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Chiropractic Strokes Again! A Landmark Lawsuit in Canada

Sandra Nette is a prisoner, condemned to spend the rest of her life in the cruelest form of solitary confinement. Her intact mind is trapped in a paralyzed body and she is unable to speak. She can move one arm just enough to type on a special keyboard. She cannot swallow or breathe on her own, and must be frequently suctioned. She feels sensations and is in pain. Her condition is known as “locked-in syndrome” and has been described as “the closest thing to being buried alive.” She is suing those responsible for her cruel fate and I hope she wins.

She was a healthy 40 year old woman who wanted to stay healthy. She did all the right things like watching her weight, eating right, and not smoking. She followed the advice of a chiropractor to include regular maintenance chiropractic adjustments in her health regimen. On September 13, 2007 she had the last adjustment she would ever have.

There was nothing wrong with her. She didn’t see the chiropractor for headaches, neck pain, back pain or any other complaint. She went for a “tune-up” that she thought would help keep her healthy. The chiropractor did a rapid-thrust adjustment on her neck. Right afterwards, she complained of feeling “sore, dizzy and unwell.” She tried to leave but had to sit down. The chiropractor failed to recognize the medical emergency, and instead of calling an ambulance he recommended that she would benefit from purchasing massage therapy from his clinic. He let her leave the office and drive home alone. She only made it part way.

In the hospital, doctors determined that she had tears in BOTH vertebral arteries in her neck. One tear was 3 inches long.

Chiropractors would like us to believe that strokes after neck adjustments are mere coincidence, that patients like Sandra go to a chiropractor because they have neck pain from a stroke-in-progress and the manipulation is not the culprit. But cases like this are crystal-clear: she had no prior symptoms and there is no question that the neck maneuvers directly caused the tears in the arteries. One of the doctors in the ER took one look at her and asked her husband, “Chiropractor?” Neurologists, emergency physicians, and rational chiropractors all recognize that neck adjustments occasionally cause strokes, but the majority of chiropractors are still resisting reality.

Chiropractors tell us that strokes after neck adjustments are exceedingly rare, and that other forms of treatment, such as NSAIDs, are more dangerous. But in this case, it wasn’t a question of comparing treatment options, because nothing was being treated. There is no evidence to support the practice of maintenance adjustments. The absolute risk is small but the risk/benefit ratio is infinite because the benefit is zero. For a fuller discussion, see my previous blog article on Chiropractic and Stroke.

Sandra didn’t know that neck manipulation could cause a stroke. She didn’t know that maintenance adjustments only benefit the chiropractor’s bank balance. She wasn’t informed, so she couldn’t give informed consent.

Sandra isn’t just suing the chiropractor. She and her husband are suing:
• Gregory John Stiles,
• The Spa and Life Stiles,
• The Alberta College and Association of Chiropractors, and
• Her Majesty the Queen in Right of Alberta (Minister of Health and Wellness).

And they are seeking an order to make it a class action suit to cover every patient who received “an inappropriate and non-beneficial adjustment from any Alberta chiropractor since 1998.” Potential beneficiaries include those patients’ spouses and their estates if they are deceased.

Among other things, they contend that the defendants owed their patients a duty to not advise procedures that lacked scientific justification, to fairly disclose the benefits and risks of their interventions, and “not to charge them a fee for services that cannot restore, maintain or enhance human health.”

The Statement of Claim runs to 80 pages and describes the foundation of chiropractic, previous lawsuits, the published literature, and warning statements by groups like the 62 Canadian neurologists who spoke out in 2002. It provides extensive, detailed evidence to show that the College and the government were well aware of the risk of stroke and it argues that the College and the Minister of Health should have acted to regulate chiropractic to prevent disasters like Sandra’s.

They accuse the College of acting in bad faith, concocting evidence, sponsoring “methodologically inadequate research studies designed to validate rather than investigate the issue” and distorting scientific findings to support traditional chiropractic beliefs and economic interests. Strong words.

They are asking for $529 million dollars in damages.

Consumer advocates and victims of chiropractic have asked to meet with Canadian legislators and the Minister of Health to propose the following guidelines:

ONE: INFANTS AND CHILDREN: Highest neck manipulation should never be done in infants and children for claims to treat such conditions as ear infections, tonsillitis, infantile colic, asthma and gastro-intestinal disorders nor as an alternative to scientific immunization against diseases such as polio, tetanus, measles, mumps, German measles or chicken pox. The Chiefs of Paediatrics of our Canadian Hospitals have all condemned such claims by chiropractors.

TWO: PHILOSOPHICAL CLAIMS: Highest neck manipulation should never be done for the claim that it is effective to awaken the “innate intelligence of the spinal cord” and thereby provide “wellness or health” of the entire body. The idea that the spinal cord has some magical “innate intelligence” is a fundamental chiropractic belief. It is false.

THREE: REPETITIVE HIGHEST NECK MANIPULATIONS: Highest neck manipulation should not be done on a repetitive basis with claims that this will keep the neck vertebrae in proper alignment. It is false to claim that highest neck manipulation is necessary for the “maintenance” of the alignment of the highest neck vertebrae. The vertebrae are attached to each other by a complex structure of bone, ligaments and muscles. Manipulating the highest neck time and time again on people who have no complaints in that area should not be done.

FOUR: INFECTIONS: Highest neck manipulation should not be done for any claims that it alters in any manner, the immune system, to prevent or to treat infections such as Acquired Immune Deficiency Syndrome and other bacterial, viral or fungal infections.

FIVE: BODY ORGANS: Highest neck manipulation should not be done for claims that it can have a health benefit upon a body organ such as the heart, lungs, kidneys and liver or as a means of preventing the onset of genetic disorders or cancer.

SIX: VERTEBRAL SUBLUXATIONS: Highest neck manipulation should never be done for the claim that it can remove so called “vertebral subluxations” in the highest neck area. It is false to claim that these top vertebrae are out of alignment, even in new born babies, and that manipulating the highest neck area one can improve the function of the brain stem as well as treat conditions such as sinusitis and even multiple sclerosis. There is no neurological or scientific basis for such claims.

These guidelines make sense, and rational chiropractors should have no objections to them. They would not interfere with spinal manipulation therapy for musculoskeletal conditions, and they would eliminate much of the quackery in chiropractic.

The outcome of this lawsuit could have broad implications. If the judge finds that providers owe their patients a duty to not advise procedures that lack scientific justification, it will open the door to similar lawsuits involving other alternative medicine modalities. It might also open the door to lawsuits against scientific MDs who can’t convince the court that a treatment is adequately supported by scientific evidence. We want to eliminate quackery, but we don’t want to make the courts the arbiters of what constitutes sufficient scientific evidence.

Lawyers are smart and they will undoubtedly put up a good defense. If nothing else comes of this lawsuit, it should at least promote a useful discussion. There have been repeated recommendations to require chiropractors to at least disclose the risk of stroke to their patients, and no official body has yet acted on those recommendations. Maybe now they will. If not the official bodies, maybe the chiropractic malpractice insurance agencies, out of sheer financial self-interest, will start requiring their clients to get informed consent from their patients.

The transcript of the trial alone ought to furnish enough documentation for someone to write a book on the risks and benefits of chiropractic and the associated science or lack of science. This may do for chiropractic what Dover did for Intelligent Design. I will follow it with great interest.

Posted in: Chiropractic, Health Fraud, Politics and Regulation

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179 thoughts on “Chiropractic Strokes Again! A Landmark Lawsuit in Canada

  1. DLC says:

    One can only hope she puts this crumb out of business.
    He should be in prison, if you ask me.
    Hey, he could come to my house, lay on my dining room table and let me fix his subluxations . . . I promise not to intentionally break his neck. Really.

  2. DBonez says:

    “innate intelligence of the spinal cord”

    Maybe Chiropractors learned their “science” from zombie movies.

  3. bodhig says:

    I have come to enjoy reading most of the posts on this blog until now. I am quite disappointed in the rhetoric written in this post.
    Why did you leave out the conclusions that the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders came to on this issue of stroke and cervical manipulations?
    They state:
    “Vertebrobasilar Stroke Study Findings
    There was an association between chiropractic services
    and subsequent vertebrobasilar artery stroke in persons
    under 45 years of age, but a similar association was also
    observed among patients receiving general practitioner
    services. This is likely explained by patients with vertebrobasilar
    artery dissection-related neck pain or headache
    seeking care before having their stroke.”
    SPINE Volume 33, Number 4S, pp S5–S7

  4. katagoshi says:

    The senselessness of this is so infuriating. Like much of “woo” medicine, it’s mostly a bunch of harmless, over-priced fluff…until it isn’t. And when it isn’t, there are no excuses, because none of it was done on the basis of any real, science-based knowledge. Conventional medicine has its risks, too, but it is also under constant scrutiny and re-evaluation as more information becomes available and medication and procedures are improved and become better understood – as far as I’m concerned, chiropractors are glorified masseuses who are trying to play doctor, and they are misleading people and performing dangerous techniques for no reason and without a proper understanding of medicine.

    I hope this lawsuit proves to be a turning point that gets things rolling in the US – alternative medicine is dangerous and undermines conventional medicine…people need to wake up and smell the naturopathic B.S.

  5. Harriet Hall says:

    bodhig,

    I didn’t leave it out. If you will follow the link in my article to my previous article on Chiropractic and Stroke, you will find a critique of the Spine article in the comments.

    It is a seriously flawed study, and even if it were true, its hypothesis is that patients already had symptoms of stroke that led them to seek medical care. That was clearly not true in the case of Sandra Nette, nor was it true for Laurie Jean Mathiason who had pain in her tailbone. And if patients see a chiropractor for neck pain from an impending stroke, shouldn’t chiropractors recognize that possibility and refrain from upper neck adjustments?

  6. jjutkowitz says:

    Oh please Harriet,

    All the studies showing association between neck manipulation and stroke are flawed as much as the Spine study because they are all statistically based and none are based on actual experiments.

    As far as the statement that this patient did not have previous stroke symptoms, you should know that just about any neurologically based symptom, including tailbone pain can be referred as stroke related symptoms.

    And your last statement is worse than seriously flawed, it shows a bias in your thinking that you do not even know is there and how lacking in reason your comments are:

    You say chiropractors should refrain from upper neck adjustments if patients see them for neck pain because they might be having a stroke is ONE of the possibilities. The fact that you note they ARE ALREADY HAVING THE STROKE admits right in that statement that the manipulation does not cause the stroke but the stoke preceeds it but was not noticed by MDs either.

    Then you advise no treatment, though the treatment relieves many and does not cause the damage? Why not treat the vast majority of people for whom the adjustment gives amazing relief from headaches, neck pain and quite a few other symptoms on a temporary or permanent basis? Just because one in a million is having a stroke?

    This is like in the 1980s when radiologists fell for that line about CAT scans being necessary to rule out tumors in every headache case until the insurance companies noticed that the incidence was less than 1 in 10,000 and refused to stop paying for the tests unless there were other indications becaue it was just a way for the CAT Scan machine purchasers to pay for their machines and more.

    Currently there is the same thing with CAT scans and heart disease, see the NY Times article from earlier this week.

    The stroke potential in manipulation, which includes wrestling and other physical activities is less than 1 in a million, so about a million people should suffer physically because one might be having a stroke, which by the way, has nothing to do with the manipulation so people should be refused treatment?

    This is silliness and playing the victim to the max. You might as well ban crossing the street in any city, or even most suburbs because every once in a while some silly person J walks and gets hit or some driver is not paying attention and hits someone.

    Dr. Jutkowitz

  7. jjutkowitz says:

    Oh Harriet,

    I should also mention that you missed the TWO studies showing that the number of Chirorpactors in a given area correlates strongly with improved health and decreased death rates in that area AND that MD ratios or the presence of more insurance covered people DOES NOT correlate with improved health or reduced mortality.

    The latest chiro study is: Correlation of U.S. Mortality Rates with Chiropractor Ratios and other Determinants: 1995
    John Hart MHS, DC [July 2, 2008, pp 1-6]

    Maybe I should reference those studies that showed greatly reduced death rates in California and Israel and everywhere else Medical Doctors have gone on strike and refused to work?

    Dr. Jutkowitz

  8. nwtk2007 says:

    I find it interesting that there is a reduced death rate where there are more chiropractors.

    I guess with more people going to chiropractors then the local medical community cannot participate as much in the 500 or so deaths caused by medical mistakes that occur everyday.

    See the attached link to the Dept Of Health and Human Services:

    http://www.ahrq.gov/qual/errback.htm

    And it’s mistakes, not just difficult cases with an understood mortality rate.

  9. vinny says:

    “Dr.” Jutkowitz, I am surprised you have not refered to the whale:to site yet, but again I see this pattern of someone with little understanding if disease pathophysiology making blanket statements about health topics. It will be a tragedy if at some point in your life you will give someone advice on treatment of an illness and that person will actually follow your advice. I am not a nuclear physicist and spending the night at a Holliday Inn Express, will not qualify me to offer advice to engineers on building their nuclear reactor. Please consider your actions when giving advice to people and how lack of knowledge can lead to serious injury. I can only hope that you will not become a victim of your own flawed knowledge and irresponsible arrogance.

  10. pec says:

    This case is very tragic, of course. But Harriet and other anti-chiro MDs are only interested because it helps their chiro-trashing campaign.

    She is trying to scare everyone away from neck adjustments based on one horrible accident. Suppose someone were injured in this way while exercising at the gym — would you try to scare everyone away from exercise?

    I practice yoga and I do my own neck adjustments (probably a lot safer to do it yourself). The health of the entire mind and body is influenced by the alignment of the cervical vertebrae. Harriet’s mind is utterly closed on this subject. She won’t look at the evidence or experience it for herself.

  11. Deetee says:

    pec, I can quite believe that the entire health of your mind is influenced by the alignment of your cervical vertebrae.

  12. Harriet Hall says:

    pec,

    I am not attacking chiropractors. I am pointing out things they do that are dangerous and that are not evidence-based. Just as I do in the case of medical doctors.

    The risks of exercise are smaller than the known benefits. My objection to cervical maintenance adjustments is that there are no known benefits.

    I support gentle mobilization treatments for musculoskeletal neck problems, but not the rapid-thrust type of manipulations that have been associated with strokes, and I don’t support them because the evidence shows they are not superior to the safer mobilization techniques.

    There isn’t a shred of evidence that “The health of the entire mind and body is influenced by the alignment of the cervical vertebrae.” That is a chiropractic belief system not based on reality.

    And I’ve tried to tell you before that experiencing something for yourself may be persuasive but is not an objective way to evaluate claims. It only leads to personal convictions and errors in thinking.

  13. Harriet Hall says:

    jjutkowitz said, “the number of Chirorpactors in a given area correlates strongly with improved health and decreased death rates in that area”

    Correlation doesn’t prove causation. I suspect that areas where people are healthier can support more chiropractors. Health correlates with socioeconomic status, and people with money can afford the luxury of chiropractic maintenance visits, of seeking treatment for minor aches and pains, and of experimenting with alternative treatment methods.

    I remember reading one study that showed chiropractors don’t live as long as the average person, and I know of no controlled studies showing that chiropractic care improves health or prolongs life.

  14. Harriet Hall says:

    Jjutkowitz said,

    “All the studies showing association between neck manipulation and stroke are flawed as much as the Spine study because they are all statistically based and none are based on actual experiments.”

    Ha! What kind of experiments would you like to see? We were able to figure out that smoking caused lung cancer without doing actual RCTs making people smoke and giving them lung cancer. I didn’t object to the Spine study because it was statistically based but because it was poorly designed.

    “As far as the statement that this patient did not have previous stroke symptoms, you should know that just about any neurologically based symptom, including tailbone pain can be referred as stroke related symptoms.”

    You missed my point. This patient didn’t have ANY symptoms. And the patient with tailbone pain had injured her tailbone. I challenge you to find a single case report of a stroke that presented as tailbone pain. The warning signs of stroke are numbness, weakness, confusion, trouble speaking or understanding, trouble seeing, dizziness, loss of balance or coordination, and sudden severe headache.

    “You say chiropractors should refrain from upper neck adjustments if patients see them for neck pain because they might be having a stroke is ONE of the possibilities. The fact that you note they ARE ALREADY HAVING THE STROKE admits right in that statement that the manipulation does not cause the stroke but the stoke preceeds it but was not noticed by MDs either.”

    You missed my point again. If a patient is already having a stroke, manipulation will only make things worse. In that case, it will not have caused the stroke but will have exacerbated it. Manipulating patients who have neck pain from other causes can (rarely) cause a stroke and patients do not benefit more from manipulation than from gentle mobilization.

    “Why not treat the vast majority of people for whom the adjustment gives amazing relief from headaches, neck pain and quite a few other symptoms on a temporary or permanent basis? Just because one in a million is having a stroke?”

    There are safer treatments (gentle mobilization, etc.) that provide the same benefits without the risk of stroke. Patients may still choose to have the riskier treatment, but they should be informed that the risk exists, even though it is small.

    “Currently there is the same thing with CAT scans and heart disease, see the NY Times article from earlier this week.”

    I will be writing about the NYT article next Tuesday. But I fail to see what that and the headache/CT business has to do with chiropractic and stroke.

  15. pec says:

    Harriet,

    It’s possible that aggressive neck adjustments can be dangerous. I really don’t know, and had heard this type of stroke is rare.

    I am not a chiropractor or an advocate for their profession. But of course I am a believer in life energy and subluxations.

    If my neck is out of alignment (because of a stressful day, too much work, etc.) I can touch the back of my neck and feel that one or more vertebrae is out of place. I have unmistakable physical symptoms at those times, which do not usually include neck pain. There may be pain anywhere, and general tiredness, weakness, lack of health and energy.

    Once I have corrected the subluxations I feel fine.

    This is not psychological or imaginary.

    Before I knew about subluxations I had no idea why my levels of energy and health varied so greatly. If I had gone to MDs they would have given me batteries of tests, found nothing, and prescribed antidepressants.

    And that is what probably happens in most cases.

  16. Harriet Hall says:

    Pec said,

    “I am a believer in life energy and subluxations.”

    Go ahead and believe; just don’t expect others to believe without evidence.

    “I can touch the back of my neck and feel that one or more vertebrae is out of place.”

    I won’t believe that until you show us the x-rays. Chiropractors used to claim that bones are out of place, but they have never been able to demonstrate it on x-rays. When tested, they have been unable to tell the “before” from the “after” x-rays. Chiropractors no longer even claim that bones are out of place; they had to develop a new definition of subluxation.

    “This is not psychological or imaginary.”

    The burden of proof is on you.

  17. nwtk2007 says:

    You can argue the existence of innate, living energy, etc. till the cows come home and never get anywhere.

    Of all the posts I have read here today this was the most significant:

    “”"”I should also mention that you missed the TWO studies showing that the number of Chirorpactors in a given area correlates strongly with improved health and decreased death rates in that area AND that MD ratios or the presence of more insurance covered people DOES NOT correlate with improved health or reduced mortality.

    The latest chiro study is: Correlation of U.S. Mortality Rates with Chiropractor Ratios and other Determinants: 1995
    John Hart MHS, DC [July 2, 2008, pp 1-6]

    Maybe I should reference those studies that showed greatly reduced death rates in California and Israel and everywhere else Medical Doctors have gone on strike and refused to work?

    Dr. Jutkowitz”"”"”

    My response was posted after several others which were actually later and thus by the time it was posted, it was way up the ladder, so to speak and might have gotten by you:

    “”"”"”I find it interesting that there is a reduced death rate where there are more chiropractors.

    I guess with more people going to chiropractors then the local medical community cannot participate as much in the 500 or so deaths caused by medical mistakes that occur everyday.

    See the attached link to the Dept Of Health and Human Services:

    http://www.ahrq.gov/qual/errback.htm

    And it’s mistakes, not just difficult cases with an understood mortality rate.”"”"”"

    You see, the greatest sin going on here is the actual ignoring and/or ignorance of the harm conventional medical science is doing to people on a day to day basis. I cannot believe that knowing this fact about the harm to the public by medical mistakes, that there can be any criticism of chiropractic, no matter what you believe.

    Medical science is running ammuck with harm to the public and it is astounding. In addition to this, I was reading from another government web site today about prescriptions being filled wrong and it calculated out to 6500 per day.

    Medical science has no room to pass any judgement on chiropractic as long as they are killing so many every day of the year. Their mistakes are a very real disease and is even a somewhat self susstaining part of the pharmaceutical industry; for their mistakes, when they don’t kill, will be treated pharmaceutically.

    I feel sorry for anyone injured needlessly and support the use of informed consent. It should be in place by law. Absolutely, but the anti-chiro groups are using this as a spring board for their campaign to get rid of chiropractic. And using it is the proper word. They don’t give a rats bottom end about Ms Nette and her condition. They actually relish in stories like this. They laugh and whoop it up when they post new stories like this on the anti-chiropractic web sites.

    They don’t CARE a whit, they USE it a great deal.

    Just my two cents.

  18. weing says:

    nitwitk2007,
    Are you saying that if you get sick you will run to your chiropractor for a cure? So what’s stopping you?

  19. nwtk2007 says:

    Nice change of the name. You sound very familiar, so should I refer to you as Wisdom or Moby or Fred or jim?

    At least I retain my identity.

    And no, I don’t run to the chiropractor for a cure for anything.

    I am not even here to argue that chiropractic cures anything at all.

    I am here to point out that guys like you are using this as a stepping stone to continue your rant against chiropractic. You are using this woman’s tragedy to your own end and couldn’t care less about her, and obviously don’t care a whit about all the hundreds killed and harmed everyday by medical mistakes in much the same fashion as Ms Nette.

    In answer to your question, nothing is stopping me nor is it stopping anyone else. If they found what they were looking for, relief and help, from the medical community, they would not run to the chiropractor.

    You failed as a chiropractor and now you want something back. You are disgusting.

    People need and deserve more.

    Fight for the use of a good informed consent that doesn’t bash or ridicule but informs about realistic risk and I am with you. Use it for self promotion and self indulgent revenge and I am not.

    Nor do I believe Ms Nette would either.

  20. Harriet Hall says:

    nwtk 2007,

    I wish people would read what I wrote and not what they want to think I wrote. I didn’t write about the Nette case because I want to get rid of chiropractors. I wrote about it because I would like chiropractors to get informed consent for procedures that have no known benefit and have a small risk of a catastrophic outcome.

    I am very offended that you think I don’t care about Sandra Nette. If I didn’t care about patients being harmed I would not have bothered to write.

    I have a very good friend who is a chiropractor who only treats musculoskeletal conditions and who doesn’t do the kind of manipulation that Sandra Nette had. I have nothing against chiropractors. I only object to things some chiropractors do that are not supported by evidence. I am particularly incensed by applied kinesiology and anti-vaccine propaganda, and by the kind of maintenance adjustments that have never been shown to benefit patients and that paralyzed Sandra Nette.

    As to comparing the harm done by doctors to the harm done by chiropractors, please read my article on Death by Medicine http://www.sciencebasedmedicine.org/?p=136 and try to understand the principle that it makes no sense to consider the harms in isolation. What is important is the harm/benefit ratio.

  21. Harriet Hall says:

    jjutkowitz,

    Just curious. Are you the Jesse Jutkowitz who invented the ABC technique and who used to take full spine x-rays on all his patients? The one whose license was revoked for “incompetent and negligent conduct”? The one who fraudulently got a license in another state and had that revoked too? The one who got a teaching position that he was not qualified for by not divulging that his license had been revoked? The one who inserted his fingers into a female patient’s rectum to administer a “coccygeal-meningeal procedure” that he said would cure her of acne and migraine headaches? The one who was written up on Chirobase at http://www.chirobase.org/06DD/abc.html and who promised to cure a patient of multiple sclerosis by adjusting his spine?

    Not that it really matters, because I don’t do ad hominem attacks and I won’t judge you on your past, but merely on the content of your comments. But I was wondering… if you are that J. Jutkowitz, what are you doing these days?

  22. Michelle B says:

    Pec wrote: Before I knew about subluxations I had no idea why my levels of energy and health varied so greatly. If I had gone to MDs they would have given me batteries of tests, found nothing, and prescribed antidepressants.

    And that is what probably happens in most cases.
    __________

    I am afraid that you still do not know why your levels of energy and health vary so greatly.

    I would love to use chiropractic (the kind which Harriet describes), but with such sloppy standards, I can not any longer take the chance (I have received chiropractic treatment in the past). I have various muscular problems, and the past chiropractic treatments relaxed my muscles, releasing great gobs of energy.

    Once a battery of tests are done, you can bring those tests to a new doctor and explain that you are not interested in further extensive testing but am interested in improving your health, preferably without drugs, or if with drugs, for a limited period of time. If you can build up trust that a doctor is not going to blindly medicate you with antidepressants, then perhaps you two can really find out what the matter is.

    Science-based medicine has non-invasive, non drug, and non-surgical treatments. Your particular case may not be easy to solve, and that can be very frustrating; and some medical doctors being idiots only add to your existing health problems. Search for a better doctor.

  23. Michelle B says:

    Pec, when muscles are contracted, they use energy, relaxing them, whether bathing in a hot tub, or massaging the kinks out, or popping bones (muscles are attached to bones via ligaments), allows the energy to be released. Therefore, subluxations need not apply as a reason why you feel more energetic after chiropractic treatment.

  24. Michelle B says:

    I probably am mistaken, I get tendons and ligaments mixed up! Think tendons connect muscles to bones, and ligaments connect bone to bone.

  25. pec says:

    Michelle B.,

    Why on earth would I go to an MD for a problem I have already solved? And actually I saw various kinds of MDs 25 years ago, when I was 30, and they told me it was just old age!

    When MDs can’t find a disease they recognize they will blame it on old age (even if you’re only 30!) or tell you to see a psychiatrist. They will never check your spine for subluxations, since they don’t believe in subluxations.

    So it would be insane for me to go to MDs now, knowing they don’t believe in the cause of the problems I have already solved. And they would try to push drugs.

    And I think subluxations are responsible for a lot more than chronic fatigue and fibromyalgia. Some of the most common chronic diseases, such as high blood pressure, might be related to the alignment of cervical vertebrae, and the spine in general.

  26. weing says:

    pec,
    I think poverty, the high price of gas, and war might be related to the alignment of cervical vertebrae and the spine in general.

  27. nwtk2007 says:

    I agree with you Pec, why would you go to an MD for something that has already been fixed or is under control? Especially when they couldn’t fix it in the first place.

    Michelle – “Once a battery of tests are done, you can bring those tests to a new doctor and explain that you are not interested in further extensive testing but am interested in improving your health, preferably without drugs, or if with drugs, for a limited period of time. If you can build up trust that a doctor is not going to blindly medicate you with antidepressants, then perhaps you two can really find out what the matter is.”

    What are the alternatives that a new MD will bring to the table for PEC? I would trust the MD’s to have hopefully eliminated the presence of any life threatening cause of his condition Michelle, but beyond that, what else will they do?

    And then there is old Weing, being krass as usual and continuing to be true to form.

  28. weing says:

    Why don’t you think they are related?

  29. Harriet Hall says:

    pec,

    I’m glad you solved your problem. Really! I’m just questioning whether your solution has anything to do with the mythical subluxation. You have given us no reason to think it does.

    “And I think subluxations are responsible for a lot more than chronic fatigue and fibromyalgia.”

    Do you have any evidence that they are responsible for chronic fatigue and fibromyalgia? Do you have any evidence that they exist in the first place? Where are the x-rays showing a bone is out of place?

    “Some of the most common chronic diseases, such as high blood pressure, might be related to the alignment of cervical vertebrae, and the spine in general.”

    Evidence, please.

    “I think poverty, the high price of gas, and war might be related to the alignment of cervical vertebrae and the spine in general.”

    That may be the funniest thing you’ve said yet. If I hadn’t read your previous comments, I would think you were joking. Are you sure George Bush isn’t responsible? Or the Elders of Zion? :-)

  30. pec says:

    “Where are the x-rays showing a bone is out of place?”

    Harriet,

    I already explained that I can feel the back of my neck with my hand and it’s obvious when a bone is out of place. I can’t believe this is something you have never noticed. I don’t need x-rays. And that would be useless since the subluxations come and go, depending on what muscles happen to be overly tense or overly lax at any moment.

    I think even an MD can acknowledge that opposing muscles should be balanced for good health. Even though of course you deny that muscle imbalance results in subluxations. Or maybe you don’t care about muscle balance either.

    The spine as a whole should follow a graceful S curve. It is easy for this curve to be disrupted when voluntary muscles are out of balance. And the voluntary muscles, of course, respond to our mental states. Mental stress can translate into muscle tension, which can lead to imbalance. And this can pull the spine out of its natural alignment.

    Maybe you have never experienced this, or maybe you have experienced it and not noticed. Until I acquired some knowledge of yoga and chiropractic I was not conscious of subtle differences in muscle balance and vertebral alignment, and how they affected my levels of energy and health.

  31. Synaptix says:

    Pec, so what you’re saying is you don’t have any evidence.

  32. weing says:

    I don’t understand what the big deal is. Pec feels tension in her neck muscles and she stretches them with yoga and they relax and she feels better. What’s the big deal? She has a subjective sensation of discomfort that she calls subluxation. That does not mean it’s an objective finding that can be verified by X-Ray or MRI. The treatment is the same, massage and stretching. Now if she wants to attribute cures for cancer and fibromyalgia to this, she has to show proof. But I notice she usually qualifies her claims with the words “might be”. In that case it’s just idle speculation and I wouldn’t pay it no mind.

  33. Harriet Hall says:

    pec,

    I have no quarrel with the idea that muscle tension can cause symptoms. Muscles can alter the curve of the spine; that’s what happens when we voluntarily bend our necks, and muscle tightness or spasm can do the same involuntarily. You can also get palpable “knots” of muscle spasm. But muscles can’t sublux the bones.

    You say “I already explained that I can feel the back of my neck with my hand and it’s obvious when a bone is out of place.”

    That’s what the early chiropractors thought. They were convinced a bone was truly out of place – they could “feel” them too. But when x-rays were taken, radiologists couldn’t see anything out of place. And when chiropractors looked at before and after x-rays they couldn’t tell them apart. They finally had to admit that there were no bones out of place and they revised their definition of what they now call a vertebral subluxation complex.

    A true subluxation is a partial dislocation of a joint and is readily visible on x-ray. This is not what chiropractors are talking about, and it is not what you are feeling in your neck.

  34. pec says:

    I am talking about what chiropractors mean by “subluxation.”

    “when x-rays were taken, radiologists couldn’t see anything out of place.”

    How many studies actually found this? If bones out of place can be felt then they must show on x-rays. And we can look at a person and see if their posture is correct or not. Incorrect posture must certainly show up on an x-ray. I am skeptical about your source.

  35. Harriet Hall says:

    pec,

    Please listen carefully.

    Chiropractors have been trying to demonstrate that a bone is out of a place for a century. They can’t. What you and the chiropractors are feeling is not a bone out of place. When a bone is subluxated, it is partially dislocated and that is visible on x-ray. You and the chiropractors are feeling something, but it is definitely not a partially dislocated bone.

    Incorrect posture shows up on x-ray. X-rays of incorrect posture do not show bones out of place; they just show a spine that is more flexed or extended. Incorrect posture is compatible with part of the normal range of motion. Bones do not go out of place when you bend over.

  36. pec says:

    Ok Harriet, “bones out of place” is not the right way to describe it. And I am NOT talking about partial dislocations.

    Sometimes a vertebrae seems to be sticking out, or the spine’s curve is not graceful. Something is wrong — if chiropractors call it a bone out of place or a subluxation you can deny their observation because of their terminology.

    We can avoid that miscommunication by changing the terminology. Science has not shown these observations to be wrong. You do not know how these misalignments might affect nerves — specifically the mylen covering of the nerves, and electrical or other unknown forms of energy that travel along them.

    Of course you deny life energy. But you could probably find electrical differences if you would only look, if only you didn’t insist that mylen is mere insulation.

  37. pec says:

    myelin, I meant.

  38. vinny says:

    Pec,

    “You do not know how these misalignments might affect nerves — specifically the (myelin) covering of the nerves, and electrical or other unknown forms of energy that travel along them.” You say this as if it is a fact, you do know this, but where is the evidence that normal changes in spine position somehow affect myelin function and deposition. If there is no nerve compression, where would such injury come from? There are diseases which can cause demyelination without physical compression but these conditions are outside the realm of chiropractic care. At least, autoimmune and infectious diseases should not be part of chirpractic care. This seems to be the basis for our disagreement over what is chiropractic fraud vs legitimate chiropractic treatment. As far as looking for evidence of life energy and spiritual force, there is a standing 1 million dollar offer to be given to anyone showing evidence of supernatural abilities. Unfortunately, these claims remain unsubstantiated. It would be interesting to live in a world filled with magic, but reality forces us to live in this world.

  39. mh says:

    Pec:

    I appreciate you don’t know what you’re talking about at the best of times, but please refrain from straying into the subject of neuroscience. I am rather sensitive about this as I have just finished an MRes in the subject. It’s taken me two hard years of study and I wouldn’t class myself as anything approaching an expert. Myelin biology is very complex and still being understood. Just because you write something as if it is fact, does not make it so.

    And subluxation has a precise medical meaning: a partial or incomplete dislocation of a bone in a joint. Do not blame miscommunication when the real problem is that chiropractors did not know what they were talking about, and still don’t.

  40. Harriet Hall says:

    pec,

    I’m glad you have admitted you were wrong and that a bone is not really out of place. I just made a fist and was thinking that by your criteria all the finger bones must be out of place! :-)

    Another hypothesis is that your observations are based on muscle tension and spasm, and that the improvement is due to simple effects on muscles and to psychological factors. I’m not talking about just the placebo effect or self-delusion; psychology could also explain it in part as a conditioned response.

    There is no need to hypothesize effects on nerves and/or “life energy.”

  41. nwtk2007 says:

    Chiropractic subluxation theory is only theoretical and as such is continually evolving and changing. When I was in school in the 90′s it was taught more as a motion restriction than as a “bone out of place” sort of thing. Obviously the motion of the joint will have tremendous impact on any associated structures and functions, including neurological structures.

    Physiological changes associated with movement are well documented but are also not fully understood or appreciated so we should not dismiss the “subluxation” theory quite so quickly.

    I have treated several thousand neck and back injuries over the years and have seen effects not associated with the injury hundreds of times, and since there is no effort to effect those associated problems, then placebo effect are ruled out.

    What ever you would call these effects or changes has no bearing on the effects or changes themselves. It happens and it exists whether you say energy is released or allowed to flow or what ever. Being a molecular biologist prior to being a chiropractor and seeing the almost unbeieivable complexity and almost un-understandable nature of the genes and how they work to produce and guide the development of organisms, I have no problem understanding that we understand so little.

    Some of us get a degree and think we “know” something when, in fact, what we should know is that we know very little.

  42. Harriet Hall says:

    nwtk2007,

    The burden of proof is on you.
    We are the ones who are saying we know very little. You are saying you know that your manipulations affected associated problems. You haven’t ruled out the natural course of illness, confounding factors, or an indirect placebo effect. Do some science.

  43. pec says:

    “I’m glad you have admitted you were wrong and that a bone is not really out of place.”

    I did not admit I was wrong. I said the terminology is confusing and tried to clarify it.

    And my observations are not merely psychological. Yes this is subjective experience but that does not mean nothing real or physical happens.

  44. Harriet Hall says:

    pec,

    It makes me so angry when you deliberately misunderstand me! You have done this over and over. I never suggested your observations were “merely” psychological. I never suggested that nothing real or physical happens. As a matter of fact, I do think something physical is happening: muscle relaxation. And I said as much.

    What I said was, “Another hypothesis is that your observations are based on muscle tension and spasm, and that the improvement is due to simple effects on muscles and to psychological factors. I’m not talking about just the placebo effect or self-delusion; psychology could also explain it in part as a conditioned response.”

  45. nwtk2007 says:

    Hall said, “The burden of proof is on you.”

    In a sense I would agree, but it is no burden and thus not actually required based upon others perceptions of what constitutes proof and what doesn’t.

    The fact is this, there is plenty of research supporting chiropractic as a treatment for neck pain, back pain and headaches. A recent new study shows good effect on blood pressure.

    But with respect, when chiropractic research is sited or any study, what so ever, is presented it is scoffed at and ad hominemly dismissed since it was chiropractic research, even when done with the medical community. It has been a waste of time. At least with the skeptic crowd.

    I’ll admit there is not as much research as chiropractic needs and it should continue, but it is there. I would challenge you to look into it, examine it and discuss why you think is is invalid.

    Since the research is there, the burden falls to you I would think.

    You say to do some science. I have and I have also examined some, not as much as I would like, chiropractic research. I have found it to be statistically sound, a bit simplistic and with results based conclusions. Why don’t you do the same?

    I am also wondering what you mean by “confounding factors” and what an “indirect placebo effect” is. My understanding is that it involves something intervening between the researcher and the test subject. When I see changes in people which have nothing to do with the injury they have and they have no idea that the treatment might possibly cause the effect, then there is NO placebo effect, not even indirect. ie. – reduced Bp while treating neck injury with manipulation even to the point where the PCP of the patient has to reduce the Bp medication. This I have seen many times. Or reduction in asthma in patients treating for neck and back injuries who notice that they have not had any asthma since they had been in treatment. Anyone who has really treated neck and back injuries with manipulation has seen this.

    I mean really, do you think the changes I have seen over the years were related to my good looks making my patients react with decreased Bp or reduced asthma? I’ll admit it’s possible but not probable.

  46. daedalus2u says:

    nwtk2007, the placebo effect causes systemic changes to physiology. There are many systems that can be affected by it, those specifically being targeted as well as many others. If the placebo effect is invoked to treat one condition, all conditions the patient has that are susceptible to the placebo effect will respond to that placebo effect even if the placebo based treatment is not specifically directed to them.

    The physiology behind the placebo effect is analogous to the physiology behind the relaxation response. All conditions that are improved by stress relief will be improved by a good placebo response.

  47. nwtk2007 says:

    Yes, but the person being tested knows what is being tested or targeted and thus the placebo. ie – a person knows a drug is being tested for reducing Bp. A sugar pill gives good response, thus placebo effect.

    People being treated for neck injury do not have any assumption that Bp might be effected.

  48. daedalus2u says:

    In effect the “placebo effect” is a conditioned response. It is a response mediated through communication that a period of “stress” is over, and physiology can “stand down” and divert resources being held in reserve to cope with that “stress” and allocate them to healing.

    The archetypal “placebo effect” is the mother’s “kiss it and make it better”.

    “Stress” is a continuum. Where ever you are on that continuum, you can always move in one direction or the other (unless you are at an extreme end). Turn up someone’s stress level and stress-related diseases will get worse, turn down their stress level and stress-related diseases will get better. Turning up stress is a nocebo, turning down stress is a placebo. It is more complicated than that because “stress” is largely local, and depends on neurogenic regulation through the ANS.

    If you need to run from a bear, your heart rate goes up, your liver dumps glucose into your blood, your pancreas dumps insulin in your blood, insulin resistance develops to allow insulin to get to more remote cells, large vessels dilate and divert blood to leg muscles and away from the gut, fat gets dumped into the blood too. You start to hyperventilate; blood pH falls to accommodate lactate from glycolysis in muscle, lactate levels go up. The brain switches from locally produced lactate to lactate from the blood, to increase maximum ATP in muscle. Superoxide is generated in mitochondria to pull down the NO levels so that more O2 is consumed and to a lower O2 concentration so that aerobic ATP production can go up. Ischemic preconditioning is triggered, reducing ATP consumption to the bare minimum to save it for running from the bear.

    Many of the acute responses of acute severe stress are “the same” as the physiological responses observed in the metabolic syndrome. They are similar in that many of the pathways are switched to that state by low NO. Systemic low NO lowers the threshold for the low NO stress effects to be triggered. If NO is low enough, they can be triggered even without a stressor.

    Under this extreme stress condition, healing is largely turned off. If you maintain that condition for long, the damage continues and is not repaired. To resume healing, the stress state needs to be turned off and the non-stress state needs to be turned back on. This is what the placebo effect is.

    If you are already in the non-stress state, a placebo will do nothing for you. If what ever is done doesn’t change you from a high stress state to a non-stress state, then the placebo isn’t working for you.

    That chiropractic manipulation does affect things like asthma, allergies and blood pressure is (to me) strong confirmation that the effects of chiropractic are mediated through the placebo effect.

  49. Harriet Hall says:

    nwtk2007,

    You claimed that your treatments caused “effects not associated with the injury” It is up to you to support that claim. Your claim is very different from claims “supporting chiropractic as a treatment for neck pain, back pain and headaches.”

    I have read more of the chiropractic literature than I can stand. Most of it is of poor quality. I’ve also read many systematic reviews and even a couple of chiropractic textbooks. The evidence shows that spinal manipulation is effective for low back pain, but no more effective than other treatments. The evidence shows that gentle neck mobilization is reasonable for some conditions, but that manipulation is probably not effective for headaches, except for weak evidence that it may help tension headaches. I am not convinced that spinal manipulation has any somatovisceral effects – even after reading the whole textbook on “Somatovisceral Aspects of Chiropractic – An Evidence-Based Approach” which I probably should write about on this blog, because its concept of evidence bears no resemblance to ours.

    I’m not surprised that you don’t understand what “confounding factors” are. They are anything you didn’t take into consideration that might have influenced the results. You haven’t taken those things into consideration. You assumed your manipulations affected blood pressure. You didn’t understand the need for control groups to rule out the possibility that it might have been due to natural fluctuations, regression to the mean, the natural course of illness, or other factors like a concomitant change in diet, weight, or other factors. Did you ever think that blood pressure might go up when patients are in pain and go down when the pain resolves?

    By indirect placebo effects, I meant that simply getting any treatment can improve things even if they are not the direct target of treatment. For instance, if a patient is worried about his back pain and you treat his back, the relief of his anxiety about the pain might tend to lower his BP.

    Asthma is a variable illness with unpredictable exacerbations. You can’t assume “post hoc, ergo propter hoc.” You have to rule out coincidence, and you have to consider that emotions and stress can affect asthma symptoms.

    The chiropractic BP study you mention is not even about chiropractic. It was a small study using NUCCA, an upper cervical technique that adjusts only C-1, a technique that is used by only a small minority of chiropractors and that is based on the “hole-in-one” philosophy that most chiropractors reject. Even the researchers were “surprised” by the results they got, and the study can’t be taken very seriously unless it can be replicated. Remember that the conclusions of most published research are wrong. I suspect this study is wrong. Time will tell.

  50. daedalus2u says:

    Virtually all placebos mediated effects occur through the final common pathway of increasing NO levels. Increased NO levels will reduce blood pressure. If you already have hypertension, then a placebo will reduce it some. How much depends on a lot of things and unless the placebo reliably raises NO levels it isn’t going to have a reliable effect on blood pressure.

    Blood pressure isn’t under conscious control. Being told a placebo is specifically going to affect blood pressure doesn’t activate neuronal pathways to regulate blood pressure. The placebo activates the NO producing pathways and raises systemic NO levels. That increased systemic NO is what lowers blood pressure.

    http://www.ncbi.nlm.nih.gov/pubmed/18227772

    http://www.ncbi.nlm.nih.gov/pubmed/15874901

    http://www.ncbi.nlm.nih.gov/pubmed/11245883

  51. Stop it! Stop defending chiros and blaming Dr. Hall for trying to scare people and being anti-chiro! At least wait for the court decision which will be made based upon the evidence gathered from a through investigation before you jump on her!

    A woman’s life was ruined! Have you no empathy?

    Dr. Hall wrote, “The chiropractor did a rapid-thrust adjustment on her neck. Right afterwards, she complained of feeling ‘sore, dizzy and unwell.’ She tried to leave but had to sit down. The chiropractor failed to recognize the medical emergency, and instead of calling an ambulance he recommended that she would benefit from purchasing massage therapy from his clinic. He let her leave the office and drive home alone. She only made it part way.”

    If those statements are factually correct, the chiro and his CAs should be ashamed and all chiros and chiro proponents should be upset, sad and sorry. Surely every chiro and employee of a chiro clinic should recognize such symptoms as being a medical emergency and call an ambulance even if a person walked in with them and hadn’t even been touched by the chiro yet.

    It is one of the things that absolutely galls me about alts who are continuously on the defensive and never willing to admit that one of their own has made a mistake, been negligence or incompetent.

    I was facially disfigured by an MD about 50 years ago. Over the intervening years several MDs, dentists and a PA have apologized to me and told me how terrible they felt that someone in their own profession, scientific medicine, could do such a thing. Many deeply regretted the fact that my parent’s had never sued the doctor. Several told me he had been incompetent.

    IMO, one of the main differences between scientific and unscientific medicine both on the institutional and personal levels is that scientific medicine is constantly objectively evaluating its drugs and therapies, pointing out its faults, taking responsibility and trying to improve. Unscientific medicine does spin control refusing to admit that any of its practitioners or that any of its remedies or treatments are either dangerous, ineffective or a ripoff. Spin control may make them feel good. It earns disrespect from me.

  52. nwtk2007 says:

    rjstan,

    Cool off. Medical mistakes kills 500 everyday. You still go to MD’s? Have you no empathy? What have you done to reduce these mistakes?

    And medicine is scientific? OK.

    Daedulus, I am not sure if you are for real or what but I can see YOU like the way YOU sound.

    And finally, Harriet Hall, the Bp is being reduced to levels below the patients PRE-ACCIDENT levels. Are you saying that the years of having high Bp and being treated by their PCP’s is just stress or pain related? If true, then elavil should do the trick, or a good beer!

    Also, the studies of chiropractic helping with HA’s have shown it to be equal or better than the afore mentioned drug. And NUCCA is done by chiropractors and thus a chiropractic technique, not that it matters and what ever that has to do with the price of tomatoes is beyond me.

    And please, I know what confounding factors are, I just don’t see what they might be in a setting where a patient treats for a few weeks at best. You listed several which are not a factor in that setting. Diet, weight and “the natural course of a disease” are not really relevant in a change occurring over a few weeks of treatment of a neck injury.

  53. nwtk2007 says:

    Also, I most definitely know about control groups in experimentation. But I am just treating neck and back injuries and have noted these changes in the past. I am not researching Bp or asthma, I just see the changes. Call it anecdotal or what ever, but they are documented, if not quantified, over my population of patients. I just see it enough to think there is something going on that correlates with current chiropractic dogma.

  54. nwtk2007 says:

    rjstan,

    The “quack” who initially gave you the silver nose drops was an MD, correct?

  55. Harriet Hall says:

    I think I have struck a nerve. I hear defensiveness. I hear fallacious tu quoque arguments. I hear someone who makes no attempt to control for confounding factors because he “can’t see what they might be.” I hear someone who doesn’t do NUCCA claiming that a study on NUCCA explains why his different treatment reduces blood pressure. I hear someone who doesn’t recognize how variable BP readings can be.

    What I don’t hear is clear critical thinking. What I don’t hear is credible evidence for the claims made.

    “studies of chiropractic helping with HA’s have shown it to be equal or better than the afore mentioned drug” ? Apart from comparison to any drug, what is the evidence that chiropractic manipulation works better than placebo for HA?

    Wikipedia, which is admittedly not an authoritative source but at least can’t be written off as an anti-chiropractic site, had this to say about spinal manipulation for headache: “A 2006 review found no rigorous evidence supporting SM or other manual therapies for tension headache.[100] A 2005 review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.[101] A 2004 review found that SM may be effective for migraine and tension headache, and SM and neck exercises may be effective for cervicogenic headache.[102] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of SM.[87″

    I count one “weak”, one “may be” and three “nos.”

    If the best argument nwtk2007 can find to support chiropractic is that MDs kill 500 patients a day, he has clearly lost the debate.

  56. pec says:

    “Remember that the conclusions of most published research are wrong.”

    And here we are, at a blog that celebrates ERB. Well I guess things won’t ever be simple.

  57. Harriet Hall says:

    Aha! pec finally got it! Science isn’t simple.

    We should never trust the results of one study in isolation. Before you decide that we can’t trust science at all, perhaps you would like to re-read my review of Bausell’s book at http://www.sciencebasedmedicine.org/?p=4 for some guidelines on how research can go wrong and how to determine which studies are more credible.

    By ERB, did you mean EBM? The thesis of this blog is that evidence-based medicine is necessary but not sufficient. You have to add critical thinking about the evidence to get science-based medicine.

  58. AntiVax says:

    Hakk: “I am not attacking chiropractors.”

    LOL! Allopaths even have a website attacking chiro http://www.chirobase.org/

    and they have a long history of doing so, they even got taken to court for it and lost.

    be thankful the chiros don’t attack allopathy, although you get the odd one attacking vaccination, although they may be barred from doing so now in many states

  59. AntiVax says:

    HAKK: Wikipedia, which is admittedly not an authoritative source but at least can’t be written off as an anti-chiropractic site.

    LOL. Wiki has 38 allopaths as editors (plus dozens of anon ones) who patrol all the medical pages and keep them pointing in the right allopathic direction.

  60. nwtk2007 says:

    Previously by Harriet Hall – “I think I have struck a nerve. I hear defensiveness. I hear fallacious tu quoque arguments. I hear someone who makes no attempt to control for confounding factors because he “can’t see what they might be.” I hear someone who doesn’t do NUCCA claiming that a study on NUCCA explains why his different treatment reduces blood pressure. I hear someone who doesn’t recognize how variable BP readings can be.”

    Struck a nerve? Not in the least. You simply aren’t listening and interpret as you want to.

    I am not explaining anything about treatment reducing blood pressure, I am pointing out a possible connection between this study and what I have seen so many times. The “intellectual” crowd likes to throw out these fallacious argument terms as if it shows they have superior knowledge and give them the “win” in the debate. What a farce. I believe that in and of it’s self is a form of fallacious argument.

    To suggest a connection between two events is not explaining anything so please try not to read anything into this other than what is meant.

    And once again about “confounding factors”. I just treat these injuries for a few weeks at best and so when I have to call a PCP to get them to review their treatment of Bp treatment and even they bring up the possible connection between the manipulation of the neck and reduced Bp I tend to agree. I, however, am not conducting a study or trying to research Bp and the effects of manipulation so confounding factors like Bp variability are not considered.

    But really, if you can dismiss this by just saying that it is variable then you obviously have no intension of looking at it objectively. That is clear and supports what I have said all along. Anything at all that appears to support chiropractic is summmarily dismissed.

    I agree with you antivax, Wiki is not the best source for anything other than scant info at best. And it’s not peer reviewed, not that I really care. Oh yes, the antichiro site you just mentioned is originated by a doctor who is not even licensed. I think he might ahve lost his “expert” credibility.

  61. Fifi says:

    Doesn’t relaxation reduce blood pressure? Wouldn’t it be safer for someone to simply go for a massage or take a long soak in the tub? Or better yet, for the patient to learn how to relax themselves so they aren’t trapped in a cycle of dependency (where they come to falsely believe that something other than relaxation, something magic, is going on and they need to pay someone else to “do” it for them)?

  62. Nwtk2007, “Rjstan, Cool off. Medical mistakes kills 500 everyday. You still go to MD’s? Have you no empathy? What have you done to reduce these mistakes?”

    Nwtk, we aren’t talking about a mistake here. We are talking about the life of a human being that was ruined by what appears to be gross incompetence. But that is not what has gotten me furious. What has gotten me furious are the comments you are posting here which indicate your utter lack of regret and sorrow, your utter lack of empathy for the injured woman and your utter failure to admit that a colleague may be responsible for it.

    I know there are several chiros who read these blogs, yet I haven’t noticed one state how sad and sorry he is about what happened to the lady, what one of his colleagues did to her, if the reports to date are factually accurate. I see you trying to do damage control and frankly I find that calous and inexcusable and the fact that other chiros are not stepping in to tell you that is in my opinion a very bad reflection on your profession.

    Nwtk2007, “Rjstan, The ‘quack’ who initially gave you the silver nose drops was an MD, correct?”

    The MD who prescribed the drug that disfigured me was not by my definition a quack. I define a quack as someone who sells a dangerous or useless product for which he makes health claims so that he can profit financially. The doctor who prescribed the drug didn’t profit from its sale. My mother bought it at a pharmacy.

    The quacks who prescribe and sell these disfiguring drugs, now called supplements, today are not practitioners of scientific medicine. They are alts and many are chiros.

    My doctor was naive. He was one of the few MDs at the time who believed the fraudulent ads of drug companies in an era when they were not strictly regulated. There was no excuse for that and there is no excuse for anyone to believe anything supplement manufacturers say about their products without seeing independent evidence that verifies their claims.

    As I’ve stated repeatedly, there should be a law that prohibits people who recommend and prescribe drugs and remedies from selling them to the patients they see. Such a law would make it very difficult for quacks who claim to practice medicine to take financial advantage of people who trust them, and quite frankly, that is something I would expect all caring practitioners to favor.

  63. Dr. Hall, “I think I have struck a nerve.”

    Medicine tends to strike nerves since it is about life and death and health.

    Quacker is a very emotional topic and rightly so. It is one of the worst, most callous forms of fraud.

    IMO, we must all learn to deal with our emotions rationally and in some professions like medicine, science and law people have to learn to be unemotional when they approach many aspects of their work but emotions are a big part of being human and must be used constructively. They shouldn’t and can’t be ignored.

  64. nwtk2007 says:

    rjstan,

    You said ,”I haven’t noticed one state how sad and sorry he is about what happened to the lady”

    And then, “The MD who prescribed the drug that disfigured me”

    Was it you or someone else?

    And you are saying the MD was naive and grossly incompetent but you are mad at the ALT’s, as you put it, who continue to, apparently, harm and disfigure, an unwitting population?

    Also, I am a chiropractor and the MD who did this is not one of my collegues; at least he who say I’m not.

    Oh yes, chiropractors do not practice medicine so the “quacks” you are referring to are MD’s. Correct?

    Also, from what I have read, the medical community says your condition was not caused by the silver in the drops.

  65. pec says:

    “The thesis of this blog is that evidence-based medicine is necessary but not sufficient”

    No, the thesis of this blog is that we should never believe anything unless it has been “confirmed” by big expensive studies. We should refrain from thinking for ourselves or trusting our own experience or the experiences of millions of others.

    We should not doubt the exalted experts who have access to the medical journals. We are not qualified, unless we are an MD, to interpret the research anyway.

    And we should trust this big expensive research when it says, for example, that a new synthetic chemical is safe and effective.

    We should not express opinions in conflict with the exalted experts and their atheist/materialist ideology. We should love drugs, especially the new ones. We should love and trust MDs and their toxic treatments.

    That is the thesis of this blog.

    And then you really confuse me Harriet when you say most of the results of research are wrong. Does that mean I will have to continue thinking for myself after all, and continue questioning the MDs who want to give my mother yet another toxic drug?

  66. nwtk2007 says:

    And pec, don’t forget all those confounding factors.

    Bp can go up and down all on it’s own. In the patients I see where it goes down to levels below their pre-accident treatment and Bp meds have to be adjusted to compensate for the change, I guess it is just co-incidental that the Bp dropped so much during the period I was treating them for their neck injury.

    It must be since according to medicine there can’t be even the slightest possibility that there might be a connection between cervical manipulation and Bp levels. According to them, it JUST CAN”T BE!

    I do like the coment by fifi, but fifi, when the Bp is 230 over 150 I don’t think there is any amount of relaxing that can get it down to safe levels.

  67. daedalus2u says:

    As they say, birds of a feather flock together.

    nwtk2007, if there are effects of chiropractic manipulations, what is the physiology behind them? Or do those effects happen by magic? That is what it seems some proponents such as you believe and are saying.

    Medicine isn’t saying that such things never happen. If it does happen, it can only happen via actual physiological processes. It can’t happen via decompression of nerves that do not exist at the sites that are being decompressed. Nerves that do not exist are imaginary. Imaginary nerves can have effects through the placebo effect. That is the only mechanism by which imaginary nerves can have effects.

    Medicine isn’t saying that the effects don’t happen. What medicine is saying is that the effects are not happening via the made-up mechanism which doesn’t correspond to reality. Fictitious nerves can’t have real results other than through the placebo effect.

    It is not necessary to understand every detail of a physiological effect to be able to use it effectively, but if there is something that reliably affects physiology; what ever that something is can be subjected to scientific analysis. If it can’t be subjected to scientific analysis, then it isn’t a reliable effect. If it isn’t reliable, it has no place in any treatment modality.

    If what chiropractors want to practice can’t be analyzed, then they are practicing faith based treatments. We should call it what it is, magical thinking and faith, or as even some chiropractors call it, a cult.

    http://www.chirobase.org/05RB/BCC/00c.html

    Those are religious based ways of thinking. Chiropractors should be honest with themselves and with the rest of us that that is what they are doing. It is ok to have religious based ways of thinking and behaving. In the US that is called freedom of religion. It is not ok to impose your religion or your cult on others without their consent. Scientology and chiropractic are both cults. They have a world view based on faith which doesn’t correspond to reality that they use to “treat” conditions. It is religion and faith, not science.

  68. Fifi says:

    There’s a decent article in Nature about relaxation and hypertension but nwtk probably won’t “like” it (which seems to be his means of discerning veracity and plausibility!).

    http://www.nature.com/jhh/journal/vaop/ncurrent/full/jhh200866a.html

  69. Fifi says:

    nwtk – It was both rjstan AND someone else…spooky! It’s almost like they’re two different people! Seriously, it was obvious rjstan was talking about how you weren’t showing any compassion for the woman who was paralyzed by a chiropractor (the subject of this blog). She didn’t seem to me to be asking for compassion for herself and clearly doesn’t “play the victim” in regards to her own experience (if anything, she seems to have used the experience to empower herself). It’s also obvious that rjstan is interested in bringing to light all different kinds of non-evidence based practices because of her own experience, whether practiced by MDs or anyone else who claims to be practicing medicine.

  70. nwtk2007 says:

    daedalus,

    How many times in the history of science have phenomena been observed but could not be explained based upon current knowledge. Thus it was magic or supernatural.

    Do you really think that modern medicine knows all there is to know about the nervous system? Thus since you can’t adequately explain something it must be hocus pocus. How arrogant.

    Neurophysiology is the least understood of all the systems of all living things.

    As to the effects seen, which you say medical science does not deny, we can only look at the little clinical evidence there is, do some more studies and hypothesize about what is observed and investigate some more, modify our hypothesis, investigate, observe and keep going.

    Unfortunately, this is where there is not enough going on in chiropractic but that is gradually changing.

    To cop out with the old religious/placebo/etc argument just reveals your biases and devotion only to that which you think you know, which is not enough to dismiss these “effect” as religious based/faith based/placebo effects.

    And would someone explain to fifi that pathologically high Bp is not going to be solved through relaxation and mind control.

    Oh and by the way, according to the medical texts, some 90% or more hypertension is of unknown cause. Idiopathic essential hypertension.

    Medical science cannot explain it so is it some sort of placebo effect caused by some glitch in the matrix? Some lack of religious devotion and perhaps a punishment for past sins or our ancestors? Just stress? Just diet? Bacterial?

    Who would have thought a few years ago that heart disease would be linked to gum disease?

    Could it be that there is at least some knowledge that we just haven’t discovered yet?

  71. Harriet Hall says:

    Logic a la AntiVax:

    I say I am not attacking chiropractors but only some things some chiropractors do.
    There is a website attacking chiro.
    Therefore I am attacking chiro.

    Wiki has allopathic and anonymous editors.
    Therefore it is anti-chiropractic.

    Facts a la Anti-Vax:

    Chiros don’t attack allopathy. (HA! Try reading a few of their websites or online forums.)
    Only “the odd” chiropractor attacks vaccination (according to their own studies, half of chiropractors do not support immunization, and many of these actively discourage immunization).

  72. Fifi says:

    nwtk – Sure, there’s loads of stuff we still don’t understand – that’s the whole premise of science and why people do studies and experiments. It’s the premise of many religions (and cults) that we’ve already been told/revealed everything and all mysteries are to be attributed to the supernatural and not to be questioned. In fact, you are a fine example of someone resorting to superstition in the face of the unknown (and even the known!) – as are the earnest promoters and adherents of woo who genuinely believe what they promote.

    Oh, and obviously you didn’t read article I linked to *lol* I guess you don’t even both looking at any articles or studies you don’t think you’ll “like”.

  73. Harriet Hall says:

    Nwtk2007

    I can’t let this pass. You said “ the antichiro site you just mentioned is originated by a doctor who is not even licensed.”

    This is a vicious lie that has been spread on the Internet by Tim Bolen and others. They say Stephen Barrett is a “delicensed” doctor. He practiced medicine for a couple of decades and then retired to become a health consumer activist. He has no reason to pay big bucks to keep up his license. I understand he does maintain a restricted license like many retired MDs, allowing full privileges for charity work but not for profit. Such a license can be instantly activated to a full license by simply paying the required fee.

    At any rate, having a license or an MD degree is totally irrelevant to the important issue: is the information on the website correct? I have never found anything inaccurate on Chirobase. Did you know there are 4 chiropractors on Chirobase’s advisory board? Did you know Stephen Barrett was once treated by a chiropractor and found spinal manipulation helpful?

  74. daedalus2u says:

    nwtk2007 no, phenomena were observed, non-physical mechanisms (i.e. magic) was invoked as the “cause” then those non-physical mechanisms (i.e. magic) were used by magicians to attempt to invoke the phenomena. Sometimes it worked, sometimes it didn’t work. Chiropractors manipulated a person’s spine, the person’s blood pressure got better, the chiropractor makes up some woo about nerves and bones that has nothing to do with reality. Then they applied that magic and woo to everything else they imagined it would work on.

    When a scientist doesn’t know the explanation for phenomena, he/she says “I don’t know.” Their default explanation is not “this must be magic”, or “this must be supernatural”. Finding an actual instance of magic or supernatural phenomena would be a first class ticket to Stockholm. Why are there no reports of magic and supernatural phenomena in the literature? Because a false report of magic or supernatural phenomena is a sure sign the scientist isn’t really a scientist, his/her scientific judgment is poor, and his/her “work” is unreliable, and isn’t worth looking at.

    When a quack doesn’t know a quack makes something up. Chiropractors made up the idea of nerves and bones in the spine doing something because they didn’t have another explanation for their observation that some things got better when they did their spinal manipulations. The explanation they came up with happened to be wrong because there are no nerves that do the things they claim.

    There is a gigantic difference between not knowing something and believing something that is wrong. 100 years ago scientists didn’t know the source of the Sun’s energy. They didn’t make up that there was a supernatural source, they didn’t invoke magic as the explanation, the source was simply unknown.

    There are no nerves in the neck that regulate hearing or vision, yet chiropractors claim manipulation of the spine can restore sight and hearing. Dr Novella had a post on that.

    http://www.theness.com/neurologicablog/?p=164

    When the default chiropractic explanation is a supernatural one, that non-existent nerves that regulate vision are somehow magically fixed by manipulating the spine, the knowledge base and standards of evidence in chiropractic is so low as to be useless.

    It is you who is dismissing possible explanations. A placebo effect explanation does fit will all the observations and would completely explain all of the physiological effects claimed to have been observed following chiropractic manipulations. Why are you dismissing a placebo effect mechanism? Not because of any data, a placebo effect explanation is consistent with all the data. Cite some data that shows a placebo effect hypothesis is wrong. If there is no data that shows it is wrong, a placebo effect hypothesis has the advantage of Ockham’s razor of being consistent with reality as we know it and doesn’t require non-existent nerves to have non-physiological properties.

  75. Nwtk said to me, “Medical mistakes kills 500 everyday….What have you done to reduce these mistakes?”

    Unlike you, I do not call myself “doctor” nor do I write initials after my name so IMO unlike you, I have no obligation to do anything. However, I am a vocal proponent of evidence-based medicine and try to teach the public how to evaluate evidence on drugs and therapies so that they can make informed decisions about their treatment options and avoid quackery. I also work very hard trying to warn the public about the danger and uselessness of silver supplements, an area in which I have a great deal of expertise.

    I can see the great efforts you are making here to warn the public about the dangers of scientific medicine, but I have seen absolutely nothing from you that indicates that you or any of your colleagues who read these blogs are trying to protect the public from quacks or grossly incompetent practitioners in your profession or that any of you reading this cares a twit about the victims of your profession. All I see is your spin and attempts at damage control. Maybe that’s what DC stands for, damage control?

    MDs who practice evidence-based medicine prescribe but rarely sell approved drugs. The only approved silver drugs are topical. They do not disfigure people. Those who promote and sell silver supplements are alts. They call silver a “natural alternative” to antibiotics. There are now many cases of argyria caused by alts’ silver supplements. Some of the alts who promote and sell silver supplements are chiros.

    Your efforts to duck responsibility and to blame everyone else for all that is wrong with medicine have the exact opposite effect on me than I think you are trying to acheive and I suspect that most laypeople would feel the same. Personally, I find it amazing that you don’t realize that yourself, that you are doing your cause more harm than good.

    Most of the last post you addressed to me sounds like gibberish. I have no idea what you are trying to say if anything, except for this,
    “Also, from what I have read, the medical community says your condition was not caused by the silver in the drops.”

    Your ignorance of me, silver and argyria is astounding. I will not waste space here re-posting links I’ve already given, but I will add this one: http://homepages.together.net/~rjstan/rose6.html#2 on the off chance that you want to start educating yourself before spouting off more about things you know nothing about.

    Once more back to the topic under discussion. A chiro has been accused of ruining the life of a human being. He is scheduled to defend himself in court. If the allegations are true, every decent chiro should be very sorry and sad for what one of their colleagues has done and should state so openly rather than trying to do damage control and blame the other guys. DC heal thyself. Clean up your own profession before trying to clean up others. That is the only way I know of for you to get the respect that you seem to so desperately want.

  76. Harriet Hall says:

    pec said,

    “No, the thesis of this blog is that we should never believe anything unless it has been “confirmed” by big expensive studies. We should refrain from thinking for ourselves or trusting our own experience or the experiences of millions of others.”

    It’s interesting that pec knows more about the thesis of this blog than its authors do. :-)

    I think we have made it clear that we should never “believe” anything; we should hold provisional conclusions based on the best available evidence. We should never blindly follow authorities. We should think for ourselves. We should not trust our own experience or the experience of millions of others because we know those experiences are often misleading.

    “you really confuse me Harriet when you say most of the results of research are wrong.”

    You really confuse me when I try to explain what I mean and you don’t listen. Have you read R. Barker Bausell’s “Snake Oil Science”? If you read it and understood its lessons, you might not be so confused.

  77. Harriet Hall says:

    We have gotten way off track. I’d like to ask Anti-Vax and nwtk2007 three direct questions:

    1. Do you think Sandra Nette’s chiropractor was at fault?
    2. Are chiropractic organizations taking any action to prevent similar incidents in the future?
    3. Do you know of any evidence supporting maintenance adjustments?

    My article criticized maintenance adjustments, manipulating necks for inappropriate reasons, using a specific type of manipulation that is more dangerous than gentle mobilization, and the failure of Nette’s chiropractor to recognize a medical emergency. I don’t think there was anything in the article that could be interpreted as hostility towards chiropractic as a whole. This discussion has degenerated into an attempt to defend chiropractic as a whole and to attack medicine. I find that very revealing.

  78. pec says:

    “We should not trust our own experience or the experience of millions of others because we know those experiences are often misleading.”

    Yes that’s right, but mainstream medical research is also often misleading, as you admit.

    We can be skeptical without rejecting everything that does not fit a particular ideology.

    The problem with your so-called skeptical movement is that you only doubt claims that conflict with your atheist/materialist ideology. You are closed-minded about anything involving non-materialist knowledge, whether ancient or new. Your open-mindedness is restricted to ideas and treatments that fit your pre-conceived world view.

    I am skeptical about traditional and alternative medical treatments and philosophies, but I also have an open mind about them.

    I am skeptical about my own experiences and the experiences of others, but I consider the possibility that they might be real. When my own experiences are similar to the experiences of millions of others, and when they agree with ideas that have been around for centuries, then I think “well maybe, just maybe, my experience is real.”

    For you, everything must be illusion and self-deception if it does not support your atheist/materialist ideology.

  79. daedalus2u says:

    Regarding the linkage of gum disease with heart disease, that is actually to be expected because they are both linked via NO physiology.

    Nitrate in the diet is well absorbed and is then concentrated in saliva ~10x over plasma. Saliva levels can exceed 2 mM/L. On the tongue commensal bacteria reduce nitrate to nitrite. Nitrite levels in saliva can reach 2 mM/L following a high nitrate meal (~100 g of lettuce has a few hundred mg nitrate).

    Nitrite from saliva produces NO in the stomach and that NO has measurable physiological effects in reducing platelet “stickiness”. Nitrite is a good antimicrobial agent, kills oral pathogens, and enhances healing.

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18231624

    It would be expected that increased nitrate/nitrite in the mouth would both improve gum health and reduce heart disease; nothing magical or superstitious, just plain old physiology. That may even be the mechanism by which a diet rich in leafy green vegetables does reduce heart disease, via nitrate/nitrite cycling in the mouth.

  80. Harriet Hall says:

    pec,

    “The problem with your so-called skeptical movement is that you only doubt claims that conflict with your atheist/materialist ideology. You are closed-minded about anything involving non-materialist knowledge, whether ancient or new.”

    Skepticism does not have an ideology. Skepticism is the antithesis of ideology – it questions everything. It even questions materialism. Some skeptics accept religion; others don’t. The only sense in which skepticism is a “movement” is that skeptics encourage everyone to think critically for themselves.

    You keep harping about our materialism. I keep telling you science does not imply a materialist philosophy. Science only asks for evidence.

    There are various claims for “nonmaterialist knowledge” and some of them contradict each other. How could you determine which ones are correct? How could you test the non-material? I’ve asked you this before and you haven’t answered. Maybe if you would answer we could come to understand each other better.

  81. Joe says:

    nwtk,

    I think it is fair for you to say you cannot explain your observations in terms of physiology. The important question, however, is not the “how” of it; more relevant is the “fact” of it. If your anecdotes have no physical basis, no explanation is needed. A wise doctor once wrote that “we only started making progress in medicine when we realized how easily we fool ourselves.”

    When medical science came to that realization, they began using controlled studies (scientific method) and discarded many old procedures (bleeding, purgatives etc.) and adopted rational and proven procedures. And medicine continues to discard rational and proven procedures that, on continued examination are shown to be mistaken. Chiropractic cannot do this because it is a cult and cannot abandon the founder’s notions.

    You complain that not enough research has been done. Well, you have several magazines given to publishing chiro research. To date, nothing relating to basic chiro claims, passes legitimate scrutiny. Yet, you want to practice this quackery till it is “proven” (you don’t entertain the notion that it it wrong) as if it were proven. That is like building a highway bridge of papier mache because you believe (without any scientific backing) it will, eventually, be proven to work at least as well as steel.

    In short, if you rely on anecdote, unsupported by any scientific hypothesis, the simplest explanation for your notions is that you are fooling yourself. That is certainly the case here. It is not a question of whether you are out in front of scientific understanding, it is a matter of your self-deception. Something you share with legions of chiros.

  82. pec says:

    “How could you test the non-material?”

    Harriet,

    Physics, the study of nature, of matter, of physical reality, is faced with trying to test the non-material. Because matter is not made out of matter! No one can say what matter is made of. The foundation of our physical reality is not physical.

    There is no simple way to discuss materialism vs. non-materialism without getting lost in philosophy.

    But I think I would be correct if I guessed you are an atheist, or at least completely uninterested in religion or spirituality. I have never heard of a member of the so-called “skeptics” movement who was not.

    And I understand perfectly well that skepticism does not follow any ideology. That was exactly my point. You call yourselves skeptics but you focus your doubt on ideas that do not fit materialist ideology. You are not open-minded regarding traditional or alternative medicine. You do not seem to be aware of ideas from alternative science.

    And I think if you open your mind to some of these ideas you would find the experience extremely rewarding and interesting. There is so much more than matter. When our minds are really open our experience can broaden.

    You don’t have to become a new-ager or a flake to benefit from alternative science ideas. You can remain skeptical and scientific.

  83. daedalus2u says:

    pec, skeptics focus skepticism and doubt on all ideas.

    “Once you have eliminated the impossible whatever remains, however improbable, must be the truth.” Sherlock Holmes

    That is how skepticism works, by eliminating the impossible.

    If you could reliably show where the hypothesis of materialism (what ever that actually is) was impossible (i.e. was falsified), skeptics would abandon it. I would abandon it.

  84. Harriet Hall says:

    pec said, “I have never heard of a member of the so-called “skeptics” movement who was not [an atheist].”

    Meet Hal Bidlack, who helps run one of the major organizations of skeptics in the US and who has acted as MC for several of the James Randi Educational Foundation’s Amazing Meetings, including the recent largest gathering ever of skeptics anywhere in the world. He is a believer and has spoken eloquently at skeptic meetings about his beliefs. He is not the only one. You can read what he wrote about being a skeptical deist at http://www.randi.org/jr/050903.html

    And for that matter, I know many atheists who describe themselves as very spiritual, who are spiritual in the sense of feeling awe before the majesty of the universe.

    But isn’t that really irrelevant to the question of what’s real and what isn’t?

    “You do not seem to be aware of ideas from alternative science.”

    What, pray tell, is alternative science? Something like the alternative flight that Dr. Crislip described? I think you must be talking about the “science” of alternative medicine and other questionable phenomena. Actually, I think you will find that we SBM bloggers are not only very aware of those ideas but have taken them seriously, have examined the evidence for them critically and have reached provisional conclusions about them for what we consider to be very good reasons.

    “No one can say what matter is made of.”

    You may not realilze that science makes no claims about ultimate reality. It is a practical enterprise, not a philosophical one. All it can do is study the observable reality of how the world works with the tools at its disposal. It can discover laws that accurately predict what will happen when two atoms collide, but it can make no claims about the underlying reality of those atoms from a metaphysical standpoint.

    “There is so much more than matter.”

    Yes, there are epiphenomena that arise from interactions of matter, such as human qualia, love, appreciation of beauty, etc. But is there anything that doesn’t depend ultimately on matter? Is there a soul that can exist separate from the body? Is there some unmeasurable human energy?

    How can we determine whether such nonmaterial concepts really exist? You have offered us no way to distinguish between nonmaterial reality and imagination. Experiences that are “extremely rewarding and interesting” might be due to epiphenomena of measurable chemical reactions in human brain cells rather than to any unmeasurable energy or immortal soul. How can we know? If you can figure out any way to test these concepts, science is ready and willing to accept the results.

    You can’t just write it off as “getting lost in philosophy.” We have a way of testing reality that doesn’t depend on philosophy. If you can’t suggest any way to determine the reality or non-reality of your nonmaterial ideas, you are the one who is lost in philosophy and you have no hope of ever making progress towards a more correct understanding of how the world works.

  85. mjranum says:

    pec writes:
    There is no simple way to discuss materialism vs. non-materialism without getting lost in philosophy.

    Only if you’re trying to hide behind bullshit.

    Physics, the study of nature, of matter, of physical reality, is faced with trying to test the non-material.

    The “non material” is testable when someone makes claims for it somehow having some kind of measurable connection with the material, objective reality.

    For example, if “chi” existed, and had some kind of effect on things in the material world, the effect would be measurable even if we couldn’t measure or observe “chi” — that would be sufficient cause to begin investigating. Even N-rays were taken seriously, at first, because of their claimed predictable effect on the real world.

    The hiding behind philosophy happens when a woo-ster tries to dodge that they’re making claims of effect without being subject to measurement. If you can’t measure or observe something either directly or through its side-effects, you can’t know it exists at all.

  86. nwtk2007 says:

    Well I’ll say this, I’m out for a while and you guys start drinking and bam! what a bunch of “stuff”, so to speak.

    We are all lost in philosophy, no doubt about it.

    Previously on St Elsewhere –

    “1. Do you think Sandra Nette’s chiropractor was at fault?
    2. Are chiropractic organizations taking any action to prevent similar incidents in the future?
    3. Do you know of any evidence supporting maintenance adjustments?

    Answers –

    1. Yes
    2. Hopefully, they will require a good informed consent but I will not endorse one which says the manipulations are not beneficial.
    3. None what so ever.

    But I think she was going for more than that and I think it will come out in the trial, if it gets to that, which I don’t think it will.

    A person doesn’t go to a chiropractor for some 7 or so years without getting some benefit and that will have to be addressed.

    I feel for you rjstan, but I have no knowledge of any chiro’s promoting any silver containing products. In fact, I have never even heard of any. Sorry.

    As far as what I have introduced, I have just made an observation, based upon literally thousands of patients, literally. I have seen these effects and do not believe it could be a placebo effect. These people are not being studied for these effects; changes in Bp and asthma. They are being treated for neck injuries.

    These occurances just happen, almost randomly, within the patient population. I don’t tell them any thing about any connection between Bp and their neck treatments. I don’t tell them that I am looking for any connection. I am not, in fact. It just comes up and I make note of it.

    I am also not saying that since it cannot be explained that it must be accepted, I am saying that it should not be dismissed.

    Now ya’ll go on with your drinking and philosophysing and I will go to bed.

  87. Harriet Hall says:

    nwtk2007,

    “A person doesn’t go to a chiropractor for some 7 or so years without getting some benefit” Of course not. She got the benefit of thnking she was doing something good for her health; she got attention and reinforcement; she probably got relaxation of tight muscles, she probably got placebo effects. But she may not have gotten any objective benefits. You said yourself there is no evidence supporting maintenance adjustments. Remember, patients kept going back to bloodletters too.

    There is little in the chiropractic literature about blood pressure. Wouldn’t you think if there were a significant effect, other chiropractors would have noticed it and studied it by now? It’s strange that there’s practically nothing about BP in the textbook on somatovisceral aspects of chiropractic.

    There is considerable about asthma in the chiropractic literature. Individual reports and case series show benefits, but when controlled studies are attempted the effect seems to vanish.

    I’m not dismissing your observations, but I’m guessing they have explanations that are not related to chiropractic theory. The next step is to carefully document your observations and publish them. The next step after that is to do a well-designed research study. If you can’t do research personally for whatever reason, you could suggest a study to a school of chiropractic. Funding shouldn’t be a problem: the NCCAM has money and is looking for well-designed studies.

    If you could show that manipulation clearly improved asthma and BP, it would be a great coup for chiropractic and would prompt further studies to explain the mechanism. Of course, chiropractic has been looking for just such clear results for a century now and hasn’t had much luck.

  88. pec says:

    “There is considerable about asthma in the chiropractic literature. Individual reports and case series show benefits, but when controlled studies are attempted the effect seems to vanish.”

    You are being unfair Harriet, and you must know it. You are implying here that many good attempts have been made and failed to find an effect. You don’t bother to mention that very little controlled research has been done on this. You also don’t bother mentioning how very easy it is to fail to find an effect, if you want people to think there is none.

    Who is going to fund large controlled studies on chiropractic? Certainly not the drug companies.

    You don’t know how effective chiropractic might be, and you should not imply that you do know, or that there is convincing scientific evidence one way or the other.

  89. weing says:

    pec,
    You mean to tell me you are too stingy to give your money for testing your pet theories? You want to waste my money on it?

  90. Harriet Hall says:

    Pec,
    Is it unfair to describe the current state of the literature? Is it unfair to judge chiropractic treatments by the same standards I use to judge any other medical treatment?

    “You are implying here that many good attempts have been made and failed to find an effect.”

    I won’t just imply, I’ll be more specific. My somatovisceral chiropractic textbook describes 2 controlled studies done by chiropractors with negative results, and the chiropractors were unhappy and tried to come up with rationalizations as to why they failed. They wanted to do science, but then they didn’t want to accept the results they got. The most recent review on PubMed describes 3 recently reported randomized controlled studies where the differences were not statistically significant between controls and treated groups

    “You also don’t bother mentioning how very easy it is to fail to find an effect, if you want people to think there is none.”

    Are you implying that the chiropractors who did the asthma studies wanted people to think there was no effect? Rather unlikely!

    Do you realize how easy it is to FIND an effect, if you want people to think there is one? And yet these researchers failed. If we had 3 studies of a new drug that showed no statistical difference from placebo, would you want the FDA to approve it? Would you spend research money to do more studies on it? I don’t think so.

    Who’s going to fund large studies on chiropractic? I already said who; didn’t you read what I wrote? Chiropractic schools, chiropractic organizations, and people who want to validate chiropractic are already engaged in lots of research. If this is really promising, they should give it priority. Besides which, the NCCAM has plenty of funding and this is just the kind of study they would love to fund. The money is there.

    I’m guessing no one has even tried applying to the NCCAM to do an asthma/chiropractic study. It’s easier to just continue treating patients on the basis of a belief. Complaining that there is no money makes a very convenient excuse to not challenge your beliefs.

    “You don’t know how effective chiropractic might be, and you should not imply that you do know, or that there is convincing scientific evidence one way or the other.”

    I haven’t implied that I know; I’ve only shown that despite a century of efforts, there is no credible evidence for a benefit of chiropractic in asthma. I’ve implied that a reasonable provisional conclusion is that it doesn’t work, and I’m quite willing to revise that provisional conclusion if new evidence warrants.

    I will go further and say I think it is highly unlikely, because the proposed mechanism is not plausible, and there are other more plausible explanations for observations like those of nwtk2007.

  91. pec says:

    “I’ve only shown that despite a century of efforts, there is no credible evidence for a benefit of chiropractic in asthma.”

    I have no idea if chiropractic can be effective for asthma. I am objecting to your implications. “A century of efforts” sounds like a lot more than 3 controlled studies. You and other “skeptics” pretend to value logic, but you frequently play games like this.

    “the proposed mechanism is not plausible”

    It is completely irrelevant whether or not the mechanism seems plausible to you. Your inability to see how chiropractic could influence the health of nerves, which in turn can influence the health of other organs, should not prevent you from looking objectively at scientific evidence.

  92. Harriet Hall says:

    pec,

    “A century of efforts” sounds like a lot more than 3 controlled studies.”

    I wasn’t suggesting there were more than 3 RCTs. That is not all that chiropractic has done to try to show it works. Chiropractic has been trying for a century to prove that ANY somatovisceral effects of chiropractic exist. The recent RCTs are only a small part of their efforts. None of their efforts has been successful.

    “It is completely irrelevant whether or not the mechanism seems plausible to you.”

    I KNOW it is irrelevant whether the mechanism seems plausible, and I have said so before, many times. I was only looking into my crystal ball and saying why I thought it was unlikely. I wouldn’t reject good evidence just because I didn’t understand the mechanism. We started using penicillin long before we had any idea that it worked by inhibiting the formation of peptidoglycan cross-links in the bacterial cell wall. And if the evidence for chiropractic treatment of asthma were half as strong as the early evidence for penicillin, we’d all be using it today. Robust data would convince us of anything, even homeopathy – I’m not rejecting the possibility, but I’m not holding my breath, either.

  93. willpower says:

    I’ve got pain along my spine due to damage caused by a fall off a ladder. It’s not debilitating in any way. But there is some obvious discomfort around one particular vertebra in the middle of my back.

    I’ve recently come across a company that uses “a comprehensive rehabilitation program for the spine’s hard and soft tissue” — otherwise known as “The Pettibon System (TM)”. They also use “non-surgical spinal decompression therapy” and claim they can partially reverse the damage to spinal disks caused by spinal injuries. The company is called “BackFit” and is based out of Victoria, British Columbia.

    They have a one-page website which is nothing more than contact information. http://www.backfit.ca

    Can anyone tell me anything about the “Pettibon System” or “spinal decompression therapy” and whether there is any evidence that it works?

    The reason I ask is because I would like to do *something* to fix the irritation I feel in that one area of my spine. If there is something that exists out there that can fix it, I’d like to do it.

    I am only interested in scientific, evidence-based answers please.

    Cheers
    Will

  94. Joe says:

    Go to http://www.ncahf.org/
    and
    http://www.chirobase.org/

    Search for decompression.

  95. Harriet Hall says:

    I hadn’t heard of the Pettibon system, but a quick look at the website doesn’t inspire confidence. Instead of references, they offer testimonials; and half of the testimonials are from DCs, most of whom refer to practice-building. The system was apparently invented by a chiropractor who said chiropractic manipulations “made a person’s spine measurably worse.” It seems to involve an inordinate number of x-rays.

    Spinal decompression may be effective in selected patients for temporarily relieving pain, but there’s no evidence that it’s better than old-fashioned traction. It makes some patients worse, has caused a ruptured disk in at least one reported case, and it is ridiculously expensive – many thousands of dollars – and is not covered by insurance. And it is illegal to claim that it repairs disks.

    I’d been seeing a lot of ads for the DRX-9000 (a company that has been sued) and now I’m seeing a trend to “comprehensive” back programs that involve such machines. These are marketing ploys, not scientific advances.

  96. Calli Arcale says:

    nwtk2007:
    “Oh yes, chiropractors do not practice medicine so the “quacks” you are referring to are MD’s. Correct?”

    Just curious — if you do not practice medicine, then what do you practice? Your patients clearly believe that you will heal them in some way. That is practicing medicine. Now, you may edge around the law by avoiding specifically stating that you can treat, cure, or prevent any disease (since that is the point where, legally, it becomes “practicing medicine”) but that is a semantic distinction and nothing more.

    The semantics of the law are important, but I would think that ethics would be more important. Which is more important: avoiding troubles with the law, or being honest with your patients? Can you really be honest with them if you allow them to believe they are receiving medical care when you are consciously not providing them with any medical care?

    The whole false dichotomy of “medicine” and “alternative medicine” bothers me greatly. I see no ethical reason to hold Prozac to a different standard than St John’s Wort, for instance. Medical doctors, chiropractors, naturopaths — you should all see yourselves as being in the same business, and not quake at the idea of being held to a high scientific standard — after all, your job is to treat people, and your patients should come first in your mind. But instead this weird false dichotomy gets created, with no real effect other than to give a free pass to a whole range of therapies, allowing them to avoid having to prove their merit as long as they carefully avoid describing themselves in certain ways. It’s BS. You should all be skeptics, aware of the insidious power of pride.

    And this has poisoned the medical mainstream as well. I worry less about the infusion of woo than I do about what it implies — that mainstream doctors, as a whole, are not being properly skeptical, and are indeed letting their pride and wishful thinking guide at least some of their decisions.

  97. nwtk2007 says:

    Sorry Calli, when I said I don’t practice medicine I meant that I don’t write prescriptions and do surgery. You sound angry but you shouldn’t be mad at me.

    I just treat injuries to the neck and back mostly with a few shoulders and knees and wrists and ankles thrown in to the mix from time to time. I use both passive and active modalities much as a PT would or any other physical medicine specialist. Nothing weird there, except I do spinal manipulation. I also work with a PT who runs a CARF certified rehab clinic and oversee some of their patients who are referred to them as well as use some of their equipment.

    I wouldn’t say that it is alternative medicine at all and is very similar to what most DC’s around here practice.

    I know about the other types, probably the ones you refer to, who do the treatments for the “visceral ” conditions and also treat things like high Bp and asthma. I do defend them a bit because medical science is not so much trying to keep these doctors from harming the public as they are just trying to get rid of a group who has helped a great number of their treatment failures and also to deflect any attention away from their gross harm they do to the public through their own medical mistakes.

    I personally think the medical community does too much harm to the public in this fashion to have the gaul to “throw stones” at alternative medicine. It is like a person with leporacy trying to scratch a chigger bite, ignoring the leporacy all the time.

    So anyway, I guess based upon what you say I practice medicine. And most of the time the “skeptics” are just full of it and have some other issue driving them other than a higher standard. On most of the skeptical sites, the skeptics sound a lot like a religious group or just another bunch of Alts.

  98. Calli Arcale says:

    No, I’m not angry, at least not with you. I’m just troubled by the dichotomy between “medicine” and “not medicine”. I think it should all be treated exactly the same, and held to the same standards. To me, the biggest crime committed by DSHEA and other efforts to integrate “complementary and alternative medicine” has been that it has *weakened* the standards by which we judge medicine. Just look at how sales of pharmaceuticals have skyrocketed now that the manufacturers can market them directly to consumers. I can’t begin to tell you how disturbed I was the first time I saw an ad on TV for an artificial knee. Mass-marketing major orthopedic surgery! It’s seriously out of hand.

    Nobody gets a free pass in my book. Unfortunately, our culture doesn’t see it that way, and by giving free passes to the herbalists, the Reiki practitioners, and the acupuncturists, they have given free passes to mainstream medicine too. Oh, the FDA still does what it can to control those things which aren’t using weasel-language to avoid describing itself as medicine, but they have been seriously handicapped over the past twenty years. Look at Zicam. The FDA came down on it like a ton of bricks for making medical claims which could not be proven, and for falsely describing their product as “homeopathic”. A few years later, they’re back in business, doing perfectly well for themselves, and with no real change to their marketing strategy. It’s depressing. Meanwhile, the same rules that prevented the FDA from putting the Zicam people out of business are also permitting things like the Vioxx scandal. It depresses me.

    Anyway. Yes, you do practice medicine, and I’m glad you think of yourself that way after all. You know your limitations; I wish more did. All practitioners have limitations, whether they are chiropractors or oncologists or whatever. The important thing is to know them. It’s what a true skeptic does — questions everything, including himself, to make sure he stays honest about everything.

  99. Calli Arcale says:

    BTW, I don’t have anything against rational chiropractors. There’s one who gives a ton of really useful advice over on Chirobase. My husband sees chiropractors fairly frequently for relief of neck and upper back issues. I *do*, however, have problems with the “straight” chiropractors, and with the ones who are clearly in it just for the money, and who will tell you anything if it gets you back in their office. I feel the same way about any medical practitioner who behaves that way, but unfortunately chiropractic has a lot of it since so many of the schools are infected with practice building philosophies; there have been lawsuits from chiropractic students who came out with lots of tips on how to promote themselves but a substandard education on chiropractic itself, and that’s sad.

  100. Harriet Hall says:

    nwtk2007 said,

    “I do defend them a bit because medical science is not so much trying to keep these doctors from harming the public as they are just trying to get rid of a group who has helped a great number of their treatment failures and also to deflect any attention away from their gross harm they do to the public through their own medical mistakes.”

    That’s insulting, unfair, and unsubstantiated. My only concern, and the only concern of all the doctors I know, is to prevent harm to patients. I have said I’m not trying to “get rid” of them, but only to prevent them from misleading people. I don’t do gross harm to the public. I’m not trying to distract attention away from anyone’s errors. I offer equal opportunity criticism of bad practices whether they happen inside or outside the medical profession. The fact that YOU bring up medical mistakes sounds like an attempt to deflect attention from the question of chiropractic harm or inefficacy. You are using the “tu quoque” logical fallacy.

    “I personally think the medical community does too much harm to the public in this fashion to have the gaul to “throw stones” at alternative medicine.”

    Hmm… if a doctor is obese, do you think he shouldn’t advise patients to lose weight? :-)

    And where would the medical community find a Frenchman (a Gaul) do the stone-throwing? I think you meant “gall.”

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