrum disorder as well as the observed increases in sympathetic activation. If the problem of autistic spectrum disorder is primarily one of desynchronization and ineffective interhemispheric communication, then the best way to address the symptoms is to improve coordination between areas of the brain. To do that the best approach would include multimodal therapeusis that would include a combination of somatosensory, cognitive, behavioral, and biochemical interventions all directed at improving overall health, reducing inflammation and increasing right hemisphere activity to the level that it becomes temporally coherent with the left hemisphere. We hypothesize that the unilateral increased hemispheric stimulation has the effect of increasing the temporal oscillations within the thalamocortical pathways bringing it closer to the oscillation rate of the adequately functioning hemisphere. We propose that increasing the baseline oscillation speed of one entire hemisphere will enhance the coordination and coherence between the two hemispheres allowing for enhanced motor and cognitive binding.” Here is the link http://www.ncbi.nlm.nih.gov/pubmed/19774789

    Anyways, the take home point was that the treatment isn’t only manipulative therapy, but also ” somatosensory, cognitive, behavioral, and biochemical interventions” I can’t go too deep in this subject (ADHD/dyslexia/autism and related disorders) as my professional interests are more in NMS rehabilitation/sports medicine.

    Your 2nd post

    ore for @NMS-DC:

    “My word, chiropractic has been around since 1895, and still needs another 5 to 10 years to be validated by research?”

    True, scientific research into chiropractic has only really been around since the late 70s, early 80s, and it only now starting to reach a level of maturity and capacity that would be considered to be at the mainstream scientifically acceptable levels. That being said, some core concepts such as the identifying precisely the specific biomechanics/kinematic markers of joint dysfunction are well underway with the technology allowing us now to get a much better idea of spinal biomechanics and how this affects neuromuscular responses. Also, the specific biological effects behind SMT are further being elucidated, research looking into how mechanical forces on tissues is tranduced into a therapeutic effects (this covers joint and soft tissue techniques) as well as getting a better understanding of the role of joint dysfunction and specific reflexes that occur segmentally in the spine, other autonomic reflexes such as somato-visceral responses. There are also many RCTs that are currently underway but that will have to be for another thread.

    “She is married to a chiropractor who was named Head of the New Zealand College of Chiropractic last year. I think that would have an impact on her objectivity”

    I was not aware that she is married to a DC, and I do think that’s a relevant point. But having read both her papers (2005, 2011) she is not a chiropractic cheerleader. I personally found her most recent article to be almost sympathetic to the plight of subluxation-based chiropractors (how the CCEI and chiropractic academics are “steering” chiropractic into a limited specialty as manual NMS experts) who are seeing their clout and vision of dissipate in the EBM era. Thanks for information though, learned something new.

    Regards,
    NMS-DC

    Regards,
    NMS-DC

  99. NMS-DC says:

    @Harriet

    Yes I know of Dr. Perle. Can you provide me a link to your discussions? What claims was he making?

    NMS-DC

  100. Harriet Hall says:

    @NMS-DC,
    The discussions took place a long time ago. I don’t know if they would still be available in an archive. The details are hazy this long after the fact, but his main claim was that chiropractic was reforming and becoming scientific, and he did convince me that he was sincerely involved in reform efforts, but he didn’t convince me that chiropractic as a whole was reforming or even was listening to him. And if I remember correctly, he advocated the use of activators.

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